“I’ve witnessed colleagues silently suffer. I have lost firefighters I considered family to suicide. Behind every emergency we answer, we carry invisible trauma: fatal wrecks, child deaths, suicides, house fires with victims. We don’t file claims; we file grief.”
Those were the words of Colorado firefighter Linda Crane as she urged her state to reinstate funding for a vital behavioral health program for firefighters. “It’s essential for the strength and resilience of Colorado’s first responders,” she argued.
Indeed, every day across the country, firefighters encounter harrowing situations and traumatic events that push their strength and resilience to the limit. Without adequate mental health support, they face a heightened risk of chronic stress, burnout, and serious conditions such as anxiety, depression, and posttraumatic stress disorder (PTSD).
Yet firefighters, emergency medical services (EMS) professionals, and other first responders aren’t getting the mental health support they need. And as a mental health crisis grows within their professions, they’re signaling the need for urgent action.
Occupational stressors test firefighter resilience
Professional firefighters experience a wide range of critical incidents, not just fires. In fact, they’re much more frequently called upon for rescue and medical aid than for firefighting. Most firefighters are exposed to high numbers of critical incidents over the course of their careers.
Responding to a survey of more than 1,200 active-duty firefighters, 7 of 10 firefighters (71%) reported stress from responding to critical incidents. Even more—about 8 of 10—reported exposure to traumatic events such as severe human suffering, life-threatening illness (80%), and suicide (79%). Repeated exposure to critical incidents tests the resilience of firefighters and can negatively affect their mental health and well-being.
Of course, not all the stress firefighters experience comes from what they encounter in the field. Overwork, low workforce morale, and issues with leadership are common stressors faced by firefighters. Lack of sleep (61%), financial worries (41%), and lack of time spent with partners (41%) and friends (39%) are others.
EMS personnel face similar stressors and more
EMS professionals encounter major challenges as well. Chronic understaffing, leadership problems, a lack of wellness support, and long wait times/hospital delays, which strain resources and staff, are among paramedics’ top 10 concerns, according to the 2025 EMS Trend Survey.
What’s more, although paramedics deliver essential medical services to communities, in many states EMS isn’t considered an “essential service,” so state and local governments aren’t legally required to fund it. A lack of support leaves EMS professionals under-resourced, overworked, and vulnerable to burnout.
First responders report burnout, anxiety, and depression
In fact, EMS professionals ranked burnout as their number one critical concern, followed by retention—which is negatively affected by burnout—and funding/reimbursement issues. Burnout also takes a toll on job satisfaction and quality of care.
EMS personnel may struggle with sleep and nutrition, which contributes to burnout. Four in 10 paramedics say they rarely or never get seven or more hours of sleep per day, and 6 in 10 report never, rarely, or occasionally making a healthy diet a priority during shifts.
Within the firefighter community, anxiety, depression, and alcohol abuse are growing concerns. Mental health screenings included in the National Wellness Survey for Public Safety Personnel showed the following:
- Nearly 40% endorsed symptoms of anxiety beyond the minimal severity threshold, and 17% of respondents met or exceeded the criteria for moderate or severe generalized anxiety disorder.
- Forty-one percent endorsed at least mild depressive symptoms, and 19% reported symptoms that meet the criteria for major depressive disorder, almost four times the rate reported in the general population.
- Twenty-eight percent indicated levels of alcohol consumption that suggest that alcohol abuse is likely.
- Twelve percent self-reported clinically significant levels of PTSD, with the most prevalent symptoms being sleep problems; trouble concentrating; avoidance of thoughts, feelings, or memories related to a stressful experience; and being watchful or on guard.
