Federal Efforts to Address the Mental Health of First Responders: Resources and Issues for Congress

Federal Efforts to Address the Mental Health of First Responders: Resources and Issues for Congress

Federal Efforts to Address the Mental Health
October 1, 2020
of First Responders: Resources and Issues
Johnathan H. Duff,
for Congress
Coordinator
Analyst in Health Policy
Police officers, firefighters, and emergency medical service personnel are often the first to

respond to a crisis or emergency. As such, these first responders may experience significant
Jill C. Gallagher
stress and/or be exposed to traumatic events in carrying out their jobs. Recognizing the unique
Analyst in
risks for first responders, the federal government has made efforts to support their mental health.
Telecommunications
Policy
Federal efforts to improve first responder mental health involve multiple programs spread out

across several executive departments and agencies. For example, the Department of Justice
Nathan James
(DOJ), the Department of Homeland Security (DHS), and the Department of Health and Human
Analyst in Crime Policy
Services (HHS) operate mental health programming for first responders. Some programs focus

on mental health for occupations generally, while others target specific occupations or address
specific circumstances such as post-disaster response.
Ada S. Cornell
Senior Research Librarian
Most programs are the efforts of a sole executive department with jurisdiction over the type of

first responder. For example, DOJ administers grant programs specifically for law enforcement.
Programs under the Law Enforcement Mental Health and Wellness Act (LEMHWA, P.L. 115-

113) specifically focus on the mental health of law enforcement officers. Other programs
operated by DOJ can provide assistance for law enforcement officer mental health, but do not focus solely on this issue.
DHS, on the other hand, focuses their efforts on firefighters and emergency medical service (EMS) personnel. For example,
the U.S. Fire Administration (USFA), which is part of the Federal Emergency Management Agency (FEMA) within DHS,
provides resources encouraging fire departments to work in partnership with mental health organizations. HHS supports the
provision of mental health prevention and treatment services, the collection of public health data, and public health
campaigns promoting mental health generally; some initiatives include programs specifically for certain occupations or
industries.
Federal first responder mental health programs are generally conducted within executive departments with jurisdiction over
the type of first responder, with few interagency initiatives and little overall coordination. In one joint initiative, the Office of
EMS in the Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) EMS provides
support to the Federal Interagency Committee on EMS (FICEMS), a coordinating body focused on defining federal research
priorities and programs to support the EMS community. FICEMS member agencies include the Department of Defense
(DOD), DHS, Department of Transportation (DOT), Federal Communications Commission (FCC), and HHS. While
FICEMS represents an example of interagency coordination, most federal activities involving first responders are single
programs for individual occupations administered by a single department.
Congress may build on existing efforts, address current gaps, or improve established programs related to first responder
mental health. For example, Congress could attempt to increase access to services for first responders. This could include
promoting mental health training or programming tailored to these occupations. Congress may also consider addressing
barriers to first responder utilization of mental health care, which include lack of knowledge about services, lack of systemic
support for mental wellness within first responder organizations, and stigma. Additionally, in considering support for first
responder mental health, Congress may determine how to organize and execute these programs on a federal level. A
coordinated approach may include a central clearinghouse for first responder mental health services, administration and
funding from a single agency, or more comprehensive mental health prevention and treatment services that address gaps in
care. Another consideration for Congress involves the degree of empirical support for first responder mental health programs,
since not all post-crisis or trauma-based interventions have been found to be safe and effective.
This report provides information and resources regarding federal programs targeting the mental health of first responders.
Here, federal activities are displayed by the type of first responder (i.e., police officers, firefighters, and emergency medical
personnel) and the primary corresponding executive department of jurisdiction. Other selected resources—including some
non-federal efforts—are also listed. An additional section describes related federal programs seeking to address mental health
and suicide administered by HHS, which may not specifically target first responders but could still serve this population.
Congressional Research Service

link to page 4 link to page 6 link to page 7 link to page 8 link to page 8 link to page 9 link to page 9 link to page 9 link to page 10 link to page 11 link to page 11 link to page 12 link to page 13 link to page 14 link to page 14 link to page 15 link to page 16 link to page 17 link to page 17 link to page 17 link to page 18 link to page 19 link to page 20 link to page 20 link to page 21 link to page 21 link to page 22 Federal Efforts to Address the Mental Health of First Responders

Contents
Introduction ..................................................................................................................................... 1
Mental Health of First Responders .................................................................................................. 3
Federal Programs Addressing First Responder Mental Health........................................................ 4
Law Enforcement ...................................................................................................................... 5
The Law Enforcement Mental Health and Wellness Act (LEMHWA) Program ................ 5
Edward Byrne Memorial Justice Assistance Grant (JAG) Program ................................... 6
VALOR Initiative ................................................................................................................ 6
National Officer Safety Initiative ........................................................................................ 6
Additional Resources .......................................................................................................... 7
Firefighters ................................................................................................................................ 8
Suicide Prevention and Mental Health Services ................................................................. 8
Additional Resources .......................................................................................................... 9
Emergency Medical Services Personnel ................................................................................. 10
Additional Resources ......................................................................................................... 11
Department of Health and Human Services (HHS) Resources ................................................ 11
Substance Abuse and Mental Health Services Administration (SAMHSA) ..................... 12
Centers for Disease Control and Prevention (CDC) ......................................................... 13
National Institutes for Health (NIH) ................................................................................. 14
Issues for Congress ........................................................................................................................ 14
Tailoring Mental Health Programming to First Responders and Increasing Access ......... 14
Addressing Barriers to First Responder Utilization of Mental Health Care ..................... 15
Including a Spectrum of Mental Health Services ............................................................. 16
Identifying Empirical Support for First Responder Mental Health Interventions ............ 17
Coordinating First Responder Mental Health Programs across Agencies ........................ 17

Tables

Table A-1. Abbreviations Used in this Report ............................................................................... 18

Appendixes
Appendix. ...................................................................................................................................... 18

Contacts
Author Information ........................................................................................................................ 19

Congressional Research Service

Federal Efforts to Address the Mental Health of First Responders

Introduction
Police officers, firefighters, and emergency medical service personnel are often the first to
respond to a crisis or emergency. As such, these first responders may experience significant stress
and/or be exposed to traumatic events in carrying out their jobs. Compounded over time,
exposure to stressful events may contribute to diminished mental health and wellness. Similarly, a
single, extremely stressful or traumatic event can negatively affect mental health for those
involved or who witness the event.
Congress, the Administration, and executive agencies have recognized the mental health-related
risks of first responders and have initiated efforts to prevent or remediate these issues. Federal
efforts to improve first responder mental health involve multiple programs spread out across
several executive departments and agencies. The federal government has generally taken a
piecemeal approach to first responder mental health initiatives. Most programs are the efforts of a
sole executive department with jurisdiction over the type of first responder (e.g., Department of
Justice and law enforcement officers) with few interagency initiatives and little overall
coordination.
Congress may be interested in building on current efforts, addressing current gaps, or trying to
improve existing programs related to first responder mental health. For example, rather than use a
broad array of individual independent programs across multiple agencies, Congress might
consider promoting a more streamlined approach with a greater emphasis on interagency
coordination and consultation. This approach could include more comprehensive mental health
prevention and treatment services that address any gaps in care. First responders may benefit
from a spectrum of mental health services devoted both to the chronic stressors of their work
environments and to acute mental health crises or traumatic events. Congress could require the
federal first responder mental health response to include greater attention to the course of mental
health, from prevention to treatment and recovery for mental disorders, for example. Similarly, in
reauthorizing or appropriating funding for federal grants for first responders, Congress may
consider ways to provide sustainable financing systems for new or existing programs, particularly
since several current programs involve discretionary grants provided once to grantees.
Additionally, many existing programs for mental health or first responders do not explicitly
address both of these issues; grants for mental health could be used for first responders (but not
necessarily) and first responder programs may not require mental health-related activities. Few
existing funding streams are solely dedicated to first responder mental health.
When supporting mental health interventions for first responders, Congress might consider the
empirical support for such programs and promote the use of evidence-based practices. Not all
post-crisis or trauma-based interventions have been found to be safe and effective. Research
remains mixed on the effectiveness of certain treatments, with some studies suggesting that some
interventions—such as particular crisis response programs—may actually promote harm.
Federal efforts to promote mental health services for first responders might also address barriers
to utilization, such as the availability of treatment services tailored to these occupations, or issues
surrounding stigma. Congress may also consider promoting a systemic approach to mental health
services, with training not only for first responders themselves, but also for management.

