Alive Is Too Low a Bar: A Quality of Life Checklist for Measuring More Than Crisis

A Quality of Life Checklist for Measuring More Than Crisis

Most of the questions we ask about first responder mental health are designed to find out how bad things have become.

Are you depressed? Are you drinking too much? Are you having nightmares? Are you thinking about hurting yourself? Do you have a plan? Do you have access to the means to carry it out?

Those questions matter. When someone may be in immediate danger, we need to ask direct questions and take the answers seriously.

But those questions measure how close someone may be to dying. They don’t necessarily tell us how much of their life is still available to them.

In Episode 164 of After the Tones Drop, I ask a different question:

What are we keeping people alive for? Because there are a whole lot of ways to lose your life without actually dying. You can lose your marriage. Your friends. Your sleep. Your sense of humor. Your relationship with your kids. Your interest in things you used to enjoy. Your identity outside the job. Your joy. Your peace of mind.

You can gradually lose almost everything that once made your life feel like yours and still wake up every morning, put on the uniform, and go to work.

You’re alive. But alive is too low a bar.

What if we measured what is still present?

Traditional assessments are usually designed to identify problems, symptoms, risks, and deficits. They ask how much pain exists and whether that pain has become dangerous.

But quality of life cannot be measured only by the absence of an emergency. So what if we also looked for the presence of the things that make a life feel livable?

Connection. Rest. Pleasure. Belonging. Curiosity. Hope. Choice. Identity. Something to anticipate. People and places that feel like home.

This is not a suicide-risk assessment. It cannot determine whether someone is safe, and it should never replace a direct conversation or professional evaluation when there is concern about suicide.

This is something different. It is a way to notice whether a person’s life is expanding, shrinking, or becoming increasingly difficult to inhabit.

It is a way to ask sooner. Before the crisis. Before the bottom. Before the house burns down.

The Quality of Life Checklist

Think about an ordinary week. Not vacation. Not a particularly awful shift. Not the best day you’ve had in six months.

Think about Tuesday.

For each statement, answer:

• Usually

• Sometimes

• Rarely

• Not anymore

That last answer matters.

There is a difference between something that has never been part of your life and something you once had but have gradually lost over time. Not necessarily in the last two weeks or even the last thirty days, which is often the measuring unit for diagnostics.

Rest and recovery

• I get enough sleep to feel restored at least some of the time.

• I can rest without feeling guilty, lazy, or useless.

• My body can come down after work.

• I have periods when I am not waiting for the next problem.

• I can sit still without immediately needing distraction, noise, alcohol, work, or my phone.

• I can get up and get motivated after resting.

• My days off include some actual recovery, not only errands, childcare, another job or simply catching up.

• I know what helps my nervous system understand that the call is over.

First responders are trained to activate quickly. The body learns to move, scan, anticipate, and respond. The question is whether it also remembers how to stand down.

Being exhausted all the time is not proof that you are dedicated. Being unable to relax is not simply your personality. And sleep is not an optional wellness luxury you earn after everything else gets done.

Rest is part of having a life. Waiting until you're dead is bullshit, despite the common saying. 

Connection at home

• I generally like going home.

• The people I live with experience me as emotionally present.

• I know what is currently happening in the lives of the people I love.

• I can listen to a story that has no urgency and possibly no point.

• I can receive affection without feeling uncomfortable or impatient.

• I can talk about something besides work, problems, logistics, or what needs to get done.

• There is at least one person at home who knows how I am actually doing.

• I still experience warmth, playfulness, affection, or intimacy in my closest relationships.

Sometimes a responder is physically home but neurologically still at work. They are sitting on the couch, but part of them is still scanning. Their spouse is talking, but they are only catching every fourth word. Their child wants attention, and every sound feels like another demand.

They came home, but they never really arrived.

That does not mean they do not love their family. It may mean the transition from work to home needs more attention than anyone realized.

Friendship and belonging

• I have someone I can call without needing a reason.

