What Firefighters and Medicine Teach Us About Mental Resilience

In 1949, fifteen elite smokejumpers leaped into the Montana wilderness to confront what appeared to be a routine forest fire. Within hours, thirteen of them were dead. The Mann Gulch disaster has since become the definitive case study for how high-performing teams collapse under extreme pressure. It was not a lack of fitness or training that killed these men; it was a breakdown in sensemaking. When their commander, Wag Dodge, realized the fire had turned and ordered his men to drop their heavy tools and lie down in a patch of grass he had intentionally set ablaze – an “escape fire” – the team failed to recognise his genius. Tethered to their training and unable to make sense of an unprecedented command, they ran uphill, tools in hand, and were overtaken by the flames.

Today, Dr. Paul Barach – a physician, former military officer, and global expert in patient safety – uses the haunting legacy of Mann Gulch to challenge our modern understanding of mental resilience. With a career spanning emergency medicine, anesthesiology and health systems reform across four continents, Barach argues that the “heroic-individual” model of medicine and emergency response is not only outdated but dangerous.

Nordic Wellbeing Academy had the pleasure to chat with Barach in relation to the MentaStress project. 

Microsystems – not individuals

Barach’s central argument is blunt: resilience has very little to do with the individual if the team doesn’t support them. “The unit of performance is not the individual. The unit of performance is the clinical microsystem.”

This insight came from five years in the military, where everything he had learned in medical school was challenged. He was trained in martial arts not for violence, but to learn that even after taking a punch, you continue to do what you have to do. He went on solo navigations for dozens of miles in uncertain terrain to practise being comfortable with not knowing. Working alongside special performance teams, he concluded that the heroic-individual model that medical training had given him was simply the wrong and unsustainable model.

“Resilience has very little to do with the individual if there’s no team that supports you.”

For volunteer emergency organisations, this reframing is fundamental. A volunteer fire crew, a civil protection unit, a search and rescue team – none of these can function as a collection of individually resilient people. The resilience either lives in the team or it doesn’t exist.

Sensemaking – a skill few teach

Karl Weick, an organisational theorist, analyses the Mann Gulch disaster in 1993. According to him, the 13 smoke jumpers lacked sensemaking: the capacity to construct enough understanding of an unfolding situation to take the next step. The question Barach puts to trainees is not “what is happening?” but “do I have enough to move to the next point of uncertainty?” Waiting for certainty before acting is not caution; in dynamic environments, it is paralysis.

“He used it as a metaphor for organism – for how to survive by changing the environment around you, not just responding to it.”

The Mann Gulch commander’s escape fire was an act of applied sensemaking under extreme pressure: he changed the terms of the problem rather than trying to solve the original problem with insufficient resources. The lesson for volunteer organisations is not to train only for expected scenarios, but to always train for the routine moments when the scenario stops making sense.

Uncertainty is a resource, not a threat

A great and initially counterintuitive point from Barach is that certainty is more dangerous than uncertainty. “Certainty is very comforting, but it’s a great danger: it offers an artificial construct of security.” When practitioners feel certain, they stop scanning. They stop adapting. They stop being afraid. They miss the signals that the situation has changed.

For volunteer emergency organisations, this has direct training implications. Programmes focused exclusively on correct procedures for expected scenarios may be producing practitioners who are capable in familiar situations and brittle in unfamiliar ones. What Barach advocates for is explicit training in the unexpected – through simulation, role-playing and scenario variation – so that not knowing what to do next becomes itself a practised, navigable state.

“Mike Tyson says everybody has a plan until they’re punched in the face. Resilience is agility – a willingness to accept that there are multiple ways to reach your solution.”

Learning by design, not by chance

Barach has spent more than two decades designing structured learning moments for clinical and emergency settings. His conviction is simple: “I don’t believe in learning by chance. Learning happens when there is an explicit effort to codify the lesson, reflect on what it meant, and extract from it what’s meaningful for future encounters.”