Congressional Research Service
1

link to page 21 Federal Efforts to Address the Mental Health of First Responders

Organization of First Responder Systems
When an emergency occurs, a person at the scene typically calls 9-1-1 to report the incident. A 9-1-1 operator
dispatches local law enforcement, fire, or emergency medical services (EMS) workers to the scene. Thus, local law
enforcement, fire and EMS are often the first professionals to arrive on the scene, and coordinate amongst each
other to assist in the response. Local jurisdictions (e.g., counties, municipalities) often have their own law
enforcement agencies, paid for by the local government. Localities often have their own fire departments and EMS
services which may be comprised of entirely paid employees (career), unpaid (volunteers), or a combination
(career-volunteer). In most jurisdictions, local governments use local tax revenues and federal grant funds to
support law enforcement and firefighter costs. Thus, police officers and sheriff’s deputies, fire, and EMS are
community-based, and locally funded and control ed. Some EMS personnel are part of local fire departments while
others are private entities that contract with local governments or medical facilities. Therefore, some EMS
personnel are public employees while others are employees of privately owned for-profit or nonprofit
organizations. Law enforcement officers are nearly always public employees.
For most incidents, local response agencies can manage the incident from start to finish. If an incident overwhelms
local resources, and requires additional assistance, the local agencies may request neighboring jurisdictions assist. If
neighboring local jurisdictions are overwhelmed, response agencies may call on the state to assist. If the event
overwhelms state resources, or spreads across multiple jurisdictions in one state or across state lines, the state
may call in the federal government, federal responders, and federal resources to assist with the response. Hence,
there is a national framework to support a coordinated (federal, state, local) response to emergencies.
This report provides information on federal programs targeting the mental health of first
responders. The programs included in this report all intend to improve mental health outcomes,
albeit in different ways. Some federal programs address first responder mental health generally,
while others may target a specific population (e.g., law enforcement officers) or goal (e.g., suicide
prevention). Some programs are explicitly for mental health or suicide-related activities, while
others could be used for these purposes, but are not necessarily intended for them exclusively.
The programs noted here focus specifically on mental health, though some may support other
behavioral health issues such as substance use. While some research suggests first responders
may have higher rates of unhealthy substance use behaviors, these may be secondary to mental
health issues.1 Law enforcement officers, firefighters, and emergency medical personnel may
develop unhealthy substance use behaviors as coping strategies for job-related stress or other
mental health problems.2 This report focuses on first responder mental health, though it includes
programs that address behavioral health generally if mental health-related activities are a primary
enterprise. A full discussion of substance use in this population—particularly substance misuse
and substance use disorders—is beyond the scope of this report.
In this report, federal activities are displayed by the type of first responder (i.e., law enforcement
officers, firefighters, and emergency medical personnel) and the primary corresponding executive
department of jurisdiction. An additional section describes related federal programs seeking to
address mental health and suicide administered by the Department of Health and Human Services
(HHS). The final section describes issues Congress may consider related to the mental health of
first responders.3

1 See, for instance, Mary Carey, Salah Al-Zaiti, and Grace Dean, et al., “Sleep Problems, Depression, Substance Use,
Social Bonding, and Quality of Life in Professional Firefighters,” J Occup Environ Med, vol. 53, no. 8 (August 2011),
pp. 928-933.
2 For example, Judith Waters and William Ussery, “Police Stress: History, Contributing Factors, Symptoms, and
Interventions,” Policing: An International Journal of Police Strategies & Management, vol. 30, no. 2 (2007), pp. 169-
188.
3 Of note, all abbreviations used in this report are displayed in Table A-1.
Congressional Research Service
2

Federal Efforts to Address the Mental Health of First Responders

Mental Health of First Responders
Research has shown that the types of stressful work conditions first responders often experience
can contribute to the development of new mental health conditions or exacerbate pre-existing
mental health conditions.4 Comprehensive national data on first responder mental health do not
exist. However, some research suggests that first responders may have higher risks for mental
health conditions, including suicidal thoughts and behaviors.5 Results from one study, for
example, found that firefighter and emergency medical services (EMS) personnel—such as
emergency medical technicians (EMTs) and paramedics—experience higher rates of lifetime
suicidal ideation and attempts than the general population.6 Another study found relatively high
rates of suicidal thoughts and behaviors among firefighters.7 EMTs may also have higher rates of
suicide than non-EMTs.8 Similar results have been found in studies on law enforcement,
describing a higher risk for suicide amongst police officers compared to the general population.9
One white paper found that police and firefighters may be more likely to die by suicide than in
the line of duty.10 The research regarding mental health risks for first responders appears mixed
however, with some studies suggesting that suicide rates among some first responders may
actually be lower than the general population.11 A systematic review of 63 studies examining
suicide in police officers, firefighters, EMTs, and paramedics revealed elevated risk for suicide
among first responders, but also noted a dearth of rigorous longitudinal research which could
provide more conclusive information.12
Although few studies have carefully examined the exact mechanisms behind the relationship
between experiences in the workplace and mental health for first responders, some believe
frequent situational stressors and/or exposure to traumatic incidents for individuals in these
occupations can result in higher rates of mental health concerns and suicide. According to the

4 See, for instance, Lupo Geronazzo-Alman, Ruth Eisenberg, and Sa Shen, et al., “Cumulative Exposure to Work-
related Traumatic Events and Current Post-traumatic Stress Disorder in New York City’s First Responders,” Compr
Psychiatry, vol. 74 (April 2017), pp. 134-143; and Jeanne Mager Stellman, Rebecca Smith, and Craig Katz, et al.,
“Enduring Mental Health Morbidity and Social Function Impairment in World Trade Center Rescue, Recovery, and
Cleanup Workers: The Psychological Dimension of an Environmental Health Disaster,” Environmental Medicine, vol.
116, no. 9 (September 2008).
5 See, for example, Charles Marmar, Shannon McCaslin, and Thomas Metzler, et al., “Predictors of Posttraumatic
Stress in Police and Other First Responders,” Ann. N.Y. Acad. Sci., vol. 1071 (2006), pp. 1-18; Zhen Wang, Sabra
Inslicht, and Thomas Metzler, et al., “A Prospective Study of Predictors of Depression Symptoms in Police,”
Psychiatry Res., vol. 175, no. 3 (February 28, 2008), pp. 211-216.
6 Colleen E. Martin, Jana K. Tran, and Sam Buser, “Correlates of Suicidality in Firefighter/EMS Personnel,” Journal of
Affective Disorders, vol. 208, no. 15 (January 2017), pp. 177-183.
7 Ian Stanley, Melanie Horn, and Christopher Hagan, et al., “Career Prevalence and Correlates of Suicidal Thoughts
and Behaviors among Firefighters,” Journal of Affective Disorders, vol. 187 (November 15, 2015), p. 2015.
8 Neil Vigil, Andrew Grant, and Octavio Perez, “Death by Suicide—The EMS Profession Compared to the General
Public,” Prehospital Emergency Care, vol. 23, no. 3 (2019).
9 John M. Violanti, Cynthia F. Robinson, and Rui Shen, “Law Enforcement Suicide: A National Analysis,”
International Journal of Emergency Mental Health, vol. 15, no. 4 (2013), pp. 289-297.
10 Miriam Heyman, Jeff Dill, and Robert Douglas, The Ruderman White Paper on Mental Health and Suicide of First
Responders, Ruderman Family Foundation, April 2018.
11 Ian H. Stanley, Melanie A. Hom, and Thomas E. Joiner, “Suicide Mortality Among Firefighters: Results from a
Large, Urban Fire Department,” American Journal of Industrial Medicine, vol. 59, no. 11 (November 2016), pp. 942-
947.
12 Ian H. Stanley, Melanie A. Horn, and Thomas E. Joiner, “A Systematic Review of Suicidal Thoughts and Behaviors
among Police Officers, Firefighters, EMTs, and Paramedics,” Clinical Psychology Review, vol. 44 (March 2016), pp.
25-44.
Congressional Research Service
3

