The 2025 fall Institute for Research on Poverty seminars hosted “Who Responds to Mental Health Crises in Wisconsin?” on Thursday, Sept. 18, open to the public for discussion focusing on frontline worker mental health crises, and building community-engaged responses.

The UW Institute for Research on Poverty began presenting the seminars in 2016. The seminars cover specific intersections of a wide variety of topics, ranging from race to economic and family systems, according to the IRP.

Rural EMS outreach program manager, James Smalls, who previously served as the Chief of the Palmyra Public Safety Department and Altoona Fire Chief and spoke on emotional exhaustion, stress and problems managing a work and life balance while being a first responder. Many first responders face mental exhaustion, particularly in rural areas and leadership positions, Smalls said.

Consequently, many front-line workers face personal mental health crises, which are often overlooked, according to Smalls. 

“When you go down that trauma rabbit hole, it’s very isolating,” Smalls said. 

Smalls said the only time he felt “normal” was when addressing the emergency, while the rest of the time, he felt unable to function. The mental turbulence caused by experiencing  critical emergencies is among many reasons why EMTs leave the field earlier than other first responders, said Smalls — it’s the workplace culture, according to Smalls. 

The state of Wisconsin provides limited funding to emergency departments, and leadership development and responder training is poor, Smalls said. 

Although the stigma surrounding mental health care impacted his career, views surrounding counseling and mental health are improving by the generation, Smalls said.

“Up until now it was — you suck it up, you go home, and you don’t talk about it . . . what we were experiencing was considered normal,” Smalls said.

According to UW’s nursing school assistant professor Rachel Odes, a multitude of problems can arise when workers on the frontlines who are not trained in addressing mental health crises get involved in said emergencies. 

Madison’s Community Alternative Response Emergency Service is dedicated to caring for people in mental health emergencies, Odes said.  A majority of Wisconsin areas tend to rely on frontline workers, unaware of specialized behavioral units, according to The Capital Times. 

Because most first responders are taught to deal with those in physical crisis, not mental crisis, they often go into mental health emergencies ill-prepared, which can be detrimental to both the individual in need of rescuing and the rescuer, according to Smalls.

Front-line workers in crises are often forced to make moment-to-moment decisions under pressure with no real instruction, Odes said.

Madison Fire Department paramedic Paco Bonnín said receiving non-trauma-informed care after a traumatic event can be very dehumanizing for patients.

Instating CARES teams across the state could make traumatic incidents and crises safer for emergency responders and people in need alike, Bonnín said.

“In the long view, [mental health care] is about taking small little steps to the outcome that the world wants,” Smalls said.