By P.J. Norwood and Jim Rascati
During a recent two month period in 2015, two firefighters killed themselves in Connecticut. These are tragic events that severely impact the firefighter’s family and friends as well as his extended family of brother and sister firefighters. There are no words to adequately describe the shock and surprise of firefighters when they are informed of these horrific events.
Suicide for first responders–both firefighters and police–is a significant problem not just here in Connecticut but nationally. Understandably, it is also a subject that many people find difficult to address. Regardless of how painful and difficult this topic is, not discussing it will not make it go away. The fact is that suicide happens to be one of the more preventable forms of death.
The breadth of the problem of firefighter suicides is very difficult to ascertain. The ability to obtain accurate data is complicated by the fact that there is no national reporting forum like there is for line-of-duty deaths. However, according to the Firefighter Behavioral Health Alliance there were 70 suicides in 2013, 107 in 2014, and 98 through October of 2015.
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A former fire chief in one of Connecticut’s larger towns had experienced nine suicides over his tenure in the fire services–two prior to his employment, two while he was chief, and five retired firefighters over the course of a more than 25-year career. And this is from just one fire department in the state.
What makes getting an accurate picture of the full extent of the problem is the fact that some departments may be less than forthright about what actually happened to the firefighter. “Firefighter Smith was cleaning his gun when it accidentally went off.” This denial or cover up probably is more prevalent when a life insurance policy becomes void if a suicide is involved.
We also know that the majority of all suicides often involve alcohol, even though the person may not have an alcohol problem. We all know that alcohol tends to lower inhibitions, thus lowering the wall of resistance that may keep some suicidal individuals alive. Given that alcohol abuse and/or dependency are already a problem among firefighters, it makes the issue of suicide even more of a concern.
But it is not just the prevalence of alcohol or other substance abuse in the firefighting service that is a concern. There are also alarming rates of divorce, acute stress disorder, and post-traumatic stress disorder (PTSD). Additional considerations are the macho mentality of being strong and independent, the false assumption that the emotional challenges of your job should not impact you, and the other cultural tensions that somehow one is viewed as “weak” if he or she talks to a therapist or counselor.
It is often said that firefighting is the best job in the world, and in many ways it is. But it is also a very intense and at times stressful job. At a moment’s notice, a firefighter can be called to a working house fire with people trapped inside or to the scene of a multiple car accident where young children are involved. Firefighters can go for days with no activity, and then suddenly have to respond to call after call with little or no breaks in between. This inconsistency and varying patterns of stress adds hidden psychological impacts and stressors to our body. According to Fire Engineering, firefighting was chosen as the most stressful job of 2015, as stated in the article “Suicide Rates Rising Among Firefighters.” The article went on to report that, according to the National Firefighters Foundation, a “department is four times more likely to experience the suicide death of a member than a line-of-duty death.
‘JUST DEAL WITH IT’
P.J. Norwood started in the fire service at the very young age of 13. It was a time when the fire service was starting to ban alcohol in the firehouses, ban riding the backstep, mandating self-contained breathing apparatus (SCBA), and incorporating emergency medical services (EMS) into the everyday culture. These were very big changes at the time, and many firefighters were hanging on to as much tradition as possible.
The mindset then was, “If you can’t handle it, this job is not for you.” The “it” was the emotional side, the side of seeing death and tragedy up close and personal. A skill that was quickly learned was the ability to build walls or bury the emotions that I was feeling. This education at the time was viewed as the right and only way to handle it. Today we are armed with more information and data, and it’s clearly not the right way. We still need the ability to compartmentalize our emotions so it doesn’t cloud our ability to function at the time of the emergency. However, we must clearly understand that trying to permanently build those walls or bury the emotions is not the best way to handle it.
The unfortunate reality is that in some departments firefighters are expected to ‘just deal with” the many critical incidents they experience in the course of their career. Although this mentality is changing, there still exists the “just suck it up” response to horrific events that many firefighter professionals encounter on the streets.
There is also the mistaken notion that if a firefighter talks to a therapist that somehow superiors and co-workers will find out, and the fear persists that this will negatively impact a person’s job. This notion is patently false. Behavioral health counseling is confidential except where governed by law. The only exceptions to confidentiality is danger to self, others, and child or elder care abuse.
What we do know clinically is that for many of us, stress can build up over time. All the preceding facts—the cumulative impact of stress, rates of alcohol and other substance abuse, macho culture, and the fear that seeking behavioral health counseling will negatively impact one’s career–all make for a potent witches brew for depression, if not suicide.
Regardless of occupation, the research shows that the number one cause of completed suicides is depression, according to the National Institute of Mental Health. Depression is very well treated when accurately diagnosed and acknowledged. The research further shows that the most efficacious treatment for major depression or bipolar disorder is a combination of psychotherapy and psychopharmacology. However, the largest group of prescribers of antidepressants is not psychiatrists or psychiatric nurse practitioners but primary care practitioners (PCP). Because of managed care, most PCPs spend very little time with their patients and are more apt to write prescriptions. In some situations, they may not suggest to their patient that they should also be in psychotherapy provided by a behavioral health specialist.
