By Daniel DeGryse
As firefighters, we have many tools at our disposal, whether it’s the gear we wear to protect us, the items we carry, or the equipment on the rigs. We know that time, weather, and other factors affect those tools, and one of our primary responsibilities is to keep them performing well. When we perform our daily inventory and discover that something is broken, how do we respond?
The tools on our rig, like tools in a toolbox, are important. With time and use, all tools, no matter—how well built—become dirty, dented, and worn. Think in a similar way how years of experience and exposure to trauma and pressure to perform wear on us over the course of a 30-year career. If you are a chief or an administrator, look back on your career and think about your most difficult task: Was it adding or reducing staffing? Was it buying a rig? Was it the critique of an incident? Or, is it how you handled substance use and mental health issues? Do you have any regrets about personnel decisions dealing with a member’s behavioral health issue?
We frequently talk about our tactical regrets, the different choices we would make on the fireground, or with response time. Most departments do not have frequent conversations about behavioral health issues, discussions that are just as important for current staff as they are for future firefighters.
The good news about all of this is that the tide is shifting, and behavioral health education is moving into the spotlight nationwide. My good friend Bobby Halton, editor of this publication, is one of the most vocal supporters of that movement, and he has been open enough to feature articles about important topics such as cortisol, vicarious trauma, and behavioral health risks associated with on-the-job injuries.
Our efforts to spread the word were reinforced with the August 2016 release of the International Association of Fire Fighters (IAFF) report, “Fire Fighters Calling 9-1-1,” which talks about the growing risks of post-traumatic stress disorder (PTSD) and cancer within the fire service. The report includes some alarming statistics:
- About 20 percent of firefighters and paramedics have PTSD, according to the Journal of Occupational Health.
- Nearly half of the firefighters surveyed in a 2015 Florida State University study have thought about suicide, 19.2 percent had suicide plans, and 15.5 percent had made suicide attempts.
We can no longer discount these issues; that was a big reason behind us bringing together some of the best clinical experts and people in the fire service in fall 2016 for the first Rosecrance Florian Symposium near Chicago, Illinois. The speaker list was incredible; collectively, they brought with them hundreds of years of experience, from leadership to research to practical experience developing behavioral health programs and components that help people better understand addiction and mental health specific to the fire service.
Nearly 200 people came from more than 20 states (and Canada), and even more fire departments. Below is a recap of the event. But first, I wanted to share some advice from a few of our own about the important behavioral health work they are doing within their own departments.
“The last people to look for help”
Frank Leto has become the go-to expert when there’s a national crisis involving first responders. Leto is a 33-year veteran of the Fire Department of New York (FDNY) and the deputy director of its Counseling Service Unit. On September 11, 2001, he responded to the World Trade Center as an officer in charge of a rescue team. Since then, he’s developed innovative outreach, counseling, and education programs for firefighters and their families. He’s also responded to some of the most traumatic national events that most of us only experienced through the nightly news such as Hurricane Katrina, the Aurora, Colorado, movie theater shooting, and the Boston Marathon bombing.
Frank easily summarizes the problems that continue to face the fire service:
“Emergency responders are the last people to look for help. The typical rookie or probie receives extensive training on positioning, building construction, tools. But there are fewer conversations about their increased risk of post-traumatic stress disorder, substance use, suicide. There are resources available in the community, but sometimes very limited resources available to the department.”
Stigma is still one of the greatest obstacles to people reaching out for help, particularly if your fire administration doesn’t acknowledge the risks of the work. When that stigma lingers, reaching out for help is seen as a sign of weakness or a way of inviting some type of punitive action. That can lead to self-medicating and increases in depression and suicidality.
Leto also said he has done presentations where he asked fire department administrators and union leaders if employees can take antidepressants and still work full duty. More often than not, they didn’t know the answer or they answered incorrectly. You can certainly take antidepressants, be it on full duty, and you should not have to tell anyone. But employees don’t know if the information is not disseminated in an appropriate way.
“How many guys have gone to a doctor and are given a prescription to help them, and they’re sitting with prescription in hand and they don’t know what to do?” asked Leto. “It’s a simple education process.”
Certainly, there are medications (such as antianxiety meds) that could affect day-to-day job performance, but that’s a perfect example of why behavioral health education needs to run through the department from the top down.
Frank will also tell you that we are getting better at this. It’s a different fire service today compared to 33 years ago when he started. FDNY’s counseling services look dramatically different, too. In the 1980s, the department had a staff of 10 counselors and a program with limited education that responded primarily to traumatic events. As we all know, 9/11 changed everything.
