Leadership Support
When leaders see well-being as critical to the department’s success, practices can be linked more closely to the department’s goals, thereby supporting its mission and driving performance.
A 2016 survey by the APA found widespread links between senior leader support for well-being efforts and a variety of positive outcomes, with more than 9 in 10 working Americans saying they feel motivated to do their best (91 percent vs. 38 percent of those without leadership support), are satisfied with their job (91 percent vs. 30 percent), and have a positive relationship with supervisors (91 percent vs. 54 percent) and coworkers (93 percent vs. 72 percent). Those with support from leaders were also less than half as likely to say they intend to leave their job in the next year (25 percent vs. 51 percent).
Leaders can demonstrate support by providing their department with clear information about available resources and how to access them. But leadership support doesn’t stop with just hanging posters and distributing helpline phone numbers. Actions speak louder than words, so when department leaders actively participate in psychologically healthy department practices themselves, they set a good example for members and serve as role models for others.
Other supportive behaviors include:
- Setting clear expectations and providing constructive performance feedback.
- Managing conflict effectively.
- Demonstrating an interest in members’ personal lives and career development.
- Directing members to relevant resources and programs.
- Providing members with sufficient autonomy and control.
- Involving members in problem solving and decision making.
- Being transparent in communications.
- Monitoring overwork and scheduling conflicts.
- Ensuring that all department members have the opportunity to engage in meaningful tasks.
- Recognizing outstanding performance and service excellence.
Stress
Stress is a normal reaction designed to help us cope with dangerous situations. Faced with a threat, this automatic response kicks us into gear so we can deal with the problem at hand. The brain triggers the release of hormones that prepare us for a “flight or fight” response to the threat. This causes a number of changes – it raises blood pressure, heart rate, and blood sugar; suppresses nonessential body functions like digestion; and alters the immune system. Psychologically, it affects our mood, attention, and motivation.
Although the stress response is helpful in high-pressure situations, the human body needs recovery experiences and is not designed to withstand the physiological changes that occur over extended periods of time. Chronic stress causes wear and tear mentally and physically and can wind up damaging health, relationships, and job performance.
In some cases, chronic stress can lead to burnout and affect motivation, confidence in one’s ability to function effectively, and actual job performance. According to the 2023 Work in America Survey from the APA, 77% of employees indicated experiencing stress from their work within the last month, and 57% indicated negative impacts from stress indicative of burnout. When someone is experiencing burnout, they have an extended period of time when they feel exhausted, unmotivated, and ineffective and their job performance can suffer. Symptoms of burnout include exhaustion, lack of motivation, frustration, cynicism and other negative emotions, cognitive problems, a decline in job performance, problems with interpersonal relationships at home and work, a decline in self-care, being preoccupied with work during leisure time, decreased life and work satisfaction, and health problems. According to APA’s 2024 Work in America Survey, people experiencing higher psychological safety at work, where team members feel they can express themselves and take appropriate interpersonal risks without negative consequences, were less likely to report symptoms associated with burnout.
Research also suggests that burnout can negatively affect people’s decision-making abilities, resulting in more risky, irrational decisions. This is of particular concern to firefighters and EMS providers, who are required to think on their feet in situations that have life-or-death implications for themselves, their fellow first responders, and the people they serve.
Recovering from chronic stress and burnout requires removing or reducing the demands and replenishing resources. Here are some ways to encourage your members to get the stress recovery experiences they need to recharge so they can be at their best at home, at work, and on the fireground:
- Time off: Be sure members of your department are taking adequate time off. This means they need to carve out time when they are off duty to clear their mind from work and take steps to recharge. This can be particularly challenging for volunteers, who also have scheduling demands with their regular jobs.
- Relaxation: Whether it is exercise, reading a book, going fishing, taking a walk, or visiting with friends and family, encourage your members to intentionally do things that help them unwind on a regular basis.
- Non-work activities: While outside interests can be the first things to go when life gets busy or stressful, keeping up with them, even in small doses, is important to stress recovery. Check in with members and provide opportunities for them to share their outside interests with each other. Communicate the importance of these non-work experiences and encourage them to take up a hobby, play a sport, take a class, or do something else non-work related that they find interesting, challenging, and engaging.
