An Intro to Firefighters and Their Mental Health ChallengesWednesday, 14 June 2017 00:00 Written by Super User
Guest blog written for ATS by Robert Avsec
In our previous article, The Effects of Stress on Our Brain and Body, we discussed how the brain processes and responds to stress and the resultant effects on our mind, behaviors, emotions, and our body. In this article, we'll discuss some of the stressors that exist for firefighters and how identifying the sources of our stress are an important step in learning to cope with on-the-job stress in a more healthy way.
In a February 2016 posting, Aljazeera America reported that in 2014 approximately 109 firefighters and paramedics took their own lives, according to the Firefighter Behavioral Health Alliance (FBHA). That's an average of two deaths per week. In 2015, a record 113 firefighters and paramedics killed themselves .
The numbers, however, could be much higher because there is no official database tracking suicide by firefighters and paramedics, according to the Aljazeera article. Very few fire departments report these incidents, and very few first responders ask for help—a product of a culture that stigmatizes showing any type of weakness, whether physical or mental .
Captain Jeff Dill, a retired firefighter and founder of the the nonprofit FBHA was quoted in the article as stating, "Suicide among our brothers and sisters is real." Dill went on to say that according to data he's collected, the number of firefighters and paramedics taking their own lives has grown nearly every year since 2011 .
Understanding What's Happening
Resilience is the capacity of an individual to recover quickly, resist, and possibly even thrive in the face of direct/indirect traumatic events and adverse situations. An individual's level of resilience is heavily dependent upon both physical factors (adequate rest, nutrition, illness or injury, and exercise) and emotional factors (absence of any organic mental illness, personality type, self-esteem and self-worth, and general satisfaction with their life). If we think of our mental health as an emotional bank account, having as many of these factors as possible being viewed as positive are like "deposits" into that bank account.
Withdrawals from the Emotional Bank Account
In many respects, firefighters have much in common with military personnel. For both, the necessary separation from their families on a regular basis (firefighters for their tour of duty and military personnel for their deployment) creates a strong sense of having two families (with corresponding roles and responsibilities) as depicted in Fig. 1 below:
Figure 1. A firefighter's two "families"
Each of those roles and responsibilities comes with their own inherent stresses. When combined with the "friction" that can arise between an individual's two families, those individual stresses can be amplified. Consider a couple of examples:
• A firefighter, and single parent, hasn't been able get time off from their tour of duty to attend several important school functions with their child this school year.
• A firefighter and their spouse are having marital difficulties that are severely straining their marriage.
• A firefighter who's "living a champagne lifestyle on a beer budget" finds himself and his family heavily in debt so he's taking all the overtime shifts he can get, and he's working a second job.
Now none of those three have anything to do with a firefighter's roles and responsibilities for their work family, right? But they are "withdrawals" from the firefighter's emotional bank account. So, when a firefighter is a situation like those above comes to work, their emotional bank account may be "low on funds" or depleted.
Work Family Stressors
Firefighters are commonly exposed to stressors from these six areas while on the job :
• Being thrust into chaotic, high-stress situations with limited information and the expectation for quick resolution of the problem.
• Technical training that develops a highly specialized set of skills, along with an expectation that failure is not an option.
• A strong sense for taking responsibility for both the problem and its outcome. Listen to the language we use. "We burned that house down." "I lost that pediatric cardiac-arrest patient."
• A strong sense of camaraderie and teamwork where there are great pressures not to let one's team members down in a critical situation.
• A culture that rewards risk taking and quick decision-making and has a negative view of self-doubt.
• The stress of not knowing when the next call may come in, where it's at, and what it may involve, aka, "Anticipation Anxiety."
And we haven't even gotten to the stresses of actually providing fire and EMS services to the civilian population! How vulnerable would a firefighter be to the trauma they might experience at the scene of a horrific motor vehicle crash, or a fire with multiple fatalities, if their emotional bank account is already "in the red"?
The Mental Health Continuum Model
Canada's National Defense [sic] and its Canadian Armed Forces (CAF) have learned from combat deployments of its personnel in Afghanistan and Iraq that many CAF members have physical and mental health concerns that, if identified and treated early, have the potential to be temporary and reversible. From those experiences—along with collaboration with the U.S. Marine Corps—they developed the model in Fig. 2 below .