“The need was so tremendous,” Leto recalled. “You had 15,000 people who worked for the department all in need of services, almost without exception. Add in EMS, a civilian workforce of 1,000 people who were all very much involved, families of the deceased and injured, and now you have about 100,000 people who needed support, all while still keeping the department running and under a terrorist threat that we thought could happen again any minute.”
The FDNY hired many more counselors and started specialized support services—family programs, groups for brothers/sisters who lost brothers/sisters, children who lost parents, and son on. Leto said that the services that exist today, 15 years later, are an evolution of the work back then, including changing things that didn’t work.
He’s also quick to say that what workqs for the FDNY may not work somewhere else. For example, Leto was called to help after Hurricanes Katrina and Rita hit the Gulf Coast. It was several years after 9/11.
“We thought we knew everything, but I got down there and quickly realized I knew nothing,” he said. “This was a completely different situation. These firefighters lost homes. Almost all of the firefighters in New Orleans were working around the clock, and their families were spread out across the country. [After 9/11] We had someplace to go home to, and family was there. It seems like every tragedy we respond to has a whole different level of circumstances, so you go in with an open mind, see what programs are in place and how to support them.”
Today, the FDNY counseling program is robust, serving about 3,500 firefighters, emergency medical technicians, and civilians a year. That number is just people who come in for scheduled appointments. The number is higher when you include field visits. The program has about 30 licensed counselors and five offices, and Leto and others such as Drew Kane (who spoke at the Florian Symposium) travel the county to help fire departments with behavioral health programs.
“After 9/11, we realized for the first time that we, as New Yorkers, needed all the help that people could give us,” Leto said. “We really want to share what we’ve learned, and when somebody needs help, we want to help now more than ever.”
Prioritizing Behavioral Health
My ties to Rockford, Illinois, are stronger since Rosecrance, a leading provider of treatment for substance use and mental health disorders, stepped up in 2014 to start the Florian Program. The Rockford (IL) Fire Department (RFD), led by Chief Derek Bergsten, has taken a leadership role in prioritizing behavioral health services for the department.
Bergsten serves on our Florian Program Advisory Committee, which helped with the startup of the program, and continues to offer guidance. Florian has its own residential substance use treatment unit in Rockford for firefighters and paramedics struggling with addiction and mental health issues such as PTSD, depression and anxiety. We expanded the program in 2017 to serve all uniformed personnel, including law enforcement and veterans.
Three years ago, RFD established a chaplain’s division so firefighters could talk with a chaplain at a fire station or on scene. After that, Bergsten and I connected and worked with Matt Olson of the Illinois Fire Fighter Peer Support to build a comprehensive peer support program for the department that meets the daily needs for staff and their families.
A dozen RFD crew members went through the peer-to-peer training hosted by Rosecrance. Derek made it a priority to educate every shift at every station about peer resources both internally and externally available to them.
Rockford has just over 300 firefighters on staff, and Bergsten got great feedback on the peer training. He said that critical to the process was selecting the right individuals internally who would become peer supporters—people who weren’t confrontational, who were patient, and who were good at making their coworkers feel comfortable talking to them. I also came in and spoke with all shifts about the resources available through Florian.
“Our employees are our most valuable assets,” Bergsten said. “I never did get resistance to any of the services we talked about. We need to make sure support is there for them when they need it and that they know how to access help that’s available.”
Bergsten has spent more than two decades in the fire service and he, too, recognizes how processing trauma and stress has evolved through the years. When the department’s employee assistance program (EAP) contract was coming up for bid, he worked closely with the city’s human resources department to make sure the right services would be available. Then, the new EAP counselor visited all shifts at all the stations for introductions and education about response times, appointments, and so on; it was more than just hanging an EAP informational flyer on the breakroom wall.
“Nothing worthwhile is easy, and we continue to push this to get to where we need to be,” he added.
Committing to This Long-Term
One thing I’ve come to recognize being a part of Rosecrance for the past three years is that the staff here is constantly evaluating how our programs work to improve efficiency and deliver the best treatment to our clients. During the first three years of Florian, we’ve identified the need for more relapse prevention education. We’ve been able to connect with many different departments across the country, and those departments have been very supportive of our mission and vision. Our early evaluation of the program is that it’s hitting the mark, with small tweaks here and there.