- Healthy sleep: Research suggests that having less than six hours of sleep per night is a major risk factor for burnout. Make sure your members are getting enough good-quality sleep. This is particularly challenging for first responders who may get calls in the middle of the night, which means it is all the more important they practice healthy sleep habits on their non-duty days. See the section on sleep below for more information and tips for helping your members sleep well.
- Additional support: Social support from friends and family can help your members manage stress but may not always be enough. Encourage those who are feeling chronically stressed or overwhelmed, or struggling with issues that are affecting their sleep, health, job performance, or relationships, to tap into resources such as EAP services, or get a referral to a qualified behavioral health professional, who can help them better manage stress and change unhealthy behaviors.
In addition to providing stress management training and resources to help members develop healthy coping skills and manage stress, comprehensive department efforts should include identifying and addressing organizational issues that create stress and reducing any unnecessary physical and psychosocial stressors in the work environment.
Mental Health
As first responders to fires, automobile accidents, medical emergencies, and other hazardous situations, firefighters are regularly exposed to dangerous and potentially traumatic events. This not only puts firefighters’ physical health and safety on the line, but can also increase risk for post-traumatic stress disorder, depression, anxiety, suicide, and other mental health concerns. These occupational hazards, combined with the day-to-day stressors we all face (including financial, family, and health issues), stigma related to help-seeking behaviors, and underutilization of behavioral health services require a departmentwide effort to keep firefighters at the top of their game, both on and off the fireground.
Mental health takes on a critical importance in high-stress, highrisk work settings, such as those in which first responders operate, where their own functioning has serious implications for the health, safety, and security of the public they serve. It is also well-known in the field of workplace health promotion that the costs and performance losses related to mental health issues often outweigh those related to physical health concerns.
Recent efforts by the Firefighter Behavioral Health Alliance, International Association of Fire Chiefs, National Fallen Firefighters Foundation, National Volunteer Fire Council, U.S. Fire Administration, and other major fire service organizations shine a spotlight on the importance of firefighter mental health and the need to remove barriers that prevent firefighters from accessing the services and resources that can keep them healthy and performing at their best.
Although stigma related to mental health issues has declined in general, work is one place where people are still concerned about potential repercussions, such as being passed over for promotions, treated unfairly, seen as weak and less competent, or becoming the target of bullying, social exclusion, or gossip. A survey by the APA found that although a significant majority of adults (73 percent) reported feeling comfortable working with someone who has a mental health disorder, more than half said they would not feel comfortable disclosing a mental health disorder of their own to their boss or coworkers. Since mental health problems aren’t necessarily visible to others, people often go to great length to keep them concealed from their colleagues. This can add to their stress, making the challenges they face even more difficult and preventing them from getting the support they need.
Mental health stigma and related underutilization of behavioral health resources are significant areas of concern in the fire service, where perceived expectations to be tough, selfless, and resilient in the face of danger can increase these barriers to self-care and reluctance to seek help. Support starts with access to good quality mental health services but doesn’t stop there. Integrating behavioral health and emotional well-being into all of your department’s health and wellness efforts is key, so it becomes a normal part of the discussion.
There are many broad-based actions a department can take to help firefighters and EMS providers address mental health concerns and support a culture that promotes psychological well-being.
- If your department provides members with health insurance, ensure that behavioral health benefits cover a broad range of services, pay a significant portion of costs, do not unreasonably impose service limits, and allow easy access to a robust network of providers.
- Make a robust EAP available to all department members and provide clear information about the services that are available and how to access them. In addition to counseling sessions, high-quality EAPs may offer informational resources, support for supervisors, and services related to financial, legal, parenting, and other life management issues. If possible, extend EAP access to spouses, dependents, and domestic partners.
- Prominently post crisis hotline numbers and information about mental health resources in common areas. Include this information in print and electronic communications, as well as in materials for spouses, family members, and domestic partners.
- Cover mental health topics during new recruit orientation and provide ongoing training for all members to increase awareness, improve mental health literacy, promote supportive behaviors to peers, encourage members to ask for help and access resources, debunk myths about mental health, and reduce stigma.
- Provide department leaders and supervisors with training on mental health awareness, recognition of symptoms, how to engage and support members around behavioral health, and crisis management for mental health-related situations.
