OBJECTIVE: Concern about psychiatric injuries for first responders has grown. We examine alternatives to workers' compensation (WC). METHOD: We conducted 15 interviews across five California departments contracted with non-WC mental health (MH) providers. We performed content analysis. RESULTS: MH support outside of WC most often was a dedicated contract with outside MH providers for assessment, diagnosis, and treatment. Departments had formal financing mechanisms with union and city support designating funding for MH care. Frustration and past WC experiences drove the desire for WC alternatives. First responders reported high levels of stigma associated with MH care. Compared to WC, these alternatives allowed more comprehensive services to injured workers along with ease of accessing care, expediting the healing process. CONCLUSIONS: Contracting culturally competent MH providers outside of WC for first responders has potential and needs formal evaluation.