By Mary VanHaute
With the momentum behind Life Safety Initiative #13 and through the work of organizations such as Firefighters Behavioral Health Alliance (FBHA), the subject of suicide among firefighters and medics is finally coming to light. Even five years ago, this subject was not commonly found in professional periodicals, on training schedules, or at conferences, and with just cause. Suicide is complex and multifaceted. It is a community-based problem that takes a community-based approach.
With all the priorities in fire service training soaking up time and resources, suicide prevention programs weren’t even on the radar. Preventing a firefighter’s death by suicide was relegated to the arena of public health education and mental health programming for the general public. Additionally, there is no bureaucratic data to draw attention to deaths by suicide within the fire service. Yet, everyone on the job knows it is happening. One anecdotal story after another surfaces through networking, and many firefighters have experienced personal loss. Data drives decision making, though, and without a central clearing house to gather consistent information, the concept remains ambiguous and takes a backseat to mandates, legislation, and other data-driven initiatives.
The FBHA’s recent research has helped quantify the impact. Programs such as Fire Strong (http://firestrong.org), sponsored by the Phoenix (AZ) Fire Department, and Safe Call Now (http://safecallnow.org) have surfaced as excellent resources for raising awareness and making resources accessible.
Yet, death by suicide within fire and emergency medical services (EMS) continues. Without baseline data, we can’t assess whether the numbers are on the rise or coming down. The bottom line is that one death by suicide is too many. Suicide is a preventable form of death that can be reduced through awareness, education, and prevention programs. Many departments, though, do not consider implementing suicide prevention programs in part because it could tax an already stretched training budget and because of the discomfort the stigma surrounding the subject creates.
Ask any agency that has lost a firefighter or medic to suicide, and they will tell you firsthand: The tyranny of hindsight is painful and costly. The cost of losing a firefighter for any reason has an economic impact on the department. But the immeasurable cost of suicide in the way it affects morale, the emotional health of surviving coworkers, and the image of the department has a greater impact. The tyranny of hindsight also reveals that it is far more uncomfortable to talk about suicide after experiencing a loss than to deal with it in a prevention mode. No department should receive an education about suicide through the pain of loss and tyranny of hindsight model; it is too great a price to pay.
How, then, does an agency justify the cost of a suicide prevention model? By measuring the cost effectiveness? By balancing the need with other training essentials? By getting resources in the hands of those who need it? There’s no easy formula, but it’s not complicated. Like other concepts in fire service training, one size does not fit all. As mentioned earlier, suicide is a preventable form of death, but it is not always predictable. Fire service is full of calculated risk based on education and experience. Similarly, careful consideration of the array of prevention programs should yield a plan of action that minimizes cost and maximizes safety with the ultimate goal of preventing a death.
Before beginning any prevention program, consider the following two precepts. First, there must be an underlying belief that suicide prevention training has a place within fire service. Without this tenet, it will be viewed as an intrusion on valuable time and resources. Second, a culture of care that supports the philosophy of Everyone Goes Home will serve as a strong foundation for implementing suicide prevention. Understanding the importance of whole health and all the different ways firefighters and medics die is a critical piece of implementing this training.
When searching for training, consider the following continuum of programming options with estimated investments of time and resources.
Minimal investment of resources. Raising awareness about suicide is the simplest form of education. It can be accomplished through the above mentioned culture of care integrated into passive information around the department. For example, free posters, wallet cards, and informational guides are available through SAMHSA (http://www.samhsa.gov), a federal agency that provides suicide prevention information. Materials specific to fire service can be found on Web sites such as http://firefightersuicide.spcollege.edu. The Center for Public Safety at St. Petersburg (FL) College offers downloadable materials through its Web site that can be customized with specific information about local resources.
Your local suicide prevention coalitions can also direct you to free literature. To find a coalition, go to the Suicide Prevention Resource Center at www.sprc.org and search by state. Other resources include local chapters of Mental Health America (www.mentalhealthamerica.net) or your employee health and wellness resource such as an extensible authentication protocol (EAP) or peer support network.
Throughout our country, the greatest number of deaths by suicide occurs in white males between the ages of 45 and 64 (www.afsp.org/understanding-suicide/facts-and-figures). Consider the demographics of your department. Regardless of their occupation, white males between 45 and 64 are at risk for suicide based on this data from the Center for Disease Control. Factor in accelerants such as personality traits of those drawn to fire and EMS work, exposure to emotional toxins on the job, the stress of shift work, and so on, and you have exponentially increased the odds that suicide may occur in your agency. Therefore, accessing information on men’s mental health that specifically addresses signs and symptoms of depression in men is another excellent source of free resources. One example of this is Man Therapy (http://mantherapy.org), a useful tool for anyone wanting to learn more about depression in men.