Federal Efforts to Address the Mental Health of First Responders

American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5), trauma is defined as exposure to actual or threatened death, serious injury, or
sexual violence. An individual may experience such an event first hand, witness it, or learn that
the event occurred to a friend or colleague. Exposure to trauma can lead to a number of mental
health issues, including increased symptoms of anxiety and depression. In some instances,
exposure to trauma can result in post-traumatic stress symptoms, including post-traumatic stress
disorder (PTSD). One study found that, for firefighters, cumulative exposure to other people’s
suicide attempts may be a risk factor for individual suicidal thoughts and behaviors.13
There appears to be little research regarding first responders seeking or utilizing mental health
treatment.14 A few studies suggest that first responders may experience barriers to accessing and
utilizing mental health treatment. One review of the literature found that first responders often
described not knowing where to get help, or having difficulties scheduling an appointment with a
provider.15 Other barriers included concerns about the confidentiality of services and fears that
seeking psychological services would have a negative effect on one’s career.16 Barriers to
accessing care may be particularly problematic for certain subgroups of first responders, such as
volunteer firefighters and police officers in small departments.17
First responders may also experience barriers to care unique to their fields, such as stigma
surrounding mental health treatment and a culture of not seeking help. One study found that on
average, about one in three first responders experiences stigma regarding mental health.18 In
another study, first responders described not feeling like they can “show weakness” or having
fears of being perceived that they are not “up to the job.”19 This study also found that lack of
knowledge about mental health and mental health treatment was a significant barrier to help-
seeking for first responders.
Federal Programs Addressing First Responder
Mental Health
Recognizing the unique risks for police, firefighters and emergency medical personnel, the
federal government has made efforts to address first responder mental health. Multiple executive
departments, including the Department of Justice (DOJ), the Department of Homeland Security
(DHS), and HHS, operate mental health programming for first responders. Some programs focus

13 Nathan Kimbrel, Michelle Pennington, and Claire Cammarata, et al., “Is Cumulative Exposure to Suicide Attempts
and Deaths A Risk Factor for Suicidal Behavioral among Firefighters? A Preliminary Study,” Suicidal Life Threatening
Behavior, vol. 46, no. 6 (December), p. 2016.
14 Peter Haugen, Aileen McCrillis, and Geert Smid, et al., “Mental Health Stigma and Barriers to Mental Health Care
for First Responders: A Systematic Review and Metaanalysis,” Journal of Psychiatric Research, vol. 94 (2017), pp.
218-229; and Sara Jones, Katherine Agud, and Jean McSweeney, “Barriers and Facilitators to Seeking Mental Health
Care Among First Responders: ‘Removing the Darkness’,” Journal of the American Psychiatric Nurses Association,
vol. 26, no. 1 (2020), pp. 43-54.
15 Haugen et al., “Mental Health Stigma and Barriers to Mental Health Care,” 2017.
16 Ibid.
17 Ian Stanley, Joseph Boffa, and Melanie Hom, et al., “Differences in Psychiatric Symptoms and Barriers to Mental
Health Care between Volunteer and Career Firefighters,” Psychiatry Research, vol. 247 (2017), pp. 236-242; and John
Violanti, Anna Mnatsakanova, and Cecil Burchfiel, et al., “Police Suicide in Small Departments: A Comparative
Analysis,” Int J Emerg Ment Health, vol. 14, no. 3 (2012), pp. 157-162.
18 Haugen et al., “Mental Health Stigma and Barriers to Mental Health Care,” 2017.
19 Jones et al., “Barriers and Facilitators to Seeking Mental Health Care,” 2020.
Congressional Research Service
4

Federal Efforts to Address the Mental Health of First Responders

on mental health for occupations generally, while others target specific occupations (such as law
enforcement officers) or focus on specific circumstances such as disaster response personnel. In
instances where first responders are employees of the federal government, the federal agencies
responsible may provide in-house resources for these individuals.20
Federal efforts to address the mental health of first responders are described below. Each section
describes the activities of the executive department with primary responsibility for the occupation
and provides additional related resources.21
Law Enforcement
DOJ has several initiatives and grant programs that provide assistance to state and local
governments for issues related to law enforcement officers’ mental health. Programs under the
Law Enforcement Mental Health and Wellness Act (LEMHWA, P.L. 115-113) specifically focus
on the mental health of law enforcement officers. Other programs operated by DOJ, such as the
Edward Byrne Memorial Justice Assistance Grant (JAG) program, the VALOR Officer Safety and
Wellness Program, and the National Officer Safety Initiative can provide assistance for law
enforcement officer mental health, but do not focus solely on this issue.
The Law Enforcement Mental Health and Wellness Act (LEMHWA) Program
LEMHWA, among other things, amended the authorizing legislation for the COPS program so
that grants could be awarded to “establish peer mentoring mental health and wellness pilot
programs within State, tribal, and local law enforcement agencies.” Congress appropriated $2
million for FY2019 and $5 million for FY2020 under the COPS account in the Commerce,
Justice, Science, and Related Agencies appropriations acts for “training, peer mentoring, and
mental health program activities” as authorized by LEMHWA.22
The COPS Office awards this funding under its LEMHWA Program. According to the COPS
Office, funds are to be used to “improve the delivery of and access to mental health and wellness
services for law enforcement through training and technical assistance, demonstration projects,
and implementation of promising practices related to peer mentoring mental health and wellness
programs.”23 The program funds projects that “develop knowledge, increase awareness of
effective mental health and wellness strategies, increase the skills and abilities of law
enforcement, and increase the number of law enforcement agencies and relevant stakeholders
using peer mentoring programs.”24

20 A complete review of all federal agencies employing first responders and the mental health resources they provide is
beyond the scope of this report.
21 Resources are listed at the discretion of CRS based on their relevance to this topic. Not all resources are from federal
agencies.
22 All public governmental agencies, for-profit and nonprofit organizations, institutions of higher education, community
groups, and faith-based organizations are eligible applicants under the program. For FY2019 and FY2020, the COPS
Office awarded fewer than 50 grants in both fiscal years to eligible applicants to serve members of the law enforcement
community. According the Bureau of Justice Statistics, there are approximately 18,000 federal, state, county, and local
law enforcement agencies. Duren Banks, Joshua Hendrix, Matthew Hickman, et al. “National Sources of Law
Enforcement Employment Data,” U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics,
NCJ 249681, April 2016, p. 1.
23 U.S. Department of Justice, Community Oriented Policing Services Office, Law Enforcement Mental Health and
Wellness Act (LEMHWA) Program, https://cops.usdoj.gov/lemhwa.
24 Ibid.
Congressional Research Service
5

