Behavioral Health Programs in the Fire Service

Programs and initiatives that can help create a dialogue about sensitive issues

By Paul Bourgeois
Published Friday, February 15, 2013 | From the March 2013 Issue of FireRescue

Editor’s note: In this article of a two-article series on firefighter behavioral health, Paul Bourgeois explains the importance of making behavioral health a priority in the fire service, starting at the department level, and offers useful information about programs and initiatives that can help create a dialogue about sensitive issues.  In the other article, Lt. Frank Fennell shares a story he initially penned in 1995, one year after losing a firefighter colleague to suicide. Read that article here. Note: If you or someone you know is thinking about suicide, please visit www.suicidepreventionlifeline.org or call 800/273-TALK.

Additional Coverage: NFFF Introduces New Model for First Responder Behavioral Healthcare

When the Great Recession hit and our economy collapsed like a lightweight truss in an attic fire, it wasn’t long before the fire service was being criticized, scrutinized and outwardly unappreciated like never before. People who once loved us now viewed us as money pits with no visible bottom.

Tough economic times not only brought scrutiny from taxpayers, but also reductions in pay and benefits. Work furloughs, station closures, pay cuts and layoffs have left the fire service, in effect, dazed and confused. It’s no wonder why we’re seeing more and more worry, frustration and sometimes even hopelessness in firehouses. I think many in our industry would agree that we may very well be in the midst of the most stressful era in fire service history.
 
Not the Average Job
Yet the behavioral health crisis among American firefighters is much more than the after-effect of budget cuts and political backlash. In my opinion, tough job conditions coupled with the economic and political environment we now live and work in has seriously compromised firefighters’ ability to effectively manage stress levels. Think about it: While our firefighters are attempting to cope with conventional life stressors, they’re simultaneously working a job where they don’t get much sleep and they sometimes witness very jarring events. Life’s stressors are difficult enough to manage under the best of circumstances, but when a person is sleep-deprived and subjected to seeing the worst of human tragedies, it can be even harder to cope.
 
The problem: At a time when tension and anxiety seem to be at an all-time high, a substantial behavioral health crisis is brewing in the fire service and “critical incident stress” language is being removed from NFPA standards. Why? Many in the fire service believe that traditional critical incident stress management (CISM) models inhibit recovery from traumatic events by exposing firefighters to additional trauma in emotionally charged debriefings. Because of these shifts, many in the fire service are having trouble visualizing what a 21st-century behavioral health program (BHP) might look like.

Programs & Initiatives Offer Help
My department wasn’t immune from this crisis, and after a several close calls and the eventual loss of one of our own, a number of us joined together and took action. From our efforts, several new programs and initiatives were implemented. Each one had an overwhelmingly positive impact on our people as well as the overall organizational culture. Quite simply, we were astonished as we watched our department transform from one that was hurting to one that was healing.  

Family Support Night
One of the first programs we implemented was called Family Support Night. We knew if we were truly going to have an impact on our people that we had to reach beyond the firefighter and touch the family unit. Family Support Night was a 2½-hour conference comprising four break-out sessions. Some break-outs session topics:
•    Steps the union was taking to preserve the wages
•    Benefits and working conditions of firefighters
•    Work and life stress and how the family can work together to manage stress, hosted by our non-denominational chaplain (who is also a degreed counselor)
•    Overall health and wellness and how simple things like nutrition, shopping and cooking together could be healthy for the whole family
•    A discussion hosted by our Employee Assistance Program (EAP) provider that covered the free services offered to employees and their families. One spouse I talked with afterward shared with me that after 25 years as a firefighter’s wife, she had no idea that their family had access to free counseling.

You’re Not Alone
As effective as Family Support Night was, we knew there was still more we could do. One thing that stuck with us was the need to underscore to our people that they weren’t alone. We wanted them to know that there were people who would do anything to help them—and this is what inspired the title and content of our next program, You’re Not Alone (YNA).  

YNA was a four-hour out-of-service training event, and it was as powerful a program as I’ve seen in my 20-year career. The response from our membership was overwhelming and, without question, the principle factor that made YNA distinctive was the use of honest, hard-hitting, in-your-face testimonials from esteemed members of our organization.

To make this happen, we asked two of our members—one a captain with a former alcohol problem and another a veteran firefighter with a previous drug dependency—to open up and share with their peers their stories of addiction and recovery. Further, a firefighter from the Phoenix Fire Department joined us and gave another amazing testimony related to his struggles with a very serious alcohol addiction. I wouldn’t have believed it if I hadn’t seen it with my own two eyes, but in a room full of firefighters, when these gentlemen spoke, you could hear a pin drop.
 
These were powerful, heartfelt testimonies that had a far greater impact on our people than any psychologist, counselor or EAP professional could have on their own. We had real firefighters struggling with real problems that everyone could identify with—people who had battled back from addiction and illness, and were now talking openly about having the courage to ask for help. It was an incredible experience to witness and a hugely important message to share.