Structured debriefing is central – but not as mere incident review. What Barach is after is what he calls “good emotional residue”: a debrief that leaves practitioners with a sense of having been seen and supported in processing what happened. This includes self-forgiveness. The “second victim” phenomenon – the responder traumatised by their own involvement in an adverse event – is real, lasting, and systematically under-addressed, leading to much burnout, broken spirited healthcare providers and turnover in emergency services. For organisations operating with limited time and resources, his advice is to start small and make it structural: even a brief, well-designed check-in after each significant call, led by a leader who models vulnerability, begins to build the reflective culture that complex emergency work requires. He advises: “Lean into near misses and near failures as they offer deep knowledge about system complexity.”

The Lesson That Took Thirty Years

Between the Mann Gulch disaster and Weick’s analysis over 40 years passed. The escape fire technique is now standard worldwide enabled by years of institutional learning. Barach finds this story both hopeful (because learning does happen) and troubling (because the pace may not be adequate for the complexity of the crises we face). However, he highlights that the pace can be accelerated through explicit, structurally embedded and deep learning processes, not through hope nor individual heroism. 

“These things are shaped,” he says. “You have to shape them deliberately.” That, perhaps, is the deepest lesson from Mann Gulch: Dodge, the commander’s escape fire was genius in the moment. The work of resilience is turning individual genius into collective knowledge – before the next fire arrives.

Further Reading

Karl Weick (1996)  “Prepare Your Organization to Fight Fires” – Harvard Business Review.

Norman Maclean (1992)  Young Men and Fire – The definitive account of the Man Gulch disaster.

U.S. Fire Administration  Man Gulch analysis and policy lessons – how the disaster became standard procedure.

Firefighter Nation  “Sensemaking and Its Effect on Firefighter and Fire Officer Decisions.”

Weick (1993)  “The Collapse of Sensemaking in Organizations: The Mann Gulch Disaster” – JSTOR.

Barach P, Phelps G. Clinical sensemaking: a systematic approach to reduce the impact of normalised deviance in the medical profession. J R Soc Med. 2013 Oct;106(10):387-90. doi: 10.1177/0141076813505045. PMID: 24097963; PMCID: PMC3791099.

Mohr JJ, Barach P, Cravero JP, Blike GT, Godfrey MM, Batalden PB, Nelson EC. Microsystems in health care: Part 6. Designing patient safety into the microsystem. Jt Comm J Qual Saf. 2003 Aug;29(8):401-8. doi: 10.1016/s1549-3741(03)29048-1. PMID: 12953604.

For more than thirty years, Steve Worrall’s professional identity was forged in the intensity of the fire service. His career progressed from trainee engineer at Rolls-Royce to Assistant Chief Fire Officer for Shropshire Fire and Rescue Service. Leadership in that environment was shaped by rigid hierarchy and a directive “Incident Commander” mindset, where the objective was always clear: rescue the casualty and bring them to safety.

When Steve later transitioned into a third career in psychotherapy, he discovered that the greatest challenge was not learning new techniques, but undergoing a profound psychological, moral and relational reorganisation. The shift required him to fundamentally rethink what it meant to lead, to help and to serve.

The Wall of “Big Boys Don’t Cry”

Steve describes the emergency services as operating within an unspoken but powerful cultural rule: “There’s still an underlying current and underlying culture within the emergency services… of big boys don’t cry and it’s a sign of weakness to put your hand up and say I’m suffering.” Whilst a structured ‘critical incident debrief’ process existed for fire crews as a form of collective group therapy post traumatic incidents, very few firefighters reached out for individual support. Emotional struggle, vulnerability or trauma were rarely acknowledged and were often viewed as weaknesses that could threaten operational credibility. Throughout his thirty-year career, Steve never cried once, even after attending hundreds of deeply distressing and horrific incidents.

The emotional wall finally cracked shortly before his retirement in 2013, while undertaking charity work in Romania. During a visit to a former prison that had become an old people’s home, he sat holding the hand of a dying woman living in appalling conditions. She asked him if he had rope on his fire engine, explaining that she wanted to hang herself. Steve says: “A tear rolled down her cheek and dropped on my hand and it was like molten metal… I came away and returned back to the United Kingdom and I cried non-stop for two weeks.”

On returning to the UK, when his senior officer witnessed him breaking down, the response was silence: the officer simply turned around and walked out. As Steve reflects, in their professional world, officers simply did not know how to respond to emotional exposure. Looking back on that period in his life, Steve is only now able to acknowledge that he unknowingly was suffering from ‘post-traumatic stress syndrome.’