- Ensure that department leaders actively participate in programs and activities related to mental health, include mental health topics when communicating about member well-being, work to promote acceptance and reduce stigma, and foster an environment open to, and supportive of, mental and emotional well-being.
- Monitor member reactions following potentially traumatic incidents, keeping in mind that individual responses and needs will vary. Remind firefighters and EMS providers of available resources, encourage use of supports, and provide on-site access to EAP professionals, as needed.
- Develop a peer support team that can respond and follow up with crews after difficult calls, or when a member needs assistance. Training programs, such as those offered by the International Association of Fire Fighters, teach peer support concepts and techniques including active listening, confidentiality, identifying members who may be struggling, and acting as a bridge to link them to mental health services.
- Offer chaplain services to provide comfort and assistance to firefighters and their families who could benefit from spiritual or faith-based support.
The Brighton Fire Department in Rochester, NY, takes a multi-pronged approach to mental health that combines training in peer support with an EAP benefit for career and volunteer members. Peer support members then provide department-wide training on the emotional and personal response to trauma.
Substance Abuse
Unfortunately, it is not uncommon for people to use alcohol and other substances to cope with stress and trauma. Therefore, some of your department members may have developed unhealthy patterns of alcohol, tobacco, marijuana, drug, or prescription pain medication use. While people may temporarily feel better, these behaviors can add to stress, impair functioning, and lead to more serious problems in the long run.
Alcohol use can weaken the body’s immune response, so members who drink heavily may be more susceptible to illness and have worse health outcomes if they do get sick. Heavy alcohol and other substance use are also linked to increased accidents and injuries, can impair judgement and decision-making abilities, and make existing mental health concerns worse. This can pose serious problems for member health, safety, and job performance and make it even more difficult for members to cope with the challenges they face both at home and on the job.
Steps you can take to prevent and address substance abuse problems in your department include:
- Providing information about alcohol and substance use in your wellness communications.
- Reminding members of department policies related to alcohol, tobacco, and other substance use and encouraging them to use available supports, including EAP services, smoking cessation resources, and health promotion programs.
- Training department leaders to identify signs of potential alcohol or other substance use problems.
- Encouraging members who are struggling with alcohol or other substance use to talk to their primary care physician about how to reduce and prevent problematic use of alcohol and other substances before it becomes more serious.
- Referring members who need help with alcohol and other substance use to a qualified behavioral health professional who can provide confidential, non-punitive services to help them identify triggers, patterns, and unhealthy coping strategies, and develop the skills they need make significant sustainable behavior changes.
Counterproductive Behaviors
From low-level incivility to bullying, harassment, and discrimination, negative behaviors in the department can affect your members’ experience on the job and, in more extreme cases, harm their well-being and functioning, as well as the department’s reputation.
Counterproductive behaviors can be especially problematic when directed toward members who return to duty following a leave of absence or treatment for mental health or substance abuse problems. If they are excluded, ostracized, gossiped about, or treated differently, it can compound their stress and make it more difficult for them to bounce back. Social support from colleagues plays an important role in promoting resilience.
While mild forms of incivility, such as rude comments, disrespectful attitudes, and a lack of courtesy may seem trivial, research suggests that these behaviors are surprisingly common. In a 2013 survey by Porath and Pearson, 98 percent of those polled said they had experienced incivility on the job. Another survey found that more than a quarter of respondents reported having left a job because of an uncivil work culture (Weber Shandwick et al., 2013). According to APA’s 2023 Work in America Survey, those employees who experience their workplace as toxic are more than three times likely to indicate their mental health has been harmed by work.
These routine transgressions can add up, increasing member stress, decreasing job satisfaction and performance, and contributing to absenteeism and turnover, as well as physical and mental health problems. Left unchecked, incivility can also escalate over time and lead to more serious problems such as bullying and harassment.
Bullying, while less common than incivility, can have serious consequences in an organization. In a major national survey, 19 percent of American adults reported that they have experienced bullying behaviors at work and another 19 percent said they have witnessed others being bullied (Workplace Bullying Institute, 2017).
Workplace bullying may be direct, such as repeated yelling and verbal humiliation, hostile glares, or silence and deliberate exclusion. Or it may be more indirect, such as behind-the-back sabotage, spreading damaging rumors, or imposing unreasonable demands designed to make the target fail. Supervisors are the most frequent aggressors, followed by peers. In instances of mobbing, members gang up to bully a colleague.
