Editor’s note: This story includes discussion of suicide. If you or someone you know is considering suicide, resources are available to help. Please see the box below.
The messy hair, scraggly fingers, white T-shirt. Charlie Vazquez still remembers every detail.
Twenty-two years ago, Vazquez was a Houston police officer planning the arrest of a man on parole who’d served time for kidnapping and sexually assaulting a child. Vazquez and fellow officers surrounded the man’s house and then he walked out, armed with a pistol.
The man aimed the gun at Vazquez and his partner. Then he turned the weapon on himself and died by suicide.
Vazquez could not sleep for months. The way the man died kept him up, and so did the thought that he and officers could have been killed.
“I started to second-guess myself a lot while on the job,” he said.
Vazquez is now Tampa International Airport’s police chief and said he still suffers from post-traumatic stress. In his line of work, he is hardly alone.
Constant exposure to trauma and death, experts say, leave first responders suffering from depression, anxiety, substance abuse and post-traumatic stress disorder at rates that far exceed the public they serve.
The stigma of asking for help exacerbates the crisis. Firefighters, law enforcement officers and paramedics are 10 times more likely to attempt or contemplate suicide compared to civilians, according to a study published six years ago in the Journal of Emergency Medical Services.
This year, 120 law enforcement officers in the U.S. have reportedly died by suicide, nine in Florida. That’s the lowest number since 2017 and below the five-year average of 149 suicides a year. Florida officers typically make up 7 percent of annual suicides, according to First H.E.L.P., an organization that collects first responder suicide data.
But that doesn’t mean the situation is improving, said Steven Hough, chief operating officer at First H.E.L.P.
He believes the drop in reported suicides is a result of underreporting during the pandemic. He said suicide reports made to the organization started to fall when the coronavirus first spread in 2020. COVID-19 has also become the leading cause of death for the nation’s officers over the past two years.
The health threat likely upended first responders’ routines, left them with more stress and reduced efforts to track suicides.
“This is speculation,” Hough said, “but I think what you’re going to see as we get past coronavirus is those numbers back up to a level that previous years have met.”
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Officer suicides peaked with 197 two years ago. The problem is so pervasive that law enforcement officers are more likely to die by suicide than in the line of duty, according to First H.E.L.P.
Vazquez fears that the nature of the profession itself is part of the problem. Police officers may worry that showing weakness or asking for help could jeopardize their careers, he said, which for many is their whole identity.
“Being a police officer is all you know,” the chief said. “If you’re not a police officer, what are you?”
• • •
Last year, former Sunstar paramedic Miguel Medina and his colleagues helped a gunshot victim who had called police to tell them that he planned to die by suicide.
He told police to come soon, because he didn’t want kids playing at the South Pasadena park to see his body. Then he hung up and shot himself.
After Medina and others loaded the man into the ambulance, they put a bag valve mask over his mouth to help him breathe. When Medina squeezed the mask to force air into the man’s lungs, blood sprayed all over the cabin.
The paramedics rushed to the hospital, Medina said, but the man’s pulse stopped within minutes.
Vivid images of trying to save the man are seared into Medina’s memory. To him, he failed.
Flashbacks are a symptom of PTSD. Other symptoms include nightmares, sleeplessness, poor appetite and feeling irritable or hyper-stressed, said Deborah Beidel, executive director of UCF Restores, an Orlando facility that offers post-traumatic stress treatment to first responders and veterans.
A PTSD diagnosis is often coupled with a diagnosis of depression. Those symptoms are a normal, short-term response to a highly stressful event, Beidel said. Treatment becomes necessary when symptoms persist for months.
Medina said he avoids driving by the location, but there are other triggers: A co-worker makes a dark joke about suicide, a television show depicts paramedics responding to a call or Medina inevitably drives by the sites of other emergencies.
Medina spent eight years working as an emergency medical technician and two years as a paramedic. The pandemic last summer, he said, caused his ongoing depression to spiral into thoughts of ending his own life.
