Unique Support for First Responders: An Interview with Sally Spencer Thomas

Losing anyone to suicide is tragic.

But losing a first responder represents a unique tragedy: someone who has spent their career putting others first, risking their life to save others — only to lose their own battle to suicide.

As part of our on-going discussion about mental health, support and prevention for first responders, we spoke with Dr. Sally Spencer Thomas to learn more.

Dr. Spencer-Thomas is a clinical psychologist, inspirational international speaker, and an impact entrepreneur. She was moved to work in suicide prevention after her younger brother, a Denver entrepreneur, died of suicide after a difficult battle with bipolar condition. Known nationally and internationally as an innovator in social change, Spencer-Thomas has helped start up multiple large-scale, gap-filling efforts in mental health including the award-winning campaign Man Therapy. Sheand has been an invited speaker at the White House.


Justice Clearinghouse Editors (JCH): We often think about first responders as being our strong heroes: the people who run into burning buildings or who capture the criminals. How has this image, perhaps, prevented or delayed some individuals from recognizing when they (or their team) need help?  

Dr. Sally Spencer-Thomas: Self-reliance, decisiveness, and courage define some of the best qualities of our first responders; they may also paradoxically be some of the qualities that put first responders most at risk for suicide.

While these qualities help our first responders problem-solve many of life’s challenges, not everything can be solved with these abilities. In fact, a stoic, “white knuckle” approach to trauma, depression, and addiction usually makes things much worse.

Like most health conditions, the earlier we identify and deal with emerging issues, the more we are to divert their course and change the outcome. Our health outcomes become catastrophic when mental health issues go unchecked, leading to the catastrophic outcome of suicide – when we let things go.

Many barriers to proactive mental health care exist in first responder communities. Some of these are structural – it’s hard to find mental health providers who understand the first responder culture. But most are attitudinal. First responders take care of others, they don’t want to be the ones needing care. They depend on one another for mental soundness. No one wants to be a weak link. Being vulnerable and sharing struggles is a big part of what makes mental health services work, and this often feels foreign, scary and irrelevant to many who pride themselves for their strength.

Finally, first responders are willing to risk their well-being – even their lives – to protect and serve others in their community. Some leading researchers are speculating that suicide risk becomes elevated in first responders because these self-sacrificial values become deranged. When faced with unbearable psychological pain, they self-sacrifice to lessen a perceived burden they believe they have become to loved ones. When we understand how the suicidal mind works, it’s not as surprising to realize that first responders can experience a perfect storm of risk for suicide: one of the biggest contributing factors is their fearlessness of death.



JCH: Tell us about your experience in working with first responders and mental health/suicide awareness. Is the awareness improving? How have you seen things change during your time in this area of mental health awareness?  

Sally: My career as a psychologist started in the early 90s as a counselor and trainer for first responders. I remember going on ride-alongs to gain insight into the intensity of the work. I was part of the Victims Assistance team in graduate school and went on scene with the first responders to provide support to people experiencing their worst day. By facilitating individual, couples and family therapy, anger management groups, parenting classes and more, I developed a deep respect and empathy for the men and women who serve our communities in this way.

Fast forward to 2013 when I was serving as the Director of the Survivors of Suicide Loss Division of the American Association of Suicidology. The executive director asked me to form a First Responder Task Force. I pulled together a number of folks locally and nationally to ask them what was needed, and together we created a video that focused on the lived experience of the impact of suicide. This resource then rippled out into a multi-year training program with the Denver Fire Department, as well as a national training program for law enforcement in partnership with the International Association of Chiefs of Police.


Over the years I have been working with first responders, I’ve witnessed a growing hunger for how best to shift the culture. First responders are well aware of the warning signs and risk factors for suicide; they have been trained repeatedly on this information since the academy. What is needed to shift the culture?  To make taking care of one’s mental health a mindset and core value of the department? The two best ways to shift culture are:

  1. Leadership engagement championing the integration of mental health and mobilizing resources
  2. Lived experience stories of hope and recovery from vicariously credible members of the community (see videos above)

The leaders who are most the successful in advancing this cultural shift are bold. They don’t worry about what others think of them for standing up for this life-saving cause, and they focus more on improving the well-being of their people. The boldest leaders often also share their own lived experience of coming through a difficult time and model reaching out to peer and professional resources as a way to improve as a leader and first responder.


JCH: Help us understand what drives a person to become suicidal? Is it really just ONE big event, like a mass casualty event? Or is it something that builds up over time because of all the things that first responders see on a daily basis?

Sally: Suicide is a complex human condition: a perfect storm of multiple forces coming into play at a given moment. The best explanation of the suicidal mind comes from Dr. Thomas Joiner, in his paradigm-shifting book, “Why People Die by Suicide” (Harvard University Press, 2006). Thomas’ research led him to conclude that there are really three variables that explain why people become at risk for suicide death.

First is a desire for suicide that includes a sense of burdensomeness and an experience of thwarted belongingness. While conventional wisdom might believe that the suicidal person is selfish, Thomas has found the opposite to be true. Those who desire suicide often believe that they have become such a burden on others, everyone will be better off if they are not around. In other words, in the mind of the suicidal person, they are practicing ultimate selflessness. When we combine this emotionally painful experience of being a burden with isolation, suicidal despair often results. Suicidal thoughts can be common in people living with unbearable pain as a coping strategy of escape. Suicidal thoughts become more lethal, however, when people have what Thomas has called an “Acquired Capacity for Suicide.” If suicide desire is the “I want to” part of the equation, “acquired capacity” is the “I can” part.

