Opening Up About Behavioral Health

Any individual who wants to excel in his career will pursue training that is on the cutting edge of the industry. Keeping all our brothers and sisters safe has always been the purpose of training, and we all dedicate blood, sweat, time, and finances to reach that goal. We strive to make that difference in stopping the needless deaths within our own firefighting community. When approximately 100 of our brothers and sisters perish every year, we each say, “Never again.”

Well it’s time to also address that other killer in the room that is affecting so many: our mental and behavioral health. Until recently, there was not even an attempt to track the number of suicides, but thanks to the Firefighter Behavioral Health Alliance (FBHA) and Captain Jeff Dill we now have an idea of the real numbers. And what they have pointed out should alarm us all. The FBHA Web site (www.ffbha.org) opens with this statement: “The Firefighter Behavioral Health Alliance was founded to always remember our brothers and sisters in the fire and EMS service who took their lives.” Thanks to Dill and his team’s work of tracking this issue and talking about it, we have a place to start this conversation.

We have many men and women in the fire service who are suffering from these issues in private because they don’t know what is going on, who to turn to, or what kind of help they even need. As you read, you may think of a firefighter in your department who committed suicide. Some of you are even thinking of someone you work with or someone in your family who has shown signs and symptoms of an individual who is struggling and could make the decision to end it all. This article is for all of us, because we either already know someone who is struggling or we will come across someone who needs our help.

Over the past few months, I had become discouraged at just how far behind we actually are in the arena of behavioral health, and then I attended the Fire Department Instructors Conference (FDIC). I had a few discussions with leaders in the field who encouraged me with some hope. Years ago, there were no behavioral health classes at any fire-related conferences or training, and in the opinion of those experts in the field, if there had been any of these types of classes-nobody would have attended. This year, by my quick count, there were 10 such focused classes, and there were even more that touched on these topics. I attended as many as I could, and I learned some new lessons and had a few lessons reinforced.

Increased Education

I heard from Chief Dan DeGryse as he talked about his experience with the employee assistance program (EAP) in the Chicago (IL) Fire Department and his current leadership and involvement with the Florian Program within the Rosecrance Institute. This is a program that focuses on first responders who are dealing with co-occurring behavioral issues. Amazingly, there are firefighters out there who are screaming out against programs like this and claiming they are a money-making scheme. I have visited the Florian Program site and have seen first-hand the preparation and resulting success. We don’t need firefighters speaking out against these types of programs; we need firefighters encouraged to attend these programs and get the help they can only find there. This is just one example of a program that is proactively focusing on firefighters who are in need.

I also heard from Dr. Beth Murphy who shared the story of a brave firefighter who wanted to pass along his experience of leaving the job after almost 30 years, the accompanying desire to commit suicide, and how he has overcome that desire with treatment and support. I was reminded of the fact that there are firefighters we are serving with who are hurting in ways we don’t see and can’t comprehend. But when there is a need, we have to be ready to respond. During the class, Murphy opened up for comments, and a few brave souls shared that the audio recording of the firefighter was a carbon copy of their lives. Post-traumatic stress disorder (PTSD) is real. There were people in our audience suffering the effects, and many of us had no idea before they spoke in that class.

I went to another class and listened to Chaplain Steve Calvert explain how he has integrated a pre-stress program within his department and it is spreading to other departments. It has become a staple of training programs for officers and new recruits alike. Calvert’s goal is to create a level of help for our personnel that falls “somewhere between the daily kitchen table counseling/debriefing and the professional clinical counseling that is offered through EAP.” The focus is to create peer counseling teams like the one that is successfully helping firefighters in the state of Illinois.

Personal Experience

On Friday morning of FDIC, I struggled to decide whether I would get up in time to go to another behavioral health class or if I would take a mental and emotional break and sleep in. Fortunately, I made the correct choice and went to another class. As class began, Chief Pat Kenny told us about the importance of behavioral health issues and then proceeded to share why he has such a passion for the topic. He told us the heart wrenching story of how his son fought depression as a child and continued to fight hard until finally ending his life as a young adult.

Kenny opened up and explained how his experience with his son has changed his view on depression and suicide. He talked about his family’s fear as they walked through the dark valley together with no road map for how to handle the situation. He shared about how he made the decision as the fire chief to keep the problems a secret from the rest of the department, and he opened up regarding how he believed this was the worst choice he could have made.

Kenny told us that he justified not sharing the information because he wanted his son to feel normal and be welcomed into the station at all times, and he went on to say that he finally realized that the real reason for the secrecy was that he didn’t want his men and women to worry that they couldn’t follow their chief because he was having such problems taking care of the needs of his son. He even made a video that he has shared with others about this part of the story. He pointed out that everyone needs to talk about the struggles they are having, whether those struggles are significant or minor. Talking about the struggles can help us work through them, and it may help someone else work through issues they assumed they were battling alone. Being genuine with open honesty will also help our personnel see us as real people with real issues; this goes for every firefighter regardless of position or rank. Kenny summed up the session with this powerful statement, “We don’t need to be Superman wearing a cape trying to save the world, all while the cape is choking the life out of us.”

