Friends of Firefighters

Upon entering an original horse and carriage firehouse circa 1872 in Red Hook, Brooklyn, firefighters coming to Friends of Firefighters (FoF) access counseling and other physical and psychiatric support services in an environment they consider to be a “sanctuary.” The traditional firehouse kitchen welcomes them and allays their fears when requesting assistance. In addition, firefighter peers who work as volunteers are on hand to guide them through the array of services. On the second floor, counseling rooms line the old bunk room. Most of the original details of the house are intact, including interior windows to delineate the officers’ quarters and bunkroom, crown moldings, tin ceilings, skylights, and wood floors. Like the kitchen, the former bunk room is familiar and comfortable, which lessens the apprehension that may accompany a visit for counseling. There is no other place like this in New York City for firefighters.

 

Friends of Firefighters was founded in 2001 in response to the terrorist attacks in New York City. In less than three hours on 9/11, the majority of the FDNY’s 12,000 active duty firefighters responded to a “total job recall” to the World Trade Center, along with countless other retired members, many of whom had family members on the job. Nancy Carbone founded Friends of Firefighters in Brooklyn the next day. Carbone walked into as many firehouses as she could and asked: “What can I do for you?” By partnering with firefighters to improvise the creation of services for their evolving needs, she created a dynamic that demonstrated that FoF was there for them. She earned their rarely extended trust.

 

Facts about Suicide and Depression   FACTS ABOUT SUICIDE   In 2004, suicide was the eleventh leading cause of death in the U.S., claiming 32,439 lives. Suicide rates among youth (ages 15-24) have increased more than 200% in the last fifty years. The suicide rate is highest for the elderly (ages 65+) than for any other age group.  Four times more men than women complete suicide, but three times more women than men attempt suicide. Suicide occurs across all ethnic, economic, social and age boundaries.  Many suicides are preventable. Most suicidal people desperately want to live; they are just unable to see alternatives to their problems. Most suicidal people give definite warning signals of their suicidal intentions, but those in close contact are often unaware of the significance of these warnings or unsure what to do about them.   Talking about suicide does not cause someone to become suicidal.   Surviving family members not only suffer the loss of a loved one to suicide, but are also themselves at higher risk for suicide and emotional problems.   WHAT IS DEPRESSION?   Major Depressive Disorder (MDD) is the most prevalent mental health disorder. In the U.S., the lifetime risk for MDD is 16.6% according to a recent study (Kessler et al., 2005). According to the National Institute of Mental Health (NIMH), 9.5% or 18.8 million American adults suffer from a depressive illness in any given year.   The symptoms of depression (listed below) interfere with one’s ability to function in all areas of life (work, family, sleep, etc).   Common symptoms of depression include depressed mood, lack of interest in previously enjoyed activities, appetite changes, insomnia, agitation or restlessness/irritability, fatigue, feelings of worthlessness, hopelessness and guilt, inability to think or concentrate, indecisiveness, recurrent thoughts of death, recurrent suicidal ideation, suicide attempt or plan.   People who have a dependence on alcohol or drugs in addition to being depressed are at greater risk for suicide.   Although both FDNY and the voluntary hospitals offered critical incident stress debriefings (CISD), most firefighters say they have been skeptical about taking advantage of the counseling for fear that what they said would end up in their records.   Symptoms of PTSD include: “Reliving” the traumatic event through thoughts, flashbacks, and nightmares (Flashbacks can be triggered by anything that causes a memory of the trauma. For example, a war veteran might experience a flashback after seeing a low-flying helicopter). Experiencing a rapid heart beat and sweating while “reliving” the traumatic event  Feeling numb Feeling emotionally detached from other people Sleep disturbances Irritability Avoidance of anything associated with the trauma Anger Difficulty concentrating Amnesia A strong response when shocked Extreme vigilance – Always feeling “on guard” Difficulty working Difficulty with social situations Inability to properly care for loved ones PTSD is highly treatable with a combination of drug therapy and psychotherapy. Source: Fire Department, City of New York, Bureau of Health Services, WTC Medical Monitoring and Treatment Program, “World Trade Center Health Impacts on FDNY Rescue Workers, A Six-Year Assessment: September 2001-September 2007,” September 2007.

Even before the initial funding was in place, Friends of Firefighters was positioning itself to meet the needs articulated by firefighters. They stated that they felt they had no place that was both confidential and nonpunitive to talk about what haunted them. In response, FoF established a firefighter-specific approach to provide confidential services including individual and couples counseling; a peer-to-peer support network; mental and physical health referrals; family weekends; couples retreats; and wellness treatments including massage and acupuncture.

 

Friends of Firefighters is independent of the FDNY. This was an important distinction firefighters insisted on, and one that FoF honors.

