By Dan Nephin
LNP
LANCASTER COUNTY, Pa. — Jerry Schramm says talking about mental health and trauma was “more or less taboo” when he became a first responder in 1997.
But that has changed.
“We have a new generation coming in, and the stigma of mental health and being able to take care of yourself is starting to fizzle,” said Schramm, 48, director of operations at Lancaster EMS.
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In Lancaster County, resources such as the Critical Incident Stress Management program help first responders deal with the trauma they face on the job that can negatively impact their mental health. But while the local CISM (pronounced SIH-zym) program has been around since the late 1980s, several people involved with it say it could probably be used more.
One of those people is Lancaster city police Sgt. Todd Grager, who admits he talked the talk before walking the walk about getting help for his mental health issues. The U.S. Marine Corps veteran has been involved with CISM for the last 15 years, helping other first responders. He currently is on the program’s executive board.
Another is Glenn Usdin, a former chief of the Lancaster Township Fire Department who became a peer member of CISM following a Feb. 13, 2024, fire where a father died trying to get to his daughter’s bedroom. She survived.
Usdin, 69, said that while he has been around death hundreds of times in his 50-plus years in emergency services, for some reason, that fire significantly affected him.
“I don’t know if it was a cumulative effect of all of the other incidents over the years, or the fact that I was one of the people in the command structure at that fire, or that I was getting older, or maybe I’ve become an old softy or whatever. That one probably got me more than any other fire or accident in my whole career. Oh, that knocked me for a loop,” Usdin said.
After going through a debriefing following the fire, Usdin said he was invited to join CISM as a peer.
“There are still a lot of leaders in positions of authority who believe that discussing mental health issues is a sign of weakness or instability, and so many of the incidents that you see and think should have been or could have been CISM team activation just are not,” he said. “And we don’t push.”
‘It has taken years to get people to buy into the program’
The local CISM program traces its roots to May 10, 1987, when 7-year-old Laura Flanagan died in a Manheim Township house fire, a tragedy that hit Eden Fire Company firefighters particularly hard.
One of the firefighters, the late Clyde “Tim” Brown, turned to psychologist Kenneth Ralph, who was then working in the county’s Office of Mental Health/Mental Retardation (now Behavioral Health and Developmental Services).
Ralph arranged a meeting where firefighters could feel free to talk about how the girl’s death impacted them. The firefighters found it helpful and wondered if more such talks could be done.
Ralph learned that Jeffrey Mitchell, a former first responder who was working on his doctorate at the University of Maryland, Baltimore College, was helping to develop what would become the Critical Incident Stress Management program.
Ralph brought Mitchell, who was a former firefighter and paramedic, to Lancaster County in January 1988 for a training session for first responders, and soon afterward the county’s CISM program was created. The local program is not an official county agency. It relies on a team of about 100 volunteers, half trained mental health professionals such as Ralph, and half peers — active or retired first responders who have first-hand understanding of what their fellow first responders can go through.
Grager, 42, said having peers is a tremendous value.
“In law enforcement, we vet everybody, right? Because we need to know who’s on the other side of the conversation from us,” Grager said. “And someone won’t ever be vulnerable and talk about how they’re feeling or talk about things that they’re going through to somebody that they don’t feel is valid.”
Team members are on call 24 hours a day, and if a first responder organization wants a CISM debriefing, it will let the team know through the county’s 911 system. Depending on the incident, Ralph or another leader will begin contacting members and set up a debriefing session, preferably within 24 to 48 hours of when the incident occurred.
“The goal is to get (first responders) to talk and put it in perspective and be able to share things that are uncomfortable and to become and feel safe enough to talk about having an unusual circumstance, unusual feelings and thoughts and behaviors (due to) an abnormal situation,” said Ralph, 75, who has been clinical director for the county’s CISM program since it was formed.
The local program had its first true debriefing following another incident involving the Eden Fire Company, which is now part of Manheim Township Fire Rescue. On May 19, 1989, J. Brian Harnley was killed and two other firefighters were injured when they were thrown from the tailboard of the fire truck they were riding on when the driver lost control while responding to a house fire.
