Dr. Erin A King

Background: Stress and repetitive exposures to potentially traumatizing events are inherent to first-responder professions. Firefighters and other crisis responders are often exposed to incidents in their work environments and are at risk of developing acute or posttraumatic symptomatology, depression, and anxiety, as well as harmful patterns of alcohol consumption. Most prior research and theory suggests that many firefighters use alcohol to cope with past and current stressors, and that increased drinking accompanies ongoing exposures to stressful occupational hazards. Objectives: The primary aim of this research was to examine alcohol consumption and mental health variables associated in the literature with alcohol misuse. Participants included 546 predominantly male career firefighters in the U.S. Using a cross-sectional design, we examined alcohol misuse in the context of self-reported depression, generalized anxiety, PTSD, and suicidal ideation using previously validated measures. Results: Based on the AUDIT's recommended cut score of 8, 38.8% of our sample reported drinking at hazardous levels. Hazardous alcohol use was also significantly associated with several mental health indicators with correlations ranging from .28 to .34. Regression analyses revealed that over 14% of the variance in AUDIT scores could be explained by psychological symptom measures, and 29% of the variance in suicide risk was explained by a model using both alcohol and mental health measures. Conclusions: Findings suggest that psychological distress is associated with hazardous drinking, and that more consistent screening and referral for these issues, as well as multi-level interventions, are needed to effectively address these behavioral health concerns among firefighters.

General strain theory posits that individuals commit crimes when they experience negative emotions following various sources of strain. One such source of strain is poverty. In this study, researchers use focus group data and apply a general strain framework to analyze criminal offending during the Missouri Community Action Network's Poverty Simulation© (2022) at a regional comprehensive university in the Southeast region of the United States. A total of 99 undergraduate and graduate students participated in the focus groups at the end of the simulation. Findings support Agnew’s (1992) theory with examples of sources of strain stemming from poverty leading to adverse emotional reactions and, at times, resulting in criminal responses that were economic. Participants noted the poverty simulation was a credible exercise that contributed to participant empathy. Implications within criminal justice and criminology education and future research are discussed.

Firefighters experience a high level of traumatic incidents in their work. This high level of exposure puts them at risk for trauma-related symptoms. These trauma symptoms include PTSD, suicide risk, alcohol misuse, and depression, and anxiety. Furthermore, repeated exposure has been found to lead to desensitization, flashbacks, irritability, and PTSD. Exposure to natural disasters may also impact ecospirituality. A survey was designed to include the Life Events Checklist, PHQ-9, GAD-7, PCL-5, and the SBQ-R. This survey was administered to firefighters from Northwest Florida in the fall of 2020 and spring of 2021. Participants were found to have higher levels of PTSD, anxiety, depression, and suicidal risk than the general population. Participants were further asked about their volunteering for religious organization activity. A significant relationship was found between volunteering for religious organization and mental health screeners. Religious volunteering predicted lower levels of PTSD symptoms, depression, and anxiety. The effect size was small.

Objective-Seeking mental health services can be challenging for first responders due to various barriers that impede access to care. The objective of this study was to gain a deeper understanding of the subjective experiences, perceptions, and meanings associated with seeking services among first responders.
Methods-The survey-design instrument consisted of questions regarding stress, psychological health, health-related difficulties, and potential barriers to treatment that first responders may experience. The questions were asked in multiple formats including multiple choice, select all that apply, and one open-ended question. This paper includes responses from the optional open-ended question (n = 78). Researchers conducted data analysis using ATLAS.ti and the analysis followed a thematic approach.
Results-Three (3) themes and several sub-themes were identified. First responders provided diverse explanations for their reluctance to seek care, such as organisational and leadership factors, stigma related to mental health, concerns about being red-flagged, limited access to care, and the financial implications of treatment. A prevailing sentiment was a lack of trust in the mental health field.
Discussion-By giving voice to the lived experiences of first responders, this study can inform the development of targeted interventions and support programs that address their specific needs and enhance overall well-being of first responders.