 

When asked how she determined that firefighters would avail themselves of the services provided, Founder and Executive Director Carbone replied, “The firefighters, themselves, literally built it. There is no validation more convincing than that.” Indeed, the initial location, just blocks from Friend of Firefighters’ current quarters, was built by firefighters in 2002. In 2005, a second location was constructed, again by FDNY members. Finally, in March of 2009, Friends of Firefighters signed a lease on a privately owned firehouse and labor was, once again, provided by New York City’s Bravest. Assisted by substantial funding from the American Red Cross 9/11 Recovery Grant Program, its purpose is to meet the needs of New York’s firefighters arising from the unique trauma of that day. In its ninth year, FoF’s programs, services, and identity have been forged and improvised in collaboration with firefighters.

 

In the aftermath of 9/11, the American Red Cross, chartered by the U.S. Congress to respond to national disasters, mobilized to collect and distribute donations made to address the needs of those affected and suffering. More than $1.1 billion was collected from donors worldwide. Initial distributions provided three to five years of support, and in 2006 additional grants awarded $5 million to 13 organizations¹. FoF was among 300 new nonprofits fast-tracked by the IRS in 2001 to qualify as nonprofits². This, along with funding from the German-American Solidarity Fund, the Robin Hood Foundation, The New York Times 9/11 Neediest Fund, and the New York Community Trust, allowed FoF to grow rapidly.  

 

In the spring of 2009, FoF moved into its present building, the original quarters of Ladder 101/Engine 202. It had not been occupied by an active fire company since 1960. Quickly growing into the new space, FoF offers in-house massage, peer counseling, volunteer positions for retired FDNY members, and mental health services with New York State licensed clinical social workers. All counselors have advanced training in trauma and bereavement and are well versed in couples treatment and substance abuse issues. 

 

Counseling services are available to immediate family members of FDNY, as well as siblings or parents if the presenting need is related to the job. When people come in for counseling, they fill out a brief inventory of symptoms and difficulties ranging from depression to trauma symptoms, substance abuse, anxiety, and aggression issues. This helps the person to focus in on exactly what he is hoping to alleviate in the sessions. Each item is rated on a scale from 0 (no symptoms at all) to 5 (the most the person could imagine). The scale is run again after three months to give people a sense that they are on the right track and to fine-tune the goals. The highest score possible, if all symptoms were rated at level 5, would be 120.

 

On average, after three months of sessions, clients are reporting a drop in symptoms of 42 points. Other feedback about our counseling services that is not captured in statistics is that people leave counseling with an enhanced sense of self control, better tools for communication, and greater awareness of how to take care of themselves long before they reach the breaking point. 

 

On average, the counseling program runs at a capacity of 25 to 30 clients at a time, some of whom stay for two sessions and some for three years, depending on their goals, interests, and motivations. A holistic approach to wellness is included in the counseling paradigm; clients are encouraged to begin and maintain an exercise routine, improve their diet, engage in relaxing or fun activities, and create a support network. Mindfulness and meditation tools are introduced to increase tolerance to strong feelings and disturbing memories. When the client is interested, trauma memories from early life or on the job are reworked and desensitized. No clients are ever turned away, and FoF has never had a waiting list. Well aware that when firefighters and spouses call for help they have tried numerous ways to resolve the problem themselves and are at a crisis point, FoF offers appointments the same week and, on occasion, the same day as the call. 

             

Some members have said of FoF’s services:

 

To provide services efficiently and professionally, FoF forged partnerships with professional organizations including Columbia Presbyterian Medical Center/New York Psychiatric Institute Department of Clinical Epidemiology; the Mt. Sinai/WTC Health Effects Treatment Program; the North Shore Child and Family Service; Maimonides Medical Center; and Fire Family Transport. FoF also partnered with several other nonprofits that were responding to 9/11 related needs, including the Safe Horizon 9/11 Mental Health Program, September Space, Voices of September 11, World Cares, and several others. After much of the 9/11 funding dried up in 2007, many of the nonprofits were forced to close their doors. FoF remains committed to the mission, though partnerships for cross referrals and fundraising have presented new challenges.  Nonetheless, FoF continues to forge new alliances with health providers, community service agencies, and other nonprofit groups that can help firefighters.       

 

Unfortunately, just because services and much-needed funding have dwindled, the needs don’t disappear. In fact, clinical observation and research demonstrates that mental and physical health needs are growing. Incidents of PTSD, depression, suicide, alcoholism, and divorce are increasing. Based on reporting, diagnoses of cancer related to toxins from the Trade Center are on the rise. Several illnesses including asbestosis, cancer, and mesothelioma can take up to 15 years to surface, as seen after the “Telephone Fire” of 1966.

 

Young firefighters are forced into retirement in their 40s, ending their careers because of asthma and other physical injuries. It is absolutely crucial that FoF remain in operation to meet the ongoing needs of the FDNY community. 

 

Environmental Protection Agency (EPA) testing completed days after the collapse of the towers found elevated levels of benzene, dioxins, polychlorinated biphenyls (PCBs), lead, and chromium still in the air. These chemical compounds released into the air in the dust cloud were of unprecedented proportion. Exposure to these dangers and the extent of the damage responders have incurred remains to be seen in many cases. The active and retired FDNY members need places like Friends of Firefighters to go the distance, to provide a safe, supportive, nonpathologizing place to come relax, restore, and get help.