The following article was submitted for the 2025 Fire Service Thought Leadership Essay Contest, focused on understanding the “why” behind mental health challenges in the fire service. This article received the third-place honor in the contest, which is managed by Darley, in partnership with the National Fallen Firefighters Foundation (NFFF).
Read past essays and learn how to submit your own essay.
By John K. Murphy
Mental health concerns are pervasive in all professions, but specific careers bring unique exposures that amplify psychological risks. Firefighting is among the most challenging occupations, blending physical danger, emotional strain, and high responsibility. This raises the question: Are firefighters truly more vulnerable to mental health challenges, or are they experiencing what others do, only in more intense forms? Understanding the “why” behind these challenges is essential for crafting effective, empathetic, and sustainable solutions.
Studies repeatedly show that firefighters face significantly higher rates of post-traumatic stress disorder (PTSD), depression, anxiety, substance misuse, and suicide ideation than the general population. According to the National Fallen Firefighters Foundation, as many as 37% of firefighters meet criteria for PTSD at some point in their careers, compared to 6.8% in the general U.S. population (NFFF, 2021). The Journal of Emergency Medical Services (JEMS) reports that suicide attempts among firefighters are over ten times more prevalent than in the civilian population (JEMS, 2018). Such figures call for a deeper look into the occupational “why.”
Stressors of firefighting
Chronic exposure to trauma: Unlike most civilians, firefighters routinely witness traumatic events — burn victims, fatal accidents, suicides, and child casualties. This repeated exposure to high-impact trauma has a cumulative effect on mental health. The concept of “complex PTSD” — where an individual is exposed to prolonged or repeated trauma — applies here. A study by the International Association of Fire Fighters (IAFF) found that 65% of career firefighters have experienced traumatic stressors that meet criteria for PTSD or acute stress disorder (IAFF, 2019).
Sleep disruption and circadian stress: Firefighters often work 24-hour or 48/96-hour shifts and may be called out multiple times at night. These schedules are similar to frequent deployments of the military — away from the family for a period of time, stressful, not knowing if today’s calls are the ones that “get you.” The military has a major mental health crisis for some of the very reasons we see in the fire service — away from home, stressful environments, sleep deprivation, and danger of being killed by a foreign actor.
Sleep deprivation is not just a quality-of-life issue; it has direct links to mental health disorders. Chronic sleep disruption affects the brain’s limbic system, exacerbating symptoms of depression and anxiety (Walker, 2017). A 2019 Journal of Clinical Sleep Medicine study found that nearly 70% of firefighters experience poor sleep quality, contributing to long-term psychological distress (Barger et al., 2019).
Culture of suppression: The fire service has long promoted stoicism, bravery, and self reliance values. “Suck it up” is the most common statement after experiencing a stressful event. While noble, this culture often stigmatizes vulnerability. Many firefighters internalize emotional pain, believing that seeking help is a sign of weakness. According to the National Volunteer Fire Council (NVFC), 82% of firefighters believe there is stigma around mental health in the fire service, and only 28% say they would feel comfortable seeking help (NVFC, 2020).
Occupational identity and the “hero” complex: One defining feature that may make firefighters unique is their professional identity. Society views them as heroes — strong, capable, fearless. This image can be empowering but also isolating. The cognitive dissonance between how a firefighter is perceived and how they may feel internally (e.g., anxious, traumatized, scared) can worsen their mental health struggles. The concept of “role engulfment,” wherein an individual’s identity becomes entirely defined by their role, is common in the fire service. Role engulfment can prevent healthy emotional expression and self-care (Thoits, 2013).
So the question here is, are firefighters unique?
In many ways, yes. While other professions — including military, law enforcement, healthcare, and EMS — also face traumatic exposures, firefighters endure a unique combination:
- Exposure to fire and physical danger
- Loss and death as frequent parts of the job
- A shift structure that disrupts sleep and family life
- A culture that suppresses emotional openness
- Public perception that leaves little room for vulnerability
- Marital, financial, and home life stressors are equally contributory
- Secondary, off-duty jobs may contribute
Still, the mechanisms of mental health decline (chronic stress, trauma, lack of support) are not unique, but the intensity, frequency, and normalization of these conditions in firefighting are particularly acute.
Systemic and organizational barriers create issues
- Lack of mental health infrastructure: Many fire departments, especially volunteer or rural ones, lack the resources to provide on-site counseling, peer support, or mental health training. A 2020 IAFF survey found fewer than 40% of fire departments had access to mental health professionals trained in first responder issues (IAFF, 2020). This creates a problem when your firefighters have no place to turn internally or externally, creating additional stressors for the firefighter, the department, and the firefighter’s family
- Inadequate training in emotional resilience: All brawn and no brain was the standard. In today’s modern fire service, that trend continues. Fire academies’ heavy focus on physical endurance, fire behavior, and technical rescue must balance out the training for the real world of the fire department and incorporate emotional intelligence, self-awareness, and emotional trauma literacy. Academics must create creative, critical-thinking, and emotionally nimble firefighters to manage in today’s environment.