Do Something

After Kenny’s class, I decided I had shed enough tears and had taken on enough sad information for a while, and I needed a break. I began to walk through the exhibits and talked to some friends, and an overwhelming thought kept coming up as I walked: We can’t just talk about it. We have to do something! I have to do something! We have to start training our personnel on the specifics of how to prepare themselves for the job so that they don’t end up a statistic. We can’t inoculate our personnel from all trauma and traumatic stress because anybody who does the job for any length of time is going to see and experience traumatic scenes that they will never be able to “unsee.”

However, we can prepare them so they know how to recognize the signs of these stressors and immediately do something about it. This article is not intended to discuss the steps that need to be taken to prevent PTSD or to treat it once it has been diagnosed; that is for another article by someone who can share an expert opinion on those steps. But we simply cannot and must not turn a blind eye to those who are suffering. For too long we have covered for our brothers and sisters when they have a need, and we have not intervened to get them actual help.

I had this burden on my mind when I met with the 30 or 40 people from the Palm Beach County (FL) area for the annual Thursday night dinner at a German restaurant at FDIC. I found my friend, Captain Larry Doelling, and said, “We have to change the way we are educating our people.” He grabbed me by the shoulder and said, “I’m with you. I have some ideas that I want to implement.”

We proceeded to talk about adding in more hours of training that are centered on behavioral health and prevention. We will be incorporating them into our new recruit and officer training. We want all of our personnel to start thinking about themselves and the stress they have faced and will face, but we also want them to start watching out for their brothers and sisters.

Kenny used this analogy to describe how this works: If a brand new probationary firefighter observes a chief on the fireground walking into an area where a wall is about to collapse, the firefighter would be expected to scream out a warning and even push the chief out of harm’s way if necessary. Why would we expect any less from any of our firefighters who see a wall of stress about to collapse onto one of our own?

A Spoonful

At the conclusion of the conference, I sat at dinner with Chief DeGryse, Chaplain Calvert, and Father Jimmy Swarthout. We compared notes, talked about plans, discussed the failures and successes we have seen, and dreamed of what we hope for the future of behavioral health.

We were all feeling pretty good about the fact that multiple classes had been offered and many people had attended, when DeGryse put a little bit of a damper on the discussion. He asked this question: “Are we really making a difference? These classes were offered this one time, there were a few hundred people who attended in total, and I feel like we went from trying to empty the ocean with a thimble to using a large spoon instead. That’s still not going to make enough of a difference.”

I responded by telling him about the passionate drive and plans that Doelling and I were going to be implementing on our return. He still was a little discouraged as he explained that it was just one department. I further explained that we would be making a difference because of this truth: A few hundred people are going back to their departments with a new understanding of this behavioral health issue, new tools to prevent long-term effects, new studies to share with their leaders, and a passion to do something about the problem. If those people take these “spoonfuls” back and begin changing the environment and discussion surrounding this important issue, then next year a new group comes back to FDIC ready to learn about it. Then with more classes being offered and more people taking these new classes, more “spoonfuls” go out to more departments. Eventually, the majority of firefighters will be talking about the importance of preventing and treating behavioral health issues.

Taking Steps

Whether you were at FDIC or working so your brother or sister could attend, this article can be a starting point for all of us to begin making a change in how our local department helps firefighters avoid triggers that bring on PTSD symptoms and treat those who are suffering from those associated effects.

Some of the steps all departments can take include the following:

  1. Talk about the stress that all firefighters will face in the course of doing their job. Talk about it when they get hired. Talk about it when they get ready to start out of your fire academy. Talk about it in regular trainings. Talk about it when a bad call happens. Talk about it when you see symptoms in one of your firefighters. Talk about it before it’s too late!
  2. Listen when the firefighters in your department talk. Don’t turn a blind eye to those who come to you or others with concerns about their mental health. For too long we have assumed that all firefighters either can “handle” the job or they are “too weak” to deal with the calls. We need to consider the fact that some of our people need help but can still perform the job once they have been helped mentally and emotionally. We also need to be willing to actively listen and have some tough conversations.
  3. Be proactive and have a counseling plan in place before problems arise. This begins with a robust EAP that has counselors who answer the phone 24 hours a day, seven days a week and has counselors who have a working knowledge of the fire department and what we do. There will be a need for a counselor who will listen to the problems, not explore the logistics of being a firefighter. The counselor will need to be mentally prepared to handle what a firefighter might share. It also requires each of us to do the appropriate research to find out which EAP partners are most suited to counsel our personnel. We should have a list of recommended professionals for our personnel. This will take work, but if we care about our people, we do what’s required to make sure we are ready when they need us.

Putting these steps into place will not keep all behavioral problems at bay, but it is essential for all fire departments to begin to implement some type of program. We have to change the way we view stress and emotional trauma, the effects of that stress, and the way we treat those who are suffering those effects. Our first steps may be the equivalent of a thimble or a spoonful, but if we keep moving forward with the necessary passion and dedication, there will be enough people carrying those thimbles and spoonfuls that we will empty oceans together.

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