From Rescuer to Empowerer

At the age of 60, Steve made the decision to “go back to school” and train as a psychotherapist. The most difficult adjustment was letting go of the rescuer role. In the fire service, Steve had been trained to take control, act decisively, and solve problems under pressure in a dynamic fast-moving environment. In therapy, his tutors repeatedly challenged him to step back, slow the pace and trust the client’s capacity for self-rescue. Empowerment, rather than intervention, became the goal.

“I wanted to be a rescuer… I wanted to dive in and rescue people and take them to a place of safety because I am an incident commander… but you have to empower people to rescue themselves.”

He also found himself wrestling with the fire service’s deeply ingrained value of perseverance. In operational settings, you never give up on a casualty. By contrast, the constraints of charitable counselling services (where clients may receive only six or eight sessions) felt ethically and emotionally uncomfortable. Accepting these boundaries required another fundamental shift in Steve’s mindset.

Redefining the Eight-Pointed Star

Currently, Steve researches how the values forged in high-risk environments are not abandoned during career transition, but transformed, which he titled Crossing the Threshold. Using the eight-pointed star – the traditional symbol of the fire service – he maps how core traits evolve within the therapeutic context.

• Observation shifts from hypervigilance to mindful presence.
• Sympathy matures into regulated empathy. 
• Tact moves from command-based authority to relational influence. 
• Gallantry is redefined as the courage to tolerate uncertainty, rather than the need for decisive action.

Steve says: “When consciously reworked, these values become resources for ethical awareness, relational depth, and sustainable therapeutic practice.” Through this lens, he reframes his professional history not as something to overcome, but as something to consciously adapt.

A New Chapter of Service

Entering the world of counselling, Steve explains, is often marked by disruption and disorientation, accompanied by a temporary loss of professional certainty. For former first responders, the transition can feel like standing on unfamiliar ground without the armour of rank or command.

Yet, through supervision, reflection, and supportive professional spaces, identity can be reconstructed rather than replaced. Instead of a loss of self, Steve sees this transition as a continuation of service in a different form.

His journey suggests that while “big boys” may once have been told not to cry, it is precisely the capacity to feel, reflect and stay present with uncertainty that enables deeper and more ethical therapeutic work.

If you would like to get in touch with Steve, please reach out to him via email.

Across the globe, a silent crisis is growing. Rates of mental illness, loneliness, and social distress are climbing, and our formal systems are struggling to keep up. But while governments and healthcare providers search for large-scale solutions, some of the most effective answers are emerging from an unexpected place: the community itself.

For a glimpse of what’s possible, Nordic Wellbeing Academy organised a study visit for 12 Estonian healthcare professionals in November 2025. One of the organisations visited was AskovFonden, a Danish civil society organization dedicated to developing social solutions for marginalised and vulnerable people. They run five core programmes (for domestic violence, eating disorders, social psychiatry, special education schools and youth) and have, since 1943, supported over 2,000 people annually through these initiatives.

Here, we are sharing the most surprising and impactful lessons from their decades of work on the front lines of social and mental health support. What they’ve learned challenges our most common assumptions and offers a powerful blueprint for a more human way forward.

To stop domestic violence, start with the people who cause it

“When we think of intervening in domestic violence, our focus naturally goes to the victim,” says Annika Svensson, who is Head of Knowledge and Documentation at AskovFonden. The foundation takes a different approach: they start with the perpetrator—revealing truths that challenge common assumptions.

Most importantly, many perpetrators were themselves exposed to childhood violence and now struggle with deep personal distress. This leads AskovFonden to question the instinct to immediately separate couples. As Annika explains: “No one wants to hit the one they love… So if you take the stand that you should separate them, we actually create more trauma because they want to be together.” Perpetrators also come from every background, not a single ‘type’. As Annika notes: “It’s not the bulky tattooed guys coming here. Not at all. It’s everyone.”

By focusing on the roots of violence rather than judgement, AskovFonden aims to break generational cycles and stop the violence for good.

Loneliness is more expensive than smoking and bad nutrition 

The numbers are staggering: loneliness costs Denmark 8 billion DKK  a year (source). To put that in perspective, the organisation’s research found a shocking truth: Loneliness is more expensive than smoking and eating badly. It is a massive factor in mental distress, a majority of people who come to AskovFonden’s social psychiatry programmes live alone.

