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Why Our First Responders Are So Burned Out

Their empathy can actually work against them.
two firefighters rescuing someone from a flooded car and a nurse
David McNew/Getty Images; Per Swantesson/Stocksy

Occupational Hazard is a series about how different jobs affect workers' mental health.

A nurse from Stockport, UK describes feeling "raw and emotional" after treating victims of the Manchester bombing. Another from Minnesota weaves together stories of patients who are homeless, addicted to drugs or victims of homicide. "Some calls get to you, no matter who you are," she says. Although separated by oceans, both share a deep awareness toward others' suffering.


This kind of prolonged empathy—while commonly believed to enhance one's health, relationships, and sense of purpose—can in fact take a toll on those working in the helping professions. According to the Compassion Fatigue Awareness Project, an organization that helps educate caregivers, helpers play host to a high level of compassion fatigue or burnout resulting from exposure to distressing situations.

"When you think of 9/11 workers or people who have worked in certain disaster sites, there's a secondary traumatic process that occurs by vicariously experiencing these horrific things," says Ravi Shah, an assistant professor of psychiatry at Columbia University Medical Center. The first responder caring for victims of the Manchester bombing, for example, could be at risk for developing PTSD symptoms and may experience flashbacks to the event.

But this isn't strictly limited to the medical community. "Burnout and fatigue is such an issue among therapists [but] even the everyday person who finds themselves in care or support roles," says Kristin Lee, a mental health clinician and lead faculty for behavioral sciences at Northeastern University.

Many people in these professions tend to focus on others at the expense of their own health. This is particularly true for social workers who often spend long hours working with vulnerable populations and dealing with trauma, severe mental illness, addiction, child abuse and poverty.


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For Ancy Lewis, a clinical social worker from New York, witnessing this kind of suffering came at a cost. "I carried the traumas and despair of my clients into my home, and would have recurring thoughts about [their] well-being," she says. "I felt this sense of hopelessness that no matter how I provided help, it would make no difference."

Helpers who often have difficulty delegating, and recognizing their need for support often don't take the time to adopt healthy and nurturing rituals for themselves. Many are better at giving than receiving, creating the perfect breeding ground for an array of symptoms like physical and emotional exhaustion, anger that verges on rage, and minor to major depression.

"Our training conditions us to be attentive to the needs of everyone around us, often forgetting to put our own masks on first to avoid depletion," Lee says. "The current hyper-competitive market and socio-political climate, together with the critical shortage of mental health practitioners has created a perfect storm—everyone needs us."

In states with the lowest workforce, there's only 1 mental health professional per 1,000 individuals. This includes psychiatrists, psychologists, social workers, counselors, and psychiatric nurses combined—a daunting fact considering that 1 in 5 adults in the US experience mental illness in a given year.

In the long-term, the effects of "compassion fatigue" can severely hinder a person from being able to care for or even empathize with others, causing absenteeism and apathy at work. "Medical professionals by definition are people who are generally looking to help others, that's part of why they got into this work," Shah says. "When they lose their empathy, we see that as a major red flag."


But one step in the right direction could be as simple as a change in perspective. New research indicates there are two routes to empathy and one of them is more personally distressing and upsetting than the other. One way involves putting ourselves in 'another person's shoes,' or imagining how it would feel if we were the one suffering, which has detrimental effects on our health. The other route takes on a more reflective stance.

A recent study collected data including stress physiology measures from over 200 participants who were placed in the role of 'helper' to a person that was suffering. Study subjects were then made to read texts describing a troubled background, which they believed to have been written by their partners (in fact, they were written by the researchers).The experiment was meant to evoke different types of empathy by dividing participants into groups and having each take different approaches to how they empathized with the person.

The findings revealed that those who imagined themselves in their partner's situation had a higher threat response than those who were asked to merely acknowledge the person's feelings. These results show that the way a helper chooses to arrive at empathy can directly affect their health and wellbeing.

Shah says that regardless of whether you're feeling the mildest of compassion fatigue or in the throes of full-blown depression, taking care of yourself is critical. He's quick to add that some of these more severe cases may call for antidepressants as a possible treatment option.


"Many of us struggle with giving ourselves permission to take the time to recalibrate and engage in restorative activities," Lee says. "It doesn't have to be extravagant—small things can make a big difference."

Part of this means implementing stress-releasing daily strategies that involve physical movement like running and meditation. If it's your job to help others, Lee recommends taking breaks, retreats, or short hiatuses from work in order to reset. "From a scientific perspective, we know that our brains function better with intermittent periods of rest—we are not intended to be robots or machines."

Both Lee and Shah also stress the importance of having a strong support system in place to prevent burnout. "Whether you're a psychologist, psychiatrist, or even if you're a nurse, talking to a friend at the water cooler about some of the difficulties you're having can be incredibly helpful and therapeutic," Shah says. "Nearly everyone in this world benefits from some kind of support from another person, and that is very, very powerful."

In Lewis' case, discussing her feelings with other social work peers and seeking out counseling was vital in overcoming her sense of isolation. It was this experience that led her to starting a coaching and consulting company that provides social workers with tools to manage and overcome compassion fatigue.

And while the numbers show that deeply caring individuals typically focus on others' needs before their own, it's important they remember to put on their own mask first. "Ensuring we take the time to engage in activities that are protective and cultivate resilience is essential to our sustainability as people and professionals," Lee says. "Remembering that we are human is vital."

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