Mental Health Resources for Veterans and First Responders

Mental health concerns are very common around the world. In the United States alone, tens of millions of people deal with substance use disorders or seriously consider suicide every year,1 2 and about 6% of the population will have PTSD at some point in their lives.3 However, certain occupations can greatly increase your risk of developing a mental health disorder. In particular, veterans and first responders (firefighters, police officers, paramedics, emergency medical technicians, etc.) are at a far greater risk than the general public.4 5

In this guide, we’ll look at some of the most common mental health issues that first responders and veterans face and offer helpful resources to get you or your loved ones the support they need.

While there are over 200 different types of mental health disorders, some of the most common ones experienced by veterans and first responders are also some of the most common experienced by the general public.6 7 8 These include, but aren’t limited to:6

• Depression
• Substance use disorder
• Alcohol use disorder
• Post-traumatic stress disorder (PTSD)

Though there are dozens of reasons why anyone may — or may not — develop a mental health disorder, a few risk factors are more frequently seen in veterans and first responders, such as: 6

• Experiencing traumatic events7 9
• Undergoing significant stress7 8
• Feeling isolated or lonely10

These risk factors don’t guarantee a veteran or first responder will develop a mental health disorder, but they do increase the chance of it happening.

Additionally, it’s important to note that even though it’s not a mental health disorder in itself, suicidal ideation is still a significant mental health issue that’s common among veterans and first responders.7 11 12 Suicidal ideation doesn’t necessarily mean someone is going to attempt suicide, but it can be a warning sign.11 We cover more of the topic later in this guide.

Before delving into specific mental health disorders, it’s worth discussing the massive impact stress has on your physical and mental well-being. Though everyone deals with stress throughout their lives, veterans and first responders can encounter extremely stressful situations on a daily or almost-daily basis. As explained by the Cleveland Clinic, there are three main types of stress that people experience:13

• Acute stress: Positive or negative short-term stress that comes and goes quickly (e.g., having a fight with your partner, being stuck in traffic, the feeling when riding a roller coaster, etc.).
• Episodic acute stress: Negative short-term stress occurring so frequently/regularly that you don’t get the needed time to relax or return to a calm state of mind. Healthcare providers are one group of people commonly affected by episodic acute stress.
• Chronic stress: Negative long-term stress that lasts for weeks, months, or longer (e.g., marriage issues, financial troubles, caring for a sick relative, etc.).

Because your body’s autonomic nervous system (the nerves in your body that control various unconscious processes, like breathing) is “in charge of” your stress response, frequent episodes of negative stress can cause an array of physical, mental, and behavioral symptoms, including:13

However, when you have long-term or chronic stress, you may experience some more serious complications, such as:13

• Arthritis
• Fibromyalgia
• Psoriasis
• Stomach ulcers
• Weight gain or loss
• Irritable bowel syndrome
• High blood pressure
• Increased heart rate
• Heart palpitations
• Infertility
• Polycystic ovarian syndrome (PCOS)

And as we mentioned earlier, long-term significant stress — such as that experienced by veterans and first responders — is also a risk factor for developing a mental health disorder like depression, anxiety, and substance use disorder, among others.6

Research shows that veterans have a risk of depression five times greater than civilians,4 and the prevalence of behavioral health conditions, like depression and PTSD, is 10% more common in first responders than in the general public (30% versus 20%).12

Studies suggest that the most frequently reported mental health challenges encountered by veterans and active service members are PTSD and depression, with the latter being “responsible for up to 9% of all ambulatory military health network appointments.”7 Veterans, in particular, may experience feelings of social isolation when adjusting to civilian life, which can contribute to depression.10

Among first responders, depression, anxiety, and stress were all found to be highly prevalent. According to a 2022 meta-analysis, the rates of depression, broken down by profession (paramedics, EMS personnel, and police), are as follows:8

• Paramedics: 37%
• EMS personnel: 28%
• Police: 22%

Interestingly, being married meant they were more likely to experience depression or anxiety.8 Also, as explained by the authors of a 2019 study, first responders are at high risk of developing depression (or depressive symptoms) from secondary traumatic stress or “compassion fatigue.”9

PTSD stands for “post-traumatic stress disorder,” a mental health condition that some may develop after experiencing or witnessing a traumatic event.14 In both veterans and first responders, PTSD occurs at higher rates than in the civilian population.15 16

PTSD in veterans

Throughout history, PTSD in veterans has been given many names, like “soldier’s heart” during the Civil War, “shell shock” in World War I, and “combat fatigue” in the Vietnam War. Only in 1980 did the disorder become officially recognized and codified in the Diagnostic and Statistical Manual of Mental Disorders.7

According to the U.S. Department of Veterans Affairs, the number of veterans with PTSD varies depending on the era in which they served. The lifetime rates of PTSD are as follows:15

• Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF): 29%
• Persian Gulf War (Desert Storm): 21%
• Vietnam War: 10%
• World War II (WWII) and Korean War: 3%

While this data does imply that PTSD has become more common in younger veterans, it doesn’t take into account the stigmas surrounding mental health that were (and still are) more prominent in older generations.17 It’s entirely possible that older veterans aren’t as likely to report mental health concerns such as PTSD.