Their solution is deceptively simple but incredibly powerful. The community centers are open 365 days a year, specifically because loneliness is most severe when the rest of the world is closed, i.e. on weekends and holidays. This provides a crucial lifeline, a place of belonging when people need it most. The results speak for themselves: 69% of participants report feeling less lonely, and 92% have successfully built a more stabile everyday life.This highlights a fundamental blind spot in our public health infrastructure. We focus on clinical treatments and individual therapies while often overlooking one of the most basic human needs: a place to belong.

To treat an eating disorder, find a “normal” roommate

AskovFonden’s rehabilitation programme for people with eating disorders is a brilliant example of social design. Instead of a purely clinical environment, they have apartments where clients live with a roommate who has a “normal” relationship with food.

The rules are strict and clear; the roommates’ only job is to live their life. The purpose is for the client to mirror the everyday patterns of another young person: to see them eat candy without guilt, share a fridge, and live without the rigid rituals that define the disorder. 

Typically, people who need to develop skills to live more independently live in shared housing. This is well suited for those who are ready to train social skills in relation to people without eating disorders. The students share the apartment with someone who does not have and has not had an eating disorder. They do not have a treatment role and are therefore not studying health or social work such as psychology, nutrition or social counseling.

This approach doesn’t replace formal therapy; it complements it. By immersing clients in a natural, non-clinical setting, it helps them re-learn what a normal relationship with food and life looks like. It uses the power of social mirroring to gently guide them back toward health, tackling a deeply psychological and isolating illness with the simple power of shared, everyday experience.

A radical return to community

The thread connecting all of Askov Fonden’s successes is a deeply human, community-first philosophy. Their work doesn’t seek to replace the formal system but to fill the critical gaps where that system so often fails. They succeed by being radically accessible and responsive. As Annika puts it, “We are not the system… We take the phone when they call.” As our societies face growing crises of isolation and mental distress, what if the most innovative solution isn’t a new technology or policy, but a simple, radical return to community?

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Five surprising innovation lessons from a Danish health initiative

Complex societal challenges—whether climate change, mental health, or broader public health issues—often become stuck in bureaucratic silos and rigid hierarchies. Well-intentioned initiatives stall under competing agendas and fragmented systems, making real progress feel painfully slow. But what if it doesn’t have to be this way?

In Denmark, a different model is showing what’s possible. The Danish Life Science Cluster, one of the country’s eight national “lighthouses,” brings together public and private partners to tackle issues such as mental health and obesity. Their approach moves beyond formal structures, prioritising collaboration and practical, measurable impact.

As Denmark’s national hub for life science and welfare technology, the Danish Life Science Cluster connects companies, researchers, and the healthcare system to drive innovation. They help turn Danish research into commercial and social solutions through public-private partnerships, regional collaboration, and international engagement.

During a study visit organised by Nordic Wellbeing Academy, 12 Estonian healthcare professionals saw firsthand how this model works in practice. These aren’t abstract theories—they’re hard-earned lessons on uniting diverse partners, learning from failure, and making real progress on problems that matter.

1. Ditch the hierarchy for a “coalition of the willing”

Instead of relying on top-down mandates, the Danish model prioritises a flexible, network-based approach. The focus is on gathering people who are genuinely motivated to address a shared challenge. Structure matters less than purpose.

“It’s like a coalition of the willing. We get the people into the room who want to address this common agenda,” says Kirsten M. Danielsen, senior project leader at the Danish Life Science Cluster.

They use a “flower” analogy: each partner is a “leaf,” bringing its own agenda and competencies. Rather than denying self-interest, the model harnesses it by uniting everyone around a strong, shared vision at the centre of the flower. This creates authentic buy-in and the agility needed to adapt without rigid hierarchies.

2. Find your breakthroughs in the “gaps”

The cluster’s work is built on the idea that innovation rarely emerges deep inside a single silo. It happens in the “gaps” between different fields and perspectives. A hospital, a tech startup, and a university researcher each see problems differently—and when those perspectives overlap, breakthroughs emerge.

