By Dr. Lori K. Gray, C.Psych. and John Snider, B.Sc., B.Ed. (Frontline Resilience

1. You! This guideline is directed to those who will provide mental health support to first responders. Before you read on, appreciate this starts with you. You serve on the frontline and share the same concerns of exposure, community spread, and its implications. On top of that, you are supporting others. If your goal is to care for others, you can only do that insofar as you care for yourself. Depleting yourself in service to others does not best serve first responders in need of support. Care for yourself as well.

2. Understand the psychology Anticipate that first responders’ stress will exceed the objective risk of contracting COVID-19. Even when the risk for contracting COVID-19 is low, first responders may experience significantly greater levels of stress. Each first responder’s level of stress will be determined by the level of threat he/she perceives along with his/her anticipation of what is to come. This has the potential to be somewhat mitigated by the extent to which first responders feel protected and supported at work and at home.

3. Stress can increase exponentially The invisible risks of COVID-19 have the potential to exponentially increase first responder stress. Examples include persons who carry the virus but do not manifest symptoms and the presentation of COVID-19, which makes it difficult to discern from a cold or flu. These unknowns create an invisible threat, which increases the first responders’ fear of unknowingly contracting and transmitting the virus.

4. Timely check-ins First responders potentially exposed to COVID-19 require expedient outreach. Outreach should be provided from each of the following: 1) Rapid health screening and direction, 2) mental health support, and 3) support from colleagues, families, and friends.

5. Frequent check-ins First responders in isolation should receive support and communication on a continued basis. It is helpful for first responders to be advised of when they will next hear from someone and how to access support in the interim. This support should be available for their spouse and family as well.

6. Monitor prognostic risk Monitor indicators of more severe mental health impact, including but not limited to symptom severity, level of functioning, level of distress, and sleep disturbance. 1-833-FRONTLN (376-6856) www.frontlineresilience.ca

7. Clinical oversight Emergency services are shoring up additional resources for COVID-19, such as increased staffing. The stress experienced by first responders is expected to amplify as community spread progresses, risk of transmission increases, and first responder depletion sets in. Arrange for additional resources for your peer support team – specifically, a mental health professional to consult to the team. Have community mental health professionals ready to receive transfers of care from your team. Arrange mutual aid from peer support teams in less impacted areas.

8. Proactive transfer of care Proactively transfer care to community mental health professionals. First responder mental health needs will increase and have the potential to escalate to crisis. Peer support teams will be taxed with an influx while balancing their frontline duties. Priority triage should be given to first responders with greater mental health needs, such as those in isolation as well as those with higher acuity, pre-existing or comorbid mental health conditions. Mental health services should be delivered via webcam to ensure those in isolation receive support while adhering to social distancing measures. Mental health professionals should ensure knowledge of COVID-19, emergency operations amidst pandemics, and first responder mental health.

9. Have on hand key contacts Be prepared to have on hand any additional contacts that may be needed by first responders and their families. Examples include but are not limited to health resources (e.g., virus testing sites, public health information sources), family support (e.g., spousal and family counselling), and practical needs (e.g., financial counselling).

10. Be mindful of the home environment Be mindful that the implications of a pandemic can increase stress in the home environment. This might include the impact of social distancing, fears of virus transmission, extended hours of work, physical and mental fatigue, resource depletion, and exacerbation of pre-existing tensions.

11. Chose interventions accordingly First responders who are concerned about their health and essential resources for themselves and their families are not in a position to engage in insight-oriented treatment modalities. The focus will be upon basic needs (e.g., health and essential resources), practical support, and foundational coping. 

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