There is a lot of resistance for firefighters seeking psychological counseling, which makes the situation even more problematic. Although stigma related to seeking mental health care has somewhat subsided in our larger society, it still remains a significant barrier within the fire service. There remains the mindset that one’s career will be negatively impacted if it is known that a firefighter has sought behavioral health therapy or has used the department’s employee assistance program (EAP). It is unfortunate, but seeking treatment can be seen as a sign of weakness–perhaps one of the primary reasons discussion of mental health issues or suicide may be avoided.
As stated previously, suicide happens to be one of the more preventable forms of death.
According to the National Institute of Mental Health, suicides are preventable. More than 90 percent of people that have committed suicide were suffering from clinical depression or some other diagnosis of psychiatric illness and/or substance abuse, which are treatable conditions.
Education, awareness and intervention may be able to prevent these tragic losses. One of the major myths that exists is the notion that asking someone if they are suicidal puts the idea in his or her head. This is factually not true. You cannot give somebody the idea of killing themselves. Most people want help and feel relieved when asked. Another myth is that suicidal people keep their plans to themselves. Most suicidal people express their intent to someone within one week of completing suicide. That communication may not be a direct “I want to kill myself,” but often times it is spoken metaphorically (i.e. “I wish I would go to sleep and never wake up” or “no one would miss me if I’m gone.”)
EDUCATION AND TRAINING
Fire service professionals are accustomed to asking difficult questions and dealing with difficult situations. However these situations rarely involve friends, co-workers, or even those we consider are second family. One of the more difficult questions or statements I have asked/stated is “I clearly understand you are struggling right now. But I need to know if you are considering suicide.” Although, the question is not difficult to pose, we may fear the answer.
Firefighters cannot prevent all fires or save every accident victim, just as behavioral health professionals cannot prevent all suicides. There are still things that we both can do to minimize, if not dramatically decrease, firefighter suicides, but we must take steps today and understand, recognize, and provide the tools to help those who need it. Just like an EMS call, we cannot stop the bleeding without the right dressing and bandages. We cannot put the fire out without water. We need the right tools for the right job and the proper training and education to deploy those tools.
It is paramount that all firefighters, not just command staff, receive education on the signs and symptoms of depression as well as the risk factors for suicide. Next, we must educate our membership how to intervene and what questions to ask, and familiarize them with treatment options and how to access them. For those agencies that have an EAPs, use them. All personnel should understand how to access EAP services, confidentiality issues, etc.
We must also understand that there is no perfect scenario. The question many still struggle with is when to reach in and say, “Hey I know you are struggling…do you need to chat?” This is different than “Hey, let’s go talk.” We all know and have been in the position when we have asked someone if they were okah and gotten the standard firehouse reply, “Yeah man, I’m good.” We need to navigate through the troubled waters and receive training so we ask the right questions the right way.
In many municipalities, regardless of size, the two departments that generally have the lowest EAP utilization tend to be police and fire departments. Yet when you look at the epidemiology for first responders, both fire and police tend to have high rates of alcohol abuse, divorce, acute stress and post-traumatic stress disorders, and, as we are learning for firefighting, very high rates of suicide. This is unacceptable and cannot continue. Firefighters must not shy away from this issue. There are resources and solutions available to reduce the incidence of suicides, and the adverse impact such tragedies have on both the biological and extended firefighter families.
Suicide is a reality in the fire service. It’s not considered a line-of-duty death. However, in many cases the root cause is cumulative stress from incidents firefighters respond to. We must step up and lead our departments by educating and providing resources to begin decreasing PTSD, alcohol abuse, and firefighter suicide. As George Healy said in his FDIC keynote speech, “When your firehouse has an LODD, it will never be the same.” Don’t wait until it impacts you, your department, or someone you know to act.
Fire Service Suicide Prevention Hotline – 800 273-TALK
P.J. NORWOOD is a deputy chief training officer for the East Haven (CT) Fire Department and has served four years with the Connecticut Army National Guard. He has authored Dispatch, Handling the Mayday (Fire Engineering, 2012); coauthored Tactical Perspectives of Ventilation and Mayday DVDs (2011, 2012); and was a key contributor to the Tactical Perspectives DVD series. He is a Fire Engineering University faculty member, co-creator of Fire Engineering‘s weekly video blog “The Job,” and host of a Fire Engineering Blog Talk Radio show. He is certified to the instructor II, officer III, and paramedic levels.
JAMES RASCATI, LCSW, has more than 35 years of experience in behavioral health. He is a partner at Behavioral Health Consultants, LLC in Hamden, Connecticut, and is the director of organizational services. He is also a clinical instructor of psychiatry (social work) in the Yale University School of Medicine, Department of Psychiatry. He has developed an expertise and interest in working with firefighters and police officers. He has developed police and fire peer support teams for eight law enforcement agencies and four fire departments in Connecticut. He is also certified as an instructor by the Police Officer Standards and Training Council for the areas of cultural awareness and diversity, substance abuse, suicide recognition intervention and management, stress management, and supervisor/subordinate relations.