Federal Efforts to Address the Mental Health of First Responders

Edward Byrne Memorial Justice Assistance Grant (JAG) Program
JAG is a formula grant program whereby funding is allocated to each state, the District of
Columbia, and each of the territories to support a variety of criminal justice initiatives.25 Each
state’s allocation is divided between the state and units of local government in the state based
upon a statutorily defined formula.26 Grant recipients can use their JAG funds for state and local
initiatives for one or more of JAG’s program purpose areas, which includes “mental health and
related law enforcement and corrections programs, including behavioral programs and crisis
intervention teams.”27
DOJ’s Bureau for Justice Assistance (BJA) administers JAG and identifies “officer safety and
wellness” as an area of emphasis for the program.28 BJA encourages grant recipients to use some
of their JAG funds to support health and wellness programs for law enforcement officers and to
cover the cost of officers attending officer safety and wellness conferences that “enhance law
enforcement education and awareness with the goal of preventing officer injury and/or death.”29
VALOR Initiative
BJA also administers the funding for the VALOR Officer Safety and Wellness Program. The
initiative provides training, technical assistance, and specialized programs to law enforcement
officers to “prevent violence against law enforcement officers and ensure officer safety,
resilience, wellness, and survivability following violent encounters during the course of their
duties.”30 The initiative consists of eight programs, one of which is a law enforcement suicide
prevention training program which provides training and technical assistance that focuses on
education, awareness, recognition, and prevention of law enforcement suicide. Congress provided
$12 million for the VALOR Initiative for FY2020.
National Officer Safety Initiative
BJA created the National Officer Safety Initiative to support President Trump’s executive order
on preventing violence against federal, state, tribal, and local law enforcement officers.31 This
initiative addresses law enforcement officer safety in three areas: law enforcement suicide, traffic
safety, and a national public awareness and education campaign. In FY2018, BJA awarded a grant
to the International Association of Chiefs of Police (IACP) to convene a national consortium of
experts and stakeholder organizations and associations in the field of officer safety and wellness.
The goals of the consortium were to produce a comprehensive report with recommendations on
consistent definitions and terminology relating to officer suicide; policy and procedure updates;

25 For more information on the JAG program see CRS In Focus IF10691, The Edward Byrne Memorial Justice
Assistance Grant (JAG) Program, by Nathan James.
26 34 U.S.C. § 10156.
27 34 U.S.C. § 10152(a)(1).
28 28 U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Assistance, Fiscal Year (FY) 2020 State
JAG Information, https://bja.ojp.gov/program/jag/fy-2020-state-jag-information#3bw09f.(hereinafter, “BJA FY2020
State JAG Information”).
29 BJA FY2020 State JAG Information.
30 U.S. Department of Justice, Office of Justice Programs, FY2020 Program Summaries, March 2019, p. 158,
https://www.justice.gov/jmd/page/file/1160581/download.
31 Executive Order 13774, “Preventing Violence Against Federal, State, Tribal, and Local Law Enforcement Officers,”
82 Federal Register 10695, February 14, 2017.
Congressional Research Service
6

Federal Efforts to Address the Mental Health of First Responders

research and data collection improvements; effective messaging strategies; and promising
practices in prevention, intervention, and post-intervention follow-up.32
Additional Resources
Law Enforcement Mental Health and Wellness Act Reports
LEMHWA required DOJ to submit a report to Congress on mental health practices and services at
the Departments of Defense and Veterans Affairs that could be adopted by federal, state, local, or
tribal law enforcement agencies. The act also required DOJ to provide recommendations
regarding the effectiveness of crisis lines for law enforcement officers, efficacy of annual mental
health checks for law enforcement officers, expansion of peer mentoring programs, and assurance
of privacy considerations for these types of programs. The COPS Office published a report in
response to this mandate in March 2019.
 Community Oriented Policing Services, Law Enforcement Mental Health and
Wellness Act: Report to Congress, available online at https://cops.usdoj.gov/RIC/
Publications/cops-p370-pub.pdf.
The act also required the COPS Office to publish case studies of programs designed primarily to
address officer mental health and well-being. In response to this mandate, the COPS Office
published eleven case studies of mental health and wellness programs in ten law enforcement
agencies and one call-in crisis line. Each case study discusses the program and its origin, focusing
on elements that can be implemented elsewhere.
 Law Enforcement Mental Health and Wellness Programs: Eleven Case Studies,
available online at https://cops.usdoj.gov/RIC/Publications/cops-p371-pub.pdf.
International Association of Chiefs of Police
The International Association of Chiefs of Police (IACP), a nonprofit organization, has a
webpage that provides several resources related to law enforcement officer suicide prevention and
awareness. Resources include a report that discusses suicide prevention and awareness with
recommendations for command staff, common factors associated with suicide, and information
on national and local suicide prevention resources; a report that discusses strategies for law
enforcement agencies that want to include officer mental wellness as a core element of an officer
safety and well-being program or reduce the threat of officer death by suicide; and information on
sample suicide prevention programs that target law enforcement officers.
 IACP, Law Enforcement Suicide Prevention and Awareness:
https://www.theiacp.org/resources/document/law-enforcement-suicide-
prevention-and-awareness.
Police Executive Research Forum (PERF)
The Police Executive Research Forum (PERF), a nonprofit police research and policy
organization, published a report in October 2019 discussing what the data can tell us about law
enforcement officers who die by suicide, risk factors for suicide in the law enforcement
profession, and warning signs that an officer might be contemplating suicide. The report also

32 U.S. Department of Justice, Community Oriented Policing Services Office, “First Ever National Consortium
Dedicated to Preventing Law Enforcement Suicide to Meet,” Community Policing Dispatch, vol. 12, no. 4, May 2019,
https://cops.usdoj.gov/html/dispatch/05-2019/suicide_prevention.html.
Congressional Research Service
7

Federal Efforts to Address the Mental Health of First Responders

outlines 10 recommendations for steps that law enforcement agencies can take to help prevent
officer suicide, including routine mental health checks, confidential support programs and
training, and family support.
 An Occupational Risk: What Every Police Agency Should Do to Prevent Suicide
among Its Officers, available online at https://www.policeforum.org/assets/
PreventOfficerSuicide.pdf.
Blue H.E.L.P.
Blue H.E.L.P.,33 a nonprofit organization that promotes awareness of mental health issues in the
law enforcement community, collects and reports data on law enforcement officer suicides. These
data have limitations, namely that they are voluntarily submitted to Blue H.E.L.P. by people who
knew the officer who died by suicide and discovered through media searches by Blue H.E.L.P.
staff, and may not be a comprehensive count of all law enforcement officer suicides. Despite
these limitations, the data published by the organization are frequently cited by the media when
discussing suicide by law enforcement officers.
Firefighters
Several federal initiatives seek to address mental health-related issues among firefighters. Often
these efforts focus on suicide prevention, though they may also provide mental health services
after critical incidents, or training on general mental health and well-being.
The National Park Service, U.S. Forest Service, and other federal agencies that employ
firefighters directly, have taken steps to address suicide among their workforce and promote
mental wellness. For example, the National Park Service (NPS) established a task force to address
firefighter suicide among their employees. The task force developed a mental health self-
assessment and tools for managers to talk to NPS firefighters about mental wellness and suicide.
The NPS made these resources and tools available to the broader fire community.34
Suicide Prevention and Mental Health Services
Some federal agencies provide suicide prevention information for fire departments at all levels of
government (e.g., federal wildland firefighters, local firefighters, volunteer firefighters). For
example, the U.S. Fire Administration (USFA), which is part of the Federal Emergency
Management Agency (FEMA) within DHS, provides resources for all fire departments and
encourages fire departments to work in partnership with mental health organizations.35 The
National Emergency Training Center (NETC) within FEMA provides research, resources, and
best practices for fire departments, including mental health training models and best practices.36
Additionally, the National Interagency Fire Center (NIFC) offers Critical Incident Stress