Severely bullied individuals may suffer a variety of health consequences, including depression and anxiety disorders. Bullying can also diminish productivity and morale, lead to higher absenteeism and turnover, and increase health care and disability costs and the risk of legal action.
Discrimination and harassment continue to pose problems in the workplace, with the U.S. Equal Employment Opportunity Commission (EEOC) receiving more than 72,000 complaints of workplace discrimination in 2019, including more than 7,500 charges of sexual harassment. This likely represents the tip of the iceberg, as the EEOC estimates that less than 14 percent of individuals who experience harassment ever file a formal complaint. Polls suggest that between 60 and 80 percent of women in the U.S. have experienced some form of sexual harassment, with most occurring in the workplace.
Despite the increased attention to sexual harassment and discrimination in recent years, few organizations have taken new steps to prevent and address these longstanding problems. Most organizations have simply reminded their members of existing policies and continued to offer the obligatory annual training designed to reduce their liability.
Research has shown that simply training people to recognize and report harassment and discrimination isn’t enough to change behavior or an organizational culture where these problems are more likely to occur. Instead, psychologists recommend a comprehensive approach that incorporates fair policies that are clearly communicated, ongoing training, leadership support of a civil and respectful culture, and the promotion of women and people from diverse backgrounds into senior leadership roles.
Here are some steps you can take to prevent and address counterproductive behaviors that negatively affect your members and department:
- Adopt policies that are fair and clear. Clearly communicate that bullying, discrimination, and harassment will not be tolerated and that members who engage in these behaviors will be subject to disciplinary action. A harsh zero-tolerance policy can backfire, however, if people believe that some parties are treated unfairly, or members feel reluctant to raise concerns because they fear retaliation or think the consequences will be more severe than the situation warrants.
- Communicate policies regularly. Share department policies and laws relating to harassment, including sexual harassment, procedures for filing complaints, and expectations of behavior for all members of the department. Incorporate the messages into ongoing trainings, send reminders by email, host a department meeting, and use other communication channels that works best for your members.
- Train witnesses to speak up. Bystander intervention training may help increase a sense of accountability and provide a process for members to speak up when they witness bullying, discrimination, or harassment involving others. The training can also encourage members to share responsibility for maintaining a safe environment, even if it means getting involved in a situation they would rather avoid.
- Build a positive department culture. Creating a psychologically healthy environment for all members can help curb any issues before they create problems. This includes gender parity and diversity in senior ranks, and leaders who model and support civility, respect, fairness, and trust. Counter-productive behaviors occur within a broader context, so be sure your department’s practices align with and support the individual attitudes and behaviors you are trying to promote.
In a culture where every member feels safe, supported, and included, people can be their best, and that’s good for your people, your department, and your community.
Diversity & Inclusion
Diversity is more than just a program or policy. Ingrained in a department’s culture, valuing diversity and promoting inclusion have broad strategic implications for innovation, well-being, performance, and success.
By itself, having a diverse department simply means there are members with different backgrounds and characteristics. While many people think of diversity as being related to race and ethnicity, it also includes differences in age, gender, ability, and sexual orientation. Ideally, your department will be a reflection of your community, which can help improve community relations and enhance your ability to identify and understand the needs of those you serve and communicate with them effectively.
Realizing the full benefits of a diverse department, however, requires inclusion. By extending the same opportunities and resources to all members and ensuring that everyone has a voice, you can tap into new perspectives, a broader set of skills, and creative ideas for strengthening the functioning of the department. More voices and more differences mean more opportunities to find creative solutions and generate new ideas. Diversity also helps organizations be more conscious of potential bias and discrimination.
Feeling excluded, discriminated against, or not fully accepted can also contribute to member stress and related health problems. In a work environment, this increased stress can cause significant problems for anyone who may be concerned about unfair treatment because of their identity. Creating a culture of inclusion and respect isn’t always easy, but it can lead to healthier members and a stronger department.
Here are some steps you can take to promote diversity and inclusion in your department:
- Diversify your department. Periodically assess the make-up of your department and actively recruit from segments of the community that are underrepresented. This can require going beyond your typical recruiting strategies and changing up communication tactics to reach groups you might not otherwise have contact with.
