Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Services Research & Administration

First Committee Member

David W. Palm, PhD

Second Committee Member

Hongmei Wang, PhD

Third Committee Member

Rachel E. Lookadoo, JD


Suicide is ranked as one of the leading causes of death in the United States. Over 40,000 individuals die by suicide each year (Stanley, Hom, & Joiner, 2016; Vigil et al, 2021), and, in 2020, it was ranked in the top 9 causes of death for all ages (10-64), and second for those 10-14 and 25-34 years of age (Centers for Disease Control and Prevention, 2022). These statistics disproportionately reflect first responders (i.e., firefighters, dispatchers, law enforcement, EMS, paramedics, etc.), as they die by suicide more than the general public (National EMS Management Association, 2016). Within their line of work of saving lives, these individuals are prone to witness more traumatic events and encounter death more than other professions. As a result, first responders may not have the appropriate practices in place at their workplace that ensure that their mental health is improving as they encounter these events continuously. This qualitative study seeks to identify the formal policy(s), procedures, or regulations that have been established in Nebraska that assess the risks and challenges first responders encounter on the job that affects their mental health and well-being. Results uncovered five themes that address not only why first responders die by suicide at a higher rate than the general population, but how effective the current Nebraska policies are and what changes in state policies Nebraska first responders want to see happen: (1) horrific encounters tied to mental illness, (2) “suck it up” mentality, (3) organizational trust, (4) lack of mental health policy in Nebraska, and (5) prevention strategies and recommendations for policy.