33 H.E.L.P. roughly stands for “Honoring the Service of Law Enforcement Officers Lost to Suicide and bringing
Awareness to Police Officer PTSD.” See more at https://bluehelp.org/.
34 Paul Keller, “Suicide in the Wildland Fire Service,” Two More Chains, vol. 7, no. 1 (Spring 2017),
https://www.wildfirelessons.net/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=bc257c49-
e09a-592e-785c-28967671cc3f&forceDialog=0.
35 U.S. Fire Administration, “Preventing Suicide among First Responders.” August 8, 2019, retrieved July 23, 2020,
usfa.fema.gov/operations/infograms/080819.html.
36 U.S. Fire Administration, National Emergency Training Center Library, accessed July 23, 2020,
https://usfa.kohalibrary.com/app/search/suicide?topic_facet=%22Firefighters.%22&sort=.
Congressional Research Service
8

Federal Efforts to Address the Mental Health of First Responders

Management (CISM) services to fire departments, which includes suicide prevention,
intervention, and post-intervention services.37
Federal agencies also provide funding for research and assistance with firefighter suicide
prevention. For example, the National Institute for Occupational Safety and Health (NIOSH) of
the Centers for Disease Control and Prevention within HHS and DHS/FEMA through its Fire
Prevention and Safety Grant (FP&S) program, provided the National Fallen Firefighters
Foundation funding to hold the Second Fire Service Suicide and Depression Summit in 2013.38 In
2014, the Firefighter Behavioral Health Alliance—an independent nonprofit organization—
received $23,750 in FP&S funds to support this organization’s efforts to provide suicide
awareness and prevention workshops.
Additional Resources
In addition to federal efforts, several nongovernmental organizations offer resources on suicide
awareness and prevention for fire departments:
 Firefighter Behavioral Health Alliance (FBHA), a nonprofit organization,
provides training to and runs workshops for fire departments and EMS
organizations focusing on behavioral health awareness and suicide prevention:
http://www.ffbha.org/resources/5-bugles-4-change/.
 The National Fallen Firefighters Foundation (NFFF) “Everyone Goes Home”
initiative focuses on firefighter safety and health and wellness—including suicide
prevention. The organization has produced a Fire Service Behavioral Health
Management Guide: everyonegoeshome.com/wp-
content/uploads/sites/2/2017/12/behavioral-health-mgmt-guide-122017.pdf., and
a Guide for Fire Chiefs: http://www.firstrespondercenter.org/wp-content/uploads/
2019/03/SuicideGuide_Chiefs.pdf.
 The First Responder Center for Excellence, an affiliate of NFFF, offers resources,
research, and tools for individuals, leadership, clinicians on first responder
behavioral health: firstrespondercenter.org/behavioral-health.
 The International Association of Fire Fighters has a Center of Excellence, which
includes a mental health hotline (1-877-766-2901); resources for fire
departments: https://www.iaffrecoverycenter.com/hotline/ptsd-mental-health/;
and clinicians who can help firefighters overcome suicidal thoughts,
manage behavioral health problems or begin recovery from addiction:
https://www.iaffrecoverycenter.com/behavioral-health/.
 The International Association of Fire Chiefs offers resources for fire department
leadership: https://www.iafc.org/search-results/#/suicide/page=1 and training for

37 National Interagency Fire Center, “Suicide Prevention, Intervention and Postvention,” retrieved July 23, 2020,
nifc.gov/CISM/SuicidePrevention.html.
38 The Fire Prevention and Safety (FP&S) Grants are authorized under Section 33 of the Federal Fire Prevention and
Control Act of 1974 (P.L. 93-498, as amended; 15 U.S.C. § 2229), and receive funding each year through DHS annual
appropriations. The FP&S Grants are part of the Assistance to Firefighters Grants (AFG) awarded each year by FEMA
to local fire departments and other eligible entities. The grant supports projects that enhance the safety of the public and
firefighters from fire and related hazards. The grant is a competitive grant, thus not all applicants may receive funding.
The primary goal is to reduce injury and prevent death among high-risk populations. In 2005, Congress reauthorized
funding for FP&S and expanded the eligible uses of funds to include Firefighter Safety Research and Development. For
more information, see https://www.fema.gov/grants/preparedness/firefighters/safety-awards.
Congressional Research Service
9

Federal Efforts to Address the Mental Health of First Responders

firefighters: iafc.org/events/event/2020/12/31/self-paced/surviving-the-job-
emotional-self-care-for first-responders.
 The National Fire Protection Association’s Fire Protection Research Foundation
is supporting a research project, “Preventing Suicide Among Firefighters
Through Implementation of Safety Planning Training for Peer Support
Specialists” with funding from the DHS/FEMA Assistance to Firefighters Grant
(AFG) Program and the Fire Protection Research Foundation:
https://www.nfpa.org/-/media/Files/News-and-Research/Resources/Research-
Foundation/Current-projects/ProjectSummaryFFSuicideIntervention.ashx.
 National Fire Service Behavioral Health Symposium 2020, see
https://www.firstrespondercenter.org/event/national-fire-service-behavioral-
health-symposium/.
Emergency Medical Services Personnel
Emergency Medical Services (EMS) provide acute medical care at the site of an emergency. EMS
are part of a larger system of coordinated medical response, whereby multiple agencies and
individuals work together to receive and respond to emergency calls. The organizational structure
of EMS, including who provides and finances the services, varies significantly from community
to community. EMS services can be based in a fire department, a hospital, an independent
government agency (i.e., public health agency), a nonprofit corporation (e.g., Volunteer Rescue
Squad), or be provided for by for-profit entities.39
At the federal level, the Office of EMS in the Department of Transportation’s National Highway
Traffic Safety Administration (NHTSA) serves as a clearinghouse of information for EMS
agencies. The Office of EMS provides support to the Federal Interagency Committee on EMS
(FICEMS), a coordinating body focused on defining federal research priorities and initiatives to
support the EMS community.40 The member agencies include the Department of Defense (DOD),
DHS, Department of Transportation (DOT), Federal Communications Commission (FCC), and
HHS. This membership also receives input from community representatives who comprise
the National EMS Advisory Council (NEMSAC).41 The FICEMS, along with the NEMSAC has
focused on strengthening mental health and wellness and preventing suicides within the EMS
community.42
The federal government also provides funding to EMS agencies for some mental health and
wellness activities. For example, EMS agencies that are not affiliated with a hospital, can apply
for federal funding under FEMA’s Assistance to Firefighter Grants for a variety of activities,
including wellness and fitness activities. Wellness and fitness activities include programs aimed at
strengthening the mental health of fire and EMS workers.43 EMS agencies may also benefit from
programs sponsored by affiliated fire departments, which may receive funding through FEMA’s

39 EMS.gov, “What is EMS?” accessed on July 23, 2020, https://www.ems.gov/whatisems.html.
40 EMS.gov, “Federal Interagency Committee on EMS.” accessed on July 23, 2020, https://www.ems.gov/ficems.html
41 EMS.gov, “National EMS Advisory Council,” accessed on July 23, 2020, https://www.ems.gov/nemsac.html.
42 National EMS Advisory Council Committee Report and Advisory, Mental Health and Wellness for the EMS
Provider and their Partners in Public Safety, August 15, 2017, https://www.ems.gov/pdf/nemsac/
NEMSAC_Final_Advisory_Mental_Health_Wellness.pdf.
43 U.S. Department of Homeland Security, Notice of Funding Opportunity, Fiscal Year 2019 Assistance to Firefighters
Grant Program (AFG), released March 13, 2020, https://www.fema.gov/media-library-data/1582223914405-
f4431dbcb610e15bbc843871328241e1/FY19AFGNOFINAL.pdf.
Congressional Research Service
10

