RESOURCES

FIRST RESPONDERS RESOURCE GUIDE
PTSD: AN ESSENTIAL UNDERSTANDING

Perhaps nothing has put PTSD in the spotlight more than combat in the Middle East. After studying and treating the PTSD of combat veterans, along with the advent of innovative and effective therapies developed specifically for trauma, we know more about PTSD now than ever, and likewise have never been better equipped to treat it.

Post-traumatic issues, such as PTSD, are curable, not just treatable; unfortunately, that doesn't mean everyone is cured. Many variables exist that can influence both resiliency and recovery, and may need to be addressed first, such as substance abuse and addictions. An individual's conformity and open-mindedness to therapy can also determine the success of PTSD treatment. 

It is important to understand that the treatments proven most effective for PTSD do not involve any need to forget the trauma, First responders are often reluctant to see a professional therapist because they think it will simply involve talk therapy, discussing the horrors while someone is scribbling away on a notepad. Many imagine that therapy simply involves years of chatting about what's wrong and hoping the therapist has some sort of advice that is useful until the next therapy session. Much of the stigma comes from the idea that PTSD is only treatable and not curable. 

Far beyond simple talk therapy, the modalities discussed in this guide incorporate techniques that exploit the natural function and cycle of the subconsciousness—the same cycle that creates and perpetuates trauma (or prepares for it, as in the case of Fight or Flight). The result is a therapy process that attains success much more rapidly than traditional talk therapy.


For an excellent and simple explanation of PTSD, we recommend this short video by the National Center for PTSD:
FINDING & CHOOSING EFFECTIVE TREATMENTS FOR PTSD

When a first responder is troubled by PTSD, they often feel reluctant to seek professional help—stigmas about lack of confidentiality and how it may affect their career one day, and fears about being mislabeled incompetent for duty or a danger to self or others, are common reasons. PTSD is essentially an injury to the mind, and, like any physical injury, may be at risk of spreading like an infection, if not treated sooner than later; however, first responders tend to seek professional help only after the infection of PTSD has spread, creating debilitating symptoms. Ultimately the perceived risks and discomfort of addressing root causes leads first responders to see professional therapy treatment as a last resort.

This simply isn't going to change unless first responder agencies develop better skills of qualifying therapists and therapy options. Qualifying therapists and treatment centers is a topic addressed elsewhere, but this Peer Support Reference Guide is all about qualifying therapy options that have been proven through evidence-based credible studies to be most effective for treating and curing PTSD. 

Watch a short video by the National Center for PTSD that can help you make wise treatment choices:
Understanding what exactly "Evidence Based" means and why is it important is explained very well in this video by the National Center for PTSD:
TRAUMA-FOCUSED THERAPY OPTIONS

The three most effective and most recommended therapy modalities for PTSD in professional mental health today are all Trauma-focused Therapy models. Much of the evidence based research worldwide that supports this has been demonstrated to effectively treat and cure diagnosed PTSD populations among combat veterans, first responders, and victims of rape or physical/sexual abuse.

When working with first responders through peer support programs or chaplain outreach, it is important to understand three things regarding Trauma-focused Therapy:

1) Trauma-focused Therapy may seem weird to them when describing it, and this fear of an uncomfortable or awkward encounter may inhibit them from pursuing such options; however, a common remark heard in our research with first responders over the years regarding this has been, "I thought it was strange and I was skeptical but I tried it and it really worked."

2)  There may be a natural reluctance to give Trauma-focused Therapy a try simply because Trauma-focused Therapy requires them to face and discuss the very nightmarish traumatic experiences that plague them; however, under the guidance of a competent professional, especially one who has worked with first responders or combat veterans, the journey unfolds in a way that allows reprocessing of the pain they most want to avoid. The end result is often followed by comments such as, "I felt like a heavy weight had been lifted for the first time and that I am less affected by the memories of the trauma."