“That was really the first call for a team where myself (and) Ken ... went out the night of the incident,” said Randy Gockley , the county’s former emergency management coordinator who has been with the CISM program since the beginning. “And I got to give Ken all the credit on that, as far as reaching out, getting the mental health people to buy into it and provide their services for free.”
Gockley, 69, said the local CISM program would not be where it is today without Ralph.
“It has taken years to get people to buy into the program, especially law enforcement,” Gockley said. “Law enforcement really wanted to take care of things internally with other law enforcement.”
The CISM team averages about a dozen debriefings a year, according to Ralph.
‘We rush into traumatic incidents’
Gockley, who was a longtime member of Lincoln Fire Company in Ephrata Borough including serving as its chief, has offered support to his peers through the CISM program and has been on the receiving end of the support it provides.
“I saw a young child actually die in front of me at a vehicle accident. The child was trapped. We could not get to the child, and the child took its last breath in front of me, and that was the first time that I had to be on the other side with being a recipient of the benefit ... versus being a peer,” Gockley said. “That was a great help to me personally.”
Though critical incidents most frequently involve homicides or fire and traffic fatalities, they can also be the result of a suicide within a first responder organization or an attack on a responder, such as when Lancaster EMS paramedic Melanie Kempf was stabbed by a patient in February 2022. Through the mental health professionals on the local CISM team, Kempf was connected with a therapist specializing in treating first responders.
At debriefings, Usdin said he talks about how human beings are not programmed to cope with traumatic events, yet responders see them repeatedly.
“And that affects you ...So to me, the ability (for responders) to be in a judgment-free zone right after the incident occurs, and to think about and share with others without any judgment or prejudice, just say, ‘This is what I saw, and this is how it’s affected me,’ has been very helpful,” he said.
The CISM program isn’t meant as a substitute for mental health treatment, but instead to help those affected deal with an immediate situation, Ralph said.
“Nobody calls us because they’re having the best day of their life and they want to share it with us,” Grager said, speaking broadly about first responders. “It’s because something went completely wrong. And we don’t get to decide when we get called.
“Dispatch dispatches you as a unit, and you respond. And that’s what we’re called to do. This is a calling,” he said. “And so at the end of the day, we rush into traumatic incidents, and we do everything that we can. And sometimes there’s not anything that we can do. And that is what causes the trauma.”
‘It was just a horrible feeling’
More recently, staff from the county coroner’s office and 911 dispatchers have been invited to take part in CISM debriefings.
“They’re visualizing in their head when they’re hearing people on the phone what’s going on on the other side of that phone line, and it’s traumatic, and they oftentimes don’t get the satisfaction of understanding what happened after the phone calls,” Grager said of dispatchers. “They’re on to the next call, and they have all these unresolved things that are happening.”
Janice Ballenger, a former Lancaster County deputy coroner, said she probably could have benefited from participating in CISM debriefings held after the mass shooting at the West Nickel Mines School, but was unaware of them.
On Oct. 2, 2006, Charles Carl Roberts IV entered the one-room Amish school in Bart Township and shot 10 girls, killing five and wounding five others before killing himself.
“Not a person reached out to me, and I took the rest of the week off. That was on a Monday, and I took the rest of the week off from everything,” Ballenger, 72, said, adding she had no recollection of the following day and had to be filled in by a friend. "... It was just a horrible feeling. It was like I had fallen in the tunnel and nobody was ever going to pull me out.”
Ballenger said she did get together informally with some firefighters to talk through what they had gone through. She recalls firefighters carrying injured girls to helicopters to be taken to the hospital.
Ballenger said she also went to therapy and self-published a memoir, “Addicted to Life and Death: Memoirs of an EMT and Deputy Coroner,” which has a chapter on Nickel Mines, as part of her healing.