He said COVID-19 made a demanding job feel nearly impossible: emergency calls shot up while the virus infected co-workers, causing staff shortages. Instead of working three or four 12-hour shifts a week, Medina said, he worked four or five.
He treated trauma after trauma, with no time in between to process. He no longer saw friends, exercised or thought about who he was when he wasn’t rushing to the scene of someone’s worst or last moment.
Then there were the patients who told Medina that COVID-19 wasn’t real as he treated them for the virus.
“I was losing a sense of self and what the purpose was for being alive,” he said.
After four months of suicidal thoughts, Medina handed in his resignation in May.
The Largo resident now works as a medical screener for a pharmaceutical company. He’s 34 and thinking about going back to school to become a physician assistant.
Recovering from a decade’s worth of trauma is an arduous and ongoing process, Medina said, but stepping away from first response and meeting with a therapist at a veteran’s hospital every two weeks has made a major difference.
“I’m doing a lot better now,” he said.
• • •
“Last to Ask” is a campaign the Crisis Center of Tampa Bay launched in August to promote its new first responder helpline.
Frontline workers can call 866-435-4376 to speak with one of 18 staff members trained to answer crisis and suicide calls and connect callers with additional help and resources. The goal is to eventually have first responders answering calls from colleagues and offering peer support, said Clara Reynolds, CEO and executive director of the Crisis Center.
The initiative is personal to Reynolds. In 1973, her mother, Lenora Ann Booth, became the first woman to serve as a Tampa police officer. Then in 1986, Booth died by suicide at age 37. Her daughter was 15.
Reynolds recalled seeing her mom walk into her bedroom and hearing a snap when Booth removed her gun from its holster. Through the reflection on the dark window across the bedroom, Reynolds watched her mom pull the trigger.
In her 12 years on the force, Booth served as an undercover narcotics officer, investigated sexual crimes against children, became a detective and was promoted to sergeant in 1982. But being an officer placed her mother under incredible stress, Reynolds said.
“She had a marriage that fell apart, found herself having to figure out how to support this child and embark upon this career that, in 1973, was just unbelievably unreasonable for a woman to want to become a police officer.”
Until Reynolds became a mom herself, she said every Mother’s Day brought a rush of emotions — sadness from missing her mom, anger at her for leaving. These feelings still come from time to time, notably during milestones like her son’s high school graduation in May. She wishes her mother could have been there.
Reynolds attributes her decision to become a behavioral health professional to an innate drive to help others — a value she said she shared with her mom — and a lifelong desire to understand what drove her mother’s suicide.
“What was the decision point? What was it about that day? Was it a culmination or was it really just a split decision?” Reynolds said. “Those are questions I’ll never have answers to.”
Reynolds said her mother suffered from a medical condition that can play a role in first responder suicides: alcoholism.
Increased alcohol and substance use is a significant risk factor linked to first responder suicides, Hough said. Over 20 percent of all suicides in the country involve intoxication, according to the U.S. Substance Abuse and Mental Health Services Administration.
At UCF Restores in Orlando, Beidel said, 6 percent of first responders are diagnosed with substance abuse issues such as alcoholism, and many more patients struggle with mild to moderate alcohol dependence.
• • •
Protests swept the nation last year after George Floyd was murdered. His death led to a national reckoning with systemic racism and police brutality. The “defund the police” movement reached prominence during the protests.
The movement and protests weighed heavily on officers’ mental health and sapped morale in many agencies, said Vazquez, Tampa International Airport’s police chief. Wherever officers turned — the TV, the internet, the radio — he felt like their profession and role in society was being degraded.
Since last summer, he said the application rate to join his department fell by half. Many veterans retired unexpectedly, citing what Vazquez called the “current political climate.”
Nationally, the retirement rate for officers increased by 45 percent and the resignation rate by 18 percent between 2020 and 2021, according to the May Police Executive Research Forum survey of about 200 police departments. There was a slight decrease in hires, but the survey found that the agencies were still filling 93 percent of their positions.
