Is it Depression or Burnout???

By Safe Call Now's Dr. Laura Brodie

Something that is not recognized by many in the civilian world is that our First Responders as a whole are more psychologically healthy than the general population at the time of hiring. How can I say this?  Well, very few careers require the psychological screening and assessment that First Responders have to pass in order to obtain their job.  In doing such a screening, the hope is to protect the public from someone who is unsafe, but the hidden benefit is to hopefully protect the individual doing the job from many of the psychological disorders that can develop from this type of work.  So, if we use the premise that First Responders are more psychologically healthy than their civilian counterpart, why are we seeing the psychological problems we are seeing within First Responders?   Problems like substance abuse, high divorce rates and suicide?  Theoretically, this should not be happening, but it is rampant. Why?

Mental health professionals are very familiar with issues such as depression and have many tools in their therapeutic toolbox to help. What they are not nearly as educated in understanding is the environment of the First Responder and the issue of burnout.  Research has shown that the leading cause of stress in First Responders is not the day to day rescues and arrests they perform.  Those chores are why the individual signed up to do the job and there is clear understanding of those tasks through the academies and ongoing training.  What is not spoken of is the organizational stress that is killing First Responders. Yes, it’s the slow, ongoing, and constant organizational stress that is doing more damage to our First Responders than any other factor within the job.  As a professor, I have chaired several dissertations that have shown this stress and the gradual breakdown of the individual does not depend on the age, sex or rank of the individual. It appears that the seven-year mark is where the stress can eventually become the most significant issue for the individual and coping breaks down.

Organizational stress is from the departments and the fall out from the public. It is the gradual wearing down of the individual in all the tasks that have to be done to cover one’s posterior through paperwork, to handle the misconceptions and accusations of the media and public and the management of troops when management classes and courses are not offered as a way to help the individual learn how to manage.  Moving up the ranks many times is based on how one does the First Responder job, not how one manages people. These are two different tasks and require a different set of people skills. Both the manager and those below are set up to fail in system that does not allow the training of management of personnel to be as important as the training to fire a weapon, put out a fire or rescue a trapped person. It is set up to fail. 

The issue of organizational stress is not being addressed in the mental health field or in the training of First Responders.  Perhaps the academies and training facilities do not want to take a hard look at their own culpability in braking down their troops. It takes courage to admit the system is eating its own. If we want to make any headway in saving lives and helping our First Responders make it to retirement and beyond we must address this issue in the open.

So this brings me to the issue of burnout vs. depression. There is no “diagnosis” for burnout in the DSM 5. It is controversial if it exists as a disorder, but given the premise I have postulated above, I am pretty sure I can say burnout is a cancer in First Responders. How can one tell the difference between depression and burnout?  The difference is, are the negative feelings focused primarily around the job, the people one works with and/or the feelings of being on a treadmill that goes no where? It is the feeling that one is trapped in a system that is eating them up?  That is burnout.  Are the symptoms turning on the person to where it is hitting self-esteem, feelings of worthlessness and suicide?  Then it is more likely to be depression.  Is the stressor external (the job) or more of an internal issue?  It is important to differential where the problem is coming from to provide the most effective assistance.

As long as the professionals want to say the issue is always depression, we will not look at the role the system has played in breaking down and destroying of perfectly healthy men and women.  As long as the organization sees it as employees that are not up to doing the job rather than examining the organization’s role in this breakdown we will continue to have the substance abuse, relationship problems and even death of our First Responders.