LINK TO PUBLISHED ARTICLE: https://www.jems.com/mental-health-wellness/proactive-approach-to-mental-well-being-in-first-responders/

The Importance of a Proactive Approach to Mental Well-Being in First Responders

January 28, 2025

By Kenny Schnell

In the high-pressure world of emergency medical services (EMS), many clinicians hesitate to share their struggles, prioritizing their duties over personal well-being. As a result, mental health challenges are often overshadowed and left unaddressed, leading to potential long-term consequences.

EMS clinicians routinely face life-threatening, emotionally stressful situations. Over time, these cumulative stressors can lead to mental health issues like burnout, anxiety, depression, PTSD, or even suicide.

To address these concerns, it is vital to adopt a proactive, scientifically validated and anonymous approach to mental wellness.

This approach helps identify early signs of mental distress while ensuring confidentiality. EMS personnel can access mental health resources, peer support, insurance benefits and professional care, creating a safety net to prevent critical incidents and support their mental health needs.

The Five Domains of Mental Wellness in EMS

Supporting EMS clinicians requires a holistic mental wellness framework, which can be broken down into five key domains:

1. Awareness of Reality: Constant exposure to trauma can distort an EMS worker’s sense of reality. Programs must focus on grounding individuals to maintain a healthy perception of their emotions and environment. Early intervention is necessary to address dissociation or avoidance.

2. Maintaining Relationships: The emotional strain of EMS work can make it difficult to sustain personal and professional relationships. This stress may lead to withdrawal or conflicts. Wellness programs that offer counseling and peer support can help individuals reconnect emotionally.

3. Orientation Toward the Future: The demanding nature of EMS work can cause burnout, disrupting individuals’ long-term career and life goals. Wellness initiatives should help personnel remain motivated and connected to their future aspirations.

4. Making Decisions: EMS workers make critical decisions under stress daily. Prolonged trauma can impair decision-making abilities, resulting in impulsive or indecisive actions. Monitoring cognitive performance through proven assessment can help identify when stress is affecting decision-making.

5. Taking Action: Anxiety, depression, and PTSD can hinder a person’s ability to take action, both at work and in personal life. Wellness programs can offer tools like therapy and coaching to help EMS professionals regain confidence and motivation.

The Case for Proactive Mental Wellness

Historically, mental health in high-stress professions like EMS has been approached reactively, addressing crises only after they occur. This model perpetuates stigma and discourages early intervention. A proactive approach to mental wellness, however, aims to identify issues early through regular, anonymous check-ins using validated tools like the Self-Management Self-Test (SMST).1

In addition, the relationship between past trauma and career choices in high-stress fields such as policing, firefighting and emergency medical services can lead individuals to seek environments that reflect their internal states of chaos or other opportunities to regain control and purpose2.

By integrating SMST into EMS shifts via mobile apps or online platforms, mental health assessments become routine, normalizing the process of seeking help. These tools empower EMS clinicians to monitor their own mental wellness before problems escalate, encouraging timely intervention.

This proactive approach also destigmatizes mental health concerns and allows individuals to take control of their well-being, contributing to a healthier, more resilient workforce. Teams trained in resilience create a culture of mutual support and early intervention, reducing the risk of burnout and mental health crises.3

Leveraging Analytics for Early Intervention

Data-driven insights are integral to proactive mental wellness strategies. Analytics allow EMS organizations to monitor key mental health indicators across the five domains of mental wellness. Tracking behavioral changes, mood fluctuations, cognitive performance, and other factors can help organizations detect early signs of mental health deterioration.

For example, subtle shifts in cognitive performance might indicate sleep deprivation or burnout, while increased anxiety levels could be a warning sign of PTSD. Analytics provide EMS teams with real-time feedback, enabling them to intervene before problems become critical. These insights also help organizations identify systemic issues, such as stressors related to workload or shift scheduling, and make informed decisions about resource allocation to support mental health.