Thomas puts conventional wisdom on its head once again by challenging the notion that people who die of suicide are not cowardly: they are among our most brave. Thomas argues with a lot of research behind him that those who are most likely to take lethal action on their suicidal thoughts are those who have a fearlessness of death. Three main contributing factors for acquired capacity exist:

  1. You are born with it. Some people just come into the world with a temperament for risk-taking. Many of these people grow up to be our warriors, entrepreneurs, athletes, and first responders.
  2. You learn it. Other people may not be born with this innate sense of courage, but they learn it over time by living through painful and provocative experiences. By being exposed to violence and life-and-death situations, you become more accustomed and less afraid; additionally, any unresolved trauma reactions from these experiences can lead to the overwhelming emotional pain that can contribute to suicide.
  3. You have access to and familiarity with lethal means, such as firearms, lethal medication, and high places. Again, these are all common denominators among our first responder communities.

When people are exposed to traumatic situations over time it’s like adding water to a bucket. Each experience adds water – some more, some less.  Eventually, the bucket overflows, and when it does, all of the trauma stored in it tends to come out together, as our memories are often linked.

Add to this overwhelming life challenges like divorce, financial hardship, and additional health concerns, and it’s understandable why people find their usual coping strategies ill-equipped to handle the pain they are experiencing.

Sally Spencer Thomas
Photo Credit: Sally Spencer Thomas
JCH: How would you coach someone who sees a team member – perhaps their partner, someone working the same shift, etc – who is worried that their teammate is just not handling things well, and may become suicidal.  What should they do?

Sally:  First, understand that for many people reaching out might feel awkward or intrusive. You might wait for a “perfect time,” which will probably never come. If you are worried about someone, check it out. What is the worst that could happen if you are wrong? You might feel embarrassed. Much worse is missing an opportunity to potentially save someone’s life.

Second, proactively reach out and request a one-on-one conversation with the person you are worried about. Make sure you have enough time and privacy to create a sense of security. Check in with yourself to decrease distractions so you can be fully present.

Third, open the conversation with concrete behavioral or situational observations you have made about changes you have noticed, and express concern. For example, “I have noticed over the past week you have been late to your shift two days and you are regularly getting into arguments with others, and I care about what might be going on. You have told me that life at home is getting overwhelming, so I just wanted to check in with you. Can you tell me what might be going on?”

Empathy and non-judgmental listening are critical at this juncture. Refrain from advice-giving or problem-solving (very hard for first responders), and just listen. Sometimes people need “encouragers,” to share, so say things like “tell me more” or “can you give me an example” and reflect back feelings and key phrases during the conversation.

It’s okay to say, “I have no idea what to say to you right now, I’m just so glad you told me.”

Fourth, when you hear themes of hopelessness, helplessness, isolation, burdensomeness, and unbearable pain, ask a direct question about suicide. It’s important to use the word to have clarity and to let the other person know you are open to the conversation and not afraid. One way to ask is, “Sometimes when people feel as hopeless as you do, they think about suicide. I’m wondering if this is true for you.”

Fifth, know what to do if they say, “yes.” The first words out of your mouth should be “thank you.” Express gratitude for their courage in sharing with you and trusting your relationship. Then emphasize your connection and collaboration by saying something like, “I am on your team, and we are going to persist until we figure this out together.” Offer hope and say, “If we were to make you less miserable, do you think you would be less suicidal? I have some ideas of things we can explore together to alleviate your misery.”

Finally, have at least five resources you can turn to as you expand the safety net, and be prepared to start taking action on them during this conversation. You can say, “is there someone in your world who would want to know how much pain you are in?” If they don’t, that is a red flag. If they do, you can call that person or persons to bring them into the support circle. Maybe there is a primary care doctor or faith leader or department chaplain they would be willing to consult. Start a list of people they can call.

Be a knowledgeable referral source by engaging with other mental health resources, so you have firsthand experience to make you more credible. Call your employee assistance program or department mental health provider. Call special first responder support resources to see how they work.

For example, here are a few anonymous crisis services specially designed for first responders:


JCH: You’ve worked in this field a long time. Can you share some of the resources you would recommend first responders check out for more information?  

Sally: Many additional resources exist. My recommendation is to develop a wellness committee within the department or regionally to share lists of trusted resources and best practices in policy and protocol.

Resources to compile:

  1. Local mental health providers who specialize in working with first responders.
  2. More intensive treatment options (inpatient, intensive-outpatient) that specialize in working with first responders.
  3. Guidelines on how best to develop and maintain a peer support program.
  4. Useful tools for screening, training, and communicating. In addition to the tools mentioned above, here are a few additional ones:


For more about Dr. Spencer-Thomas’ speaking and training availability and topics, visit: www.SallySpencerThomas.com, follow her on Facebook (@DrSallySpeaks), Twitter (@sspencerthomas) or LinkedIn.



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