By Frank Leto
Most firefighters can name a call they still think about years later. Anyone who has spent time in this work knows that some calls echo long after the sirens stop.
Recently, the London Assembly Fire Committee reported that sickness absence within the London Fire Brigade has cost an estimated £84 million since 2021, with stress, anxiety and depression now the leading cause of long-term absence among its firefighters.
For many outside the fire service, those numbers came as a surprise. For many inside the fire service, they did not.
Firefighters have always carried the psychological burden of the job. What is new is that departments are finally beginning to measure it. Once you start measuring something, it becomes harder to ignore.
Over the years, I have had the privilege of spending time with firefighters in many different places, and one thing becomes clear very quickly: No matter the language, the patch on the shoulder or the city on the rig, the emotional realities of this job look remarkably similar.
The trauma people see and the trauma they do not
When people think about trauma in the fire service, they often imagine the “big” incidents — the multiple-alarm fire and the MCIs. Those calls certainly stay with you. But what many people outside the job do not realize is that the deeper burden often comes from the steady rhythm of smaller tragedies that make up an ordinary shift — the fatal car wreck near the end of a long night, the overdose in a bathroom, the elderly person who dies alone in an apartment.
Many of these calls don’t make national headlines. Most do not even make the local paper. But firefighters remember them. Sometimes those memories sit quietly in the background for years before resurfacing. Over the course of a career, firefighters may respond to thousands of potentially traumatic events (PTEs). Any one of those calls may seem manageable in the moment. Over time, however, the accumulation of those experiences can begin to leave a mark.
Researchers have described firefighting as a profession shaped by repeated exposure to traumatic events, with a cumulative psychological toll over time.
What the research is showing
The numbers coming out of London reflect a pattern researchers have been documenting across the world for years.
In Canada, a large national study examining public safety personnel found that nearly 45% screened positive for symptoms consistent with at least one mental health condition. Among firefighters specifically, roughly one in five reported symptoms associated with post-traumatic stress disorder.
Those findings helped spark national discussions and eventually led several Canadian provinces to adopt presumptive PTSD legislation, recognizing the condition as an occupational injury for firefighters and other first responders.
Research in the United States has revealed similar trends, with studies suggesting that roughly 20% of firefighters experience symptoms consistent with PTSD, compared with about 6% to 7% of the general population. Researchers have also found that firefighters experiencing PTSD frequently report depression, anxiety and sleep disruption. Additionally, studies show that chronic exposure to stress has been associated with an increased risk of cardiovascular disease and other long-term health conditions.
Seeing the pattern
The United Kingdom has also begun examining firefighter mental health more closely. In London, stress, anxiety and depression are now the leading cause of long-term sickness absence among London Fire Brigade staff, prompting calls for stronger support, including peer-to-peer support.
Similar findings are appearing across Europe. Research involving firefighters in Germany and Portugal has documented elevated levels of post-traumatic stress symptoms and psychological distress among firefighters exposed to repeated traumatic incidents.
In Israel, where firefighters frequently respond to large-scale disasters and security-related emergencies, researchers have also documented significant exposure to potentially traumatic events among operational crews. Studies there have found notable levels of post-traumatic stress symptoms among firefighters.
Australia has seen comparable patterns as well, particularly following the devastating 2019 to 2020 Black Summer bushfires. Thousands of firefighters worked for months under extreme conditions during those fires. Research conducted afterward documented elevated levels of psychological distress, including PTSD symptoms, among responders.
Major disasters often bring attention to these issues because of their scale. But firefighters know that the psychological burden of the job rarely comes from a single event. It accumulates. Call by call. Year after year.
Lessons learned after 9/11
In the FDNY, the conversation around behavioral health changed dramatically after September 11.
Thousands of firefighters and rescue workers were exposed to trauma on a scale few departments had ever experienced. In the years that followed, long-term monitoring programs documented elevated levels of PTSD, depression and anxiety among responders.
But something else emerged from that experience as well. One of the most important lessons was the value of peer support. Firefighters do not always open up easily to clinicians. But they will talk to someone who understands the job, someone who has worn the same uniform, sat at the same kitchen table and responded to the same kinds of calls.
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In the years after 9/11, the FDNY expanded peer support programs significantly. Those efforts eventually helped shape programs that departments across the country and around the world have since adopted. And over time, a simple truth emerged: Firefighters are far more likely to ask for help when the first conversation begins with someone they trust.
At the same time, the fire service has begun expanding mental health education, improving access to clinicians who understand the job, and working to reduce stigma at every turn. Increasingly, mental health and access to support are becoming both a top-down priority and a bottom-up part of the fabric of the job.
The quiet power of walking alongside
One of the recommendations emerging from the London Fire Brigade review is a stronger focus on peer-to-peer support.
The International Association of Fire Fighters has recognized that reality and expanded peer support training significantly in recent years. According to the association, to date, the IAFF has delivered 690 peer support trainings, with 13 additional programs scheduled through March 2026. More than 14,316 firefighters and peer supporters have been trained, supported by a growing network of 47 instructors bringing this work to departments across North America, according to the IAFF Health and Safety Division.
Those numbers matter, but the real impact of peer support rarely appears in training reports. It happens in quiet conversations between firefighters who understand one another. Sometimes that means sitting down at the kitchen table. Sometimes it means taking a walk together. And sometimes it simply means being there when someone needs to talk.
A healthier fire service is a stronger fire service
Over the course of my career working with firefighters and other disaster responders, I have had the privilege of watching the fire service slowly change the way it approaches behavioral health. Departments are investing in support programs. Peer teams are expanding.
Firefighters are speaking more openly about the emotional side of the job.
Perhaps most encouraging of all, younger firefighters entering the profession seem far more comfortable having these conversations. They understand that asking for help is not weakness. It is part of staying healthy in a profession that asks a great deal from the people who choose it.
No firefighter should carry the burden alone
The £84 million figure attached to London’s report may sound like a financial story. But behind every number is a firefighter who has been affected by the job in ways most people will never see.
Firefighters understand the physical dangers of the job when we sign up. What many of us do not fully understand at the beginning is the emotional burden that can accumulate over time.
The encouraging thing today is that the fire service is beginning to face that reality with honesty. We are talking about things that once stayed hidden and building systems of support that did not exist a generation ago.
Addressing the emotional toll of this job rarely comes down to a single solution. It takes strong leadership, peer support, access to clinicians who understand the fire service, supportive families, and a culture that allows firefighters to speak openly about what they are experiencing.
The strength of the fire service has never just been in the apparatus we ride or the tools we carry. It has always been in the people who look out for one another. When firefighters take the time to do that, when we walk alongside someone who may be struggling, the burden of this job becomes a burden no one has to carry alone.