Federal Efforts to Address the Mental Health of First Responders

AFG programs. Additionally, recipients of FP&S grants are encouraged to partner with fire
departments, including volunteer fire departments and EMS services, on grant-funded initiatives,
including mental health initiatives. This may provide opportunities for EMS agencies to engage
with professionals on the issue.
Additional Resources
For EMS agencies that are not part of a fire department, the federal government provides general
resources for first responders. For example, the U.S. Fire Administration within FEMA provides
links to the National Volunteer Fire Council’s Fire/EMS helpline, which provides suicide
prevention, mental health, and addiction services for firefighters.44 The U.S. government may
offer help to first responders during or after disasters, including mental health services. For
example, during the Coronavirus Disease 2019 (COVID-19) pandemic, the Administration and
executive agencies established the Federal Healthcare Resilience Task Force to lead the
development of a comprehensive strategy for the U.S. healthcare system to manage its response
to COVID-19, including support for healthcare workers.45 The Task Force established an
EMS/Pre-Hospital Team comprised of EMS and 911 experts from the CDC, FEMA, NHTSA
Office of EMS, U.S. Army, U.S. Coast Guard, USFA, and nonfederal partners to provide state,
local, tribal, and territorial first responders with resources to deal with the stress related to the
pandemic.46
Department of Health and Human Services (HHS) Resources
The U.S. Department of Health and Human Services supports the provision of mental health
prevention and treatment services, the collection of public health data, and public health
campaigns promoting mental health—including for some specific occupations or industries. This
comes in the form of mandatory funding for mental health services through programs like
Medicare and Medicaid, discretionary grant funding to states and other organizations for
prevention or treatment activities, or technical assistance and other resources for grantees and
industry organizations. HHS agencies, such as the Health Resources and Services Administration
(HRSA), provide training and support for many medical providers in particular.
Historically, states—as opposed to the federal government—have borne the primary
responsibility for the provision of community mental health services. This legacy continues today,
with the bulk of federal discretionary funding for mental health services distributed to states via
block grants. For example, the Substance Abuse and Mental Health Services Administration
(SAMHSA) administers the Community Mental Health Services Block Grant to states and
territories annually. The grants support activities related to prevention and treatment of mental

44 U.S. Fire Administration, “Preventing Suicide among First Responders.” August 8, 2019, retrieved July 23, 2020,
usfa.fema.gov/operations/infograms/080819.html.
45 In response to the pandemic, the U.S. government (Administration and Executive Branch agencies) organized its
response efforts in accordance with the National Response Framework. The U.S. government developed a response
plan, identified anticipated roles and responsibilities of federal departments and agencies, and established an
organizational structure to respond to the pandemic. As part of this effort, the U.S. government established several
interagency working groups to focus on specific aspects of the response. The Federal Healthcare Resilience Task Force,
an interagency task force run jointly by HHS and FEMA, was created to support the healthcare system and workers
during the pandemic. For more information, see U.S. Department of Health and Human Services, PanCAP Adapted:
U.S. Government COVID-19 Response Plan, March 13, 2020, p. 9.
46 Federal Healthcare Resilience Task Force, EMS/Prehospital Team, COVID-19 Behavioral Health Resources for
First Responders, April 25, 2020, https://www.ems.gov/pdf/Federal_Guidance_and_Resources/
Personnel_Health_and_Safety/COVID-19_Behavioral_Health_Resources_for_First_Responders.pdf.
Congressional Research Service
11

Federal Efforts to Address the Mental Health of First Responders

health disorders. States have considerable flexibility with how they use these funds. Other HHS
agencies, such as the Centers for Disease Control and Prevention (CDC), assist with the data
collection and technical support surrounding mental illness and treatment-related activities.
CDC’s National Institute for Occupational Safety and Health specifically focuses on the safety
and health of workers and they often offer programming specifically for first responders. Many
mental health-related activities for first responders, therefore, may be state and local initiatives
with possible support from certain federal programs.
Substance Abuse and Mental Health Services Administration (SAMHSA)
The Substance Abuse and Mental Health Services Administration is the federal agency primarily
responsible for supporting community-based mental health and substance abuse treatment and
prevention services. Located within HHS, SAMHSA provides federal funding to states, local
communities, and private entities for mental-health related activities through block grants and
other formula and discretionary grants. Through such grants, SAMHSA supports activities that
include education and training, prevention programs, early intervention activities, treatment
services, and technical assistance—often for specific populations (such as disaster response
personnel) or areas of concern (such as suicide prevention). SAMHSA does not provide mental
health treatment.
SAMHSA Suicide Prevention Resources
SAMHSA supports a number of programs addressing suicide prevention. Some of these
initiatives target specific populations, such as young adults or Tribal communities, while others
provide resources for the general population. SAMHSA’s Suicide Prevention Resource Center,
for instance, provides technical assistance, training, and resources to organizations working to
develop suicide prevention strategies. On some occasions, SAMHSA and the Suicide Prevention
Resource Center will publish materials targeting specific occupations, such as first responders.
SAMHSA mental health and suicide prevention for first responders resources:
 SAMHSA Suicide Prevention Resource Center: http://www.sprc.org/
 Resources for First Responders: http://www.sprc.org/settings/first-responders
 Resources for Law Enforcement: http://www.sprc.org/settings/law-
enforcement
SAMHSA Disaster Technical Assistance Center (DTAC)
SAMHSA operates a Disaster Technical Assistance Center (DTAC) as the foundation of its
disaster response initiatives.47 Through the DTAC, SAMHSA partners with the Federal
Emergency Management Agency (FEMA) to assists states, territories, tribes, and local entities
with all-hazards disaster behavioral health response planning. SAMHSA DTAC uses appropriated
funds for programs that support survivors of disasters as well as organizations and providers
administering aid. For example, through an interagency agreement with FEMA, SAMHSA
operates the Crisis Counseling Assistance and Training Program (CCP), which provides
behavioral health outreach and psycho-educational services to individuals in areas affected by
disasters, including response personnel.48 Other SAMHSA DTAC initiatives include immediate

47 SAMHSA, Practitioner Training; Disaster Technical Assistance Center (DTAC), https://www.samhsa.gov/dtac.
48 SAMHSA, Practitioner Training; Disaster Technical Assistance Center (DTAC); Crisis Counseling Assistance
Congressional Research Service
12

Federal Efforts to Address the Mental Health of First Responders

crisis counseling via the Disaster Distress Helpline49 and resource publication through the
Disaster Behavioral Health Information Series resource collections.50
SAMHSA DTAC resources:
 SAMHSA Disaster Technical Assistance Center resource portal:
https://www.samhsa.gov/dtac/disaster-responders
 DTAC Tips for Disaster Responders: Preventing and Managing Stress:
http://store.samhsa.gov/product/Preventing-and-Managing-Stress/SMA14-
4873
 DTAC Tips for Disaster Responders: Identifying Substance Misuse in the
Responder Community: http://store.samhsa.gov/product/Identifying-
Substance-Misuse-in-the-Responder-Community/SMA14-4874
 DTAC online trainings for first responders: https://www.samhsa.gov/dtac/
education-training
 DTAC online behavioral health trainings: https://www.samhsa.gov/dbhis-
collections/online-trainings
Centers for Disease Control and Prevention (CDC)
The Centers for Disease Control and Prevention is the federal government’s lead public health
agency. CDC’s mission is to “to protect America from health, safety and security threats, both
foreign and in the [United States].”51 CDC is organized into a number of centers, institutes, and
offices. Some of these focus on specific public health challenges (e.g., injury prevention); others
focus on general public health capabilities (e.g., surveillance and data collection).52 CDC also
operates the National Institute for Occupational Safety and Health which disseminates
information related to occupational health for a variety of fields, including sometimes first
responders.53 CDC frequently makes data available and publishes reports on health and mortality
outcomes, and provides resources on prevention and evidence-based interventions.
CDC suicide prevention resources:
 CDC report “Suicide Rates by Industry and Occupation – National Violent Death
Reporting System, 32 States, 2016” (2020) 54: https://www.cdc.gov/mmwr/
volumes/69/wr/mm6903a1.htm
 CDC technical assistance package “Preventing Suicide: A Technical Package of
Policy, Programs, and Practices”: https://www.cdc.gov/violenceprevention/pdf/
suicideTechnicalPackage.pdf