Many first responders aren’t getting the mental health support they need
Although calls have been made for the reinstatement of behavioral health programs in Colorado, firefighters are unlikely to use mental health support even when they have access to it. Research has shown that firefighters have access to peer support (93%), spiritual services (83%), psychologists or counselors (72%), and psychiatrists (59%), but they are reluctant to use these resources for a number of reasons, including
- Fear that their mental health struggles will become known and harm their professional standing;
- Fear that they’ll be viewed as unstable, weak, or crazy (despite not feeling this way about peers with mental health challenges);
- Concern that providers don’t understand the unique culture or challenges of firefighting; and/or
- Feeling that they should tough it out and/or handle challenges on their own because they chose the profession knowing what it entails.
In contrast, 40% of EMS personnel are dissatisfied with the mental health services offered by their employers, exposing a lack of support for first responders. Half of survey respondents disagreed with the statement that their agency offers adequate well-being support.
Calm Health supports first responders and other underserved populations
Whether due to stigma, a lack of available resources, lack of awareness, and/or busy schedules, first responders are an underserved population when it comes to mental health support. Addressing this gap demands mental health solutions that are tailored for the unique challenges, lifestyles, and needs of first responders.
Calm Health is a digital mental health app that offers evidence-based programs tailored for underserved populations, including people with chronic conditions, communities facing discrimination, and people dealing with occupational stress and trauma, such as first responders.
Developed by psychologists with deep subject matter expertise, these programs help overcome common barriers.
- First responders can engage with programs privately, eliminating the impact of stigma.
- They can listen to episodes at their own pace at any time and from any location, fitting them into their hectic schedules.
- Content speaks to the unique culture, challenges, and needs of first responders, helping earn their trust.
- Calm Health helps overcome awareness and navigation challenges by guiding users to appropriate mental health benefits and resources based on their personal mental health screening results and their self-reported goals and topics of interest, such as anxiety, depression, sleep, or trauma.
By combating barriers to care, Calm Health can help first responders get appropriate and timely support, whether their screening results suggest possible symptoms of mild, moderate, or severe anxiety or depression. For example, first responders with Calm screening results indicating they may have symptoms of moderate anxiety or depression can be guided to find a therapist or take advantage of available mental health benefits, such as an employee assistance program.
Support the mental health and well-being of first responders and other underserved populations
Get the e-book
Calm Health’s Mental Fitness Program for Fire and EMS Professionals
Developed for Calm Health by Patricia Watson, Ph.D., Mental Fitness for Fire & EMS Professionals is an evidence-based program that offers insights and practical advice to support firefighters and EMS professionals with the challenges that come with first-responder life.
Each episode walks listeners through easy-to-apply tools that are recommended by other first responders as their go-to actions when they’re under stress. First responders learn how to check in with their stress levels, create a sense of safety, find calm in difficult moments, strengthen relationships, and shift their mindset in small but powerful ways.
These episodes are included:
“Mental Maintenance for First Responders”
“Checking in with the Stress Continuum”
“Improving Your Sense of Safety”
“Cultivating Calm with Your Breath”
“Prioritizing Meaningful Relationships”
“Put a Wedge Between You and Stress”
“Build Hope By Shifting Your Focus”
“Service Your Mind Like Your Truck”
Patricia Watson, Ph.D., has been a psychologist at the National Center for PTSD since 1998. Before that, she served eight years as an active-duty Navy psychologist. She earned her doctorate in clinical psychology from Catholic University and completed a fellowship in pediatric psychology at Harvard. She co-authored stress first aid models for various high-risk occupations, helped develop multitiered mental health programs for first responders, co-authored international peer support guidelines, and co-edited books and resources on disaster mental health, military culture, early intervention, and resilience.
Other Calm Health resources
First responders and other underserved populations can take advantage of a full library of evidence-based resources and mindfulness content, including these:
- Anxiety Survival Guide
- Navigating Depression with Practical Tools
- Build Stress Resilience
- Support for Trauma and PTSD
- Grief Support: A Guide to Coping after Loss
- Stress and Burnout Support
The capacity of first responders to protect communities is rooted in their mental health and well-being. Employers and health plans can support them by adopting mental health solutions tailored to their unique workplace culture, challenges, and needs.
