Table 1.

Summary of opportunities and challenges in mental health programming or policy

Theme	Description
1. Variations in programming and policy exist across jurisdictions, with small or rural departments sometimes facing barriers to robust programming.	a. Certain programs (peer support, CISM, employee assistance programs) are common across departments, but others are unique or novel. b. Health insurance benefits can vary and may be lacking among volunteer or part-time employees. c. Overall, variation is viewed both positively and negatively, depending on the circumstances.
2. Opportunities exist to enhance mental health awareness and self-care training for first responders.	a. First responders receive little or no training in mental health awareness and self-care, with training type and duration differing by profession. b. Additional training is seen as desirable.
3. A need exists for specialized mental health clinicians accustomed to and capable of effectively working with first responders.	a. There exists a need for clinicians who are knowledgeable about and culturally sensitive to issues first responders face. b. Some departments or programs engage in their own efforts to address the issue.
4. Confidentiality protections are lacking for peer supporters not trained in Critical Incident Stress Management (CISM).	a. Peer supporters who are trained in CISM are protected under confidentiality laws covering any peer discussions extending from CISM activities. b. Peer supporters lacking CISM training are not protected under those confidentiality laws.
5. Having an internal champion and broader community or political support is key to mental health program and policy advancement.	a. Robust mental health activities are often the result of grassroots efforts led by a champion rather than the consequence of top-down directives. b. Champions are often aided by broader community or political support.
6. Interdepartmental collaboration provides opportunities for sharing resources and best practices.	a. Some programs, especially peer support programs, collaborate with other departments or jurisdictions. b. Some peer support organizations share best practices with other programs or benefit from information shared with them.