First responder mental health is not a soft topic. It is a command accountability issue. And in four decades of fire service and military experience I have watched more people quietly fall apart than I have watched people ask for help.

I was one of them.

Not in the way you might picture it. I was not in crisis. Functioning, leading, looking the way everything was supposed to look from the outside. But I was carrying things that had accumulated over decades of emergency response, military service, and the particular weight that comes with leadership from the age of 16. I just did not have a name for it yet, and the culture I had grown up in did not exactly offer a roadmap.

This post is about what changed. Not because I had a breakdown. Because I made a decision.

The Stats Nobody Talks About at Shift Change

According to the NFFF’s Confronting Suicide report: “Even at general population rates, a fire department is three times more likely to experience a suicide in any given year than a line-of-duty death.” Three times.

The number of firefighter suicides is estimated to be at least 100 per year. According to the “Ruderman White Paper on Mental Health and Suicide of First Responders,” the suicide rate for firefighters is 18 per 100,000 compared to 13 per 100,000 for the general public.

We spend enormous resources on operational safety. Mayday protocols. Firefighting training and standards. SCBA fit tests. Personal protective equipment. We train relentlessly for the physical threats. All of which are critical to our survival.

But the threat that may kill more of us than the fire does not come from the building. It comes from inside the person walking into it.

That number is not an abstraction to me. I have known people on both sides of it. The ones we lost, and the ones who came close. And when I sit with that honestly, the common thread is not weakness. It is a culture that taught people the only acceptable answer to ‘how are you doing?’ is ‘fine.’

The behavioral health crisis may not be the loudest threat in this profession. It has simply been the least talked about.

What I Did and Why I Am Telling You

I have done both neurofeedback and EMDR. I want to be direct about that because the specifics matter. This is not generic advice to ‘seek help.’ This is a Division Chief telling you what he actually did.

Neurofeedback is a form of brain training that uses real-time feedback from your own neural activity to help the brain regulate more effectively. It is not electrodes and it is not hypnosis. Think of it as a workout for the regulatory systems that get overloaded by years of high-stakes response work.

EMDR stands for Eye Movement Desensitization and Reprocessing. It is an evidence-based trauma treatment that has an A rating from the International Society for Traumatic Stress Studies. What it does, in plain language, is help the brain process experiences that got stuck. In our world, those stuck experiences are not rare. They are occupational.

I did not do these things because I reached a breaking point. I did them because at some point I decided that carrying the load quietly was not actually strength. It was avoidance dressed up as discipline.

There is a difference. I did EMDR specifically because a colleague I respect as a chief officer and a friend shared experiences he had with treatment, and associated incidents we had in common throughout our careers. This leader took the time to share his story so that I could learn from it, and it helped.

Why Does Command Culture Make This Harder to Talk About?

Here is what I know about the military and first responder culture I have lived in for the last four decades. Most of us were trained that asking for help signals vulnerability, and vulnerability signals that you are not fit to lead. That belief has been so embedded it does not even surface as a thought. It just operates in the background, shaping every decision about what you disclose, who you talk to, and what you push through. That is changing.

A few years back, my rescue company crew and I responded to a cement truck that rolled down a 100-foot ravine, in a driving rainstorm with flash flood warnings reported to be imminent, teetering on the edge of another dropoff. This cement truck, one of four in a convoy, had lost his brakes going down a steep road. He had radioed his fellow drivers to: “Tell my family I love them” before he rolled down the ravine. The extrication to bring the driver’s remains home to his family was four hours long, and despite calls from command to stop the recovery effort due to rising waters, we were not leaving him behind.

Our culture is not malicious. It grew from genuine necessity. You cannot run toward danger and simultaneously process every fear you feel. Compartmentalization is a real and functional skill in this profession. The problem is that the same skill that keeps you operational in the acute phase can become the thing that prevents you from ever processing what you absorbed.

The body keeps score. That is not a metaphor. That is neuroscience.

What Happens When Command-Level Leaders Models This?

I am going to be straightforward about something. The most powerful thing any officer can do for the behavioral health of the people they lead is not to launch a program. It is to be honest about their own experience.

When command-level people normalize treatment, the culture shifts. Not immediately, and not universally. But it shifts. The firefighter who has been white knuckling something for three years suddenly has a different data point about what it means to do this work and still get support.

That is what Creator leadership looks like in this context. The Empowerment Dynamic framework I work with through EMPOWER2Evolve describes a Creator as someone who is outcome-focused and takes responsibility for the results they want to produce. Waiting for the culture to change on its own is a Victim orientation. Going first is a Creator move.

I am not saying this to position myself as something exceptional. I am saying it because someone said it to me once, and it mattered. And because the data tells us the cost of the alternative.

