BY Beth Murphy
The phone rings in your office or home, and it’s a call delivering the horrible news that one of your firefighters has committed suicide. This is a horrific event for anyone, but your department is trained to help others in trouble. However, when it comes to one of your own, you’re at a loss. What follows are confusion, numbness, “what ifs,” “I should have known,” and other assorted forms of self-flagellation. What could you or the other members of the department have done? What signs did you miss? Was he or she late for work, sleeping all of the time at the station, decreasing in performance, using increased sick leave, looking hung-over at work, experiencing marital discord; using increased medications or making frequent visits to the doctor? What did you miss? What has been going on with your firefighter? How long has this been going on?
You then begin to think back to the potential missed opportunities where you might have intervened. What did it look like? You then ask, “How would I really know? I’m not a psychologist? If I did notice something was wrong, what would I say? How would I say it, and what resources do we have to help?”
Mental health and suicide are mental health issues that have confronted our society for many years. In the fire service, much like the military, these conditions are not discussed or treated. Just mentioning that you have a mental health problem is an indication of weakness and carries a stigma that to most people says, “I’m weak or fragile?” This is especially true in the military where mental health issues are not to be talked about and suicides are nearing epidemic proportions. The past Secretary of Defense Leon Panetta, in response to the growing epidemic, stated, “Leaders throughout the department (military) must make it understood that seeking help is a sign of strength, not a sign of weakness. It is a sign of strength and courage. We’ve got to do all we can to remove the stigma that still too often surrounds mental health care issues.”
The fire service is not much different from the military. Firefighters help others; they don’t need help. Too often, firefighters have turned to suicide, and survivors in the department don’t know what to do or how to help. The fire service has developed into an industry in which every firefighter injured or killed in the line of duty triggers an investigation to look at conduct by fire personnel, training, leadership, fireground operations, policies, and the overall department to prevent the problem from happening again. What if the death or injury is from the firefighter who attempts or commits suicide? Do we reevaluate our own human condition and perform a mental health assessment on ourselves or our brother and sister firefighters? Probably not, as we feel very uncomfortable intervening into someone else’s life to say, “What is going on, and how can I help?”
In the general population, suicide is the 10th leading cause of death; on average one person every 13.7 minutes dies by suicide. Suicide among males is approximately four times higher than among females; approximately 56 percent of suicides are completed by firearms, followed by 24.7 percent hanging/suffocation; 33.3 percent of suicide decedents tested positive for alcohol, 23 percent for antidepressants, and 20.8 percent for opiates. There is one suicide for every 25 attempts. [i]
The National Mental Illness statistics indicate several mental illnesses that are strongly associated with suicide include depression, bipolar disorder, anxiety disorder, schizophrenia, substance use disorder, eating disorders, and conduct disorders. Their studies indicate that major depressive disorder affects approximately 14.8 million American adults and is 70 percent more prevalent in women than men.
The statistics for firefighters is not well known. There is virtually no research on firefighter suicides, although many articles citing anecdotal evidence have been written by firefighters and a handful of mental health professionals connected with the fire service. Scant research has been conducted on factors of stress and stress response. More research has been conducted on physical stressors and responses such as heart disease, stroke, and cancer. The truth, however, is there is more focus on the physical health because of the high percentage of cardiac events among the firefighters, but we do not address the issue of mental health and suicide with the same urgency.
A number of groups are making major contributions to increasing awareness and providing solutions including Chief Jeff Dill and the Firefighter Behavioral Health Alliance,[ii] the National Fallen Firefighters Foundation, the National Volunteer Fire Council, and Dr. Gist, along with Dr. Joiner, Dr. Nock, and Dr. Berman. These individuals and groups are beginning to provide crucial statistics and an understanding of suicide and mental health issues in the fire service and are bringing hope for change. However, despite the information being provided by these individuals, the actual dissemination of information and policy-making based on this information is not happening. I believe this is related to the aversion to “intruding” into another person’s life and intimating that he or she may be struggling with mental illness. There is some movement toward supporting the mental health of firefighters, but it is slow and not enough. To be blunt, firefighters’ mental health needs to be prioritized, and policy, assessments, and ongoing monitoring, in line with what has been done for physical fitness, needs to occur. Talking about suicide will not cause someone to attempt suicide, but it may save someone from suicide.
