To our Local County Commission, Tennessee General Assembly, Governor Bill Lee, and the Tennessee Supreme Court

Subject: Demand Immediate and Comprehensive Mental Health Reform for All First Responders

We, the undersigned residents, first responders, family members, and advocates across Tennessee, urgently call upon our elected officials and judicial leaders to enact comprehensive mental health reforms that protect those who dedicate their lives to protecting us.

 

THE CRISIS WE FACE
Whereas, firefighters, paramedics, EMTs, law enforcement officers, dispatchers, and emergency medical responders are exposed to repeated traumatic events throughout their careers—including fatal accidents, violent crimes, child fatalities, mass casualty incidents, and catastrophic fires—resulting in cumulative psychological injury that often goes unrecognized and untreated;​

Whereas, approximately 30% of first responders develop behavioral health conditions including depression and PTSD during their careers, compared to 20% in the general population;​

Whereas, research shows suicidal ideation rates among firefighters range from 25% to as high as 46.8%, with suicide attempt rates of 15.5%, far exceeding general population rates of 13.5% ideation and 4.6% attempts;​

Whereas, in 2024, at least 143 firefighters and EMTs died by suicide nationwide, with experts estimating that only 40-60% of first responder suicides are actually reported, meaning the true toll may be significantly higher;​

Whereas, firefighters die by suicide at a rate of approximately 18 per 100,000, compared to 13 per 100,000 in the general population, and research demonstrates firefighters are 1.72 times more likely to die by suicide than the general working population;​

Whereas, EMS clinicians have been found to be 1.39 times more likely to die by suicide than non-EMS personnel, even after adjusting for age, gender, race, and ethnicity;​

Whereas, law enforcement officers, firefighters, and EMS personnel are more likely to die by suicide than in the line of duty;​

Whereas, the mental health burden is further compounded by excessive shift demands, chronic understaffing, and inadequate compensation, which force many first responders to work extended hours, irregular shifts, and even multiple jobs to support their families;​ These harsh realities drive sustained fatigue, erode coping skills, and make it nearly impossible for responders to recover before the next traumatic incident, creating a vicious cycle where overwork increases exposure to trauma and psychological distress;​​

Whereas, the mental health crisis among first responders is compounded by a culture of silence, stigma around seeking help, inadequate access to confidential counseling, limited peer support programs, and insufficient funding for trauma care;​

Whereas, Tennessee enacted House Bill 310 in 2025, which expanded workers' compensation PTSD presumption coverage to law enforcement officers and emergency medical responders beginning July 1, 2025—joining firefighters who already had such coverage under the James "Dustin" Samples Act of 2023—but this legislation is not retroactive and leaves behind thousands of responders whose trauma began before these dates;​

Whereas, the Tennessee Supreme Court decision of October 13, 2025, denying disability benefits to Chattanooga firefighter Matthew Long—on the grounds that repeated exposure to trauma is simply "expected" as part of the job—sends a harmful message that mental health injuries are not legitimate disabilities deserving of care and compensation;​

Whereas, many first responders face arbitrary technical barriers to accessing mental health care, including restrictive eligibility requirements, narrow definitions of qualifying trauma (such as requiring events to be "unexpected"), inadequate coverage periods, burdensome documentation requirements, and lack of family support services;​

Whereas, while Tennessee has made progress through the Public Safety Behavioral Health Act of 2018—requiring employers to provide at least 10 mental health sessions for full-time firefighters and EMS personnel—this law does not cover law enforcement officers, part-time or volunteer responders, or dispatchers, and enforcement and awareness remain inconsistent;​

 
OUR DEMANDS FOR REFORM
We therefore demand that County leaders, the Tennessee General Assembly, Governor Bill Lee, and the Tennessee Supreme Court take the following comprehensive actions:

 
1. EXPAND AND IMPROVE PTSD & MENTAL HEALTH COVERAGE
A. Make PTSD Coverage Fully Retroactive

Extend workers' compensation and disability coverage under House Bill 310 and the James "Dustin" Samples Act to all first responders, regardless of when their trauma occurred or when symptoms began.​

Eliminate arbitrary coverage start dates (such as July 1, 2025 or January 1, 2024) that exclude responders whose mental health injuries predate recent legislation.​