By standing up and speaking to their peers, these guys showed that it was OK for even the most hardened fire service veteran to reach out and ask for help, and through their testimony gave instant credibility to both our internal and external counseling resources. The impact on our culture was almost immediate, as in only a few weeks’ time, we had nearly a dozen members refer themselves for professional help.

Peer Support Team
Another critical improvement to our program was the expansion of our Peer Support Team. Recognizing that several of my most veteran team members were nearing burnout, I asked them to help me expand our membership. I presented them with an employee roster and asked them to pick 30 of the most trusted and respected members of our department (out of approximately 400 people). Once they did, I asked them to condense their list down to 15 people. When they completed that, I asked them one last time to narrow it down and give me their 10 best selections. We then took that list and went out and recruited our future team.

This approach to recruitment was vital because not everyone is cut out for this sort of work. Peer Support Team members must be well respected and trustworthy, and they must possess the highest degree of discretion if they are to be recognized by co-workers as someone they can turn to in a time of need. When building your team, remember, don’t just recruit people; recruit the right people. Failure to do so can compromise the integrity of your entire program.

These initial efforts were so successful and well received by our members that our fire chief appointed one of my counterparts to a special assignment where he was asked to continue researching programs and treatment options for firefighters. His work proved very fruitful.

Post-Treatment Support Program
From his efforts, our organization adopted a post-treatment support program designed to assist firefighters upon their release from inpatient or outpatient treatment programs. The agency we’re working with is called Recovery Monitoring Systems (RMS). Their founders were willing to customize a program for us in which their counselors serve as a form of peer support that helps firefighters stick to their post-treatment recovery plan. RMS claims a success rate of more than 85% for long-term sobriety.

Resiliency Study
Another important innovation was the discovery of research directed at the concept of resiliency. The study of resiliency began in the military, as our armed forces have experienced an excessive number of soldiers suffering from emotional illness.

The study of resiliency attempts to answer the question, “Why do two soldiers go to war and both see very bad things, yet one comes home well-adjusted while the other struggles to cope?” The life factors that make one person more resilient than another are, in some cases, simple, but understanding them and integrating these principles into training can help maximize the support provided internally by peer support team members.

Making Changes Moving Forward
Comprehensive BHPs for the next generation should include training that serves to educate firefighters as well as their families. They should contain information about treatment and self-referral options for firefighters and their families that are confidential and non-punitive.

Also critical are the serious-minded out-of-service training programs like YNA that are geared toward changing the sometimes insensitive fire service culture of toughness and durability, and that make it culturally acceptable to ask for help. These programs cannot simply be lip service or based on a flyer pinned up on the firehouse corkboard. They must be personal, genuine, come from the heart and involve the support of both management and labor.

Programs that utilize peers as portals to connect firefighters to definitive treatment resources are invaluable and should serve as the backbone of a 21st-century BHP. Without proper training, however, firefighters should not attempt to counsel their peers; rather they should serve to connect them to the appropriate behavioral health resources.  

What You Can Do
The National Fallen Firefighters Foundation will soon lead the industry in peer support training, engaging everyone in the fire service to manage behavioral health in their organization. Be on the lookout for the rollout of a wonderful new program geared toward training every firefighter on the issues of firefighter behavioral health.  

Another critical step in the future of fire service behavioral health programs that we haven’t mentioned yet is working with your EAP and other community clinicians to enhance services. Most of us don’t realize that our EAPs are willing to tailor services to meet the complicated needs of firefighters. Don’t be afraid to ask your EAP to designate specific counselors or attend training that educates them about the work of firefighters and the emotional stresses of the job. You can even require them to ride along or attend major training events like live fire drills or after-action reviews of major incidents. Again, most are willing to work with us; we’ve just never asked.

Stay in tune with research on resiliency, and look for opportunities to incorporate it into your BHP training. Post-treatment monitoring programs are out there, too. Find an organization that is willing to work with you to develop a program that suits your needs.

Have the courage to protect your fellow firefighters and begin working on a 21st-century program for your department. There are several things you can do today to modernize and upgrade your behavioral health program, and many of them can be implemented regardless of your organization’s size or orientation—and for little to no cost.

In Closing
Several weeks ago in Michigan, I sat and listened to FireRescue magazine Editor-in-Chief Tim Sendelbach talk about fireground safety, and he challenged the audience to have the courage to speak up and stop unsafe acts. But how many firefighters would have the courage to speak up and confront a fellow firefighter in need of emotional support? How many of us would just mind our own business or even cover up a problem that we knew was getting worse? In the fire department, it seems like we’re never afraid to express our love and support for one another at the local pub following a firefighter funeral or memorial. But day to day, we struggle to say things like, “I love you, man,” “I’m here for you, sister,” or “I would do anything to protect you.” But that is precisely what we need to do and what our people need to hear from both peers and those in leadership positions if we’re going to change the culture of the American fire service as it relates to behavioral health issues. 

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Behavioral Health Programs in the Fire Service

Programs and initiatives that can help create a dialogue about sensitive issues
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