3)   You may have to use the art of leverage in convincing a first responder to try Trauma-focused Therapy. If they are resistant to trying a session, you can leverage with them by getting them to agree to at least look at some online resources (the information presented here is a good one). Getting them to speak to a therapist over the phone about what a therapy session will be like is also great leverage.


So what is Trauma-focused Therapy?

Trauma-focused Psychotherapy focus on the memory of the traumatic event and why its meaning is interruptive and damaging. Far more than simply coming face-to-face with the experience, these therapies actually reprocess the experience in a way that remaps the subconscious mind where it originates. Essentially it is not the memory itself of the trauma that causes harm, but the meaning that is anchored to that memory, along with all the pain that meaning brings with it.

Trauma-focused Therapy requires courage but it can be rewarded with a heavy payload of authentic healing and freedom. Prior to Trauma-focused Therapy, many experts believed PTSD was only treatable, not curable. Not only are many proclaiming themselves to be cured of PTSD after Trauma-focused Therapy, but 10 and 20 year follow ups in some cases showed no relapses into PTSD or addictions spawned by PTSD. 

With Trauma-focused Therapy, the effectiveness is not due to forgetting trauma, but having methods and tools taught by a professional therapist that allow you to dis-empower its impact. Trauma-focused Therapy is distinctively quick at getting results, too--often in 2-3 months or less.

There are three Trauma-focused Therapy treatments found to be most effective through peer-reviewed published evidence, as well as endorsements and implementation for PTSD by the Department of Defense, the Veteran's Administration, the American Psychiatric Association, and the World Health Organization They are Eye Movement Desensitization and Reprocessing (EMDR), Cognitive Processing Therapy (CPT), and Exposure Therapy (ET).


A final note about Trauma-focused Therapy:

Whether you are a peer support leader, a chaplain, or someone currently battling PTSD, know that the fear of facing the trauma and all its ugly details is largely the reason why so many first responders don't give Trauma-focused Therapy a chance. 

An effective counter to this fear is reminding yourself of the simple truth that you are going to face your trauma one way or another, whether you like it or not. You can choose to face it in a controlled atmosphere under the guidance and treatment of a professional, or you can face it without choice at the worst possible times, and, perhaps, for the rest of your life. If you don't face your trauma, your trauma will face you. 


EYE-MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR)

Unlike most forms of talk therapy, EMDR focuses less on the traumatic experience itself and more on the distressing meanings that result. EMDR helps by reprocessing memories, beliefs, and emotions with a particular focus on details like sounds, smells, conversations, reactions, perceptions, and movements, During the talk session, the therapist interrupts the normal traumatic response to these memories through a method that incorporates the right and left brain hemispheres. The most common method EMDR therapists use is having the client follow an object with their eyes in the way a hypnotist would use a pendulum (although EMDR is not hypnotism). 

How does EMDR work?

Although there remains some debate on exactly how and why it works, the process of EMDR is believed by many researchers to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, triggering deeply seated internal associations to surface as the client begins to reprocess the memory and its disturbing meanings and their subsequent feelings. 

What happens during EMDR? 

During an EMDR session, the therapist will ask his or her client to choose a memory from the trauma and identify the negative thoughts, emotions, and feelings that are expressed in the body. During this time, the therapist will ask the client to focus their eyes on the alternating movement of a finger or an object.

This interruption disassociates the trauma from the traumatic response, while reprocessing meanings anchored to the details that trigger the reaction. As the traumatic memory becomes less traumatic, they are re-framed with healthier meanings. Over time, these healthier meanings become the normal reaction when the traumatic memories intrude, thus interfering with the symptoms that previously caused debilitation.

An EMDR therapy session involves eight phases:

1) History and treatment planning
2) Preparation, to establish trust and explain the treatment in-depth
3) Assessment, to establish negative feelings and identify positive replacements
4) Desensitization, which includes the eye movement technique
5) Installation, to strengthen positive replacements
6) Body scan, to see if the client is now able to bring up memories of trauma without experiencing negative feelings that are no longer relevant, or if reprocessing is necessary
7) Closure, which occurs at the end of every session
8) Re-evaluation, which occurs at the beginning of every session

EVIDENCE FOR EMDR:

More than 30 positive controlled outcome studies have been done on EMDR therapy. The first civilian clinical outcome research on EMDR in the United States was published in The Journal of Consulting and Clinical Psychology in 1995, with a 15-month follow-up published in 1997 (Wilson, Becker and Tinker, 1995, 1997). The research reported a remission of 84 percent of those initially found to have single-trauma PTSD after only three 90-minute sessions. 