• I spend time with people I actually enjoy.

• At least one person knows me as more than my rank, role, title, or usefulness.

• I do not have to perform competently all the time.

• I can admit when something is difficult without immediately making a joke or minimizing it.

• I feel like I belong somewhere.

• I initiate contact instead of waiting for everyone else to reach out.

• I have not quietly disappeared from the people who care about me.

Isolation does not always look like sitting alone in a dark room. You can be surrounded by people all day and still be profoundly isolated.

You can answer every radio call, sit at the kitchen table, participate in the group chat, and have nobody who knows what is happening inside you. Proximity is not the same as connection.

Fun, pleasure, and uselessness

• I regularly do something because I enjoy it.

• I have fun that does not need to produce an outcome.

• I can participate in a hobby without turning it into competition, training, income, or another accomplishment.

• I laugh out loud regularly.

• I can be completely fucking useless for an afternoon without hating myself for it.

• I still notice small things that feel good.

• I have something in my life that would look unnecessary on a résumé.

• I can remember the last time I had fun without needing alcohol to get there.

This category can be surprisingly difficult for highly competent, productive people.

Tell them to complete a task and they will get it done. Tell them to train for something, fix something, build something, lead something, or help somebody, and they know exactly what to do.Ask what they do purely for fun and suddenly the room gets quiet. A life made entirely of usefulness may look successful from the outside. It can also become incredibly lonely to live inside.

Identity outside the job

• I know who I am when nobody needs anything from me.

• I have relationships that are not based entirely on the job.

• I have interests that existed before the uniform or could continue after it.

• A bad shift does not determine my entire sense of worth.

• I can imagine a meaningful life after retirement, injury, transfer, or career change.

• I can describe myself without leading with what I do for work.

• There are parts of my identity that no department, diagnosis, investigation, injury, or retirement can take from me.

The job can be deeply meaningful. It can provide purpose, identity, structure, competence, community, and belonging.

That is exactly why it can become dangerous when the job becomes the only place those things exist.

If the uniform becomes the whole person, anything that threatens the uniform begins to threaten the self.

We should not wait until someone loses their career to ask who they are without it.

Presence

• I can stay mentally present during ordinary moments.

• I notice when someone I love is trying to connect with me.

• I can eat a meal without rushing through it.

• I can watch a movie, take a walk, or have a conversation without constantly checking my phone.

• I remember portions of my life that have nothing to do with emergencies.

• I do not feel as if I am always trying to get through today so I can begin living later.

• I participate in my life instead of only managing it.

Most of life does not happen during the major events.

It happens while someone is telling you a long story in the kitchen.

It happens during the drive home.

It happens over dinner, on the porch, in the grocery store, or while nothing especially important seems to be occurring.

It happens on Tuesday.

If we are only fully alive when something is on fire, ordinary life can begin to feel flat, slow, irritating, or strangely difficult to tolerate.

But ordinary life is where most of our living happens.

Physical well-being and coping

• I pay attention when my body tells me something is wrong.

• I address pain instead of simply learning to function around it.

• I eat, hydrate, move, and sleep well enough to support the demands I place on my body.

• Alcohol or other substances are not becoming my primary way to transition, sleep, connect, or feel something.

• I can recognize when a coping strategy is costing me more than it is helping me.

• I do not need to be in crisis before allowing myself to seek care.

• I treat my body like something I plan to keep living in.

There are coping strategies that help us survive a particular period and then quietly overstay their usefulness.

Something that once helped may eventually become part of the problem.

Recognizing that does not make the person weak, dishonest, or broken. It means their life may now require a different tool.

Choice and agency

• I experience meaningful choices in my life.

• I can say no without drowning in guilt.

• I can set a boundary before resentment makes the decision for me.

• I can make changes when something is repeatedly harming me.

• My entire life is not organized around reacting to other people’s needs.

• I believe my actions can make at least some things better.

• I am not simply enduring each day because I cannot imagine another option.