B. Remove Technical Barriers to Care

Eliminate the requirement that traumatic events must be "unexpected" to qualify for benefits, recognizing that cumulative trauma from repeated exposure to horrific incidents—even if anticipated as part of the job—causes legitimate occupational mental health injuries.​

Simplify eligibility criteria and eliminate burdensome documentation requirements that prevent responders from accessing needed care.
Establish a clear presumption that PTSD, depression, anxiety, and other mental health conditions are work-related for all first responders, placing the burden of proof on employers rather than injured workers.​

Ensure that cumulative trauma—not just single catastrophic incidents—qualifies for coverage and compensation.​

C. Expand Coverage Beyond Current Limitations

Include depression, anxiety disorders, substance use disorders, and other mental health conditions that result from or are exacerbated by first responder work.​

Recognize that mental health injuries often manifest years after exposure and require long-term treatment and support extending beyond one-year diagnostic windows.​

Extend coverage to all first responder categories including part-time personnel, volunteers, dispatchers, and retired responders experiencing delayed-onset symptoms.​
 
2. INCREASE FUNDING FOR MENTAL HEALTH SERVICES
A. County-Level Funding

Establish dedicated county budget line items for first responder mental health programs, including peer support teams, counseling services, and Critical Incident Stress Management (CISM) programs.​

Allocate funds for annual mental health screenings, confidential counseling sessions, and family support services for all first responders in their counties.

Fund local peer support training and team development through organizations like the Tennessee Public Safety Network.​

B. State-Level Investment

Increase state appropriations for the Tennessee Department of Mental Health and Substance Abuse Services' First Responder Mental Health Program beyond current levels.​

Fund statewide peer support networks, 24/7 crisis hotlines staffed by trained first responder peers, and mobile crisis intervention teams.

Provide grants to rural and under-resourced counties to establish local mental health infrastructure for first responders, similar to existing grant programs for PTSD workers' compensation costs.​

Ensure adequate funding for the James "Dustin" Samples Act grant program and expand it to cover all first responder categories, not just firefighters.​

C. Insurance and Benefits Reform

Require all employer-sponsored health insurance plans covering first responders to include comprehensive mental health and substance use disorder treatment with no lifetime caps or restrictive session limits.

Eliminate or minimize co-pays and deductibles for mental health services accessed by active and retired first responders.

Ensure compliance with the Public Safety Behavioral Health Act of 2018 requirement for at least 10 mental health sessions, and expand this to 20-30 sessions annually to provide adequate treatment.​
 
3. MANDATE COMPREHENSIVE MENTAL HEALTH TRAINING AND SUPPORT
A. Routine Mental Health Training

Require all first responder agencies to provide annual trauma-informed care training, stress management education, and suicide prevention programs as mandated by the Public Safety Behavioral Health Act.​

Mandate Mental Health First Aid, Crisis Intervention Team (CIT) training, or equivalent behavioral health training for all personnel.​

Train supervisors and administrators to recognize signs of PTSD, depression, and suicidal ideation, and to respond with compassion and appropriate referrals rather than disciplinary action.​

Require annual training on understanding signs and symptoms of stress, depression, anxiety, psychological trauma, complex trauma, and addiction; navigating and reducing mental health stigma; utilizing de-escalation strategies; and promoting resiliency.​

B. Critical Incident Stress Management (CISM)

Mandate Critical Incident Stress Debriefings (CISD) following all major traumatic events, conducted by trained mental health professionals and peer support teams within 24-72 hours.​

Establish county and regional CISM teams with dedicated funding, regular training, and coordination through the Tennessee Disaster Mental Health Strike Team and Tennessee Public Safety Network.​

Provide defusing sessions, demobilization support, crisis management briefings, and respite centers as components of comprehensive CISM services.​

C. Peer Support Programs

Create and fund formal peer support programs in every fire, EMS, and law enforcement agency, with trained peer counselors available 24/7.​

Protect peer support communications under legal confidentiality statutes to encourage honest, stigma-free conversations and ensure anonymity.​

Provide ongoing training and quarterly refresher courses for peer support team members.​

Fund participation in Tennessee Public Safety Network peer support training and certification programs.​
 
4. CHANGE THE CULTURE AROUND MENTAL HEALTH
A. Combat Stigma

Launch statewide public awareness campaigns highlighting that seeking mental health care is a sign of strength, not weakness, building on existing Tennessee Department of Mental Health initiatives.​

Require agency leadership to publicly support mental health initiatives and model healthy coping behaviors.