The purpose of last year’s protests wasn’t to demoralize officers, said Brittany Peters, director of the Center for Wellness and Clinical Development in Tampa. The movement’s goal was to direct attention to police brutality in Black communities and called for diverting funds from law enforcement budgets to underfunded community needs.
She also pointed out that supporting officers’ mental health is critical for the communities they serve. Research shows that officers who exhibit abusive behavior on the job are more likely to report post-traumatic stress symptoms, Peters said.
PTSD is commonly associated with childhood traumas that can result in poor emotional regulation as an adult, Peters said, so officers should learn to process their traumas and manage ongoing stress when they enter the profession. But she said that doesn’t mean mental illness is to blame for police violence or biased policing.
“When a lot of people hear (defund the police), they feel as though we’re going to have a society where there’s no law enforcement and that’s scary, " Peters said. “But at the same time, the reality is that there are people who don’t feel safe with law enforcement in their community.”
• • •
The stigma of asking for help and a culture that expects first responders to “suck it up” puts them at particular risk of post-traumatic stress, said Beidel, the director of UCF Restores and a professor of psychology and medical education at the University of Central Florida.
“When there’s no help,” she said, “the only relief they can think of is taking their life.”
The intensity of their experiences can make it harder for first responders to find help. Therapists who aren’t trained to treat first responders can be overwhelmed by their experiences, Beidel said. Often the patient ends up having to console the mental health professional.
She has treated at least 25 first responders who told her their former therapists decided they could no longer treat them because they couldn’t handle their traumas.
“The message this sends first responders is that you can’t be cured or you can’t be helped,” Beidel said.
The solution is to train therapists in the culture, language and issues of the first responders they’re treating.
Every therapist at UCF Restores takes a cultural competency course taught by the Florida Firefighters Safety and Health Collaborative. They learn the lingo and lifestyle of the job, try on firefighting gear and visit firehouses. They also shadow police officers, riding on patrol and learning about assignments and workdays.
The members of the Sun Coast Police Benevolent Association, a Pinellas County police union, are referred to a short list of civilian therapists who have been known for their ability to handle law enforcement trauma, said president Jon Vazquez, a St. Petersburg canine officer.
Some law enforcement agencies hire a mental health professional to counsel officers, but he said fear of that information reaching supervisors keeps some from opening up to their agency counselors.
Since becoming president last year, Vazquez said union leadership has urged state and local officials to fund a scholarship program that encourages retired officers to become licensed mental health professionals.
The program would meet the needs of both officers who want peer-driven mental health care, he said, and law enforcement retirees who want to continue working in public service.
• • •
At UCF Restores, two-thirds of the patients treated each year are first responders. Almost half suffer from PTSD, and another 11 percent have some symptoms of post-traumatic stress.
A quarter of the first responders at the facility also are diagnosed with anxiety disorder, Beidel said, while many struggle with alcohol abuse and depression.
The facility offers a three-week intensive outpatient program. The morning is dedicated to exposure therapy, Beidel said, which uses virtual reality to expose the patient to the sights, sounds and smells of their specific traumas. Sessions can go for two hours, decreasing as the patient becomes increasingly desensitized.
First responders and veterans spend afternoons building skills to cope with common PTSD symptoms, such as anger management and poor sleep habits.
Therapists also lead discussions about guilt and moral injury, Beidel said, which can occur when, inevitably, a first responder cannot save someone.
“When we ask our first responders what’s the most traumatic thing they experienced,” Beidel said, “most of the time they say it’s a child’s death.”
Beidel said that 76 percent of first responders and 66 percent of veterans who graduate from the program no longer meet the diagnostic criteria for PTSD.
First responders who cannot travel to Orlando for the three-week treatment can call UCF Restores for a one-session consultation. A clinician starts the call by asking why the frontline worker decided to call and, if they had a magic wand, what in their life they would change. Then the clinician helps set a behavioral or mental health goal and a plan to achieve it.
