Verified by 
The need for mental health care is especially high for those individuals who protect society—who step into danger that none of us will ever experience—and it behooves us to find a way to make this care possible.
Firefighters, police officers, first responders, and airline pilots are repeatedly exposed to potentially traumatic events and occupational stressors that are inherent in their respective professions. They are exposed to physical, intellectual, and emotional demands that can be draining and lead to feelings of exhaustion, frustration, and helplessness. Each profession has unique experiences that the rest of us cannot fully appreciate.
Firefighters must deal with unfathomable experiences, for example, being summoned to a raging blaze where a family is trapped inside and they are unable to enter the residence due to the fragility of the structure. Fire jumpers, a select group of firefighters who risk their lives, parachute into the center of a blaze that they are tasked to extinguish.
Police officers experience similar levels of stress. They may be called for a routine domestic disturbance that inadvertently turns into either an active shooting incident or a hostage situation.
On the other hand, their work can also be tedious and time-consuming. For example, detectives attempting to solve a murder might have to knock on every door in a 20-story apartment building and later come up without any new information. The work can be slow, boring, and meticulous, only to end in frustration and disappointment for those who patiently seek out information on a crime.
The lack of predictability keeps both fighterfighters and police officers on constant alert. This hypervigilance can be extremely taxing and draining on both the body and the mind. If one is constantly in survival mode relaxation is impossible, which can impact relationships and overall well-being.
Furthermore, police officers wear body cameras which enable every movement during their on-call duties to be watched and judged.
First responders are constantly on alert because of the nature of their work as well. The likelihood of witnessing some kind of trauma is high. It is the first responder who is the primary attendant on the scene of a plane crash or other massive causality event.
Depression, anxiety, and substance abuse are also common. Suicide is also a concern, as the incidences have increased in recent years. There is a basic misconception that hopelessness is directly related to the job, but it is not. Rather, it impacts significant primary relationships when individuals withdraw from social support. Alcohol may be a trigger for harming oneself as well, due to an inability to talk about life-changing experiences that the person may believe only a peer could understand.
Given the nature of this work, why is it that these individuals don’t always seek out mental health care and support for issues that can be as severe as post-traumatic stress disorder?
As in most of society today, there is a stigma in acknowledging and receiving mental health care. There are concerns about the confidentiality of the information and a lack of understanding of the protections that HIPAA provides.
Furthermore, some people in these professions believe that a therapist cannot relate to their experiences unless they have been in similar circumstances. In addition, many individuals in these stressful professions do not experience themselves as needing such care.
A 2020 article in JAMA titled "Prevalence of Mental Illness and Mental Health Care Among Police Officers" covered a sample of 434 police officers in Texas found only 26% reported current symptoms of a mental illness or distress, a notably low percentage.
The administrations tend to be hierarchal in nature and are mostly defined as a masculine culture, although this is slowly changing.
In recent years, many departments have instituted successful proactive coping strategies. These include peer support, work-recovery strategies, mindfulness training, and critical incident stress management.
As with many large organizations, mental health care is "farmed out" to outside vendors (Employee Assistance Plans, for example) sending a message that mental health care must happen outside the scope of daily work. It would be far more helpful to hire mental health care providers in-house and have them move among the workers so that they can become team members in the same environment.
Airline pilots and air traffic controllers also work in stressful jobs, although aggregate data is less available due to FAA regulations. The overriding issue for pilots is that if they acknowledge that they need mental care, until very recently the FAA clearly communicated that admission to ongoing psychotherapeutic care could result in a removal from active flying status. An admission of mild anxiety or depression can be career-ending. The use of psychotropic drugs can be disqualifying for aeromedical certification purposes.
On March 23, 2017, Andrea Lubitz, a co-pilot, excused the pilot from the cockpit telling him he would manage the radio communications. He subsequently locked the cockpit and crashed the plane into the Alps killing all on board. He had reached out to dozens of doctors prior to this flight who were concerned about his suicidal tendencies and being declared unfit for work. He kept the information from his employer. This incident opened the eyes of the FAA.
On August 23, 2023, a pilot was witnessed attacking an airport parking lot gate with an axe because the gate would not open when he was trying to park his car. Another employee tried to wrestle the axe away from him, but he held it securely until another individual became involved. A spokesman for the airline communicated that this individual would be able to fly again once he handled “whatever stressed him out.” In my clinical opinion, such a display of rage indicates deeper problems other than stress.
Lastly, on Nov 11, 2023, Joseph Emerson, a pilot, was traveling in the jump seat of an Alaska Airlines affiliate. He attempted to pull two handles that would have engaged a system that cut fuel to the engines. Mr. Emerson complained about depression for years (without telling anyone but his wife) and took psychedelics before the flight to manage his anxiety.
These examples highlight the need for accessible mental health care.
There can be a stigma in overtly seeking out mental health treatment. Some professions can even be punitive. Another blockade is our insurance industry. When an individual wants to see a therapist and use their insurance for payment, a mental illness diagnosis is required for most extended care. Therefore, self-pay is the only avenue for complete confidentiality. This is an additional expense that burdens individuals. This makes it intrinsic in the payment system that you must have a mental illness defined by the DSM, another deterrent.
Mental illness is a cauldron of folklore and outdated mythical attributes not consistent with the current level of understanding of diagnosis and treatment. How can we change the stigma of mental health care so that all those who need help can seek it out?
