First responders supporting each other in a peer support network

First Responder Mental Health: A New Approach to Peer Support

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Mira Elwood in Health & Wellness October 2026 • 4 min read.

"REACT training program shows promise in equipping first responders to support their colleagues' mental well-being."


First responders face traumatic situations daily, putting them at high risk for stress injuries and mental health challenges. Recognizing this, public safety agencies are seeking effective ways to support their personnel's psychological well-being. Traditional approaches often fall short, highlighting the need for innovative, accessible solutions.

A promising approach involves training first responders themselves to become peer support providers. These individuals, sharing similar experiences and understanding, can offer a unique level of empathy and connection. The REACT (Recognize, Evaluate, Advocate, Coordinate, and Track) program is designed to do just that: equip first responders with the skills and knowledge to support their colleagues in distress.

This article explores the REACT program, detailing its development, core components, and the results of a pilot study evaluating its effectiveness. Discover how this training program is empowering first responders to become mental health allies, fostering a culture of support and resilience within their communities.

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Stigma, Service Use, and PTSD

Worldmetrics’ February 12, 2026 statistics report says 64% of first responders avoid seeking help because of stigma, while 12% use mental health services. It also reports that peer support programs reduce PTSD symptoms by 23%. Separately, a 2025 peer-reviewed systematic review summarized by MHStats reports PTSD prevalence ranging from 18% to 33% across studies; the range reflects variation among studies, rather than a single prevalence estimate.

The Growth of Peer Support

The FBI’s 2022 account describes growing interest and support for peer programs as first responder communities address the psychological well-being of police officers, firefighters, EMTs, correctional officers, and dispatchers. The DOJ guide notes that some agencies have provided employee peer support programs for a long time, while others share information about state and national programs. The sources describe an established but evolving practice; they do not identify a single founding milestone. TCTI describes training in recognizing warning signs, listening without judgment, maintaining confidentiality, and connecting peers with resources.

REACT: Building a Foundation for Peer Support

First responders supporting each other in a peer support network

The REACT program was developed through a collaborative effort between mental health professionals and public safety agencies. This partnership ensured the training was tailored to the specific needs and challenges faced by first responders. The program's design incorporates key principles of adult learning and social cognitive theory, emphasizing hands-on practice and skill development.

REACT training consists of four modules, each designed to build upon the previous one:

  • Module 1: Understanding Mental Health Disorders: Provides a foundational understanding of common mental health disorders, such as PTSD and acute stress disorder, while emphasizing that PSPs are not meant to diagnose or treat.
  • Module 2: Identifying Stress Injuries: Equips participants with a shared mental model and language for recognizing and discussing stress injuries.
  • Module 3: Initiating and Maintaining Conversations: Focuses on motivational interviewing techniques, overcoming stigma, and attending to both the peer's and the PSP's reactions.
  • Module 4: Acute Stress Management: Introduces acute stress management techniques, including anger management and cognitive restructuring principles.
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Evidence and Emerging Models

The article “Here for My Peer: The Future of First Responder Mental Health” notes that peer support interventions have been used successfully as a first-line psychological intervention in high-risk groups, including military personnel and firefighters. The 2nd Alarm Project paper proposes an evidence-informed, reciprocal collaboration across social work and public health practice, policy, and research to help prevent and treat trauma exposure in firefighters. A separate study of obstacles to mental health treatment included 1,485 first responders. The supplied descriptions do not report that study’s findings, so they do not support conclusions about which treatment barriers were most common.

Policy Challenges and Program Reviews

One study examined opportunities and challenges for people advancing mental health policy and programming for first responders, using qualitative content analysis and interviews with 16 firefighters and emergency medical personnel, among others. A separate review searched PubMed, Scopus, and PsycINFO for peer-reviewed U.S. studies describing, implementing, or evaluating post-critical-incident support programs for law enforcement, fire, EMS, and other first responders. The source descriptions use different approaches—interviews in one case and a literature search in the other—and do not provide results that would support a direct comparison of program effectiveness.

A key element of the REACT program is its "train-the-trainer" methodology. By training first responders to train others, the program aims to create a sustainable network of support within public safety agencies. This approach multiplies the program's impact and fosters a culture of ongoing learning and support.

The Future of First Responder Support

The pilot study results suggest that the REACT program is a promising approach to improving mental health support for first responders. Participants demonstrated increased knowledge and self-efficacy in providing peer support, indicating the training's effectiveness in equipping them with the necessary skills.

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Peer Support in Practice

The 2021 article “First Responder Peer Support: An Evidence-Informed Approach” describes exposure to intensely traumatic incidents as a potential source of adverse psychological and physiological reactions. It says peer support programs have been used to mitigate these potential effects and notes that Critical Incident Stress Management (CISM) has been widely employed in emergency services. A 2025 article highlights peer support workers’ lived experience with mental health challenges and recovery as a key part of their support for others, particularly in first responder settings.