Moderate investment of resources. You can couple an awareness campaign with education and training at a moderate investment of time and money. Suicide prevention training programs run along a spectrum and, with a little research, departments can find something that fits their training schedule and budgets. A key component in your research is finding a program that is geared toward public safety personnel and is intended for prevention within the ranks. Many suicide prevention programs are available to the general public, and there is training designed to teach public safety personnel how to recognize and assist the general public. Fewer programs are customized for fire and EMS to teach suicide prevention among their peers. Careful study and discernment will help you locate those specific programs. Begin with your local suicide prevention coalition, your EAP, nonprofits such as Mental Health America, or a local mental health provider. Ask about free or low-cost training and the appropriateness of the training for fire and EMS.
However, use caution. If suicide prevention training is brought into your agency without commitment, support, and purpose, it has potential to fail and further exacerbate an attitude that this type of training is folly and a waste of time. The same would be true if the training is not customized to fire and EMS service or if the trainer is not familiar with the culture.
The Fire that Burns Within program at St. Petersburg (FL) College (http://firefightersuicide.spcollege.edu) is one resource for customized training available at no cost or minimal cost. This one-day training provides comprehensive information and gives attendees tools to set up a suicide prevention programs in their departments. Customized training in smaller increments of time is also available. The investment for the agency would require time and resources as the agency hosts, promotes, and sponsors the event. St. Petersburg College also promotes the training and coordinates funding for the event to make it affordable for the attendees. Expert speakers and trainers offer the course at your location and on your schedule.
Another example of a deliverable training program is QPR training (www.qprinstitute.com). Paralleling the principles of cardiopulmonary resuscitation in healthcare, QPR teaches participants to recognize the warning signs of suicide and act boldly to ask the suicide Question, Persuade the person to get help, and Refer them to help. QPR is considered a gatekeeper training program, which means it is designed for people who interact with each other on a regular basis. It is not a form of counseling or therapy but rather a way to courageously and compassionately intervene when someone appears to be at risk for suicide. An internationally recognized program, QPR is the model for many state and local suicide prevention coalitions. It can be customized for fire and EMS personnel, and the QPR Institute has instructors trained in this area of expertise. QPR can be taught in a 90-minute time period with a recommended 25 to 30 participants in the course. It requires a minimal investment of money to purchase classroom materials that accompany the training.
Maximum investment of resources. Instituting a suicide prevention strategy with goals and projected outcomes requires a system-wide approach. Train-the-trainer programs that certify personnel with a vested interest in training on this subject yields high returns on the investment. The QPR Institute provides train-the-trainer courses, and St. Petersburg College’s Fire that Burns Within program provides a toolkit and training materials for personnel who want to develop their own training program. Tuition for the QPR train-the-trainer course (around $500) may be offset by local grant dollars from a suicide prevention coalition, a local mental health resource center, or private funding. Applying for grants or scholarships to attend the train-the-trainer course may be expedited by the fact that QPR is a commonly used, well-recognized program with proven effectiveness. As mentioned earlier, attending training from St. Petersburg College’s Fire that Burns Within program can be done at minimal or no cost to the department depending on availability of and eligibility for federal grant dollars.
This larger investment of time and funds can appear daunting at first, but the return on the investment comes quickly when implemented through a system-wide, comprehensive approach. Having a QPR instructor in house ensures continuity of instruction and contributes to sustainability of the program. For example, teaching QPR in the academy is an opportunity to inoculate recruits and introduce them to the concept of suicide prevention. Having an in-house trainer allows the department to reintroduce the course materials once members are off probation or through ongoing in-service trainings.
Finding time and funding for any type of suicide prevention training is challenging. Yet, even the smallest amount of time dedicated to raising awareness could yield an immeasurable result. If you have considered including suicide prevention in your training regime but keep pushing it further down your list of priorities, think again. Reassess the cost of training and the cost of not training. What price are you willing to pay to learn about suicide within the fire and EMS profession?
Mary VanHaute served as an instructor and counselor at Northeast Wisconsin Technical College in Green Bay, Wisconsin, and Niagara, Wisconsin, for 29 years. Her avocation includes lay ministry in her church, advocacy for law enforcement, and suicide prevention. She served on the state board of Wisconsin COPS (Concerns of Police Survivors) as support coordinator and received a national award for COPS as Volunteer of the Year. She is a master trainer for the QPR institute in Spokane, Washington, and serves on the Wisconsin State suicide prevention steering committee. She dedicates her work to the memory of her brother Charlie, a Milwaukee (WI) Fire Deparment firefighter, who was a victim of suicide 19 years ago.
