By Doug Nemecek

First responders—notably firefighters, police, emergency medical teams, and 911 dispatchers—are dedicated and heroic public servants in our communities. In the course of their service, they face frequent and direct experiences with violence, death, destruction, trauma, and societal struggles that can have emotional consequences.

And because many first responders reside in the communities they serve, there is a higher potential that they will personally know those impacted by the situation to which they are responding.

All of these factors have contributed to the alarming rate of unaddressed mental health and substance-use issues among first responders. One in five firefighters and paramedics will suffer from post-traumatic stress disorder (PTSD) in their career, according to the International Association of Firefighters (IAFF).

Seven to 19 percent of police officers have symptoms of PTSD. In comparison, only 3.5 percent of the general population experiences PTSD.1,2 More police die by suicide than by homicide; the number of police suicides is 2.3 times that of homicides.3

Associated Stigma

In its April 2017 survey4 on the mental health of first responders, the University of Phoenix found that 85 percent of the more than 2,000 participating first responders have experienced symptoms related to mental health issues. While three-quarters of the survey respondents said they have mental health services readily available to them, nearly 70 percent also said those services are seldom or never used at their organization. That could be due to the pervasive stigma associated with mental illness and mental health treatment.

It is important that communities and the health-care delivery system focus on responding to these trends. If not addressed, the behavioral health challenges within first-responder populations will put health and lives at risk.

Community leaders must be prepared to come to the rescue of first responders, and their loved ones. How? Offering solutions like an employee assistance program (EAP), access to a quality and affordable local network of health-care providers, education and awareness resources, and public and private collaboration. All will help reduce the stigma of seeking treatment and also help first responders to better manage their mental health and address substance-use issues.

My employer—the global health-service company Cigna—has been working with public sector employers and their employees for nearly 50 years. The company has been a leading voice to address the many concerns unique to first responders, including burnout, compassion fatigue, vicarious trauma, and critical stress, that may lead to an increased rate of PTSD and other ongoing mental health and substance-use issues.

Available Services

Cigna's solutions for clients and customers include behavioral health programs and an award-winning 24/7/365 EAP. Many times, these services are also open to the general public; for example, during natural disasters or incidences of traumatic violence in our communities.

First responders and the public also have access to Cigna's online resources available at in the Disaster Resource Center for physical, mental, and emotional self-care during turbulent times, available in English and Spanish.

In addition, Cigna recently added to its network of participating providers the IAFF Center of Excellence for Behavioral Health Treatment and Recovery. This one-of-a-kind facility located outside Washington, D.C., focuses on treating firefighters experiencing post-traumatic stress and other behavioral health issues. Adding the IAFF center to Cigna's network provides better and more affordable access to specialized care for current and retired IAFF union members who are Cigna customers.

The Cigna team has and will continue to explore the extremely complex and specific behavioral health needs of this population. In addition to offering its own solutions, Cigna is a catalyst for action. It convenes local stakeholders to help make a difference in the overall quality of life and positively impact the safety, health, and well-being of the communities it serves.

To discuss solutions to support first responders in your community, contact your local Cigna office or visit

Endnotes and Resources:

1 Carlier IV, Lamberts RD and Gersons BP. (1997). Risk factors for posttraumatic stress symptomology in police officers: A prospective analysis. Journal of Nervous and Mental Disorders, 185, 498-506. Gersons BP. (1989).

2 Patterns of PTSD among police officers following shooting incidents: A two-dimensional model and treatment implications. Journal of Traumatic Stress, 2, 247-257.

3 Ibid.

4 Reference in University of Phoenix Releases First Responder Mental Health Survey Results Article, Majority of First Responders Face Mental Health Challenges in the Workplace, April 18, 2017.


Doug Nemecek, M.D., is chief medical officer, Cigna Behavioral Health, Eden Prairie, Minnesota.

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