By NATHAN FLETCHER and DAVID LEONHARDI | CalMatters

More first responders lose their lives to suicide than in the line of duty. We’re doing something about it.

Last week, our country remembered the first responders and innocent Americans who lost their lives during the Sept. 11, 2001, terrorist attacks on America.

A lot has changed over the past 18 years, but one thing remains the same: firefighters, law enforcement officers and other first responders in counties and cities across our nation continue to risk their lives to protect complete strangers.

First responders run toward danger when others are running away. They have taken an oath to serve and protect. First responders are highly trained tacticians. They are conditioned to be tough, stoic, and stand up in the face of menacing situations, all to protect us.

But while first responders are protecting us, who is protecting them?

First responders see traumatic situations daily.

Violence, injury and chaos are inherent to first responders’ line of work and are triggers for post-traumatic stress. Repeated exposure can cause immediate and delayed distress that can lead to social and emotional impairment and affects one’s behavioral health. If untreated, this trauma can cause problems with family, social and work activities.

For many first responders, seeking behavioral health support using their department resources is still not a viable option.

Stigma associated with reaching out for help prevents first responders from getting the support they need. The stigma can stem from a fear of being passed over for promotion, breach in confidentiality by sharing intimate information with a person associated with their department, or being viewed as unfit to perform their duties.

First responders in a mental health crisis need quick access to a cost-free, confidential and stigma-free support system that is not directly tied to their department. This will help people by linking them to the clinical intervention they need to successfully get past their struggles.

Nationally, more first responders lose their lives to suicide than in the line of duty, according to the Ruderman Family Foundation.

In 2017, the nation’s first responder community experienced the tragic loss of 93 firefighters and 129 police officers in the line of duty. That same year, nationally we lost at least 103 firefighters and 140 police officers died of suicide.

The Firefighter Behavioral Health Alliance says that an estimated 60% of firefighter suicides are not reported. Therefore, the actual number who die by suicide may be much higher.

Our region’s police, fire and sheriff department leadership in San Diego County have been working proactively to change the culture around wellness, educate the ranks about impacts of trauma on the job and promote access to support services.

Some of the public safety departments have expanded access to employee assistance programs and other services. The San Diego County Sheriff’s Department cited that 526 counseling quarterly hours took place from Jan. 1, 2019-March 2019.

CalFire reported 72 counseling hours took place during that same period. This is encouraging, but the equity of support services varies across our county.

A recent article in the Journal of Psychiatric Research concluded that stigma and barriers to care are experienced by a significant proportion of first responders, which can lead to delays or refusal to obtain mental health care; increasing the risk of worsening post-trauma mental illness for this group.

The San Diego County Board of Supervisors supports our policy for a confidential, stigma-free behavioral health support program that was named after a young, talented first responder who tragically took his own life.

The Fire Captain Ryan J. Mitchell’s First Responder Behavioral Health Support Program will help any first responder during a mental health crisis — any municipality or branch of public safety in San Diego County, active or retired.

We want to help first responders make an instant connection with a peer support specialist. They will receive free, confidential help and be connected to a licensed clinical professional. To combat the stigma of getting help, we will also launch a public education campaign about how to get help, manage stress, trauma and behavioral health challenges.

We must do more to protect those who put their lives on the line every day to protect us.

— Nathan Fletcher is a San Diego County Supervisor, [email protected]. David Leonhardi is president of the San Diego County Deputy Sheriff’s Association, [email protected]. They wrote this commentary for CalMatters.