I am always quick to point out that our response to stress and trauma in emergency services has to include a mental health component. Please don’t assume that I have anything against licensed clinicians; they occupy an important space in the overall approach to addressing the needs our first responders have in the area of mental and emotional wellness. But that doesn’t mean that there may not be some problems associated with that.
For example, clinicians often don’t understand the first responder culture. I’ve heard horror stories from police officers who have seen a therapist that wouldn’t allow them to have a firearm in the office, or from medics whose therapists have broken down crying because they couldn’t stand to hear the accounts of the traumatic scenes that we have all responded to, or from firefighters who were told by a therapist that they should probably go into a different line of work. And if therapists can’t understand the culture, they’ll never be able to earn the trust of those they would like to try to help.
Clinicians often don’t have sufficient training in the field of psychotraumatology. Many clinicians have limited training in dealing with issues relating to post-traumatic stress and being able to effectively work with individuals suffering from a variety of stress-related disorders. The worst outcome of that is that everything gets labeled as PTSD when the vast majority of first responders and military personnel, even those who are dealing with stress-related symptoms, do not meet the diagnostic criteria for PTSD.
I’ve used this statement many times in training mental health professionals to work with first responders: “If the only tool you have is a hammer, every problem looks like a nail.” The hammer that clinicians have is the DSM-5, and every person they see needs a diagnosis. I have seen personnel misdiagnosed as having narcissistic personality disorder, borderline personality disorder, passive-aggressive personality disorder, obsessive-compulsive personality disorder. We have to be careful about not confusing exaggerated behaviors caused by stress with symptoms of genuine disorders with similar characteristics. It would be important to keep in mind that every military member of first responder you might see as a clinician has already had to pass some pretty rigorous screening for mental disorders prior to being hired or allowed to enlist.
In future articles in this series on breaking the stigma, we are going to talk more specifically about what family members can do to understand and help their loved one who may be suffering, what peers can do for one another, and what clinicians can do to be more effectively prepared to help first responders manage their stress and to better adjust to the trauma they experience on the job. The more we know, the better able we are to work together to break the stigma that is keeping so many of our first responders from getting the help they need.
Feel free to reach out to us any time for information or just to chat about any personal struggles you may be having – m.me/callforbackup.org/.