The second randomized EMDR study of civilians (Rothbaum, 1997) was conducted by an established cognitive behavioral therapy researcher. It reported a 90 percent PTSD remission in sexual assault victims after three 90-minute sessions. 

The third civilian study was financed by Kaiser Permanente (Marcus et al., 1997, 2004) and reported that after an average of six 50-minute sessions, 100 percent of the single-trauma victims and 77 percent of the multiple-trauma victims no longer had PTSD. 

A subsequent study (Carlson et al., 1998) conducted at a Veterans Affairs facility used 12 treatment sessions and reported a 78 percent remission in PTSD.

EMDR is recognized as an effective form of treatment for trauma by the American Psychiatric Association, the World Health Organization, the Veteran's Administration/Department of Defense.

Source Citations:

Carlson, J. G., Chemtob, C. M., Rusnak, K. , Hedlund, N. L. and Muraoka, M. Y. (1998), Eye movement desensitization and reprocessing (EDMR) treatment for combat‐related posttraumatic stress disorder. J. Traum. Stress, 11: 3-24. DOI: 10.1023/A:1024448814268

Marcus, Steven & Marquis, Priscilla & Sakai, Caroline. (2004). Three- and 6-month follow-up of EMDR treatment of PTSD in an HMO setting. International Journal of Stress Management. 11. 195-208. 10.1037/1072-5245.11.3.195. 

Rothbaum, Barbara. (1997). Controlled study of eye movement desensitization and reprocessing for post-traumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic. 61. 317-34. 

Wilson, Sandra A.,Becker, Lee A.,Tinker, Robert H. (1997), Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment for posttraumatic stress disorder and psychological trauma. Journal of Consulting and Clinical Psychology, Vol 65(6), Dec 1997, 1047-1056 DOI: 10.1037//0022-006x.65.6.1047


FINDING AN EMDR THERAPIST:

Look for a licensed, experienced therapist, social worker, professional counselor or other mental-health professional with additional training and certification in EMDR. The EMDR International Association is one source of credentialing. 

TALK TO AN EMDR THERAPIST FOR FREE

Looking for an EMDR therapist with experience helping first responders? Do you have questions about whether or not EMDR would be a good fit for you or a peer? 

As a service to first responders, we can connect you to a variety of therapists that may be a good fit for you or we can have one contact you and answer your questions. This is a FREE service without obligation and you are not required to reveal your identity. Simply fill out this quick form and let us know how we can help.

You can search for an EMDR therapist near you using the following links:




Here is a good video by the National Center for PTSD, explaining EMDR:
COGNITIVE PROCESSING THERAPY (CPT)

Cognitive Processing Therapy (CPT) is a type of Cognitive Behavioral Therapy (CBT) found to be effective for treating post-traumatic stress disorder (PTSD). CPT focuses on teaching clients a set of skills that help them challenge the negative meanings, beliefs, and emotions that come with PTSD in such a way to gain control over their intrusive impact. It has been highly useful for those who anticipate being exposed to further trauma or mental stress due to their occupation or life circumstances. 

How does CPT work?

CPT focuses on repairing the damage traumatic events have done to a person's perceptions and beliefs about themselves, their life, and their environment. Through specific cognitive restructuring skills, CPT allows them to challenge negative thoughts and faulty perceptions related to their trauma, develop healthier perspectives and coping skills, and get on with their life while being equipped with new tools to stay that way, even if new trauma occurs.

What happens during CPT therapy?

