Sharon L. Cohen
Co-author of Disaster Mental Health Community Planning
The month of June is designated as a time to spotlight the causes and effects of Post Traumatic Stress Disorder (PTSD. The need for this focus is now even more important for first responders because of the growing emotional impact of the COVID-19 pandemic, worsening natural disasters from climate change, and increasing number of mass shootings. Yet, despite the higher prevalence of depression, acute stress, trauma, substance abuse, and suicidal thoughts in firefighters, it is often very difficult for them to find and access behavioral health resources. Increasingly, firefighters are thus calling for enhanced resiliency training for all new recruits, ongoing review of these programs, and 24/7 accessibility to trauma-informed counselors.
In a 2018 International Association of Fire Fighters’ survey, 7,000 respondents overwhelmingly replied that stressful job experiences have impacted their mental health: 19% have had suicidal ideation, 27% have struggled with substance abuse, 59% have experienced family and relationship problems, and 65% are haunted by memories of a bad call.
Nationwide, depression and PTSD affect about 30% of first responders in comparison to 20% of the general population. About 4% of Americans have considered suicide, but this number is nearly ten times higher for firefighters. Similarly .5% of all Americans have attempted suicide and close to 7% of firefighters. Due to their direct fire exposure, numerous hours without a break, and lack of sleep, wildland firefighters are disproportionately impacted and susceptible to emotional issues and suicide.
It is essential that all voluntary and paid fire departments offer trauma-informed resiliency training for new recruits, ongoing review of this information for all firefighters, and counselor availability. A supportive and peer-focused environment with strong team support has the most positive impact on personnel. Encouraging leadership can create a department where mental health stigma is reduced and open communication is maintained. Firefighters know their increased emotional risk, the symptoms that may arise, and what counselors to contact if needed.
A peer and counseling support program will often include:
- Understanding of job risks and an emphasis on the importance of mental health. Firefighters are encouraged to seek help from peers and counselors and not see this need as a personal weakness. They must understand that invulnerability to trauma is an unfortunate falsehood.
- Knowledge that everyone handles stress differently and some are more resilient than others. There is no “one way” that people respond to stressful experiences.
- Awareness of most critical symptoms and necessity to seek help as soon as these arise. The longer people ignore warning signs and postpone support systems, the greater the chance for developing PTSD.
- Emphasis on contacting a counselor who is well versed in trauma care and knows the most effective ways to expediently help clients. Telehealth is increasingly available. Digital trauma intervention (apps) can easily be downloaded, but the effectiveness is not yet validated because of typical sporadic use and impersonal form of care.
- Knowledge of wellness activities regularly used to build resiliency and respond to times of acute stress. This approach includes the importance of exercise, positive sleeping habits, and healthy meals. Such activities can be provided onsite, through the local community and/or online.
- Setting of personal goals for the firefighters’ ongoing wellbeing. Peer support and activities with family and friends help maintain emotional stability.
- List of phone numbers, websites, and local resources for immediate and long-term care.
- Ability to talk to each other in small groups or one-on-one about coping mechanisms. Especially after a major incident with injuries and/or fatalities, such close communication is beneficial.
It is best that fire department leadership ask for input from a trauma-informed counselor before leading their resiliency programs. In many cases, this counselor may help lead the sessions.
Resiliency training needs to be part of a well-rounded mental health program. Firefighters must continually be aware of their vulnerability have a strong peer support system and 24/7 availability to mental health providers. A list of local certified mental health professionals as well as emergency numbers should be posted in all department locations. These include:
- Local 211 support.
- The Share the Load program run by the National Volunteer Fire Council with a help line and collection of resources for help and support. https://www.nvfc.org/programs/share-the-load-program/
- SAMHSA First Responders and Disaster Responders Resource Portal https://www.samhsa.gov/dtac/disaster-responders
- National Suicide Prevention Lifeline – 1-800-273-8255. This is not responder-specific, but anyone can call who requires immediate help.
- International Association of Fire Fighters, Firefighter/ Family Crisis and Support Line – 844-525- 3473. This is a 24/7 hotline for firefighters and family members with mental health counselors with fire service experience.
- Heart 911 SMART program for first responders. A program “for first responders delivered by first responders” who have learned to manage stress-related symptoms. https://heart911.org/2020/04/17/heart911-smart-program/
Studies increasingly report on the importance of this peer support model that stresses the close involvement of experienced firefighters in mental health efforts. When a traumatic incident occurs, such support may play a valuable role in trauma reduction as well as encouragement to seek further help. Like anyone else in the general public, firefighters frequently are hesitant to seek outside treatment. Firefighter peers can talk about their own treatment and what to expect. They become trusted models who can provide education, encourage open communication, and support those who need to seek treatment for long-term care.
Sharon L. Cohen of Newtown, Connecticut, is co-author with LPC Bob Schmidt of Disaster Mental Health Community Planning (Routledge 2020), which provides a roadmap on developing a disaster mental health intervention plan that helps greatly reduce the incidence of PTSD and other long-term emotional problems following a human-caused or natural disaster. The pandemic and worsening natural disasters nationwide have led to a mental health crisis for individuals of all backgrounds, particularly the most vulnerable. For more information: www.disastermentalhealthplan.com.