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Firefighters are repeatedly exposed to potentially traumatic events and occupational stressors (i.e. physical strain, shift work that results in disrupted sleep schedules), thus they experience an increased prevalence rate for a variety of psychological disorders and suicidality. Firefighter culture is unique and those firefighters who endorse mental health concerns and treatment barriers vary by subpopulation (volunteer, career, wildland) and geographical factors (rural vs. urban). Mental health providers must understand the complexity and nuances of the firefighter vocational experience to effectively work with this subpopulation. Extant literature suggests that anticipating negative outcomes from treatment, stigma, and structural barriers inhibit treatment engagement. These treatment engagement factors likely interact at various time points and influence firefighter mental health outcomes. Practice implications highlight how these barriers can be addressed via peer support, informal support, telehealth approaches (e.g., digital storytelling), work-recovery strategies, mindfulness, and critical incident stress management. Future implications suggest that firefighters would benefit from updated clinical practice guidelines specific to this subpopulation to provide optimal care. The emergent research in this area allows for a more advanced understanding of firefighter mental health, highlights research gaps, and appropriate training of culturally competent mental health providers that incorporates diversity factors. The objective of this article is to (a) describe firefighters’ mental health prevalence rates, (b) discuss specific help-seeking and treatment engagement strategies, and (c) review practice implications and research recommendations to enhance cultural competency for mental health providers with the aim of increasing utilization of firefighter-specific behavioral health services.

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Measurement-based care (MBC) is an effective pantheoretical practice framework that enhances mental health treatment outcome. MBC entails routine, systematic administration of standardized scales to measure patients' treatment response, inform clinical decisions, and tailor practice approaches and treatment planning to the individual needs of each patient. In 2016, the Office of Mental Health Operations and Mental Health Services in the Veterans Affairs Central Office launched the MBC in Mental Health Care Initiative. In accordance with this initiative, MBC was implemented within 2 mental health clinics at a large VA Health Care System in the southeastern United States. This program evaluation project examined the utilization of MBC measures across disciplines (i.e., psychiatry, psychology, social work) in the 2 clinics and clinicians' perspectives on MBC processes. Results suggested no significant differences between clinics in terms of rate of MBC measures administration. However, there were significant differences in the relative number of measures and the relative number of patients who were administered MBC measures across disciplines. Input from clinicians regarding their perspectives and experiences with the MBC implementation in their respective clinics were qualitatively and quantitatively evaluated, and barriers to MBC implementation were examined from the perspective of stakeholders.

Some research suggests that firefighters are possibly at greater risk than other at-risk first responder/public service populations for suicidality (e.g., police, Veterans, active duty military non-deployed males; Martin et al., 2017 ; Stanley et al., 2015; Stanley et al., 2016 ). Behavioral autopsies have been utilized to elucidate the clinical picture of other at-risk populations; however, to date there is no proposed or applied model for a suicide behavior autopsy in fire personnel. Developing a standardized suicide behavior autopsy will allow for a comprehensive understanding of firefighters who die by suicide and highlight potential areas for intervention. The aim of this paper is to integrate best practices for autopsy procedures from other high-risk populations into a comprehensive theoretical model for a proposed behavioral health autopsy for firefighters. Our recommended protocol is presented along with relevant limitations, clinical implications, and recommendations for future research.

The coronavirus 2019 (COVID-19) pandemic is an unprecedented emergency situation with significant stressors causing adverse impacts on mental health across the globe. Certain individuals are potentially more vulnerable during the outbreak, in particular those with medical vulnerabilities to COVID-19, eg, elderly, living with chronic illnesses, as well as individuals with pre-existing mental health issues such as anxiety disorders, depression, suicidality, and loss/grief. Additionally, individuals with persistent post-acute COVID-19 symptoms, eg, long haulers, are also a vulnerable population. During this international crisis, pandemic-related stressors, such as isolation/quarantine, lockdown, social distancing, homeschooling, loss of income or employment, and/or loss of loved ones could negatively affect these vulnerable subgroups and their overall life functioning. This paper aims to aid in the management of this international emergency by identifying potentially vulnerable subgroups because of the COVID-19 pandemic and by providing recommendations related to appropriate mental health referrals/interventions. This paper also aspires to enhance the knowledge of first responders and lay persons about vulnerability factors to readily help individuals struggling with mental health issues during the pandemic.