Figure 2. This model recognizes the spectrum of health concerns, be they mental or physical, that may impact CAF members during their careers. The model goes from health, adaptive coping (green), through mild and reversible distress or functional impairment (yellow), to more severe, persistent injury or impairment (orange), to clinical illnesses and disorders requiring more concentrated medical care (red).
The arrows under the four colored blocks denote the fact that this is a continuum, with movement in both directions along the continuum. This helps indicate that there is always the possibility for an individual to return to full health and functionality. No one is "written off" simply because they are showing symptoms of post-traumatic stress, or are being treated for mental health issues associated with their symptoms. It also identifies that the earlier intervention of some sort is provided, the easier it is to return to full health and functionality (the green block) .
It's a Leadership Thing
As depicted in Figure 2, the CAF has recognized that the health and well-being of CAF members must be a responsibility shared equally by the individual and members of the individual's chain-of-command. Organizational leaders have a responsibility for their personnel and have a vital role to play in preventing and managing distress .
The model also points out that as the severity of the illness increases, this may result in a more robust Health Services (mental health professional) intervention, but the leader never abdicates their responsibility for the individual. Leaders always have a role and responsibility to maintain contact and support their members throughout the continuum of mental health care .
The actions of the chain of command also have an impact on the movement of the individual along the continuum. Significant life events certainly impact one's mental health (as I described earlier), however what is even more significant is the impact of small daily "hassles" on the job can have on exacerbating an individual's distress over time. The leader has a role in affecting those "little things" in the day-to-day work life that can cause distress in their personnel.
Recognizing Where One is on the Continuum
Firefighters take great pride in "having each other's back". So, how can one firefighter or officer recognize that an individual is having a rough time? After all, it's not like they're going to have a sign around their neck stating, "Help! The stress of the job is having a negative impact on me!", right?
Figure 3 below is the "companion" to the Mental Health Continuum Model . As with all models, it's not meant to be all-inclusive for the signs and symptoms of post-traumatic stress or other stresses that an individual may be experiencing. But it's a good start.
Figure 3. Everyone in the organization has a responsibility to be "on the lookout" for members of the team who may be struggling with the mental health challenges of the job. Keep in mind that most drowning victims don't realize they are drowning until it's too late. Same with mental health issues.
What if every fire station had a 3-foot by 5-foot poster with this model, posted on the wall, so that it was a daily reminder of what we should be on the lookout for to truly "have each other's back"?
1. Aljazeera America. Amid culture of silence, more firefighters die of suicide than on the job. February 20, 2016. [Available on-line] http://america.aljazeera.com/watch/shows/fault-lines/articles/2016/2/20/amid-culture-of-silence-more-firefighters-die-of-suicide-than-on-the-job.html
4. FireRescue1. PPE for firefighter psyche. [Available on-line] https://www.firerescue1.com/fire-chief/articles/52328018-PPE-for-firefighter-psyche/
5. Canada's National Defence [sic] and Canadian Armed Forces. The Military Mental Health Continuum Model. [Available on-line] http://www.forces.gc.ca/en/caf-community-health-services-r2mr-deployment/mental-health-continuum-model.page
9. Canada's National Defence [sic] and Canadian Armed Forces. The Military Mental Health Continuum Model. [Available on-line] http://www.forces.gc.ca/en/caf-community-health-services-r2mr-deployment/mental-health-continuum-model.page
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Battalion Chief Robert Avsec (Ret.) served with the Chesterfield (Va.) Fire & EMS Department for 26 years. He was an active instructor for fire, EMS, and hazardous materials courses at the local, state, and federal levels, which included more than 10 years with the National Fire Academy. Chief Avsec earned his bachelor of science degree from the University of Cincinnati and his master of science degree in executive fire service leadership from Grand Canyon University. He is a 2001 graduate of the National Fire Academy's Executive Fire Officer Program. Since his retirement in 2007, he has continued to be a life-long learner working in both the private and public sectors to further develop his "management sciences mechanic" credentials. He makes his home near Charleston, W.Va.