First responders in crisis find help through ReST

A peer-facilitated, small-group process has proven effective in alleviating the suffering of moral injury

The nation's first responders face high-stakes challenges every day as they serve and protect our communities. Their work takes a heavy toll on their well-being and we must address the issue head-on – so first responders can find relief for themselves and their colleagues.

The toll I’m talking about is often referred to as moral distress or moral injury. While these conditions were first used with combat veterans, we now know that moral distress impacts a variety of professions, including first responders, who also engage in high-pressure, life-and-death work that can lead to utter exhaustion, a sense of inadequacy or failure, emotional isolation, sorrow, frustration, guilt, anxiety, feeling overwhelmed and wanting to end a career. These are the normal responses of people when they face devastating conditions, especially when their work is to protect and save others.

There's a lot of data showing us how deeply and profoundly moral distress impacts first responders. All you have to do is look at attrition rates to see the result. Fire Departments and EMS are facing high turnover rates. New York City recently saw its biggest exodus since 9/11 with police resignations and retirements up 32% in one year, and staffing shortages have been reported in Philadelphia, Chicago, Oakland, Los Angeles, San Francisco, Seattle and more.

Making first responders aware of moral distress and how it presents in their lives and work is crucial for their well-being and also to sustain their commitment to professions that start, for most, as a passion with a deep and important purpose.

I founded the Shay Moral Injury Center at Volunteers of America in January 2018, in honor of my friend, psychiatrist Dr. Jonathan Shay, who treated Vietnam-era veterans and coined the term "moral injury." He defined moral injury as the "undoing of character" caused by the moral anguish of what combat veterans experienced that made them question their identity and lose faith in themselves, their moral foundations and life purpose.

While a source of intense emotional suffering, Dr. Shay was adamant that moral injury is not a mental health disorder, but an appropriate response of moral conscience to devastating conditions. The pain itself is a sign of a working conscience. With his help and other experts, the Shay Center created and tested a confidential, peer-facilitated, small-group process that proved effective in alleviating the suffering of moral injury in veterans outside therapeutic counseling contexts. Non-therapeutic approaches to moral injury can be used by anyone, and having them available for those with mental health conditions like PTSD produces better outcomes for therapy.

In response to the pandemic, we used what we learned from that veterans' program to create a one-hour online program for processing moral distress in small groups facilitated by peers called ReST (resilience strength time). It uses the teamwork model so common in first responder work to create an atmosphere of mutual support, trust and non-judgment. We have learned, in our years of work with veterans and others, that these groups – whether in person or virtual – work because they offer an environment of shared understanding and compassion that builds non-judgmental relationships, encourages empathy, enhances self-worth, enables shared meaning-making, and restores moral agency. ReST helps people face the future with anticipation and curiosity.

Our VOA|ReST 4 First Responders program is free, confidential and available to first responders nationwide including firefighters, law enforcement officers, emergency medical technicians, paramedics, dispatchers and emergency department medical personnel. Groups of no more than 10 meet virtually with trained peer facilitators to maintain resiliency and their commitment to their work, and to mitigate the often career-ending effects of burnout and moral distress.

ReST for First Responders is unique in that it is available to participants when they need it and from the comfort of their own setting. Our sessions are ongoing and occur several times a week at different times of day to create options for participants. First responders are welcome to join as often as they choose because groups are not dependent upon having the same people attend each time. We protect identity by using first-names only, or even aliases should a participant choose. A session provides a safe, judgment-free space for open conversations with a peer facilitator who can identify with and understand the experiences of first responders. The peer connection is a vital component of relieving the stress and pain of their work. Together, participants practice deep listening, mindfulness and other techniques to find relief from their pain and build the resiliency necessary to continue their work and process moral distress and moral injury.

Experiences that lead to moral distress or moral injury have no fix or cure. Instead, they must be accepted as true and real, and the painful feelings they evoke must be shared so the experience can be processed through connection, sharing, listening and compassion. We know our ReST program is working – we hear that from participants every day. Research on the virtual sessions has found:

We continue to hold sessions regularly, so please join us – and encourage your friends and colleagues to try it. First responders can sign up for the free program through this link and find times that will fit your schedule. When you address moral distress and moral injury, you not only put yourself back in the driver's seat by becoming proactive and intentional – you also give yourself the opportunity to help your first responder brothers and sisters do the same.

Dr. Rita Nakashima Brock is senior vice president and director of the Shay Moral Injury Center at Volunteers of America and a leading national expert on moral injury and distress. Volunteers of America is a non-profit organization founded in 1896. One of the country's most comprehensive human services providers, it serves almost 1.5 million people annually in 46 states including children, families, those with disabilities, those who are incarcerated, veterans, the elderly, the homeless, those with mental health and addiction needs and many more.