By Michelle Fayed
David was a loving husband and a dedicated father, a man committed to helping his community, and a beloved firefighter with nearly three decades of service in his department. He was the kind of person who made a difference in the lives of those who encountered him.
David, only 48 years old, left those who loved him far too soon as a result of his years-long struggle with post-traumatic stress disorder (PTSD). Sadly, he was just one of many who has succumbed and will succumb to this tragic professional hazard.
Firefighters At Risk
No one becomes a firefighter without understanding that significant danger is involved. Nevertheless, it seems that not nearly enough attention and effort are spent preparing our professional community to contend with the mental health dangers associated with the job, such as PTSD. Firefighters are three times more likely to die by suicide than in the line of duty. The data also show that suicide rates are on the rise; a major study shows that from 2013 to 2017, the rate of firefighter suicide increased at a shocking 89 percent rate.
It’s no secret that mental health-related illness and substance use disorders remain disproportionately prevalent among firefighters. Recent research efforts to improve understanding of the problem by organizations such as the Firefighter Behavioral Health Alliance have confirmed the tragic toll taken by years of neglect.
Tolerating the stigmatization of mental health conditions is no longer an option in the firefighter community. Thankfully, efforts are underway to shift the profession’s culture toward recognizing such disorders as a work-related hazard and a much-needed embrace of preventative care.
Recent research has provided findings that all firefighters should be made aware of. One in five firefighters/paramedics will suffer from PTSD at some point in their career, with active duty fire/EMS personnel between the ages of 31 and 50 at greatest risk. This stems directly from exposure to traumatic episodes in the line of duty. In fact, according to the Journal of Occupation Health, approximately 20 percent of emergency service personnel experience PTSD, which is a significantly higher rate than that found among the general public. Further compounding the problem is the potential for comorbidity of PTSD with other mental health issues such as depression, substance abuse, family dysfunction, and violence. Those affected by PTSD are six times more likely to complete a suicide attempt.
Time to Translate Data into Remedial Action
Despite the findings of recent research into PTSD among firefighters, efforts focused on the development of resources to combat the problem remain inadequate. It is time for the data to be translated into remedial action. Further tragedy should not have to take place for change to happen.
Delivering the kind of proactive mental health care needed by the firefighting community can only begin with a change in professional culture. Departments should make early identification of and intervention with protocols an ongoing part of their operational and continuing education agenda. Open and regular discussion of the matter is key, particularly where communication can be facilitated across ranks and generational lines. It is vital that a sense of responsibility be invested in every department member.
The firefighting profession, as a whole, already has mechanisms in place to emphasize and deliver mental health assistance after significant events. For example, critical incident stress management is a widely used intervention program in the fire/emergency medical services service. These organized debriefings cater to the needs of responders following an exposure to direct trauma or suffering and target the intense stress of emergency and disaster relief activity. Nevertheless, the stigmas associated with mental health and substance abuse disorders can easily cause an unhealthy fear of being labeled scared or weak, among other reputational concerns. These concerns can significantly inhibit engagement during such meetings and can create a pressure for individuals in need to remain silent. When we consider the array of stressors to which professionals can be exposed on any given shift, the dangers involved in not promoting receptivity to mental health care is obvious.
Approach to Take
policy and operating procedures. Policymakers should consider taking a “first aid approach,” which teaches individuals how to identify, understand, and respond to signs of mental illnesses and substance abuse disorder. This type of instruction should aim to provide the skills needed to initiate contact and obtain assistance for someone showing signs of disorder or crisis. Rather than attempting to diagnose a problem, facilitating contact with a professional mental health provider should be the primary goal.
Sometimes, firefighters can find themselves spending more time at work than home with family. This creates a responsibility and an opportunity for professional peers to assist with early intervention when mental health-related issues become apparent. Much like approaching an incident scene, initial steps taken once someone in distress has been identified revolve around the fundamental principle of establishing security before engagement. It is imperative that a person who appears to be suffering from a mental health condition be assessed for any risk for violence or self-harm.
Taking the initiative to develop the fortitude and professional skill necessary to approach someone showing signs of crisis requires effort. However, given the likelihood that such preparation will be put to practical use, as demonstrated by the above-mentioned research data, firefighter professionals have great incentive to run toward such preparedness rather than away from it. The more properly trained individuals there are within a department, the greater the likelihood that needed care will be delivered and tragedy averted. It can also help to create the kind of discretion that may often be needed for initial engagement.
Most persons in crisis who have reached the point of contemplating self-injury or suicide can immediately benefit from the relief of being able to relate their troubles without encountering judgment. Combating the negative aspects of the “superman” persona often associated with the firefighter/paramedic profession through proactive departmental efforts to oppose expressed and implied stigmas is key. Fostering a work place in which seeking out help is the norm, combined with a professional culture that values each individual enough to emphasize proactive assistance, significantly increases the likelihood that a person in crisis will reach for recovery rather than self-harm.
Presently, many departments rely on a chaplaincy program or an employee assistance program to provide personnel with treatment options, but it is to be expected that not everyone will desire to seek help from within their own department. The fear of some disciplinary reaction, whether reasonable or not, can prevent professionals from coming forward. The first-aid approach should include instruction on the availability of treatment options beyond those provided by a department, giving those who may end up providing aid the ability to direct individuals in crisis to outside therapeutic sources.
The Mental Health First Aid program for Firefighter/EMS professionals provides participants with an experiential and interactive course designed by expert firefighters/paramedics to meet the unique needs of emergency service providers with regard to mental health and substance abuse. Studies show that improving mental healthcare literacy will save lives; improve the mental health of professionals administering care in addition to those receiving it; expand knowledge of mental illnesses and treatment options for use in other professional/personal circumstances; increase the availability and quality of services provided; and reduce overall social pressures that may drive individuals with mental health needs away from care rather than toward it.
1. Firefighter Behavioral Health Alliance.
Michelle Fayed is a firefighter/paramedic and a 15-year veteran of Miami-Dade (FL) Fire Rescue. She is a Mental Health First Aid (MHFA) national trainer and content developer of the MHFA Fire and EMS module. She has presented nationally on the topic of mental health in emergency services including at FDIC International, the National Professional Development Summit, the Virginia Fire Rescue Conference, the National Association of State Fire Marshal’s Conference, and at congressional staff briefings in Washington D.C.