CPT therapists identify and explore the ways that trauma may have altered a client's thoughts and beliefs, affecting how they feel and behave. The therapist will choose specific limiting thoughts and beliefs that keep the client trapped in the trauma cycle, then he or she will teach the client a set of strategies that challenge and modify these thoughts and beliefs. These strategies become very effective outside the therapy session, as clients practice them with progressive competency. CPT therapists may focus on safety, trust, power, control, self-esteem, and relationship intimacy, since these tend to be common areas affected by traumatic experiences. 

Evidence for CPT:

Cognitive processing therapy was originally designed to help traumatized survivors of sexual assault; however, it gained significant recognition as a successful treatment for combat veterans suffering from PTSD. 

Research indicates CPT is effective in significantly reducing PTSD symptoms (Watts et al., 2013; Cusack et al., 2016). Further research shows it effectively treats PTSD in sexual assault survivors (Chard, 2005), combat veterans who served in Vietnam, Iraq and Afghanistan (Chard et al., 2010), and adult males with comorbid TBI and PTSD (Chard et al., 2011). CPT treatment success have been found to be maintained in 5 and 10 year post-treatment follow up regarding reduction in PTSD, depression, and anxiety in sexual assault and Veteran samples (Resick et al., 2012). The number of individuals who no longer meet criteria for PTSD after CPT varies across studies. Rates of participants who no longer met PTSD diagnosis criteria ranged from 30% to 97%, Compared to control groups not receiving CPT, 51% more participants treated with CPT achieved freedom from any PTSD diagnosis (Jonas et al., 2013). 

The American Psychology Association, the Veterans Health Administration, and the Department of Defense strongly recommend CPT for PTSD, and the Veteran Association’s Office of Mental Health Services has also established a training program for CPT therapists. 

SOURCES CITED:

Chard, K. M. (2005). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73(5), 965-971.

Chard K, Schumm J, Owens G, Cottingham S. (2010) A comparison of OEF and OIF veterans and Vietnamveterans receiving cognitive processing therapy. J Trauma Stress. 2010;23(1):25–32.

Chard KM, Schumm J, McIlvain S, Bailey G, Parkinson R. (2011) Exploring the efficacy of a CPT-CognitiveOnly (CPT-C) focused residential treatment program for veterans with PTSD and traumatic braininjury. J Trauma Stress. 2011;24:347–51. doi:10.1002/jts.20644

Cusack, K., et al., (2015) Psychological treatments for adults with posttraumatic stress disorder: A systematic review and metaanalysis, Clinical Psychology Review, http://dx.doi.org/10.1016/j.cpr.2015.10.003

Jonas D. E., Cusack K., Forneris C. A., Wilkins T. M., Sonis J., Middleton J. C., et al. (2013). Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD): Comparative Effectiveness Review No. 92. (Prepared by the RTI International-University of North Carolina Evidence-Based Practice Center Under Contract No. 290-2007-10056-I). AHRQ Publication No. 13-EHC011-EF. Rockville, MD: Agency for Healthcare Research and Quality. 

Resick, P. A., Williams, L. F., Suvak, M. K., Monson, C. M., & Gradus, J. L. (2012). LongTerm Outcomes of Cognitive–Behavioral Treatments for Posttraumatic Stress Disorder Among Female Rape Survivors. Journal of Consulting and Clinical Psychology, 80(2), 201-210. doi: 10.1037/a0026602

Watts, C., Hossain, M., & Zimmerman, C. (2013). War and Sexual Violence: Mental Health Care for Survivors. The New England journal of medicine, 368(23), 2152-2154.


Finding a CPT therapist:

Mental health providers can receive training and certification for CPT. Some institutions, such as university clinics, provide training seminars and workshops in CPT. Additionally, several CPT treatment manuals have been developed to assist clinicians in delivering the therapy. 

