Moving firefighter mental health beyond conversation

There are concrete steps fire officers can take to prevent, recognize and respond to firefighter mental health problems


SAN ANTONIO — The good news about firefighter mental health issues is that we're having the conversation. That is evident by an entire tract of educational seminars on the topic at IAFC's Fire-Rescue International Conference. 

The bad news is we still have a long way to go in preventing, recognizing and treating them. Clinical Psychologist and retired firefighter and EMT Dr. Beth Murphy examined causes, identifiers and what to do about mental illness in her presentation. 

Dr. Murphy discusses firefighter and EMT mental health issues at FRI. (photo/Rick Markley)
Dr. Murphy discusses firefighter and EMT mental health issues at FRI. (photo/Rick Markley)

Looking at how biological, social and psychological factors interact in a person's make up helps understand why some firefighters are more resilient than others to job stress, she said. 

Those who are strong in all three areas tend to handle the stress well. However, weakness in one area, such as not being accepted within the fire department, can lead to problems in the other areas and increase vulnerability to mental health issues like depression, she said. 

And the physical and mental health components are also inseparable. Physical limitations like injuries or not being good enough shape to do firefighter work can lead to mental health problems, she said. 

Likewise, mental health problems like depression or PTSD adversely affects physical conditions like tolerance to pain. 
"Physical and mental health are tied together," she said. "You cannot tease those apart."

While it is difficult to nail down in exact numbers the toll mental health takes on the fire service, the numbers we do have are profound. Murphy said that of all people who die by suicide, 90 percent exhibit one or more mental illnesses. And so far this year there have been more than 80 firefighters or EMTs who died from suicide as reported by the Firefighter Behavioral Health Alliance — and there's strong indication that those reported numbers are far below the number of actual cases.

Murphy advised people to take a hard look at their own lives for risk factors like changes in behavior such as substance use and abuse, sleep patterns, irritability, reclusiveness and despondency. She said to look for those factors in others on the department. 

Risks for suicide, she said, tends to manifest itself in three ways: having no fear of what should scare people, having a perception of being a burden to others and having a low sense of belonging to important groups like families and fire departments.

"Social support is one of the number one ways people get over stress," she said. That means acting when warning signs are present, even when unsure what to do. Listening, recommending counseling, asking mental health professionals for advice on talking to a coworker and not leaving a person alone are all things any firefighter can do.
And, she said, if someone confesses suicidal thoughts, take that threat serious — even if it has been repeated but not acted on. Don't leave that person alone, even if you don't know what to do, she said.

One of the barriers to getting firefighters and EMTs the help they need is training those in command to put policies in place to help them and knowing what to do when a firefighter presents mental illness symptoms. 

More systemic, are problems firefighters face who do come forward and find themselves out of work and without disability pay. 

One of the seminar attendees told of a firefighter who sought help and was denied coverage. Not only did it harm that firefighter, but sent a message to other firefighters not to come forward with mental health problems. The person would have been better off with a broken ankle, as that would have been fully covered, the attendee said. 

One person said she got around similar problems on her department by tying the PTSD treatment to alcohol abuse, despite alcohol abuse being a symptom of the problem rather than the actual problem. 
Part of the problem is that stress is often not recognized as part of a firefighter's or EMT's job. Another problem is that benefit providers do not recognize the PTSD can be cumulative as opposed to tied to a single traumatic event. 

As with the battle to have cancer recognized as an occupational illness, mental health issues face an uphill battle from within and from outside the fire service. 

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