Psychological safety, workplace incivility, and institutional betrayal: Organizational factors shaping mental health in first responders

First responders operate in high-stakes environments where organizational culture may influence mental health outcomes. This study examined the associations between psychological safety, workplace incivility, and institutional betrayal and their impact on posttraumatic stress disorder (PTSD), depression, burnout, and resilience among emergency medical services and fire personnel in Florida. A cross-sectional survey of n = 799 first responders measured mental health symptoms and organizational climate using validated scales. Findings revealed that 33.2% of respondents screened positive for probable PTSD, 32.3% reported moderate to severe depressive symptoms, and 27.6% reported moderate or high burnout. Institutional betrayal was reported by 59.5% of participants and was significantly associated with elevated PTSD, depression, and burnout and lower resilience. First responders experiencing mental health challenges reported significantly higher levels of workplace incivility. Greater exposure to incivility was strongly associated with lower resilience and higher rates of PTSD, depression, and burnout. In addition, psychological safety scores were consistently lower across all organizational levels, including supervisors, command staff, peers, and teams, among individuals with mental health concerns. These findings suggest that adverse organizational experiences may be linked to poorer mental health outcomes, regardless of role or rank. The results underscore the need for organizational interventions, such as leadership training, peer support, and transparent accountability policies, that promote psychological safety, reduce incivility, and restore trust. By addressing these modifiable workplace factors, first responder agencies can work to improve morale and wellness, while also positively influencing recruitment, retention, and overall workforce stability. Future research should explore causal pathways and evaluate the long-term impact of organizational culture change initiatives.