You can search for a CPT therapist near you using the following links:




CPT is summarized very well in this video by the Veteran's Administration:
PROLONGED EXPOSURE THERAPY

Prolonged Exposure (PE) is a type of Cognitive Behavioral Therapy (CBT) developed for PTSD that teaches clients to gradually approach the memories, emotions, and beliefs related to trauma that a client has been avoiding due to the pain they cause. By confronting these issues directly, but gradually, and under the guidance of a therapist, clients are able to reduce the impact and fear of their triggers, while gaining better control over reactions to them. Often a cathartic mental detoxing occurs with mild distress involved, leading to the client feeling like a debilitating weight has been lifted after each therapy session.

How does PE work?

PE is based on Pavlov's associative learning theory—when two experiences occur together, the brain learns to associate them. Ivan Pavlov practiced the habit of ringing a bell each time he fed his dogs. Eventually, the dogs would demonstrate reactions to the bell, such as salivating or tail wagging, because they associated eating with the ringing. Pavlov then stopped feeding them when he rang the bell, and, soon, the dogs stopped reacting when they heard it. PTSD is a similar association, in that memories are glued together with meanings that illicit responses as if the trauma were occurring again. The subconscious mind does not understand the difference between past trauma and the memory of it—it reacts with a flight or fight response that interferes with the normal quality of living.

What happens during a PE therapy?

A typical PE session typically lasts 90 minutes and occurs once per week for approximately 2-3 months, and involves Imaginal Exposure and In Vivo Exposure.

During Imaginal Exposure, the therapist guides a client through the retelling of the traumatic event, while exploring the thoughts and feelings associated with it. This helps to decrease the unwanted triggers of trauma, the fear of such triggers, and lessens distress when trauma is recalled.

During In Vivo Exposure, the therapist looks at the real life exposure to things that the client has been avoiding due to fear of triggers and the symptoms that occur from them. The therapist will first ask the client to make a list of what they have been avoiding (places, activities, people, etc.), the the therapist will help the client create an “exposure hierarchy” by ranking what is avoided based upon how much distress they cause.

Evidence for PE:

PE is one of the most empirically tested and researched interventions for PTSD. It has been studied in over 20 randomized clinical trials with more than 20 years of research supporting its use and is reported to produce improvement in about 80% of patients with PTSD. PE received an Exemplary Substance Abuse Prevention Program Award from the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA). A review by the Agency for Healthcare Research and Quality (13), which used extensive criteria for evaluating study quality, included 19 RCTs of PE. The review concluded that there is high strength of evidence to support the efficacy of exposure therapy such as PE for reduction of PTSD symptoms and depression symptoms. It is important to note, that PE has more clinical trial evidence than EMDR or CPT because it has been in use much longer, not necessarily because it is more effective. 

Finding a PE therapist:

Health providers can receive training and certification for PET. Some institutions, such as university clinics, provide intensive workshops or seminars in PET, with therapists completing one-on-one consultation therapy cases. 

Find an Prolonged Exposure Therapist near you using the following link:



Prolonged Exposure Therapy is explained very well in this video by the Center for PTSD:

CHOOSING THE OPTION THAT FITS BEST

With several effective options available, how does one know what fits them the best? One therapy option may sync better for one person than another. Chemistry and connection with the therapist is also a factor, so it is important not to be too dismissive of a certain therapy without considering these influences. First responders have reported to us that they tried one therapy format but found another to be what worked for them. Explore options and resist the temptation to be discouraged at any point. 

Be optimistic but realistic! 

There is no definitive therapeutic prescription to cure PTSD or other challenges like addiction or depression—one must explore and see what works best; many report finding relief right away and make a quick recovery; others may be more resistant to some lifestyle changes that may be interfering with a therapy that would otherwise be more effective. In the same way one would need patience while waiting for antibiotics to make them feel better, mental health therapies benefit from the same patience—usually with great reward.

Consider the Therapist

Much of a therapy's success comes from the therapeutic relationship, and not simply the therapy protocol itself. In the way that you might socially connect to a coworker or friend, syncing with a particular therapist can be much the same way—you simply feel you are on the same wavelength and are particularly receptive to the therapy as a result. Some therapists offer a free consultation to first responders. It may be limited in time to 20-30 minutes, but it can give a first responder a chance to learn more about the therapy method, while getting a limited feel of any social connection. This free initial consultation may be over the phone or in person, depending upon the therapist or your distance.

