The American Institute of Stress https://www.stress.org/how-the-best-handle-s
With the suicide rate among firefighters becoming more prevalent, along with the number of mental health issues such as post-traumatic stress disorder, anxiety, depression, alcohol and substance abuse, the once taboo subject can no longer be ignored.
Firefighters who are diagnosed with PTSD are six times more likely to commit suicide, according to Jim Brinkley, director of Occupation Health and Safety for the International Association of Firefighters. Addiction adds another layer of risk for suicide.
“I can tell you the real issue is not suicide, the real issue is the underlying mental health conditions that really lead to the outcome of suicide,” Brinkley said. “That is what we really need to focus on. That is what many of our members (firefighters) are suffering from, whether it’s post-traumatic stress, general anxiety or acute anxiety.”
PTSD, according to the National Center for PTSD, “can occur after you have been through a trauma. A trauma is a shocking and dangerous event that you see or that happens to you. During this type of event you think that your life or other’s lives are in danger.”
“We know every firefighter you ask can readily name three instances in their career that are going to stay with them for the rest of their lives,” Brinkley said. “It’s just the way it works. We all have them in out memory banks, but it’s how you process those images and how they impact you in your daily life.”
For years in the fire services industry there has been a stigma associated with mental health issues, according to fire officials. Firefighters who suffer from such issues as PTSD, substance abuse or depression have been reluctant to ask for help or seek out treatment.
One in every five IAFF firefighters is believed to be suffering from PTSD.
Brinkley notes those are just the ones they know about. He believes the issue may be under reported because of the stigma attached to the problem.
“We know that we have many that are suffering in silence,” he said.
According to statistics provided by Doug Stern, director of communications and public affairs for Ohio Association of Professional Fire Fighters, 92 percent of firefighters say the stigma is a barrier to seeking behavioral health treatment, and 28 percent of firefighters believe behavioral health issues will hurt their pride or their reputation, or they worry about confidentiality or are not aware of available services.
“We work in a culture that if you ask for help, it’s a sign of weakness and it has always been that way,” said Matt Askea, a lieutenant in the Akron Fire Department and IAFF peer support leader. “The reason for that, I think is because our job requires us to be around traumatic situations on almost a daily basis, so if we show any signs that those types of calls or those situations cause us discomfort, then there is a lot of thought that maybe we shouldn’t be in this kind of work.”
He also believes that with the stigma attached to mental/behavioral health issues, those firefighters may worry if they seek help that it could put their job in jeopardy, affect their ability to get promoted or cause them to be seen as a weak link by their co-workers. He also believes they may feel other people will not see them as being dependable in an emergency situation and look at them as being wounded or injured and not the type of person others would want to work with.
“We are the ones you call for help,” Brinkley said. “We know that 92 percent of firefighters report that stigma is a barrier to seeking help… We are the ones you call for help so I’m not supposed to be asking.”
According to Askea, it’s a very stressful job and its just not normal for people to be exposed to these types of events day after day, week after week, year after year.
“It will affect you,” he said. “ We are a resilient group of people and we can take a lot of stress, but you know sometimes even the strongest of folks need to reach out and get some help.”
Although The National Center for PTSD says that it can happen to anyone, the percentages for those who work in the fire service are a lot higher. Approximately seven or eight out of every 100 people will have PTSD at least once in their lives, compared to one in five of firefighters and paramedics, according to the Journal of Occupational Health Psychology.
One statistic that Askea finds alarming is that firefighters are an estimated three times more likely to die by suicide than in the line of duty. He notes they are trying to reduce these numbers so they are looking at why it is happening and looking at the risk factors in general, which include PTSD, clinical depression, chronic pain, alcohol or substance, in addition to the daily risks of the job such as burn out or compassion fatigue.
He also believes that education is the number one factor in reducing the stigma and enabling firefighters to ask for help.
“If we reduce the stigma, and if get administration on board with this and our peers actually encourage post traumatic stress members to take the steps needed, then those numbers will go down significantly,” Askea said.
“We need to change the stigma that we can’t talk about it if we are upset about a call we went on,” said Bill Mastroianni, a lieutenant, for Euclid Fire Department and director of operations for the OAPFF. “We are trying to spread the word that behavioral health is a problem in the fire service and that we are trying to address it. We are trying to get more people involved in recognizing behavioral health.”
Warning Signs — What to watch for
The IAFF Recovery Center list the following as signs of possible post-traumatic stress disorder:
• Avoidance of situations that resemble the event
• Persistent mood swings
• Difficulty performing duties or tasks
• Difficulty concentrating
• Chronic pain
• Chronic feelings of hopelessness or despair
• Substance abuse or addiction
• Inability to relax
• Feeling disconnected from friends or family
• Relationship difficulties
The Firefighter Behavioral Health Alliance says the top 5 warning signs, known as “RAILS,” that could indicate a firefighter is suicidal or dealing with PTSD are:
• Recklessness/Impulsiveness — These might be subtle signs such as purchasing guns when a person has always been against them. Riding a motorcycle recklessly or charging into burning buildings against policy or procedure.
• Anger — Suppressed anger or explosive anger from seemingly minor issues can be a dangerous sign. Displacement (directing one’s anger at someone else instead of the intended person) is often observed and directed at family.
• Isolation — Becoming distant from their career company around the station or volunteer firefighters who don’t participate in drills or calls as much. Members might even display isolation around their family. They lose interest in family activities.
•Loss of Confidence in skills and abilities — Several firefighters and EMTs have advised FBHA they lost confidence in their ability to get the job done due to concentrating on emotional or personal issues they were battling. A seasoned firefighters who can’t remember how put an engine in gear to pump is an example.
