First Responder Mental Health Care Needs Go Beyond Counseling

Employee Assistance Programs (EAPs) are employer-sponsored services that typically provide short-term counseling, referrals, and support for a variety of work-life and mental health concerns.

While most first responder agencies in the United States have access to an EAP, the quality and accessibility of these programs can vary greatly, according to Kellie O’Dare Wilson, Ph.D., 2nd Alarm Project founder and executive director.

The organization serves fire service, law enforcement, corrections, emergency medical services, 9-1-1 telecommunicators, arson investigators, forensics specialists, flight medics/crews, family members, retirees, recruits/cadets, and lifeguards.

First responders primarily seek peer support for stress, critical incidents, PTSD, family concerns, substance use, and workplace issues.

“Many EAPs are not designed with the unique culture, demands, and behavioral health needs of first responders in mind,” O’Dare Wilson said. “As a result, these programs are often underutilized and, in some cases, viewed with skepticism or mistrust by the very people they are intended to serve.”

Stigma, lack of confidentiality, limited provider availability, and unfamiliarity with first responder culture remain common challenges that limit EAP effectiveness, O’Dare Wilson said.

To address these gaps, agencies are turning to Behavioral Health Access Programs (BHAPs), which offer a more tailored approach. According to O’Dare Wilson, BHAPs are designed specifically for first responders and emphasize fast access, trusted care, and services that reflect the realities of emergency response work.

“These programs play a critical role in reducing barriers to care, supporting early intervention, and building trust across the workforce,” she said. “Unlike traditional EAPs, BHAPs often include peer support integration, navigation assistance, and access to occupationally competent mental health providers who are trained to work with first responders.”

An effective BHAP includes several essential components, including a clinician network trained in first responder issues, integration of peer support, behavioral health navigation systems, and a strong commitment to confidentiality and occupational competence.

“These programs also emphasize proactive outreach, coordination with leadership and families, and regular evaluation to monitor outcomes and adjust services based on user feedback,” O’Dare Wilson said.

She said developing and maintaining a high-quality BHAP is not without challenges. “A common barrier is the shortage of clinicians who are adequately trained in first responder culture,” said. “This can be addressed by building out a specialized network and offering targeted provider training.”

In the UCF/FFSHC Clinician Awareness Program (a partnership between the University of Central Florida and the Florida Firefighters Safety and Health Collaborative), a two-day immersive training is designed to give licensed mental health providers firsthand insight into the firefighter experience.

Participants step into the role of a firefighter for a day, gaining a deeper understanding of fire service culture, evidence-based treatment approaches for this population, and engaging in hands-on activities with bunker gear, tools, and realistic scenarios reflective of the challenges firefighters face.

Another obstacle: limited funding or administrative support. “But many programs demonstrate a clear return on investment through improved workforce morale, reductions in absenteeism, and crisis intervention success,” O’Dare Wilson said. “Stigma, while persistent, can be mitigated by strong leadership endorsement and early peer engagement. Importantly, BHAPs should complement—not replace—existing services like EAPs, providing a deeper level of support where traditional programs fall short.”

O’Dare Wilson noted if an employee finds that their EAP is not meeting their needs, whether due to limited access, mismatched providers, or lack of support, they are encouraged to raise these concerns through appropriate channels.

Many departments have wellness coordinators or union representatives who can advocate for additional resources. In some cases, individuals may seek referrals outside of the EAP system, or advocate for the implementation of a BHAP to better meet workforce needs.

Evaluating the effectiveness of an EAP or BHAP involves reviewing several key indicators: utilization rates, user satisfaction, appointment timeliness, and outcome tracking such as symptom improvement or job performance changes.

For BHAPs, cultural fit and clinician responsiveness are also critical metrics, said O’Dare Wilson. “Agencies should regularly solicit feedback and make adjustments as needed to ensure their behavioral health programs are meeting the evolving needs of their personnel,” she said.

O’Dare Wilson pointed out there are many examples of BHAPs making a difference.

• In one instance, a firefighter experiencing PTSD was connected to an occupationally competent clinician within 24 hours—far faster than what a typical EAP might offer—and received care that extended well beyond the standard three to five sessions.
• In another example, a peer support team member helped a colleague access care through the BHAP navigator, coordinating family engagement and workplace support while maintaining confidentiality and trust.
• In a department facing multiple suicides, the BHAP helped implement a system-wide suicide prevention effort, which in turn increased help-seeking behaviors and early identification of those at risk. 

“Ultimately, the behavioral health needs of first responders are complex and growing,” O’Dare Wilson said. “While EAPs can serve as an important foundation, BHAPs offer a deeper, more customized solution that honors the realities of the job. Investing in a strong, culturally competent behavioral health infrastructure is not only a wise organizational decision—it’s a moral one. Agencies that prioritize the mental wellness of their personnel send a clear message: those who protect and serve deserve protection and support in return.”