Introduction

In April 2018, The Ruderman Family Foundation published a white paper on the subject of mental health and suicide rates of first responders. In the more than three years since that report came out, the severity of mental health challenges, and the tragic prevalence of suicide among first responders has not changed unfortunately. Indeed, the situation has been exacerbated by the COVID-19 pandemic along with increased public scrutiny and media coverage driven by police shootings. These front-line workers have faced mounting stress and isolation. Together these factors have led to a wave of resignations and retirements from law enforcement agencies (MacFarquhar, 2021). Since the publication of the white paper, several developments led to a significant increase in first responders’ stress and workload. Law enforcement agencies were affected by the ever-looming immigration crisis at the southern borders of the US, social and human rights protests, mass shootings in schools and places of worship, and civil unrest and protests. First responders had to deal with the consequences of storms and hurricanes, wildfires in California that destroyed everything in their path, and extreme temperatures that led to loss of human life. The after-effects and the toll of such stress on the lives and mental health of first responders remains to be studied and will be felt for many years to come. In our 2018 White Paper, we compared the numbers of law enforcement officers, firefighters, and Emergency Medical Technicians (EMTs) who died by suicide and of those who died in the line of duty in 2017. We found that in 2017, both police officers and firefighters were more likely to die by suicide than in the line of duty (Ruderman White Paper, 2018). In updating this study three years later, as we compare these numbers again for the years 2020 and 2021, we also need to take into consideration the implications of the coronavirus pandemic for the mental health of first responders. The COVID-19 pandemic changed life as we know it starting in March of 2020 and created new challenges that all first responders are continually facing.