Breaking the Stigma: Changing the Culture of Silence

This is the fourth article in a series called “It’s OK to Not Be OK: Real Conversations About Mental Health in Public Safety.” Over the next several months, Jason Fox will dive into topics that every EMS provider, firefighter, dispatcher, student, and leader needs to consider—not just for their career, but for their lives outside the uniform too. Read previous articles.

In previous articles, we've talked about mental health, the stigma around it, and how mental health challenges can occur. In this article, we'll start looking forward and identify ways to reduce our stress and improve our mental health.

When you think of someone who’s “tough,” what comes to mind? For a lot of us in public safety, it’s the image of a provider who never flinches, never cries, and definitely never talks about their feelings. We’ve been raised in a culture that equates silence with strength and vulnerability with weakness. But here’s the truth: Tough isn’t silent. Tough is honest.

The stigma surrounding mental health in EMS, fire, and law enforcement has been around longer than any of us. It's deeply rooted in tradition. We’ve heard it all before:

• “This job isn’t for the weak.”
• “You just have to shake it off.”
• “If you can’t handle it, maybe you’re not cut out for this.”

These aren’t just sayings—they’re cultural barriers that keep too many people suffering in silence.

Let’s be real: this job is hard. It’s heavy. And pretending that it doesn’t get to you—that doesn’t make you strong. It makes you tired. It makes you disconnected. And worse, it makes you feel like you’re the only one struggling. But I promise you—you’re not.

So why does the stigma still exist?

Part of it comes from fear. Fear that if we speak up, we’ll be seen differently. That we’ll be labeled as unstable, unreliable, or unfit for duty. That opening up will cost us our reputation—or worse, our job. In a profession built on trust and control, admitting we’re not OK can feel like handing over our armor.

Another reason? Pride. We’re helpers. Problem-solvers. The people others call when things go wrong. So, what happens when we’re the ones in need of help? For some, that feels like failure. But it’s not. It's human.

There’s also the weight of tradition. Generations before us were taught to keep their emotions locked down. They didn’t talk about stress or trauma. They coped the best they could—sometimes through humor, sometimes through silence, sometimes through unhealthy habits. They weren’t wrong for how they handled it. They just didn’t have the tools or the permission to do things differently.

Today, the conversation is changing—but slowly.

Younger generations are coming into the field with a different perspective. They’ve grown up in a world where mental health is talked about more openly. They’re asking questions, setting boundaries, and challenging the idea that “sucking it up” is the only way forward.

And for some veterans in the field, that’s uncomfortable. It feels like a challenge to the old way. But really, it’s an invitation to evolve.

Breaking the stigma doesn’t mean abandoning toughness. It means redefining it.

Tough is:

• sitting in the station and saying, “that call messed me up a little.”
• checking in on your partner and really meaning it.
• going to therapy, taking a day off, calling a friend.
• knowing when to push through—and when to pause.                                                                                                

Tough is knowing your limitations and having the courage to say, "No." No to the extra shift or to taking on yet another problem. A problem or time commitment that you simply do not have the bandwidth for. The idea that you must fix all the problems for all the people is unfair and can lead to burnout; it can also segue into depression.

Some of the bravest moments I’ve seen didn’t happen on a scene. They happened in quiet conversations after the shift. I’ve watched seasoned medics tear up while sharing how they’ve coped with loss. I’ve seen new EMTs speak up about anxiety. I’ve heard dispatchers describe the toll of hearing tragedy unfold call after call. And in every one of those stories, there was strength—not weakness.

If we want to truly support one another, we must start having real conversations. That means making space for emotion, for questions, for honesty. It means leaders going first, sharing their own challenges, modeling vulnerability, and creating a culture where mental health isn’t taboo.

This isn’t just about the big gestures. Sometimes it starts with small things:

• Say “thank you” after a hard call.
• Ask, “How are you really doing?” and wait for the real answer. 
• Share your own story, even if it feels uncomfortable.
• Shut down harmful language—“man up,” “this job isn’t for everyone,” “get over it”—and replace it with support.
• Create peer check-ins, mental health briefings, or buddy systems in your department.

Resist the urge to pile on or make the next joke. In public safety, we often use humor at the expense of others. While our intentions may be that of humor and fun, what impact are the jokes having? How can someone admit their fears, faults, or shortcomings if they’re fearful of ridicule and jokes? Again, I appreciate good humor and have made some of the darkest and cruelest jokes but at what cost? What impact did my words have on someone else? While most jokes are said with no ill intent, what impact are they having?

At home, your culture matters just as much. Talk to your spouse. Your kids. Your friends. Let them in. You don’t have to give the graphic details. But let them know when the job is taking a toll. Give them the chance to understand—and to support you versus the idea of “they won’t understand” or that you’re protecting them. By isolating them, you’re not only hurting them, you’re removing and limiting your inner circle and support.

For leaders: your role is critical. You set the tone. If you lead with empathy, others will follow. If you make mental health a priority, your team will too. It’s not about being soft. It’s about being smart. A healthy team is a strong team. A connected crew is a resilient crew.

Regardless of position, people are watching you and are often trying to emulate you. If they idolize you (and I’m sure many do) they will try to mold themselves after you. If they see you pretending to be 10 feet tall and bullet proof, they will try to do the same. Likewise, if they see their idol is human and has feelings, they are more likely to express their feelings.

So, what does it look like to break the stigma?

It looks like honesty over image. Connection over isolation. Courage over silence.

It looks like providers who aren’t afraid to say, “I’m struggling.” And teams who respond with, “We’ve got your back.”

There will still be hard days. The calls won’t necessarily get easier. But if we build a culture where it’s OK to not be OK—where talking about mental health is as normal as talking about protocols—we give each other a fighting chance to stay in this career long enough to make the difference we set out to make.

Let’s change the conversation. Let’s change the culture. Let’s remind each other: tough isn’t silent. Tough is honest. And together, we’re tougher than we think.

In the next article, we will discuss how we can’t give something we don’t have and that we can’t pour from an empty cup as we discuss the importance of self-care.