Program (CCP), https://www.samhsa.gov/dtac/ccp.
49 SAMHSA, Find Treatment; Disaster Distress Helpline, https://www.samhsa.gov/find-help/disaster-distress-helpline.
50 SAMHSA, Practitioner Training; Disaster Technical Assistance Center (DTAC); DBHIS Collections,
https://www.samhsa.gov/dtac/dbhis-collections.
51 See the CDC website at https://www.cdc.gov/about/organization/mission.htm.
52 Information about CDC’s organization is available at http://www.cdc.gov/about/organization/cio.htm.
53 For an example of CDC resources specific to first responder mental health, see https://www.cdc.gov/coronavirus/
2019-ncov/hcp/mental-health-healthcare.html.
54 See also this Bureau of Labor study on workplace suicides https://www.bls.gov/opub/mlr/2016/article/suicide-in-the-
workplace.htm.
Congressional Research Service
13

Federal Efforts to Address the Mental Health of First Responders

National Institutes for Health (NIH)
The National Institutes of Health (NIH) is the primary agency of the federal government charged
with performing and supporting biomedical and behavioral research. The agency consists of the
Office of the Director and 27 institutes and centers, each of which focuses on particular diseases
or research areas in human health. Multiple institutes within NIH support various aspects of
behavioral health research generally, but the National Institute for Mental Health (NIMH)
represents the primary organization within NIH focusing on mental health. In addition to
conducting and supporting research, NIMH provides authoritative information on mental
disorders and resources for the public.
NIMH resources:
 NIMH mental health information: https://www.nimh.nih.gov/health/index.shtml
 NIMH research: https://www.nimh.nih.gov/research/index.shtml
 NIMH outreach and news: https://www.nimh.nih.gov/outreach/index.shtml
Issues for Congress
Congress, the Administration, and executive agencies have recognized the mental health-related
risks of first responders and have initiated the aforementioned efforts to prevent or remediate
these issues. Congress may be interested in building on these efforts, addressing current gaps, or
trying to improve existing programs.
Tailoring Mental Health Programming to First Responders and Increasing
Access
Some research suggests that first responders may experience barriers to accessing mental health
treatment.55 First responders may have the same access to mental health resources in their
communities as others; however, specialized mental health prevention and treatment services
geared toward the unique aspects of being a first responder may increase participation and reduce
barriers to receiving care. For instance, in a survey conducted by the National Volunteer Fire
Council (NVFC), more than 75% of firefighters indicated greater willingness to use a program
that was tailored to their needs compared to a program for the general public, such as the national
suicide hotline.56
Supporting organizations that tailor programs for first responders, such as the Firefighter
Behavioral Health Alliance, may increase services to first responders and reduce barriers to
access. A challenge to this approach involves sustainable funding. For example, while FBHA
received federal funding from the FP&S grant program, the funding is competitive and limited,
and typically not awarded to the same organization year-over-year. Organizations receiving
funding to establish mental health programs may then have to finance these programs from their
own budgets, or close the program due to lack of sustained funding. Further, in some federal first
responder grants, only fire or police departments can apply; nonprofit organizations—such as
those focusing on first responder well-being—are not eligible to apply. In other first responder
grant programs, spending on mental health (e.g., training, services) is not an eligible expense. In
addition, workers who support first responders—such as 9-1-1 call takers and dispatchers—may

55 Haugen et al., “Mental Health Stigma and Barriers to Mental Health Care,” 2017.
56 Jones et al., “Barriers and Facilitators to Seeking Mental Health Care,” 2020.
Congressional Research Service
14

Federal Efforts to Address the Mental Health of First Responders

also experience stress on the job. These stressors are expected to increase as communication
systems improve, allowing callers to send images and videos from the scene to call-takers. These
workers may also benefit from mental health programs and services.57 In reauthorizing or
appropriating funding for federal grants for first responders, Congress may consider expanding
categories of eligible applicants or activities to support mental health services or establishing
more sustained financing systems for these programs.
For example, the National Suicide Prevention Lifeline (1-800- 273-TALK) provides critical
counseling and referral services for individuals contemplating suicide. While not specific to first
responders, public safety agencies and organizations promote the Lifeline as a resource for
individuals in these fields. In July 2020, the Federal Communications Commission designated 9-
8-8 as the National Suicide Prevention Lifeline.58 The shorter number is intended to make it
easier to remember, however it is not yet operational (it is expected to be operational by July 16,
2022). When military veterans call the existing number, they are routed to services that are
specific to individuals who have served in the military. Congress may consider following a
similar template for first responders by enabling referrals to mental health services specific to this
population. A coordinated list of programs and organizations specifically tailored to first
responders may lead to increased access and use.
Addressing Barriers to First Responder Utilization of Mental Health Care
Improving access to treatment—even to tailored programs—may not alone significantly increase
utilization of mental health treatment. Federal efforts to promote mental health services for first
responders might also address other barriers to utilization, such as stigma. Research has identified
stigma of mental health treatment as a barrier to receiving care for first responders specifically.
One review of the research found that over a third of first responders identified stigma as a
barrier.59 Fears that treatment will not be confidential, could harm their careers, or could result in
judgment from peers and superiors influence first responders’ decision not to seek mental health
treatment.60 Law enforcement officers, firefighters, and emergency medical personnel may fear
being viewed as “weak” or “not up to the job” by coworkers and leadership.61 In some instances,
individuals may purposefully ignore symptoms and eschew care to avoid these perceived
consequences. Congress may consider encouraging, prioritizing, or allowing mental health
training not only for first responders, but also for management, through new or existing federal
grant programs.
Some studies on first responder mental health care have identified facilitators to treatment
utilization that could counteract barriers. When the effects of stress on mental wellness is
acknowledged and individual first responders realize they are “not alone” in having difficulties
coping or experiencing symptoms of a mental health issue, for instance, they are more likely to
seek treatment.62 Responders included in one study noted that when their coworkers recognized
that they needed help and when they had positive experiences with a mental health provider, they

57 Katie McBride, “911 Dispatchers Hear the Worst Moments of Our Lives. Who Listens to Them?” Vice, March 13,
2020, https://www.vice.com/en_us/article/9398qy/911-dispatchers-hear-the-worst-moments-of-our-lives-who-listens-
to-them.
58 Federal Communications Commission, “FCC Designates ‘988’ as 3-Digit Number for National Suicide Prevention
Hotline,” press release, July 16, 2020, https://docs.fcc.gov/public/attachments/DOC-365563A1.pdf.
59 Haugen et al., “Mental Health Stigma and Barriers to Mental Health Care,” 2017.
60 Ibid.
61 Ibid.
62 Jones et al., “Barriers and Facilitators to Seeking Mental Health Care,” 2020.
Congressional Research Service
15