Now, even though PTSD in veterans may be most commonly attributed to experiencing or witnessing violent events, secondhand exposure can also lead to the disorder. For example, learning that a family member or friend experienced a terror attack can cause PTSD.7

Additionally, it’s important to point out that some veterans may develop PTSD after experiencing military sexual trauma (MST) during their service. MST refers to either sexual assault or sexual harassment that occurs during military service. About 1 in 3 women and 1 in 50 men report experiencing MST. Along with PTSD, MST survivors may also have trouble sleeping, feel on edge, develop depression or anxiety, have physical health problems (like chronic pain), and more.18

PTSD in first responders

Unfortunately, many people aren’t aware of the risk of PTSD in first responders. Some believe it to be a “military-only” condition. But as mentioned, PTSD and depression rates among firefighters and police officers are nearly five times higher than in the general population,19 and studies show the longer someone works as a first responder, the higher the likelihood of developing PTSD.5

As noted by the authors of a 2019 review, first responders are frequently “confronted with exposure to traumatic events, including potentially life-threatening situations as well as the grave injuries and deaths of colleagues and civilians.” The review also explains that first responders develop PTSD at rates ranging from 6% to 32%, as opposed to only 7-12% of the general U.S. adult population.20

Compared to studies on PTSD in veterans, there isn’t as much data on the disorder in first responders, but the research that does exist all points to first responders needing a similar amount of support.

PTSD symptoms

Sometimes, PTSD symptoms can seem a lot like depression or anxiety. However, there are some distinct symptoms characteristic of the disorder. These include:14

• Intense, intrusive thoughts or feelings related to the traumatic experience
• Having flashbacks or nightmares
• Feelings of guilt or shame
• Avoiding situations, places, or activities related to the traumatic event

Some people with chronic stress due to physical or mental health concerns turn to unhealthy coping mechanisms.13 As with the other mental health disorders we’ve covered, veterans and first responders are at a higher risk of developing substance use disorders.9 21

According to a 2019 study, “all types of first responders” face an increased risk of developing substance use disorders compared to the general population.9 Similarly, approximately 11% of veterans have a substance use disorder, with binge drinking and alcohol use disorder being two of the more common issues.21

The symptoms of substance use disorder vary based on the type of substance being used, but common signs generally include:22

• Having a strong urge or desire to use the substance
• Experiencing difficulty cutting down or managing substance use
• Continuing to use the substance even if it causes issues in relationships or at work
• Using the substance even when it may put oneself or others at risk
• Developing a tolerance for the substance
• Experiencing withdrawal symptoms

Substance use disorder can range from mild to severe, but the symptoms are often the same, just at different severities.22

As of 2020, veteran suicide rates reached their highest level in recorded history. Researchers found that those who witnessed others killed or wounded in combat are at a “substantially higher risk” than veterans without that history.23 Accordingly, veterans make up approximately 18% of all suicide deaths in the United States — a rate of roughly 1.5 times higher than that of non-veterans.7

Though there isn’t as much data on suicide in first responders, research shows that “the lifetime prevalence of suicidal ideation in police officers was 25% in female officers and 23.1% in male officers.”12 Similarly, a 2021 systematic review notes that suicidal ideation in first responders is “at least twice as high” as that of the general population.25

Even though having suicidal ideation doesn’t mean someone is guaranteed to attempt suicide, it’s still worth watching out for the warning signs. The Cleveland Clinic explains that these signs include:26

• Talking openly about suicide
• Feeling trapped
• Having mood changes
• Becoming socially withdrawn
• Writing a suicide note
• Experiencing a sudden sense of calm
• Behaving recklessly
• Giving away possessions

If you or a loved one is having thoughts of ending their life, reach out to the Suicide & Crisis Lifeline by dialing 9-8-8 or visiting the organization’s website.

Below you’ll find a collection of resources to help veterans, first responders, and their families find the support they need.

For veterans:

• Depression Symptoms, Screening & Veteran Resources
• Resources for Veterans Feeling Isolated | Don't Wait. Reach out.
• Social Isolation Experienced by Our Veterans - VA News
• Addiction Treatment for Veterans

For first responders:

• American Addiction Centers
• First Responders Foundation
• First Responders and Disaster Responders Resource Portal | SAMHSA
• Traumatic Events Tip Sheets | First Responders and Recovery Workers
• ResponderStrong

Crisis lines:

• 988 Lifeline
• Línea 988 (988 Lifeline for those who speak Spanish)
• Veterans Crisis Line
• Crisis Phone Numbers and Contact Information for Fire, EMS, Police, and Veterans