The fire chief's role in firefighter mental health
Fire chiefs play two critical roles in identifying and correcting firefighter mental-health issues – at both the macro and micro levels
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A battalion chief has become short-tempered and erratic in his decision making. A company officer is rumored to be going through a bad divorce and drinking heavily when off duty. A firefighter who was involved in a particularly bad medical call has been calling in sick a lot since then.
As a fire chief, should you say or do anything in response to these circumstances? Should anyone? And if someone does take action, exactly what should that person do?
Firefighters sometimes hesitate to get involved when a colleague might be having problems related to behavioral health, because they don't want to intrude. They respect professional and personal boundaries. All firefighters have problems now and then, right? Why should it be the business of others, and especially the chief of the department, to intervene?
Sometimes necessary intervention is undermined for the opposite reason: firefighters at all levels in the organization are too close, too much like family. These close relationships may provide an opportunity for someone in need to seek advice or counsel. Or they may allow coworkers to make excuses for a colleague and to cover for that person instead of confronting the problem.
There are some limitations on what fire chiefs can do. Except on the smallest, most close-knit departments, it is unlikely that chiefs would even have knowledge of small behavioral changes with one individual. Even if they had such knowledge, it could be awkward for the department chief to make a comment directly to a firefighter about his or her personal life.
But there are many people who do have access to this information about even the newest firefighter on the job. Company officers, training officers, direct supervisors and coworkers who work side-by-side with their crews will always notice key behavioral changes if they are paying attention.
The first and hardest question when considering any kind of intervention related to behavioral health is whether that intervention is appropriate. Just because a firefighter gets into an argument with a coworker does not mean he is having mental health problems. The death of a loved one is always painful but can be manageable if someone has good support systems in place.
Patterns are important. If someone gets into an argument with a member of the service community, maybe that firefighter is just having a bad day. If that same firefighter gets into confrontations repeatedly with the public, it's likely something else is going on.
The same is true for other indicators. Come to work hungover one day, and you get to talk about the great bachelor party you attended the night before. Come to work hungover every shift and everyone on the crew should be concerned.
Once the decision has been made to say something, what do you say? The best strategy is to keep it simple, express clear observations but make no assumptions. The goal is to reach out, create an opening and start the conversation. For example, if a firefighter seems disturbed and withdrawn following a bad medical call involving a child, an officer or coworker might approach the person privately and say, "You seemed affected by that last medical call we went on. It got to me too. Want to talk about it?"
It is important to remember that in nearly every instance, when a person who is having difficulties is asked this question, he or she will initially respond with denial. "No, I'm OK," is the expected response.
This response does not mean that everything is OK. Maybe the trouble is fleeting and will resolve on its own. Or maybe the firefighter is not ready to talk about it. In either case, the person initiating the conversation can respond empathetically without being pushy, such as by saying, "I know I always think of my own kids when I see a child hurt like that."
The purpose of this brief conversation is not to ensure that the firefighter seeks help, but rather to make it safe for that firefighter to seek help if he or she makes the decision to do so. And if that happens, the person initiating this conversation will be seen as an ally and a potential resource.
These brief conversations may seem simple but can be very difficult to initiate. Many resources exist to help individuals plan for these encounters. One classic 15-year study was published as the book "Difficult Conversations: How To Discuss What Matters Most" by Douglas Stone, Bruce Patton and Shelia Heen. Many additional resources exist online through such organizations as the American Psychological Association and the Association for Psychological Science.
Of course, there are times when a stronger intervention is necessary. Examples would be when someone comes to work under the influence of alcohol, a physical confrontation occurs in the station or a firefighter threatens suicide. Departments must have clear protocols for what happens in these situations and all members must be educated in what to do as well as the expectation that they will act.
Fire chiefs play a key role when it comes to the first response in workplace behavioral health issues. Although they might not be the one to intervene at all levels, they do have particular responsibility for knowing their senior staff members and speaking up to problems among these ranks. Battalion chiefs, assistant chiefs and deputy chiefs often lack the support framework that comes with working on a regular crew. They may feel isolated. Taking care of one another must be an ethic and expectation that reaches up as well as down within the organization.
Chiefs must invest in creating a culture where asking for help is OK. Firefighters are so used to being the ones to provide the help that asking for it may be very difficult for them. In some organizations, asking for help in any way is perceived as weakness and thus avoided. Fire chiefs must be leaders in changing this cultural norm.
Chiefs' role in change
Change comes in several ways. First, all chiefs must lead by example — taking care of themselves, asking for help and becoming better listeners. Then they must invest time and money in creating skills and resources that support positive behavioral health. These resources may come in many forms: expanded employee assistance programs, contracts with mental health professionals that specifically serve first responders, creation of peer support teams, or links to community services related to family welfare, substance abuse and suicide.
Training must be part of this approach. Most people are not naturally good at having the so-called difficult conversation, but communication is a skill set that can be learned and improved. Special attention should be given to the roles and expectations of first-line supervisors when designing this training.
A number of resources exist to help firefighters deal with personal and organizational issues related to behavioral health. For several years, the National Fallen Firefighters Foundation has offered programs such as Taking Care of our Own and Stress First Aid to help firefighters deal not only with major trauma such as line-of-duty death, but also routine stressors that can lead to larger problems down the line. The International Association of Fire Chiefs recently sponsored a free webinar focused on firefighter behavioral health. Some fire departments have found value in Man Therapy, a humorous but still substantial approach to how men specifically deal with stress.
All department members must be informed of resources available to them and how those resources can be accessed. Confidentiality is critical if firefighters are going to trust any system related to behavioral health.
Peer support teams can be a great addition to a fire department, but again, the key to success is how such teams are created and sustained. Who will be the members? Should members be recruited or just included as random volunteers? What kind of training will be provided and how will training be sustained in the long run?
There are many ways to create such teams. A few years back I heard a story from a consultant who works with departments to set up peer support teams. He had worked with a department of around 400 members to establish its first peer support network. Not surprisingly, members were initially hesitant to step up to become involved.
So they had an election. They asked every department member to confidentially submit the name of a person on the department they would trust to talk to if they had a personal problem. The votes were counted and the 12 highest vote-getters were informed, "Congratulations! You have been nominated by your coworkers to be on the peer support team."
The department required the nominees to attend the training (for which they were all paid overtime), but they had no obligation past that point to actually join the team. However, at the end of the three-day training, 11 of the 12 did decide to join and were welcomed by their peers.
When it comes to facing the challenges of workplace behavioral health, fire chiefs must take a leadership role on both a large scale — working to change the culture — and a small scale — working to change themselves. The commitment displayed by chiefs will determine the direction any fire department will go when it comes to managing issues of behavioral health. And they could very well save lives through this commitment.
This article, posted on March 22, 2016, has been updated