Hopelessness is not always the belief that absolutely nothing can improve.

Sometimes it sounds like:

“This is just how it is.”

“This is the job.”

“This is marriage.”

“This is what happens when you get older.”

“I just need to make it to retirement.”

“I don’t have any other choice.”

A sense of agency does not mean having control over everything. Nobody has that. It means believing there is still somewhere in your life where your choices matter.

Hope and anticipation

• I have something coming up that I genuinely look forward to.

• I can imagine parts of my future that are not entirely about work.

• I am curious about what happens next in my life.

• I still make plans.

• I believe pleasure, connection, or meaning are available to me.

• I can identify something I want, not only something I need to avoid.

• The future feels like somewhere I might want to go.

A person does not have to actively want to die in order to have stopped wanting very much at all.

That is part of what gets missed.

We wait for someone to express a desire for death while overlooking the gradual disappearance of desire from their life.

What are they excited about?

What do they want to see, learn, repair, experience, taste, build, or become?

What is calling them forward?

Support and honesty

• Someone knows how I am really doing.

• I know who I would contact before things became an emergency.

• I have access to support I believe is genuinely confidential.

• I can ask for help without believing I have failed.

• I can say, “I don’t feel like myself,” even if I cannot explain why.

• I do not minimize my pain simply because somebody else has it worse.

• I believe I deserve support before I reach rock bottom.

You do not have to be the sickest person to deserve care.

You do not have to earn help by hurting badly enough.

Somebody else having it worse does not magically make you well.

And you do not have to be suicidal to deserve a seat in a place designed to help you reclaim your life.

Don’t just count the answers. Look at the direction.

This is not a test you pass or fail.

There is no magic score that determines whether your life is good enough.

Pay attention to patterns.

Which categories are strong?

Which ones feel thin?

Where did you answer “not anymore”?

What has changed during the past six months?

What are you compensating for?

What have the people who love you been trying to tell you?

A single difficult week does not necessarily mean your quality of life is collapsing. But a gradual downward trend deserves attention, even if you are still going to work, paying your bills, and getting everything done.

Especially if you are still getting everything done.

Competence can hide an incredible amount of suffering.

One question to begin

If the whole checklist feels overwhelming, start here:

What would make your life ten percent better?

Not perfect.

Not completely healed.

Not free of stress, grief, responsibility, or difficult calls.

Ten percent better.

Maybe it is sleeping through the night twice a week.

Calling a friend back.

Going home on time.

Taking the fishing poles out of the garage.

Scheduling the appointment.

Having an honest conversation with your spouse.

Turning off the group chat for one evening.

Taking a walk without your phone.

Saying no to one more overtime shift.

Doing something enjoyable without needing to be good at it.

Ten percent matters.

A life can disappear through a million small losses.

It can also begin returning through a million small choices.

Prevention has to begin before the crisis

We should keep asking direct questions about suicide. We should know the warning signs, provide crisis resources, and act when someone may be in danger.

But if that is the beginning and end of our wellness strategy, we are starting far too late.

Protecting sleep is suicide prevention.

Treating addiction early is suicide prevention.

Addressing chronic pain is suicide prevention.

Protecting relationships is suicide prevention.

Building an identity outside the job is suicide prevention.

Making it safer to talk about shame, grief, fear, anger, and exhaustion is suicide prevention.

Helping someone enjoy an ordinary Tuesday is suicide prevention too.

Because the goal cannot simply be a beating heart, a completed shift, and another day marked off the calendar.

The goal is a life that still contains the person living it.

So yes, ask how bad things have become when that question needs to be asked.

But let’s also ask what is still good.

What is missing?

What has quietly disappeared?

What needs attention?

What makes this person feel most like themselves?

What would make life ten percent better?

And what might help them build a life they actually want to stay for?

Alive matters.

Of course it does.

But alive is simply too low a bar, and we need to start measuring differently if we truly want to make a dent in this public safety suicide crisis.