“If the goal is to stop snapping at wife and kids,” Beidel said, “then we figure out how to help them be less irritable or calmer.”
Doctors treating COVID patients also have been utilizing this program, Beidel said.
Patients receive treatment free of charge at UCF Restores, which is funded by the state. Any Florida first responder or veteran is welcome, Beidel said. The facility offers to pay for a three-week hotel stay for patients who travel from outside Orlando.
UCF Restores began 10 years ago as a federally funded research program to create a PTSD treatment program for Iraq and Afghanistan war veterans, Beidel said. The facility has since expanded to treat patients suffering from a range of frontline trauma. It includes the National Center of Excellence for First Responder Behavioral Health, which matches firefighters and EMS workers with trained peer support.
Beidel said agencies that employ first responders must make sure their insurance covers mental health care, doesn’t limit sessions and offers a wide range of approved providers.
The paperwork alone can be so burdensome that it keeps some from seeking help, Beidel said.
Medina, the former paramedic, said employers should take the lead in destigmatizing professional mental healthcare by encouraging frontline workers to take regular paid time off for therapy.
“We shouldn’t think about a stress injury differently from a leg injury,” Beidel said.
• • •
In 2018, Gov. Rick Scott signed a bill that extends worker’s compensation benefits to first responders diagnosed with PTSD. Tampa International Airport police Chief Charlie Vazquez said the legislation was a critical step forward but didn’t go far enough.
The statute states that the first responder must notify their employer of the PTSD claim within 52 weeks of the traumatic event to qualify for benefits. But individuals suffering from post-traumatic stress often take years to recognize that they need help, Vazquez said. It can take even longer to get a professional diagnosis.
When Vazquez served as the president of the Tampa Bay Area Chiefs of Police Association two years ago, his platform was officer suicide prevention. The association is composed of the top officials from 30 law enforcement agencies in seven bay area counties. He organized events where experts educated police chiefs on the importance of mental health and encouraged them to continue the conversations with their departments.
Vazquez represents the association on the governor’s task force for first responder suicide. He said the group submitted its proposal for statewide mental health education and training in law enforcement to the governor two months ago.
“I am working hard to remove the stigma of talking and asking for help,” Vazquez said, “but I didn’t do that myself.”
In his nearly three decades in law enforcement, Vazquez had never recounted to anyone — family member, colleague, mental health professional — his trauma outside the sex offender’s house in Houston and how it affected him, until now.
Vazquez said he hardly remembers the thousands of names he has worked with over the years. But he can recall that man’s name — and the loud thump of his body hitting the deck of the house.
He wanted to ask for help, but he said he was too afraid of being seen as weak. Times have changed, the chief said.
In leading by example, Vazquez said he hopes to encourage other first responders to protect the vulnerable and, for once, be vulnerable with others.
If first-responders need help
If you are a first-responder in crisis or know one who is, these resources can help:
Call the Crisis Center of Tampa Bay’s first responder helpline at 1-866-435-4376 or dial 211. Visit lasttoask.com online to learn more about the program.
Call UCF Restores, an Orlando facility that treats first responders and veterans. For consultations and general inquiries call 407-823-3910, for a single-session consultation call 407-823-1657 or go online at ucfrestores.com. To contact UCF Restores online at go to ucfrestores.com/contact.
Call the Veterans Crisis Line by dialing 800-273-8255 and pushing 1. Send a text to 838255 or use the online chat at veteranscrisisline.net/get-help/chat
Call the National Suicide Prevention Lifeline at 800-273-8255.
If you need help
Need help? If you or someone you know is contemplating suicide, reach out to the 24–hour National Suicide Prevention Lifeline at 1-800-273-8255; contact the Crisis Text Line by texting TALK to 741741; or chat with someone online at suicidepreventionlifeline.org. The Crisis Center of Tampa Bay can be reached by dialing 211 or by visiting crisiscenter.com.