Grager said having 911 operators and coroner staff take part in CISM debriefings is also beneficial to help everyone understand the totality of an event.
“We have a circle discussion about everybody’s role in the incident and how things happen. And naturally feelings that are associated with what that person’s role was come out in the debriefing, and it helps paint the picture for everybody else that’s in every other facet of that incident to really understand it,” Grager said.
‘There’s such a stigma’
Grager said he and a couple other people involved with the CISM program have been spreading the word at crisis intervention training run by the county. The training is run by the county’s probation and parole department and is intended to give police resources when responding to calls involving people with mental health issues or in crisis.
“But a portion of that has turned into officer wellness and self-care, and in doing that, that’s how we’ve kind of used that opportunity as a way to spread the word about CISM. Because years ago, CISM wasn’t something that was widely used and it wasn’t known about throughout the law enforcement and first responder communities,” Grager said.
At the same time, Grager acknowledged that the CISM program has been around nearly four decades.
“It’s been around, but the problem is that the word didn’t spread because there’s such a stigma with mental health and first responders,” he said.
Grager said he hopes that by working with the CISM program and other mental health efforts, first responders will be able to seek help and take better care of their mental health. He and others noted that suicide rates are higher for first responders than the general population and four officers have taken their own lives during his time with the Lancaster city police department.
“What can we do to change the culture to make it so that we don’t have to wait until these things happen, where we can have things at the tip of our fingers, where we have people and resources that genuinely care, that aren’t going to judge you because of how you feel or how you respond to trauma, where you can really just feel valued as a human?” he asked. “Because we’re all just doing this human experience together.”
‘I’d always come up with some excuse’
While Grager’s mental health issues stemmed from his time in the Marines, he continued to experience traumatic events as a police officer, but admits he kept ignoring them.
“I’d always come up with some excuse, like, ‘I’m not bad enough, I don’t have any problems,’ ” Grager said.
Grager said it took him 16 years after his stint in the Marines and the trauma at his job as a city police officer, and the January 2020 suicide of a friend and fellow veteran, before he went to the Department of Veterans Affairs for help.
His time in the Marines included a deployment to Afghanistan, where he took part in Operation Asbury Park, an eight-day battle in 2004 in which more than 80 Taliban fighters were confirmed killed and a handful of Marines were injured.
The Marine Corps “got every last drop out of me while I was in. ... They flew me back and basically told me to turn my stuff in and said, ‘Have a nice life,’” said Grager, now the city police department’s Community Engagement Sergeant. He started with the department in January 2006, six months after being discharged.
“When I first started this job, I didn’t want to seek out any care because I was afraid that I’d lose my job because I knew that I would be diagnosed with PTSD (post-traumatic stress disorder) and I didn’t know how to navigate that, because we didn’t talk about that stuff back then,” Grager said.
Through CISM and other work with officer mental health he is doing in the department, Grager wants to make sure that other first responders know they don’t have to keep silent.
He developed an internal peer support program for the police department, and earlier this year he steered LCBC’s downtown church campus, which was looking for a project to help the department, to renovate its chaplain room into a safe room where officers can decompress after coming back from high-stress calls. It has a video console, sofa, yoga mats, drinks and snacks.
“That’s just a small little thing, but you wouldn’t believe how much that’s kind of become something that everybody kind of appreciates,” Grager said.
Grager said helping others has also helped him with his mental health healing, as has his faith.
“Spirituality is a part of my journey. It doesn’t mean that that’s everybody’s, but at the same time, that’s a large part for me,” he said.
As for his CISM work, he said, “I realized that when I was doing these (CISM) debriefings and I allowed myself to become vulnerable and share my own personal experiences, not only did it help me provide help to other people that were going through things, but it also helped me to process some of the trauma that I’ve gone through.”
Get help
If you or someone you know is in crisis and needs immediate help, contact the following organizations:
988 Suicide & Crisis Lifeline, suicidepreventionlifeline.org, or call, text or chat 988 (The previous number 800-273-8255 still works).
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