With FEMA support, the IAFF partnered with Texas A&M and Baylor Scott & White Healthcare to build a Suicide Postvention Standard Operating Procedure (SOP) for the fire service. The result is a structured framework that gives departments clear guidance to support crews, families, and Locals after a loss, while reducing the risk of further harm.

Suicide assessment is now embedded as a core element of IAFF Peer Support training, and that reach has expanded. In 2025, the Safety Planning Intervention for Suicide Prevention course was opened to all members, not just peer support teams. The training walks participants through building a personalized safety plan, including how to recognize warning signs and respond in a crisis.

These actions by the IAFF represent strong leadership from an organizational standpoint and should be applauded.

What Does This Look Like at the Crew Level?

One of the first calls I responded to as a new battalion chief was a teenage cardiac arrest, secondary to a suicide attempt. While working the cardiac arrest, I recalled that two of the crew members had children the same age and gender as the patient. Following transport, we had a tailboard defusing outside the emergency department. It was a short, easy way to check in on the crew and see how they were doing. Often the informal conversations, where senior crew members share what they are thinking, help the rest of the crew process. Whether it is an informal conversation or a more formal debriefing, conversations help.

A Note on Access

One practical barrier to first responder mental health care is that most conventional behavioral health providers have no framework for what this work does to the nervous system. Forty-year-old trauma is processed differently than a car accident. Occupational cumulative exposure is not the same as a single critical incident. The provider matters.

Providers that offer first responder assistance range from peer-based support to vetted clinical professionals and specialized treatment centers. Each state is different when it comes to resources and financial support. In Colorado, for example, the Colorado Firefighter Trust provides reimbursement for neurofeedback and EMDR as covered expenses.

The International Association of Fire Fighters has peer support resources. The Firefighter Behavioral Health Alliance maintains a directory. These exist because enough people understood that the formal behavioral health system was not built for this specific population.

The Question Worth Sitting With

What would change in your department if the senior leadership got honest about this? Not a campaign. Not a poster in the day room. What if the people at the top of the org chart just stopped pretending they were unaffected?

I am not asking that rhetorically. I am asking it as a command officer who tried both approaches. Carrying it quietly is slower. It costs more. And the people below you in the org chart are watching whether you are practicing what the department values or just endorsing the slogan.

If you are in a senior leadership role, you are already shaping the culture whether you intend to or not. The only question is whether you are shaping it deliberately.

That is the work.

The Bottom Line

First responder mental health is a command accountability issue. The data is clear, the tools exist, and the culture is shifting. What has not changed is this: the people at the top of your org chart set the standard for what is normal to talk about and what stays buried. If you are in a leadership position in this profession, you are already shaping that standard. The only question is whether you are doing it on purpose.

In Your Lab This Week

Reflection: Where in your organization is the ‘we’re fine’ culture most active? Is that a cultural norm you are reinforcing, or one you are in a position to interrupt?

Practice: This week, have one honest conversation with someone you lead about behavioral health, yours or the culture’s. Not a program announcement. A real conversation.

Frequently Asked Questions

How do I know if my crew is struggling with their mental health?

Rarely does a struggling firefighter walk into your office and say so. Watch instead for the behavioral shifts: withdrawal from the crew, increased irritability, cynicism that goes beyond the usual firehouse humor, changes in performance, or increased sick leave. The challenge in this profession is that many of the warning signs look like normal stress responses at first. If you are paying attention to your people consistently, and if you know your people, the pattern change will be visible before the crisis is.

Is neurofeedback or EMDR covered for first responders?

It depends on your state and department benefits. In Colorado, the Colorado Firefighter Trust covers both neurofeedback and EMDR as reimbursable expenses. Other states have peer-based funds, union-supported EAP programs, or specialized first responder treatment grants. The Firefighter Behavioral Health Alliance maintains a national directory of vetted providers and resources. If your department does not currently cover these treatments, that is a leadership conversation worth having.

What is the difference between a peer support debrief and formal mental health treatment?

Peer support is first-line and relationship-based. It works because it comes from someone who has been there. A tailboard conversation after a difficult call, a check-in from a senior crew member, a peer support team follow-up, those are not replacements for clinical care. They are the bridge to it, and they reduce the activation energy required to take the next step. Formal treatment, whether EMDR, neurofeedback, or counseling with a first responder-informed provider, addresses the neurological and psychological load that peer support cannot reach on its own. Both matter. Neither replaces the other.

Scott Richardson is a Division Chief with more than 40 years of fire service experience, a FEMA USAR rescue specialist, combat medic, paramedic, and co-founder of EMPOWER2Evolve. He writes the Under Pressure series on leadership in high-stakes environments. Read more at empower2evolve.com/blog.

Photo courtesy of South Metro Fire Rescue.

3 Vital Questions® is a registered trademark of Seven Generations Leadership, Inc. Used with permission.