- EMS has displaced fire as the primary response: Emergency medical services responses account for more than 70% of fire departments’ calls for services, bringing a whole host of emotional trauma for the firefighters. Personal struggles and identifying with their patients become a reality for the firefighters as they treat and transport the sick and injured within their communities.
- Disincentives to disclose struggles: Fear of discovering a weakness, either physical or mental, scares many firefighters. The fear of being put on leave, losing advancement opportunities, or being labeled unfit deters many firefighters from acknowledging psychological struggles. The fire service “family” may not be so much a family, and may not be as supportive as we need.
Solutions and recommendations
Mental wellness in the fire service requires structural change, cultural shift, individual empowerment, and a more accepting attitude that we are unique in some ways but not so much in others, especially when it comes to mental wellness.
- Normalize mental health conversations: Departments should include mental health as a standard training topic, debriefing, and even casual check-ins. For example, the “You OK?” campaign by the Firefighter Behavioral Health Alliance promotes routine peer-to-peer check-ins, reducing stigma and encouraging early intervention.
- Peer support teams: Develop and train peer support teams comprised of firefighters themselves. These individuals are uniquely equipped to recognize signs of distress and provide immediate, empathetic support. Peer support programs in fire departments such as FDNY have shown measurable reductions in psychological distress among participants (Sull et al., 2015). Many departments have engaged in peer support teams, but not every department has one. Chaplaincy is also an alternative to peer support groups and is very successful in that department embracing those resources.
- Access to culturally competent therapists: Not all therapists understand the emotional landscape of first responders. Fire departments should contract or partner with professionals trained in occupational trauma. Partner with organizations like the First Responder Support Network (FRSN) or Center for Firefighter Behavioral Health, specializing in such training.
- Integrated wellness programs: Comprehensive wellness should include mental health screenings, physical health checkups, nutritional support, and resilience-building exercises. A program example is the Phoenix Fire Department’s Behavioral Health Program, which integrates psychologists into stations and dispatches them alongside crews after major incidents.
- Sleep hygiene protocols: There is never enough sleep time, especially in a busy fire house. Many firefighters’ second jobs interfere with quality sleep. The department, if possible, adjusts shifts to allow for circadian rhythm recovery, and the firefighters need to self-regulate those second jobs. The department should provide rest environments in stations and educate members on sleep recovery techniques. Some departments have integrated a nap schedule into a busy work schedule.
- Leadership training in emotional intelligence: Officers and chiefs must model vulnerability, empathy, and emotional literacy. Leadership sets the tone. A leader who checks in on mental health normalizes it for the entire crew. Although this may be a generational issue, it is never too late to train the “old salts” into the modern fire service and the support needed for its firefighters — maybe not for them, but for others.
A call for continued research and policy development
The fire service needs continuous longitudinal, peer-reviewed research on mental health outcomes, especially for career vs. volunteer firefighters, urban vs. rural departments, and minority members. Mental health protocols should also be built into National Fire Protection Association (NFPA) standards. For example, NFPA 1500 mentions behavioral health but lacks specific, enforceable mental health requirements.
Firefighters are unique — not because they are more susceptible to psychological disorders by nature, but because their environment, culture, and role expose them to compounding risk factors. However, this uniqueness is not a life sentence. Through honest conversations, structural changes, and culturally attuned interventions, the fire service can move toward a future where mental health is not a burden but a badge of resilience.
ABOUT THE AUTHOR
John Murphy is a fire commissioner for Fire District 38 in Washington and a retired deputy fire chief for Eastside Fire and Rescue.
References
Barger, L. K., Rajaratnam, S. M. W., Wang, W., O’Brien, C. S., Sullivan, J. P., Qadri, S., … Czeisler, C. A. (2019). Common sleep disorders increase risk of motor vehicle crashes and adverse health outcomes in firefighters. Journal of Clinical Sleep Medicine, 15(3), 413–423.
Firefighter Behavioral Health Alliance (FBHA). (2021). “You OK?” Campaign.
International Association of Fire Fighters (IAFF). (2019). Behavioral Health Survey. IAFF. (2020). Behavioral Health Access Survey.
Journal of Emergency Medical Services (JEMS). (2018). Mental Health and Suicide in Firefighting.
National Fallen Firefighters Foundation (NFFF). (2021). Firefighter Life Safety Initiatives.
National Volunteer Fire Council (NVFC). (2020). First Responders and Mental Health: A Survey Report.
Sull, A. C., Sull, K. C., & Czyszczon, G. (2015). Peer support in the fire service: Reducing trauma through connection. Journal of Workplace Behavioral Health, 30(1 -2), 107–122.
Thoits, P. A. (2013). Self, identity, stress, and mental health. In C. S. Aneshensel et al. (Eds.), Handbook of the Sociology of Mental Health (pp. 357–377). Springer.
Walker, M. (2017). Why We Sleep: Unlocking the Power of Sleep and Dreams. Scribner.