- Promote connections. When new members join the department, link them with others who have similar backgrounds or experiences. Set them up for success by facilitating mentoring relationships and opportunities for other members of the department to get to know them.
- Share decision making. When one person controls hiring, training, scheduling, and promotions, it can create the potential for unfair treatment. Create a system of checks and balances in the department, so more than one person is involved in decisions and help ensure that no one is being unfairly overlooked or given preferential treatment.
- Give honest feedback and performance evaluations. Leaders and supervisors sometimes feel uncomfortable giving negative feedback to someone who is part of a marginalized group out of concern that they may be seen as biased or prejudiced. As a result, they may miss opportunities to help the member improve their performance, which can inadvertently stifle their development, hurt their career, or prevent them from participating in desirable assignments.
- Think broadly. Consider the diverse needs of members when creating department programs and policies. Provide all members with opportunities to have meaningful input into the development, implementation, and evaluation of department practices.
Chelan County Fire District 5 is one department that is working to build a membership that is representative of the population it serves. Having bilingual members has already become indispensable in providing services to non-English speaking residents in the community.
The Oshkosh Fire Department has created a recruitment task force with a variety of community stakeholders. The department is working with college interns to develop a recruitment plan, campaign, and web site, and is collaborating with the Big Brothers Big Sisters organization on a program that reaches middle school aged girls. Additionally, the department launched a Fire Explorer Post that is 25 percent female and started a campaign with a local credit union to promote saving for EMT/Paramedic programs starting in high school.
Trust
Trust plays an important role in the fire service and affects members’ well-being and performance. In a 2018 survey of the U.S. workforce conducted by the APA, one in five workers said they do not trust their employer.
Approximately 9 out of 10 working Americans who said they trust their employer reported being satisfied with their job (89 percent), compared to less than half of employees who don’t trust their employer (46 percent). Those who trust their employer were also more likely to say they are motivated to do their best at work (89 percent vs. 53 percent), have a positive relationship with their supervisor (90 percent vs. 56 percent), and say they would recommend the organization as a good place to work (80 percent vs. 41 percent).
Employees who said they don’t trust their employer were more than three times as likely to say they’re typically tense and stressed out at work (71 percent vs. 20 percent) and to indicate that they plan to look for a new job within the next year (58 percent vs. 18 percent), compared to those who trust their employer.
In the high-risk situations where firefighters and EMS providers work, trust is even more critical, as members must feel confident following instructions from leaders and know they can rely on each other, even when putting their lives on the line. Consistency and reliability, fairness, transparency, and shared goals and values can all contribute to a culture of trust in the department. Past APA surveys also found that trust is higher in organizations that recognize members for their contributions, provide opportunities for involvement, and communicate effectively.
Organizational Justice
As with trust, people who feel that they are treated fairly in their organization have better well-being and performance outcomes compared to those who do not feel treated fairly. Organizational justice is linked to higher levels of job satisfaction, motivation, and work engagement. Those who say they are treated unfairly are more likely to report feeling stressed out on the job, to say they are more cynical and negative at work, and to say they intend to leave the organization within the next year.
Your members’ attitudes and behaviors are shaped by their perception of decisions and processes, as well as how they are treated in the department. Department leaders treating members with dignity and respect is a good starting point, but open, transparent communication, reasonable explanations for decisions, and providing opportunities for members to have input into decisions that affect them can further strengthen members’ experience of being treated fairly
In many organizations, even those in which members are treated with respect, decisions, outcomes, and processes may not be seen as fair. In an APA survey, only around half of working Americans said the decision-making procedures in their work unit are applied consistently and free of bias. Similarly, just half of employees said rewards, recognition, and other job-related outcomes reflect their work, effort, and contributions to the organization.
Senior leaders typically have a more positive view of their organization than front-line workers do and are more likely to believe that outcomes are fair and that decision-making procedures are applied consistently. Therefore, it is imperative that department leaders seek feedback from department members and identify any gaps that need to be addressed.