Firefighters are trained to respond to a wide range of emergencies, and over the course of responding to emergencies, are exposed to a variety of potentially traumatic events. Repeated exposure to traumatic events may adversely impact firefighters' mental health. Combined with stigma surrounding help-seeking, lack of systematic resources and referral programs, and other barriers to care, firefighters do not routinely receive a continuum of trauma informed, assessment and treatment services from trained professionals. The purpose of this paper is to describe an evidence-informed approach to a reciprocal, collaborative model among social work and public health practice, policy, and research; and to offer a framework for researchers, clinicians, and policy advocates to more effectively achieve goals of preventing and treating trauma exposure in firefighters. This paper provides a comprehensive literature review, as well as describes a case study of a successful public health intervention for mitigating exposure to trauma among a population of firefighters. The significant contribution of mental health issues to the burden of disease among our firefighters is a matter of considerable public health concern. Effective approaches to mitigating behavioral health needs must bridge both mental health disciplines and public health to minimally, include access to evidence-based assessment and treatment, peer support capacity building, widely available mental health education, and leadership development to promote culture change. When considering a model for services with firefighters, reciprocal collaboration among researchers, health care professionals, first responder organizations, families, and other relevant community stakeholders is essential for success.

Purpose-The purpose of this paper is to articulate the results of a comprehensive literature review and grassroots outreach with first responder organizations to present an operationalized framework for organizations to utilize as a blueprint in developing customized behavioral health access program (BHAP) programs.Design/methodology/approach- Historically, authorities having jurisdiction (AHJ)over fire service organizations have primarily offered behavioral health interventions through Employee Assistance Programs (EAPs) or commercial insurance carriers. These programs are necessary but may prove insufficient to meet the scope and needs of trauma-exposed firefighters and the firefighters' families.Findings- A BHAP is a comprehensive and operationalized plan which clearly specifies the mental health services fire department members and families need, where those services are available within their communities and levels and standards of care that are expected in the provision of these services.Originality/value- The BHAP is becoming a world standard of behavioral health care for first responders. While some fire service agencies are beginning to create BHAP guides, developing and implementing a BHAP can be time consuming and overwhelming, particularly for departments with limited internal and external resources. While the results of this review focus on BHAP within the fire service, this framework is applicable across all first responder professions.

Firefighters are exposed to a variety of potentially traumatic incidents in their work (Sattler et al., 2014). High levels of trauma exposure put firefighters at risk for mental disorders and symptoms. Using a survey designed to assess the mental health needs of firefighters from a hurricane disaster zone. the authors examined the prevalence of depression, anxiety, posttraumatic stress disorder, alcohol misuse. and suicide. The authors found that the firefighters in the sample reported moderate-to-high levels of mental health symptoms. Moreover, we found that job-related exposure to natural disaster plays a statistically significant role in predicting posttraumatic stress disorder, which provides further evidence of increased risk for mental health symptoms among first responders. More research is necessary to determine the types of events that contribute significantly to negative mental health responses in firefighters.

In 2019, the viral pandemic known as COVID-19 touched and indelibly impacted the global community, including the United States. The impact of COVID-19 was particularly onerous for the US's incarcerated. Not only is the United States the leading incarcerator in the world, but the the carceral system represents the nation's largest de facto mental health treatment setting. The carceral system is overrepresented by people of color, people with disabilities, and people of lower socioeconomic status-with great overlap between these populations. In combination with tough-on-crime policies, the US prison population also now finds itself aging, a process accelerated by confinement. The present systematic literature review describes the current state of peer-reviewed scholarship addressing the impact of COVID-19 on mental illness, incarceration, and their intersection in the United States. To be considered for inclusion, articles (1) were based in the United States or, if a global study, explicitly inclusive of the United States; (2) addressed COVID-19 and mental illness, COVID-19 and US incarceration, or COVID-19 and mental illness and US incarceration; and (3) were published or in-press between December 2019 and October 2021, as either a peer-reviewed commentary or research article in an academic journal. The final literature sample yielded 34 peer-reviewed articles. Ten themes and accompanying figures were developed within each of the three intersections: Intersection #1, COVID-19 and mental illness; Intersection #2, COVID-19 and US incarceration; and Intersection #3, COVID-19 and mental illness and US incarceration. Implications for respective US policies, programs, and systems are discussed.