Importance of Training and Certification

The success of the SMST depends on proper training and certification for peers within EMS organizations. Certified peers are equipped to interpret the results and engage in confidential, sensitive discussions about mental health. This training ensures that peers can support colleagues in managing their mental health proactively, rather than waiting for crises to occur.

Certified peers play a crucial role in normalizing mental health check-ins and promoting a culture of support within EMS teams. This training ensures that EMS workers feel safe discussing mental health concerns and fosters early intervention, reducing the stigma around seeking help.

Ensuring Confidentiality and Access to Comprehensive Resources

Anonymity is essential for encouraging EMS clinicians to seek help. Confidential mental wellness platforms provide a safe space for individuals to report their mental health status without fear of stigma or professional consequences. This environment fosters early self-reporting, allowing for timely preventive measures.

In addition to ensuring confidentiality, a comprehensive mental wellness program connects EMS workers to a full range of resources, including peer support, clinical care, and insurance benefits. Many EMS clinicians are unaware of the mental health benefits available to them through their insurance plans, so integrating these resources into the wellness platform is crucial.

For example, if an individual is experiencing early signs of burnout, they can be referred to peer support networks for camaraderie and shared experiences. If more intensive intervention is needed, they can access licensed clinicians who specialize in trauma and stress management. This holistic approach ensures that EMS personnel receive the support they need to manage their mental wellness.

Preventing Critical Incidents

Being able to track the effects of stress and trauma in real time is crucial to preventing its long-term impact.4 The ultimate goal of a proactive, scientifically validated, and anonymous mental wellness program is to prevent critical incidents.

By monitoring mental health indicators in real time and offering early interventions, EMS organizations can reduce the risk of medical errors, absenteeism due to burnout, or even suicide.

Early intervention is particularly important in EMS, where mental health directly impacts job performance. Ensuring that all personnel have access to necessary mental health resources—whether through peer support, insurance benefits, or clinical care—helps prevent mental health issues from escalating.

This proactive approach not only protects EMS workers but also ensures the safety of the communities they serve.

Conclusion

The mental well-being of EMS clinicians is critical to public safety. A proactive, scientifically validated, and anonymous mental wellness program fosters a culture of psychological safety within EMS teams.

By leveraging data to monitor mental health across the five domains—Awareness of Reality, Maintaining Relationships, Orientation Towards the Future, Making Decisions, and Taking Action—organizations can intervene early, preventing crises before they occur.5

By connecting individuals to resources such as peer support, insurance benefits, and clinical care, EMS organizations can ensure that their workforce remains mentally resilient and capable of handling the immense pressures of the job. In doing so, they protect both their personnel and the public they serve.

About the Author

With over 30 years as a paramedic and a distinguished career as the retired director of Williamson County (TX) EMS, Kenny Schnell brings unmatched expertise to advancing mental health in high-stress industries.

Formerly serving as vice president, general manager and senior director at ESO, Schnell is now the president of the MindMe Corporation, creating innovative solutions for proactive mental wellness. Passionate about supporting healthcare and public safety professionals, he leverages decades of leadership and technology experience to drive meaningful impact.

References

1. Wehmeier PM, Fox T, Doerr JM, Fox T, Doerr JM, Schnierer N, Bender M, Nater UM (2020) Development and validation of a brief measure of self-management competence: the Self-Management Self-Test (SMST). Therapeutic Innovation & Regulatory Science, 54(3): 534-43. The SMST — BlueCloud Mind

2. Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Chapter 13: Healing Trauma: Owning Your Self, pages 266-283

3. Driven Resilience® Program. “Resilience First Aid.” Driven Resilience

4. Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Chapter 4: Running for Your Life: The Anatomy of Survival, pages 51-70

5. Werdin S, Fink G, Rajkumar S, Durrer M, Gurtner C, Harbauer G, Warnke I, Wyss K, on behalf of the SERO Study Group (2024) Mental health of Individuals at increased suicide risk after hospital discharge and initial findings on the usefulness of a suicide prevention project in Central Switzerland. Frontiers in Psychiatry, 15: 1432336. Suicide Prevention Study — BlueCloud Mind1.