Building Peer Leadership and Confidence

Interviews in the study “Ensuring Optimal Mental Health Programs and Policies for First Responders” included examples of first responders creating peer support teams within their departments or taking leadership roles to promote mental health. A separate 2021 intervention study delivered peer mental health support to first responders and measured self-efficacy and intentions to have supportive peer conversations before and after the intervention. Together, these sources point to department-level peer leadership and the evaluation of supportive conversation skills as areas of ongoing work. The supplied descriptions do not give the intervention’s measured results.

While the study had some limitations, including a small sample size and limited follow-up data, the findings provide valuable insights for future research and program development. Future studies should focus on long-term outcomes, compare REACT to other support models, and explore the impact of ongoing mastery experiences on skill maintenance.

Ultimately, the REACT program represents a significant step forward in addressing the mental health needs of first responders. By empowering them to support one another, we can foster a culture of resilience and well-being, ensuring they are equipped to handle the challenges they face every day. This proactive approach is essential for protecting those who dedicate their lives to protecting us.

Who took part in the REACT pilot

  • 30 individualsThe pilot involved 30 people across six public safety agencies: four fire departments and two emergency communication centers.[1]

REACT pilot study at a glance

PopulationFirst responders from public safety agencies[1]
Sample size30 individuals[1]
SettingFour fire departments and two emergency communication centers[1]
DurationAll-day training[1]
Main outcomeKnowledge and training-related self-efficacy[1]
Times cited22[1]

How later work places REACT among peer approaches

A later article cites REACT as an example of peer support used as a first-line psychological intervention in high-risk groups, including firefighters; it also points readers to the original work for development and pilot evidence.[2]

That article notes that REACT had previously been evaluated using self-efficacy, and describes a practice scale in which participants judged their certainty about completing a familiar task of increasing difficulty.[2]

What remains to be tested about REACT

  • Would the training produce similar outcomes in other public safety roles and agency settings beyond the participating fire departments and emergency communication centers?[1]

Terms used in the REACT study

REACT
Recognize, Evaluate, Advocate, Coordinate, and Track[1]

Sources

  1. REACT: A paraprofessional training program for first responders—A pilot study (Guilford Publications, 2017)
  2. Here for My Peer: The Future of First Responder Mental Health (2021)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1521/bumc.2017.81.2.150, Alternate LINK

Title: React: A Paraprofessional Training Program For First Responders—A Pilot Study

Subject: Psychiatry and Mental health

Journal: Bulletin of the Menninger Clinic

Publisher: Guilford Publications

Authors: Madeline R. Marks, Clint Bowers, Natasha S. Depesa, Benjamin Trachik, Frances E. Deavers, Nicholas T. James

Published: 2017-06-01

Everything You Need To Know

1

What is the REACT program and why is it important?

The REACT program provides a unique approach by training first responders to become peer support providers (PSPs). The goal is to equip them with skills to recognize, evaluate, advocate, coordinate, and track stress injuries within their colleagues. These PSPs share similar experiences and understanding, which can foster a unique level of empathy and connection. This is significant because traditional approaches often fall short, highlighting the need for innovative, accessible solutions. The REACT program directly addresses this need, fostering a culture of support and resilience within their communities.

2

What are the main modules of the REACT training?

The REACT program is structured around four key modules. Module 1 focuses on understanding mental health disorders such as PTSD and acute stress disorder, while emphasizing that PSPs are not meant to diagnose or treat. Module 2 is about identifying stress injuries, using a shared mental model and language to recognize and discuss them. Module 3 focuses on initiating and maintaining conversations, including motivational interviewing techniques and addressing stigma. Finally, Module 4 introduces acute stress management techniques like anger management and cognitive restructuring principles. Each module builds upon the previous one, providing a comprehensive training experience.

3

What is the 'train-the-trainer' methodology in the REACT program and why is it important?

The 'train-the-trainer' methodology is a core element of the REACT program. This means that first responders are trained to train others. This approach is crucial because it creates a sustainable network of support within public safety agencies. It multiplies the program's impact, allowing for wider dissemination of knowledge and skills. The goal is to foster a culture of ongoing learning and support, ensuring that the principles and practices of REACT are consistently reinforced and accessible to all personnel.

4

How does the REACT program help first responders recognize mental health issues?

The REACT program is designed to help first responders recognize the signs of stress injuries and mental health challenges in their colleagues. The training provides a shared mental model and language to discuss these issues, which is important because first responders face traumatic situations daily. The program focuses on equipping first responders with the ability to identify common mental health disorders like PTSD and acute stress disorder. By recognizing these issues early, first responders can support their colleagues before conditions worsen.

5

What do the pilot study results suggest about the effectiveness of the REACT program?

The pilot study results showed that the REACT program is promising for improving mental health support for first responders. The participants demonstrated increased knowledge and self-efficacy in providing peer support, indicating the training's effectiveness. This is important because it suggests that the program is achieving its goals of empowering first responders to support each other. The increased self-efficacy suggests that first responders feel more confident and capable in providing peer support, leading to a more supportive and resilient environment.

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