What are some of the signs to look for in firefighters? They include feelings of helplessness and hopelessness, loss of interest in daily activities, loss of the ability to feel joy and pleasure, decrease in appetite or weight changes, and changes in sleep patterns to include insomnia or waking in the early hours of the morning. The following may also be present: anger or irritability, loss of energy, fatigue, sluggishness, and being physically drained. What is most important on the fireground is there may be increasing reckless behavior and freelancing that endangers the firefighter and fellow firefighters. Many individuals finding themselves in this situation may begin to use alcohol in situations where it’s physically dangerous, or they may mix alcohol with prescription medication to blunt the effects of the symptoms noted above.
In addition to the symptoms above, according to Dr. Joiner, other significant signs of suicide are thwarted belongingness, perceived as being a burden, and capability for suicide. Thwarted belongingness is a belief that you are alone, isolated, not part of your family, friends, or work. Perceived burdensomeness is the feeling that everyone would be better off without you. Capability for suicide is a combination of disposition and experience that overrides your aversion to pain and suffering. [iii]
Some risk factors for suicide are white, male, and an older age, although suicide in the age groups between 25-45 years of age accounts for the second and fourth leading cause of death, a higher rate of divorce or separation or early widowhood; prior suicide ideation, threats, and attempts; history of trauma; and a history of reckless or violent behavior or traumatic brain injury, other severe injury, and chronic pain
If you are concerned about someone you supervise or work with, ask yourself the following questions: What did you see? What are your concerns? What would you do?
The most important thing anyone can do is to have the tough conversation and dare to intrude. You have the most important tool already within your possession, and you use it every day as part of your job–compassion. Talking to someone in trouble doesn’t require any special training. Do a size-up, observe, listen, and refer. There are many quality resources available for your use: peer support; EAP; chaplains; community mental health providers; hospitals, and crisis lines, to name a few.
The department should develop a policy that outlines the signs and symptoms and course of action, similar to the drug and alcohol program your department may already have in place. Most importantly, the policy should not be punitive; it should be supportive. Further, any policy should include the EAP number, if you have one, the crisis line number, a peer support group member if you have one, and contact information for the chaplain. [iv]Then develop a comprehensive mental wellness program that includes all of the above resources and provide Psychological First Aid [v]for all of your employees and firefighters. Also, contract with or hire a psychologist and provide ongoing training in mental health and suicide prevention for your firefighters.
Following is a list of some support and information resources:
Crisis Lines and Online Supports.
First Responder specific, Safe Call Now- safecallnow.org, 206-459-3020
Firestrong, firefighter online- www.firestrong.org
National Programs on Suicide: www.suicide.org or 1-800-SUICIDE
National suicide prevention lifeline- 800-273-8255
Resources and Sources of Information
Substance Abuse and Mental Health Services Administration – http://www.samhsa.gov
National Center for PTSD *- http://www.ptsd.va.gov
American Psychological Association- www.apa.org
National Fallen Firefighters Foundation: www.firehero.org
National Volunteer Fire Council: www.nvfc.org
Mental Health Recovery-military program
Ask Care Escort, online screening tools and fact sheets. http://www.mentalhealth.va.gov/index.asp
Endnotes
[i] http://www.cdc.gov/violenceprevention/pdf/Suicide.
[iii] Joiner, T., (2005). Why people die by suicide. Cambridge MA: Harvard University Press.
[iv] http://firechaplains.org.
[v] http://www.ptsd.va.gov/professional/pages/ Providers_Disaster.asp.
BIO
DR. BETH L. MURPHY, PsyD, is a clinical psychologist and a retired firefighter. She was a firefighter/EMT for 12 years and an acting lieutenant, a hazmat technician, and a peer support member. She attained her doctorate in clinical psychology while working as a firefighter with the City of Bellevue in Washington State.