Sleep
According to the Centers for Disease Control and Prevention, insufficient sleep is linked to chronic health conditions, including heart disease, high blood pressure, depression, obesity, and type 2 diabetes. In addition to the impact on physical and mental health, sleep deprivation can increase the likelihood of accidents and injuries and impair decision making, memory, and performance. For firefighters and EMS providers, poor sleep can have especially serious implications, putting their own lives at risk, as well as those of their fellow firefighters and members of the public they serve.
Here are some tips for healthy sleep you can share with your members:
- Maintain a regular sleep schedule, even on your days off. Try to get at least seven hours of sleep per night.
- Make sure your bedroom is quiet, dark, and comfortable.
- Avoid staring at a TV, computer, tablet, or smartphone right before bed.
- Limit your caffeine and alcohol intake.
- Do not eat a large or heavy meal before bed.
- Stay active and exercise regularly.
- Use relaxation techniques, such as mindfulness, meditation, or breathing exercises.
- If you continue to struggle with poor sleep, talk to your primary care doctor and get a referral to a sleep specialist.
In a randomized trial of a sleep health education and sleep disorder screening program at a mid-size fire department, researchers at Brigham and Women’s Hospital in Massachusetts found that firefighters who participated in the program had a 46% reduction in work loss due to disability and a 24% reduction in reportable injuries in the 12 months following the program.
Trauma & Resilience
Resilience, or the ability to adapt to highly stressful or adverse events, is critical to the functioning of firefighters, EMS personnel, and departments, especially given the high-risk, unpredictable nature of work in the fire service.
Although most people are generally resilient and able to bounce back even from extreme circumstances without significant impairment, first responders are regularly exposed to potentially traumatic events. This chronic exposure can increase risk for trauma-related issues and other behavioral health concerns, including post-traumatic stress disorder. These symptoms, following exposure to a life-threatening or catastrophic event, may include:
- Intrusive memories, flashbacks, or dreams
- Distress when in circumstances similar to the traumatic event
- Avoidance of situations resembling the stressor
- Inability to remember all or part of the traumatic experience
- Sleep disruptions
- Anger or irritability
- Difficulty concentrating
- Hypervigilance
- Exaggerated startle response
In addition to stress-related problems such as PTSD, firefighters may also experience the non-clinical problem of moral injury resulting from their exposure to difficult situations at work. Litz and colleagues (2009) defined moral injury as the distress that results when an individual perpetrates, fails to prevent, or witnesses events that go against deeply held moral beliefs or values. Jeff Dill examined moral injury in a sample of 479 firefighters and found that 276 (57%) of the firefighters reported experiencing a morally injurious event. Examples of these events included injured children, failing to correct colleagues making mistakes, and mass shootings.
People vary in terms of their threshold for developing symptoms, and although genetic, biological, and personality characteristics do play a role, how members think about adverse events, the coping strategies they use, and their willingness to seek help when needed all affect their capacity to cope with potentially traumatic experiences. This, in turn, has implications for the level of mental health symptoms they may experience following exposure to adverse situations, as well as their overall well-being, interpersonal relationships, and job performance.
In addition to providing access to high-quality mental health services to help members who may be struggling after being exposed to life-threatening or traumatic events, departments can provide resources and create an environment that promotes resilience and the ability to successfully cope with the extreme work-related stressors present in the fire service.
A review by Britt et al. (2016) identified a set of resources that can influence capacity for resilience. These include:
- Unit cohesion, support, and flexibility
- Family support, close interpersonal relationships, and low levels of conflict
- Community resources, connections, and a sense of belonging
The injury or line-of-duty death of a fellow firefighter is a traumatic event that, should it occur, will significantly impact the rest of the membership. Departments should prepare for this scenario by putting into place standard operating procedures/guidelines, including the support that will be provided to personnel.
By creating a supportive department culture, promoting work-lifevolunteer balance, providing resources that foster positive family relationships and social supports, encouraging members to stay active and engaged in their communities, offering training and resources that help members develop effective coping skills, and maintaining an environment where members feel comfortable talking about mental health and seeking help when needed, you can help members of your department build their capacity for resilience and successfully manage the stressors they face on the job.
Chief Thomas Steele at Mt. Gilead Volunteer Fire Department says that senior members of the department are open about their own struggles and share what has and has not been effective in coping with those challenges. This not only provides guidance that can benefit newer members, but also creates an open environment where people feel comfortable talking about difficult issues.