To engineer these gaps, the cluster intentionally brings together public organisations, private companies, and academic experts. The result is more creativity—and more friction. Many solutions don’t fit neatly within existing funding categories: they aren’t just hospital projects or business ventures. This forces teams to stitch together a “patchwork” of financing.

As Kirsten M. Danielsen explains: “Innovation lives best in the gaps between knowledge and competences.”

3. Treat failure as a valuable data point

While many organisations bury failed projects, this model views failure as “just as valuable” as success. The philosophy is simple: fail fast, learn, and iterate. Failure isn’t an ending—it’s information.

Yet this mindset clashes with traditional funders. Large investors, especially EU programmes, are “looking very linear,” expecting predictable pathways to impact. Embracing failure requires educating funders and reframing success across a portfolio of experiments.

The payoff is clear. “One company went broke on a fast-track project after failing to secure public partners. They learned, reformed, and reapplied later with two public partners already secured,” Kirsten M. Danielsen shares. A categorical failure became the stepping stone to future success.

4. The secret ingredient is a “neutral hub”

For such diverse partners to collaborate, trust is essential. The Danish Life Science Cluster serves as a “neutral hub”—neither public nor private, but something in between.

Kirsten M. Danielsen puts it plainly: “You have to have someone who is not public and who is not private but in the middle to facilitate this meeting.”

This neutrality prevents partnerships from collapsing under mistrust or competing incentives. It creates a safe space where organisations can speak candidly, negotiate honestly, and stay focused on their common goal instead of protecting their own turf. Without this neutral facilitator, the whole structure risks falling apart.

5. Prioritise real-world data over formal evidence

While scientific research has its place, the cluster distinguishes between academic evidence and practical, real-world data. For many companies, seeing how a solution works across six schools in a municipality is more valuable for development than a peer-reviewed paper.

The Danish Life Science Cluster tracks progress using a “growth ladder” that maps a company’s journey from idea to impact. The results are significant: more than half of the companies in 2022 projects moved at least two steps up the ladder within two years.

These metrics translate to real-life impact. One company created a “midwife in the pocket” app for pregnant women, which has since expanded to Germany. Another built a divorce-support app for children—scaling from 30 Danish municipalities to 160 across the Nordic region.

As Kirsten M. Danielsen explains: “We do not research, but we can say we used this in six schools in one municipality and the solution or the results of that is so and so. So both the company and the administration get data. They don’t just say ‘I feel it’s a great idea’, but they can say ‘In this situation, it is a great idea’.”

Conclusion: A New Blueprint for Progress

Solving complex problems demands a fundamental shift in how we collaborate. The Danish Life Science Cluster offers a compelling model—one built on trust, shared purpose, adaptive learning, and real-world experimentation.

These principles aren’t just management theory. They are the engine that turns ambitious visions into solutions that improve real people’s lives. Because behind every successful innovation, the goal is always the same: to help humans live healthier, happier lives.

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How the UK police force is transforming mental health support for its officers

Policing is a profession that demands not only physical strength but also immense mental resilience. Over the past two decades, the demands on police officers have changed tremendously and so has the conversation around mental health in policing. 

To understand this shift, Nordic Wellbeing Academy spoke with Professor John Harrison, National Police Chief Medical Officer for England and Wales. His work has been pivotal in shifting the culture from one of silence and stigma to one of openness and support and how mental resilience is being prioritised in modern policing. 

The Challenges: Stigma, Culture, and Evolving Demands

Historically, policing has been dominated by a “macho culture”, where emotional vulnerability is often seen as weakness. Officers relied on coping mechanisms like dark humor, alcohol, or simply bottling up their feelings. As John notes: “Police and fire services have quasi-militaristic structures with macho cultures that historically ignored emotional feelings.”

This culture created a significant stigma around mental health, leaving many officers feeling isolated. The problem was compounded by the fact that policing itself has evolved dramatically. Where officers once dealt primarily with traditional crimes, they now face complex issues like domestic abuse, sexual violence and online paedophilia – all of which carry a heavy psychological burden.

Another challenge is the lack of experience among newer officers. John points out that around 25% of officers today have less than five years of service, meaning they often lack the maturity and coping skills to handle the traumas they encounter.

Building Resilience: From Individual to Organisational Support

John explains, “Peer support networks allow officers to speak with colleagues who understand their experiences. This creates a sense of camaraderie and trust, which is essential for breaking down barriers to seeking help.”