Implement the "Always Ready, Never Alone" messaging and similar campaigns that normalize mental health support for first responders.​

B. Protect Responders Who Seek Help

Strengthen prohibitions against retaliation, demotion, or termination of first responders who access mental health services or take medical leave for mental health treatment, as established in the Public Safety Behavioral Health Act.​

Ensure that seeking mental health care does not negatively impact career advancement, assignment opportunities, professional reputation, or security clearances.

Establish clear policies that mental health treatment is protected and confidential.

C. Support Families

Provide mental health resources, counseling, and education for the families of first responders, recognizing that trauma affects entire households.​

Offer support groups and crisis intervention services for spouses, children, and other family members.

Include family members in wellness programs and psychoeducation about the impacts of first responder stress and trauma.
 
5. LEGISLATIVE AND JUDICIAL ACTION
A. Expand House Bill 310 and the James "Dustin" Samples Act

Amend Tennessee law to make PTSD and mental health coverage fully retroactive and universally accessible to all first responders, including those diagnosed before July 1, 2025 or January 1, 2024.​

Clarify in statute that repeated exposure to trauma—even when such exposure is considered part of normal job duties—constitutes a legitimate occupational injury requiring full benefits and support.​

Remove the "unexpected event" requirement from pension and disability policies that deny benefits when traumatic incidents are deemed foreseeable aspects of first responder work.​

Extend the one-year diagnostic window to allow for delayed-onset PTSD and other conditions that may not manifest immediately after service or specific incidents.​

B. Reverse Harmful Judicial Precedents

Call upon the Tennessee Supreme Court to reconsider its decision in the Matthew Long case and similar rulings that deny disability benefits for mental health injuries sustained by first responders.​

Advocate for legislative clarification that mental health disabilities are compensable injuries under workers' compensation, disability, and pension law with the same standing as physical injuries.

Ensure judicial interpretation recognizes that cumulative psychological trauma is a legitimate occupational disease deserving of benefits.

C. Expand the Public Safety Behavioral Health Act

Extend coverage under the Tennessee Public Safety Behavioral Health Act of 2018 to include law enforcement officers, dispatchers, part-time personnel, and volunteer first responders.​

Increase the mandatory minimum mental health sessions from 10 to at least 20-30 annually to provide adequate treatment for complex trauma.

Strengthen enforcement mechanisms and penalties for employers who fail to comply with the Act's requirements.

D. Annual Reporting and Accountability

Require annual public reporting on first responder mental health outcomes, including suicide rates, PTSD diagnoses, treatment access, grant disbursements, and program effectiveness.​

Establish an independent oversight committee with first responder representation to monitor compliance and recommend ongoing improvements.

Mandate data collection on first responder suicides through a statewide reporting system similar to the FBI's Law Enforcement Suicide Data Collection system.​
 
OUR COMMITMENT
We, the undersigned, commit to:

Advocating publicly for these reforms at county commission meetings, legislative hearings, and community forums.

Supporting first responders and their families by reducing stigma, offering assistance, and promoting mental health awareness.

Holding our elected officials accountable by voting for leaders who prioritize first responder mental health and opposing those who do not.

Participating in local peer support networks, mental health awareness campaigns, and fundraising for first responder wellness programs.
 
CONCLUSION
Our first responders answer every call, rush toward danger, and carry the weight of our community's worst moments. The research is clear: they face PTSD at rates 5 times higher than the general population, die by suicide at nearly twice the rate of other working adults, and struggle with mental health conditions that are both preventable and treatable.​

It is time for Tennessee to answer their call with comprehensive, compassionate, and fully funded mental health support that recognizes the reality of cumulative trauma, eliminates arbitrary barriers to care, and treats mental health injuries with the same urgency and respect as physical injuries.

No more loopholes. No more delays. No more first responders left behind.