• Sleep Deprivation — Loss of sleep can indicate stress, anxiety, post-traumatic stress or several other emotional issues a member might be struggling with and not realize.
Bill Mastroianni, a lieutenant for Euclid Fire Department, believes that changing the culture of the fire department is a key step in eliminating the negativity associated with mental/behavioral health issues in the industry.
“We need to start by changing the stigma in the fire service that we are all tough guys and don’t have feelings,” said Mastroianni, who also is director of operations for Ohio Association of Professional Fire Fighters. “To make this happen we need to have a significant change in the culture as well. We need to recognize the signs of behavioral health issues amongst our brothers and sisters and get them the help they need.”
The lieutenant realizes that this won’t happen overnight, but he said that they have made a significant step in the right directions with their peer to peer support teams.
The International Association of Fire Firefightersand OAPFF are taking a hard look at the mental/behavior health issues occurring in the fire services industries by working to break down the barriers and remove the stigma associated with the mental health issues faced by firefighters through a relatively new peer support program.
The peer-to-peer support program is comprised of firefighters who receive training in active listening skills and crisis intervention. They learn the signs and symptoms, and they learn things to say that will work and things that should avoid saying because they might be a trigger or create more barriers and they provide a bridge to the services that the firefighter may need, according to Jim Brinkley, director of Occupational Health and Safety at IAFF.
“I may be reluctant to go in and speak to a clinician with the employee assistance program because I don’t trust them, they are a part of management,” Brinkley said. “But if I work with another peer, a fellow fighter who knows and has worked with that clinician and can tell me what to expect… and that my chances of coming back to the job full time are in my favor if I seek that help (then) that helps break down the stigma and helps build that trust.”
“We are taught a lot during those few days of training. A lot of it is the same skills a counselor or therapist would use — active listening, empathy towards the individual you are speaking of and talking about education,” said Matt Askea, a lieutenant in the Akron Fire Department and a peer support leader.
He describes the program as being proactive as opposed to reactive and notes that mental health in the fire service has been historically reactive with critical instances stress management.
There have been a lot of support models out there in the past, according to Brinkley, most of which he describes as being employee assistance programs which are employer clinical based programs where employees could reach out to clinicians if needed.
“Firefighters do not trust anybody but themselves especially when they are hurting and they need help,” Brinkley said. “What we learned many years ago was that the peer support model is the most effective, not only does it reduce the stigma, it helps build resiliency.”
He also notes that it’s a system firefighters are already used to. They rely on their peers, rely on each other in the firehouse for everything that they do including sharing their deepest darkest secrets to telling about the stuff that makes them the happiest.
“So having a peer based model that has clinical oversight is the key to successful treatment and is the key to breaking down that barrier,” he said.
Ohio currently has 30 firefighters throughout the state who are able to deploy to stations across the state or the country to assist with peer support services when firefighters are in distress, whether from a traumatic incident they responded to, line of duty death or suicide of a co-worker.
“The program just rolled out in Ohio this year, so with it being in its infancy, it’s still to early to measure its effectiveness,” Askea said. “Basically we are trying to figure it out, it’s all a work in progress right now.”
Mastroianni noted that the peer support team has only done a few things at a local level as they are trying to get more people trained as peer supporters.
“We haven’t had a huge need for it in Northeast Ohio, but if we do have something we are ready to be dispatched out there to help them with whatever behavioral needs they may have,” he said.
If a firefighter needs more assistance than what a peer can provide, the IAFF has teamed with Advanced Recovery System to open the IAFF Center of Excellence for Mental Health Treatment and Recovery just outside of Washington D.C.
According to Brinkley, almost 160 firefighters have been treated at the 64-bed facility which just opened this in March. Approximately 40 percent of the 160 were treated for PTSD.
“That is a high number, 40 percent,... No one would of thought the number would of been that high when we first opened,” he said.
Brinkley feels that what makes the Center of Excellence different from other treatment programs besides it being just for firefighters, is that it offers an aftercare program.
“From the minute the firefighter enters treatment in the Center of Excellence,we start working on the after-care program,” he said. “A case worker starts to identify resources back in the firefighter’s local community...see what services are available and start to establish connections.”
All firefighters treated at the center leave there with a written, 18-month aftercare plan.
In addition to the peer-to-peer support group and the Center of Excellence, the IAFF includes in all its events, programming on behavioral health, everything from their “Stamp out Stigma” education program to addressing PTSD through peer support and a session on the Center for Excellence.
Brinkley notes that five years ago a behavioral health class was the least attended session at events, but now they are the highest attended.
“I think the stigma is going away. I think we are breaking down that barrier,” Brinkley said. “The battle isn’t over, but I think the education up front, building the resilience, the peer support, and then having the safety net of a center where you can go where other firefighters are being treated is going a long way.”
Where to turn for help
Once the signs of mental health issues are suspected or recognized in a firefighter, the next step is seeking help. There are several options available:
For crisis situations contact:
• The IAFF Center of Excellence for Behavioral Health, 855-900-8437.
• National Suicide Prevention Hotline, 800-273-8255
If not in a crisis situation but need to talk about a mental health issue contact one’s Ohio Association of Professional Fire Fighter peer support team.
• National Fallen Firefighter Foundation — Everyone Goes Home Initiative 13 gives a road map for fire departments on mental health protocols.
• Pocket Peer — An online educational tool and resource guide for firefighters
• IAFF’s efforts to address firefighter mental health.
• Firefighter Behavioral Alliance
• IAFF Center of Excellence for Behavioral Health Recovery Center
— Additional resources provided by Matt Askea, Akron Fire Department