So far, the program has helped more than 125 active and retired first responders from all ranks representing more than 90 departments in 12 states. To honor that commitment, the important work of Florian was immortalized in a sculpture meant to represent the courage and dedication of men and women in the fire service.
Colorado-based sculptor Austin Weishel created a bronze fire helmet that sits on the Florian unit in Rockford. The unit is decorated with other firefighter memorabilia from Chicago and New York, and artwork created by the clients.
The helmet bares the Rosecrance Florian name on the front, as well as the Maltese cross. Each side features different images and words that are familiar to the fire service and recovery, including the Serenity Prayer and names of the Rosecrance Florian Advisory Committee. Committee members, who are active and retired fire service leaders from across the country, funded the project.
The helmet is about 25 percent larger than a regular fire helmet and weighs about 70 pounds. A big reason why Weishel was the perfect person for the job is because he has experience as a volunteer firefighter and has done several other sculptures for the fire service, police, and military.
“I really wanted to capture something with the program forever, to tell the story around the helmet,” Weishel said. “People should be reassured that the fire service brotherhood is still alive with Rosecrance.”
Growing the Conversation
The helmet was on display at the first Rosecrance Florian Symposium in 2016 near Chicago. The event turned out to be three terrific days of real, comprehensive talk about behavioral health in the fire service—what we’re doing to address it and what still needs to be done.
The first day featured preconference training sessions in Mental Health First Aid, taught by Rosecrance’s Sarra Reichwald, and Illinois Fire Fighter Peer Support with Jada Hudson and Matt Olson. More than 90 people attended; we ended up having to expand registrations for those sessions because there was so much demand for them.
The next two days were jam-packed with experts in the field from across the country: Drew Kane with FDNY; Bobby Halton with Fire Engineering magazine; Ryan “Birdman” Parrot and John Walters with Sons of the Flag; Suzy Gulliver with the Warriors Research Institute; and fire service leaders from Illinois, Wisconsin, New Jersey and Florida. Rosecrance staff members, including Dr. Raymond Garcia and the Rev. Jim Swarthout, also spoke, and nationally recognized comedian Mark Lundholm performed.
The symposium was open to anyone with an interest in furthering the conversation about behavioral health in the fire service, including new and longtime firefighters and paramedics, fire service administration, chaplains, clinicians, family members and government officials/fire department trustees, and board members.
I’ve been encouraged by the positive feedback and responses from everyone who attended. People eagerly told me about the cross-country connections they made that would have never happened had they not attended the symposium. One person mentioned that he ran out of business cards because he handed them out to so many people.
There was education about stress, suicide prevention, peer support, addiction, the chaplaincy, and PTSD. There was excellent audience participation at the Friday behavioral health panel featuring Dr. Suzy Gulliver, John Walters, Pat Kenny, and Bergsten that was moderated by Bobby Halton. Halton did a session called “Misplaced Priorities” and said it was one of the most challenging presentations he’s put together because it was so personal and so many people connected with it. A committee is already planning this year’s event, which takes place September 21-22 near Chicago (visit rosecranceflorian.org for more details).
I talked to Halton after the symposium, and he gave me a little grief about the theme of this article. He said he’s heard too many people say that people are your greatest assets and not follow up that statement with action. He also said that connecting with people starts with being kinder and gentler. Speaking of the stigma associated with addiction and mental health, he recalled the large number of people who offered help when he had cancer but how the response is typically so different when someone is struggling with a behavioral health disorder.
“Rather than say people are your most valuable tool, the thing we need to value the most is people’s humanity and the needs of our fellow humans,” Halton said. “[Sir Winston Churchill] referenced not being at the beginning or the end, but being at the end of the beginning. For the fire service and where we are with behavioral health issues, I think we’re at the end of the beginning. There are a lot of voices out there talking about it and raising the issues; it will be interesting to see where we go as an industry.”
Ultimately, we want people to feel like it’s okay to talk about these issues and know that there are people who care and places they can go for help. I wanted people to walk out of the symposium and go back to their communities to have these discussions in an open forum so we can continue to leave the firehouse better than we found it.
I think we’re well on our way.
Visit www.rosecrance.org/substance-abuse/florian-firefighter-treatment-center for more information about the Rosecrance Florian Program or contact Dan DeGryse at (815) 387-2461, (312) 833-0196, or firstname.lastname@example.org to make a referral.
Daniel DeGryse is a battalion chief for the Chicago (IL) Fire Department and a director with the Rosecrance Florian Program.