Help for the helpers: a systematic review of factors influencing help-seeking in emergency service personnel

Given the physically and emotionally demanding nature of their work, many emergency service (ES) personnel encounter personal mental health challenges during their careers. However, there is often an unmet need for mental health support, as many ES workers are reluctant to seek help, and thus delay or avoid accessing appropriate supports. In order to improve and increase mental health help-seeking for such professions, it is vital to understand the barriers and facilitators to help-seeking in this population. The present study is a systematic review of the extant literature to determine what factors influence help-seeking in paramedics, firefighters, police officers, and emergency department doctors and nurses. A search was conducted across seven databases (PubMed, MEDLINE, PsycINFO, PsycARTICLES, CINAHL, Cochrane Library and Scopus) up to September 2021. Peer-reviewed studies published in English that examined help-seeking and at least one potential influencing factor within any of the abovementioned professions were eligible for inclusion. However, studies were excluded if they solely examined ES personnel in training, in the armed forces, or in the context of specific documented events (e.g. natural disasters, disease outbreaks, or acts of terrorism). Quantitative findings were synthesised using narrative synthesis, and qualitative data was analysed thematically. Methodological quality across all included studies was assessed using the Mixed Method Appraisal Tool (MMAT). Sixty-five articles met the inclusion criteria, comprising 40 quantitative studies, 17 qualitative studies, and eight mixed methods studies (106,199 total participants). Stigma-related concerns were the most prominent barriers to help-seeking across the studies. A broad range of help-seeking facilitators were also identified, including organisational support, referral processes, and appropriate accessible supports, but each of these alone may not be sufficient to facilitate help-seeking for all ES personnel. The review was limited by regional and English-language restrictions, the small number of available studies on some ES populations, the exclusion of certain ES populations, and a limited yield of studies examining physical health. Additionally, help-seeking was variably measured, and most findings were correlational. Nevertheless, the studies overall indicated that aspects of ES roles may exacerbate regular barriers to help-seeking, and thus there is a need to account for the unique nature of the ES role in designing support services and structures to improve the mental health and wellbeing of ES personnel.