Federal Efforts to Address the Mental Health of First Responders

were more likely to use treatment services. Support from leadership and unions was also cited as
an essential component to combatting stigma and promoting a culture of help-seeking.
Including a Spectrum of Mental Health Services
The federal government generally takes a piecemeal approach to first responder mental health
initiatives. A more coordinated approach could include more comprehensive mental health
prevention and treatment services that address any gaps in care. This might include attention to
the course of mental health, from prevention to treatment and recovery. The federal compilation
of services could include overall mental and behavioral well-being resources, prevention
programs, diagnostic services, mental health treatment, crisis support interventions, or other
behavioral health services such as those addressing substance use disorders. They may also seek
to balance attention to mental health disorders as much as general mental wellness, resilience, and
coping.
Recommendations from one study emphasized mental health screenings, education campaigns,
and interventions after a trauma or critical incident as possible effective programs.63 Other
suggestions have focused on prescreening for preexisting mental health issues, improving coping
strategies, boosting resilience, and enhancing social support.64 For example, prescreening for
mental health concerns—a strategy used in other high-stress fields such as the military—can help
identify those individuals who are most at risk for negative psychological effects of trauma.
Prescreening is designed to identify first responders who may benefit from additional supports,
not as a tool to exclude individuals for the job. Congress may consider expanding or prioritizing
eligible costs in federal grants to include mental health initiatives that can incorporate these
activities.
Congress may also consider the types of mental health interventions for first responders when
supporting or establishing these types of programs. Mental health programs can target a number
of different aspects of psychological functioning. Some interventions are solely for the aftermath
of a critical incident. These programs target trauma-related symptoms but may not be effective in
addressing other aspects of mental well-being. Other programs are preventive. These
interventions aim to build resiliency to lessen the risk of mental health issues after exposure to
chronic stress or a traumatic incident. Suicide-related interventions may help with reducing
mortality during a mental health crisis, but other complementary treatments may be necessary to
address underlying mental health problems contributing to that crisis.
First responders may benefit from a spectrum of mental health services devoted to both the
chronic stressors of their work environments and also acute mental health crises or traumatic
events. Understanding the role of preexisting risk factors of first responders may also help
identify individuals at high risk for mental health problems. An existing mental health concern,
for example, could trigger an acute crisis. Prescreening may identify individuals entering these
fields who are particularly at risk. Congress may choose to support a broad array of first
responder mental health programs providing a spectrum of services or targeting certain
subpopulations (such as police officers) or incident types (such as traumatic events).
Alternatively, Congress could address several specific issues through a compilation of
complementary programs each targeting a specific subpopulation or issue.

63 Ibid.
64 For examples, see Wang et al., “A Prospective Study of Predictors of Depression Symptoms in Police,” 2008; and
Marmar et al., “Predictors of Posttraumatic Stress in Police and Other First Responders,” 2006.
Congressional Research Service
16

Federal Efforts to Address the Mental Health of First Responders

Identifying Empirical Support for First Responder Mental Health
Interventions
Another consideration for Congress involves the degree of empirical support for first responder
mental health programs. Not all post-crisis or trauma-based interventions have been found to be
safe and effective. Research remains mixed on the effectiveness of certain treatments, with some
studies suggesting that some interventions—such as particular crisis response programs—may
actually promote harm. For example, some studies have found that Critical Incident Stress
Debriefing (CISD), which is used after a traumatic event, may prevent symptoms of post-
traumatic stress disorder,65 while other studies suggest it is ineffective and may even increase the
risk of PTSD.66 When supporting mental health interventions for first responders, Congress might
consider the empirical support for such programs and promote the use of evidence-based
practices. The attention paid toward first responder mental health is relatively new. Given the
dearth of research, federal funding for studies on mental health treatments for first responders
may help identify effective programs specifically for this population. Databases to help track first
responder mental health could also help identify areas most in need. Similarly, agencies focusing
on mental health—such as SAMHSA and NIMH—could play more significant roles in addition
to the agencies primarily responsible for each specific occupation. This may be achieved through
joint grant programs or joint research, and through coordination of research priorities and joint
publication of findings.
Coordinating First Responder Mental Health Programs across Agencies
In considering support for first responder mental health, Congress may determine how to organize
and execute these programs on a federal level. Currently, most federal activities involving first
responders are single programs for individual occupations or specific agency (e.g., police officers,
firefighters, or EMS) workforces. Some federal programs do not target mental health specifically
either, but rather could be used for mental health-related activities, among other allowable uses.
While Congress has provided some funding for mental health programs and services for first
responders, funding has been piecemeal, spread across many federal agencies and many grant
programs. As a result, some mental health advocates have called for a more coordinated approach
to provide accessible, quality care for first responders. Congress could consider whether to
continue individual program administration through executive departments of jurisdiction, or
establish a more coordinated or centralized approach. One of the challenges with this approach is
the decentralized nature of the first responder system, and the diversity of first responder
agencies. Some law enforcement agencies—such as police departments in populous metropolitan
areas—may be large public institutions, while rural fire departments, for example, may be much
smaller and composed almost entirely of volunteers. Effective mental health programs would
need to consider the diversity in these agencies and provide enough flexibilities to meet the needs
of the various first responder organizations.

65 See, for instance, Ross Priebe and Leah Thomas-Olson, “An Exploration and Analysis on the Timeliness of Critical
Incident Stress Management Interventions in Healthcare,” International Journal of Emergency Mental Health, vol. 15,
no. 1 (2013), pp. 39-49.
66 For examples, see Arnold AP van Emmerick, Jan Kamphuis, and Alexander Hulsbosch, et al., “Single Session
Debriefing after Psychological Trauma: A Meta-Analysis,” The Lancet, vol. 360, no. 9335 (September 2002), pp. 766-
771; and Morag Harris, Mustafa Baloglu, and James Stacks, “Mental Health of Trauma-Exposed Firefighters and
Critical Incident Stress Debriefing,” Journal of Loss & Trauma, vol. 7, no. 3 (2002), pp. 223-238.
Congressional Research Service
17

Federal Efforts to Address the Mental Health of First Responders

Appendix.
Table A-1. Abbreviations Used in this Report
Abbreviation
Definition
BJA
Bureau of Justice Assistance
CCP
Crisis Counseling Assistance and Training Program
CDC
Centers for Disease Control and Prevention
CISM
Critical Incident Stress Management
COPS
Community Oriented Policing Services
DHS
U.S. Department of Homeland Security
DOD
U.S. Department of Defense
DOJ
U.S. Department of Justice
DOT
U.S. Department of Transportation
DSM-5
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
DTAC
Disaster Technical Assistance Center
EMS
Emergency Medical Service
EMT
Emergency Medical Technician
FBHA
Firefighter Behavioral Health Alliance
FCC
Federal Communications Commission
FEMA
Federal Emergency Management Agency
FICEMS
Federal Interagency Committee on EMS
FP&S
Fire Prevention and Safety Grant Program
HHS
U.S. Department of Health and Human Services
HRSA
Health Resources and Services Administration
IACP
International Association of Chiefs of Police
JAG
Edward Byrne Memorial Justice Assistance Grant Program
LEMHWA
Law Enforcement Mental Health and Wellness Act, P.L. 115-113
NEMSAC
National EMS Advisory Council
NETC
National Emergency Training Center
NFFF
National Fallen Firefighters Foundation
NHTSA
National Highway Traffic Safety Administration
NIFC
National Interagency Fire Center
NIMH
National Institute of Mental Health
NIOSH
National Institute for Occupational Safety and Health
PERF
Police Executive Research Forum
PTSD
Post-Traumatic Stress Disorder
SAMHSA
Substance Abuse and Mental Health Services Administration
USFA
United States Fire Administration
Source: Prepared by the Congressional Research Service.

Congressional Research Service
18

Federal Efforts to Address the Mental Health of First Responders

Author Information

Johnathan H. Duff, Coordinator
Nathan James
Analyst in Health Policy
Analyst in Crime Policy

Jill C. Gallagher
Ada S. Cornell
Analyst in Telecommunications Policy
Senior Research Librarian

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or
material from a third party, you may need to obtain the permission of the copyright holder if you wish to
copy or otherwise use copyrighted material.

Congressional Research Service
R46555 · VERSION 1 · NEW
19