Removing the Stigma Is Hollow When Mental Injury Leads to Financial Ruin

We don’t need to look very hard to find an abundance of information on removing the stigma from mental health injuries in EMS. A simple Google search of “mental health stigma in EMS” produces millions of hits.

Changing the wording from “EMS” to “first responder” increases the number to the hundreds of millions. This article is not another article on “removing the stigma.” Instead, I focus on the futility of placing the responsibility to remove the stigma on first responders when the system itself is inherently designed to propagate stigma in mental health injuries.

Our line of work is dangerous, and mental injuries are often neglected in workers’ compensation laws. Asking the afflicted to remove the stigma for mental injuries is a hollow request if we don’t demand legal and financial protections for duty-related mental injuries.

I want to be clear—the system propagates stigma. However, the system is not responsible for how we treat our brothers and sisters in the first responder community. We must not place the blame for mental injuries on each other. In one of my presentation slides is a meme that was largely circulated on social media. It states: “PTSD is a normal reaction to extreme trauma, just as bleeding is a normal reaction to being stabbed” (source unknown).

Our brothers and sisters who suffer mental injuries in the line of duty deserve to be respected in the same way we respect those with physical injuries. However, there is a missing link. Line-of-duty mental injuries are largely uncovered by workers’ compensation and place the burden of care, blame for injury, and financial consequences upon the first responder.

What About the Fakes?

When we make pleas to remove the stigma directed toward the afflicted community, we are placing the blame for the injuries on ourselves. The hard truth is we direct the cause of the stigma toward one another and are sheepish to demand equal protection for mental injuries as are available for physical ones. The side objecting to having protections in place for mental injuries often cites, “It’s just too easy to fake a mental injury.”

My question is simple. If mental injuries such as post-traumatic stress are “easily faked,” why do we have clinicians specialized in its treatment? How would a mental health practitioner differentiate between the real McCoy and an imposter?

It was not all that long ago that back injuries were considered “easily faked.” Also, not long ago there was the almost nonexistent use of analgesia in prehospital medicine because “pain is easily faked.” Since that time, prehospital care providers have been trained to recognize pain from the patient interview as well as concrete physical findings such as inflammation, edema, increased heart rate, blood pressure, and respirations.

The System Today

The system currently in place in large swaths of our country doesn’t recognize mental injury as work related. This system works by having a meeting, continuing education events, or other training about removing the stigma from mental injuries.

Unfortunately, what we witness is a peer stepping forward seeking help, and later witnessing that their employment has been terminated. This system renders the entire “remove the stigma” crusade moot. The current system celebrates stigma on the hand that provides financial support to employees and calls for the removal of stigma on the hand where no cost is incurred. This is a rather rewarding position; on the surface it looks like a supportive environment, while underneath lives the fear of bankruptcy among our peers who had the audacity to be injured on the job.

Steps to Correct

So, what do we do about it? First, we must support our brothers and sisters who need medical care for mental injuries. In this area, we must do whatever it takes to not only get them the help they need but also ensure their financial well-being. This might look like working a trade time with no intention of repayment while they are unable to work, fundraising for their families, chipping in a few dollars, or offering to set up birthday parties and holidays for their children. We can’t falter. This isn’t about whether we like our peers; it’s about family. In families, we don’t have to like each other, but we must support each other. 

Second, we must make a lot of noise in seeking workers’ compensation protection for line of duty mental injuries. This will look slightly different in our varied states and communities. Those employed in union departments should push unions to take immediate action. We must educate the public, lobby legislators, and use our voice to replace any legislator not willing to support our cause.

Volunteers have a huge voice in this undertaking. Volunteer departments by design tend to be in much closer contact with their communities due to recruitment drives, fundraisers, community events, smaller community size, and personal relationships outside of the department. The argument is simple—payroll is expensive but is much higher than the cost to provide the support needed to treat duty-related mental injuries. Communities not willing to support their volunteers may need to find a way to replace them with full-time staff. We can’t morally ask people to risk their livelihood for a volunteer position. The current lack of volunteers in many communities is only exacerbated should a volunteer receive an injury and not be supported. Not only does that volunteer leave but their families spread the word, making recruitment that much harder.

Third, we shouldn't be in this fight alone. Mental health injuries are a problem in all first response disciplines. This is not a call only to EMS. EMS should join the fight alongside our comrades in dispatch, law enforcement, healthcare, and the fire service. Our departmental policy for mental injuries should look no different than the policy for physical injuries. If there is even the slightest difference, we are writing in stigma.

Finally, the American worker has made their voices heard throughout American history, most often by using their feet and their wallet. If your state is dug in on opposing workers’ compensation coverage for mental injuries incurred in the line of duty, move to another state where these protections exist. The current shortage of EMS providers and first responders will only be exacerbated by states unwilling to support these workers. Worker shortages not only affect service levels and response times but have profound impacts on local and state economies.

On all fronts, we must be united. This is not asking for financial protection while performing a dangerous occupation, it is a demand.