In conclusion...

Understanding the variables that exist outside the methodology of any therapy is essential to being open-minded and ultimately responsive to its help. In other words, don't be dismissive of a therapy without perhaps trying it with a different therapist. Ultimately the choices are credible options, each of them being reported to us by countless first responders as being the key to authentic change, freedom, and healing.


SUPPORTIVE THERAPIES
Much like the immune system of our body, our mind is protected and treated by its own immune system, and just as many factors influence the effectiveness of the body's immune system to stave off or heal from injury and illness, our mind works much the same way. Incorporating a multitude of simple changes outside the therapy office can be as essential as 

As mentioned before, the best approach is to compliment the therapy you receive from a professional with lifestyle changes on your own that reinforce resiliency from future trauma and/or healing from past trauma. Think of the three of self: mind, body, and spirit—and make a disciplined effort to address them regularly so that there is some measure of balance.
EQUINE THERAPY

Equine Therapy is more than simply an interactive experience with horses. Through the guidance of a certified equine therapist, there is great benefit to many mental health challenges, including PTSD. 

Download information on Equine Therapy:






CANINE THERAPY

The therapeutic value of dogs is by no means a new concept, but often this option gets lost among the more trauma-specific options; however, Canine Therapy for PTSD and depression has the support of many published studies, such as the ones linked below. There is a difference between simply having a dog around as a pet and spending therapy-focused time with a dog. Being a dog lover will enhance the effectiveness of Canine Therapy.

Download information on Canine Therapy:




FITNESS

Fitness can easily be ignored as an influence on PTSD resiliency or recovery; after all, most assume exercise is good for our bodies and minds, but the effects of PTSD often interfere with the motivation or energy to exercise. Many PSTD sufferers do not acquire restful sleep or are drained of energy due to depression. Exercise tends to become neglected, leading to chemical imbalances and a lack of detox via the lymphatic system, which has a strong influence on susceptibility to trauma or impedence of recovery from trauma. Addictive behaviors can compete with proper exercise (and nutrition), as well.

It is imperative that all first responders put in at least 30 minutes of focused exercise at least three times per week. Ideally this would include some measure of resistance exercise (weight lifting, swimming, mountain biking, etc.) and not simply a low-impact cardio (running, playing tennis, hiking, etc.).

Fitness for the body is always fitness for the mind. 

DOWNLOAD INFORMATION ON THE ROLE OF PHYSICAL FITNESS ON MENTAL HEALTH:






NUTRITIONAL SUPPORT

Many assume we should all eat healthier, while moderating unhealthy foods, but first responders can be deficient of certain nutrients or require higher than normal levels. Our programs teach small but significantly influential changes first responders can make that will give nutrition a strong role in trauma resiliency and recovery. 


DOWNLOAD INFORMATION ON THE ROLE OF NUTRITION IN MENTAL HEALTH:






THE SPECIFIC ROLE OF NUTRITION ON ADDICTION & RECOVER:









SPIRITUAL SUPPORT

It is unfortunate that spiritual health is often unconsidered in areas of mental health. Much research shows that mental health challenges, particularly trauma-related, are often accompanied by spiritual distress in the form of anger, shame, confusion, and even loss of faith altogether.

No outreach to mental health is complete without addressing the spiritual, and the methods of doing so can be done without prejudice against religions or denominations, or even beliefs like Atheism or Agnosticism require attention of the spirit. We are spiritual beings whether we want to admit it or not, and life presents questions of the spirit that are common to us all.

There are easy ways to incorporate spiritual therapy and counseling and, not only are there many studies on the essential role of addressing spiritual questions during trauma recovery, but many programs have implemented spiritual discussion as a part of their standard PTSD treatment program, including the Veteran's Administration's outreach to combat veterans.