Additionally, external networks of trauma therapists have been established to provide specialised care, such as Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR). These therapies are designed to help officers process trauma and build resilience.

While individual resilience is critical, John emphasises that organisational resilience is equally important. This means creating a work environment that supports mental wellbeing through policies, training, and leadership. He states, “We’re shifting from focusing solely on individual resilience to building organisational resilience. This involves training managers to recognise signs of stress in their teams and fostering a culture where wellbeing is prioritised.”

Increasingly, data analytics play a crucial role, too. By tracking metrics like sickness absence, burnout rates, and presenteeism, the police force can identify trends and tailor their support programmes more effectively.

The Future of Mental Health in Policing

As John puts it: “We’re trying to embed the concept of wellbeing in our workforces, with leadership from everybody in policing from a wellbeing perspective.”The goal is to create a culture where mental health is not just discussed but actively supported – where officers feel empowered to seek help without fear of judgment. With continued effort, collaboration, and investment, the future of policing can be one where resilience and wellbeing are at the heart of the profession. For now, the message is simple: mental health matters, and in policing, it’s not just a personal issue – it’s an operational necessity.

As part of the MentaStress project, NWA visited Greater Copenhagen Fire Departmentin April 2025 and learned more about their history, transformational journey, and current landscape of psychosocial support. MentaStress aims to enhance mental health and stress management for first responders through augmented reality (AR) training.

More recently, NWA Senior Communication Advisor, Anna Gallinat, had the chance to interview Christian Hagelund Vangsgaard, firefighter and crew commander in Copenhagen, who is driving the change for more mental resilience on the job. 

In 2017, tragedy struck at an Ariana Grande concert in Manchester, England, when a terrorist attack killed 22 people and injured over 1,000. While the headlines focused on the victims and the perpetrator, a lesser-known aftermath unfolded quietly within the emergency services. A crew of firefighters called to the scene were denied entry due to misinformation and security protocols. Treated as an active shooter situation, the incident led police to hold back the fire crew – a decision that had deep psychological consequences.

“Not being allowed to do your job is one of the key factors for developing Post-Traumatic Stress Disorder (PTSD), which is what happened there,” explains Christian Hagelund Vangsgaard, Crew Commander for the Greater Copenhagen Fire Department.

Around 10 years ago, the Department started recognising that large-scale security incidents like terror attacks were no longer remote possibilities but real threats. Greater Copenhagen’s fire service launched a new wave of training programmes, which aimed not only at technical readiness but also at mental resilience.

The training initiative was spearheaded by Christian and his colleague Andreas Corell, who believed that modern emergency response demanded a new mindset. Firefighters were trained to handle high-stress, high-risk environments as well as how to process the psychological impact of those events. The goal: to prevent PTSD by addressing its root causes – lack of preparedness and the inability to act.

The biggest challenge wasn’t the technical component. It was changing a deeply ingrained culture. According to Christian: “The biggest part was not the technical preparation, like how to do a special kind of first aid. It was to change the mindset that these incidents are dangerous in a different way and that mental preparedness as well as resilience are big parts of it.”

In a traditionally stoic and physically demanding profession, change isn’t easy. The fire service, like many emergency organisations, has long been steeped in a culture that rewards toughness and discourages vulnerability.

  “Culture is a difficult thing to change, but not impossible.”

Christian Hagelund Vangsgaard

To shift the mindset, Christian began with leadership – his own. After each emergency call, his team holds a debrief. These start with a discussion of technical actions, but in more significant situations, they also include mental and psychological evaluations. As crew commander, Christian leads by example: “I feel it is my responsibility to set an example, not just on the technical side of a call, but also on the mental aspects of the job.” He usually begins by sharing how a particular incident affected him emotionally, which encourages others to do the same.

“We all get affected by something at some point in different ways. And it’s okay to get emotionally affected, because we’re not made of stone. We are whole human beings, not machines.”

Today, the Greater Copenhagen Fire Department includes mental resilience as a key part of its operating model. “The more you talk about it, the more you normalize it,” says Christian. His leadership has helped foster a culture that embraces emotional awareness alongside operational excellence. The shift from silence to dialogue, from suppression to resilience, is making the department stronger, better prepared and more human.