Many first responder agencies already have a chaplain, but this does not mean spirituality is properly being addressed as a necessary component of the PTSD experience; therefore it is important for peer support teams and chaplains both to understand its role in the life of someone battling PTSD. As a resiliency factor, studies show that a spiritually grounded person exhibits more resistance to trauma, or able to recover faster when PTSD does occur.

Having a plan to address this important topic will go a long ways to have a properly balanced program that will address mental health issues among first responders in a way that will authentically help them. The following dowloads can help guide you in such an implementation.


DOWNLOAD INFORMATION ON THE ROLE OF SPIRITUAL SUPPORT IN MENTAL HEALTH:
FREE & CONFIDENTIAL COUNSELING RESOURCES
First responders are often resistant to taking that first step to get professional help, and usually the predominant inhibitor is lack of confidentiality or discomfort in addressing issues directly with someone they don't know. Many first responders are reluctant to bring up suicide with a therapist because they fear they will be reported as unfit for duty and deemed a harm to self or others. What options exist that may lessen their fears and get them counseling without a requirement to identify themselves?

Along with our SUICIDE RESOURCES, we have assembled some options that are nationwide counseling outreaches, some of which are specific to first responders (and veterans), and staffed by the same. All contacts in these resources are trained in crisis intervention. These confidential counseling options are FREE and available 24 hrs/day, 7 days/week, including holidays.


VIRTUAL OR TEXT COUNSELING

Over 30% of all people who call suicide hotlines hang up as soon as they hear a human voice on the other end. Virtual crisis counseling has become more popular among those in crisis and first responders are no exception. Whether it is via text or online chat, we recommend the following resources for message-based counseling:


CRISIS TEXT LINE
741741

Many prefer to communicate difficult conversations via text rather than voice. Since August of 2013, Crisis Text Line has fielded over 105 million text messages. Anyone can reach a text counselor trained in crisis intervention by sending a text to 741741. Watch a TED talk from the founder.  

MILITARY VETERANS CRISIS TEXT LINE
838255

The Veterans Crisis Line offers phone (see below), chat, and text support for Military Veterans who are in crisis and would like to speak with another veteran about their issue. The text outreach was launched in 2011 and has since fielded over 123,000 messages. Text: 838255 for help or go online to chat virtually.

LIFELINE CRISIS CHAT

Some first responders may like the idea of text counseling but don't want to use their private phone to do so. The Lifeline Crisis Chat allows users to chat for free with a counselor online without requiring any login or personal information. The program is a joint outreach by the National Suicide Prevention Lifeline and Contact USA.

IMALIVE

IMAlive is the world’s first virtual crisis center 100% staffed by volunteers who are trained in crisis intervention. In the first year since the launch IMAlive has helped thousands of people in crisis online. The online platform allows immediate rapport via a live chat interface.


PHONE COUNSELING

NATIONAL SUICIDE PREVENTION LIFELINE/THE VETERAN'S CRISIS LINE
800-273-8255 (Press 1 for Veteran)

The National Suicide Prevention Lifeline is a suicide prevention network of 161 crisis centers that provides a free 24/7  hotline available to anyone in suicidal crisis or emotional distress. The outreach was founded in 2004, taking over 1 million calls in its first four years. They offer a special hotline for Military Veterans who are in crisis and would like to speak with another veteran about their issue by simply pressing 1 during the call menu.

COPLINE (POLICE COUNSELING)
800-267-5463

Copline is a 24/7 phone line for police officers and their family members. It is answered by retired police officers who are trained in crisis intervention.

SAFECALL 
206-459-3020

Safe Call Now is a 24/7 crisis line for first responders to speak confidentially with active or retired first responders and/or mental healthcare providers who work with first responders.

FRONTLINE RESPONDER SERVICES 
866-676-7500

Frontline Responder Services is a 24/7 crisis line answered by other first responders who understand and are trained to help. They also offer other services that address addiction and marriage & family.

NATIONWIDE/STATEWIDE LOCAL SEARCH

Suicide.org offers a nationwide list of local crisis counseling services searchable by state.
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