IAFC Quick Take: Information and flexibility key to addressing behavioral health needs

Capt. Frank Leto, deputy director of the New York Fire Department Counseling Service, outlines how COVID-19 impacted members’ behavioral health, and how the department is meeting their needs

In an IAFC Coronavirus Task Force webinar, President Gary Ludwig introduced FDNY Capt. Frank Leto, deputy director of the department’s Counseling Service, to discuss how officials have modified and enhanced procedures to meet the mental health needs of firefighters and EMS providers during the COVID-19 pandemic.  

Leto – who has served as the director since before the Sept. 11, 2001, terror attacks and has assisted with the mental health needs of members through numerous crises – noted he was surprised at the scope of the toll the public health emergency inflicted.  

During his presentation, Leto outlined myriad ways the pandemic was affecting members at all levels of the department, and how the FDNY Counseling Service adapted to their needs. He also detailed the changes that are being made to prepare for a second wave of COVID-19 in the fall, and the actions leaders are already taking to address complicated behavioral health needs.  

FDNY paramedics Elizabeth Bonilla, left, and Keith Kahara, right, prepare to load a patient on oxygen into their ambulance on an emergency call, Wednesday, April 15, 2020, in the Bronx borough of New York.
FDNY paramedics Elizabeth Bonilla, left, and Keith Kahara, right, prepare to load a patient on oxygen into their ambulance on an emergency call, Wednesday, April 15, 2020, in the Bronx borough of New York. (AP Photo/John Minchillo)

Memorable quotes about the importance of behavioral health during a crisis 

Here are some memorable quotes from Leto. 

“The amount of stress on the members, with the constant, daily changes in the protocols and in their work schedules, and whatever else was going on in their homes, and then sickness on top of it, really brought stress into the department and to each individual member.”  

“We protect our families from information, we protect our families from what we deal with on an everyday basis, and now we were going home and infecting them. Members were calling up and saying, ‘I have a child with cystic fibrosis,’ or ‘I have a wife that’s undergoing cancer treatments, I cannot go to work and bring this home to her.’” 

“[Members] were anxious, like I’ve never seen, to go to work. I’ve been in New York a long time, and been through many difficult times in this city, but never did I get calls … saying, ‘I just don’t want to go to work,’ and, ‘I’m just a bundle of nerves.’ It was just building and building and building.” 

Top takeaways for addressing behavioral health needs during a crisis 

The following are three takeaways from the FDNY’s response to its members' behavioral health needs. 

1. Provide as much information as quickly as possible  

During the 2001 terror attacks on New York City, Leto described responding to the scene as working in a “void,” noting his family knew more about the developments of the attack than he did, as they were listening to a constant stream of information from the news.  

“In a crisis, information can be very healing,” he said. “Not having information is very stressful on a first responder or firefighter.” 

To give the 17,000 members of the FDNY the reassurance and knowledge they needed to feel as safe as possible at the time, the department distributed a daily document outlining:  

  • The current number of members out sick with the virus  

  • The number of members who had returned to work 

  • The number and names of any members who had died 

  • Protocol changes 

“This was one of the main things we learned after 9/11 is to give that information, and it can really make an impact on the emotional health of the department,” Leto said.  

2. Look at behavioral health needs from all aspects

FDNY members were impacted by the pandemic in a variety of ways, all of which took a toll on the department as a whole and created challenges for leaders that had not been seen in past crises.  

Members were dealing with:  

  • Anxiety of becoming infected 

  • Anxiety of infecting other family members 

  • Behavioral and mental health issues due to quarantine and illness 

  • Traumatic effects of on-the-job responses 

  • Mental health effects from isolation 

  • Concerns with providing safe child and eldercare 

  • Grief due to loss of family members, friends and a general sense of safety 

  • Financial stress 

  • Increased domestic violence 

  • Exacerbation of pre-existing conditions, such as substance abuse, depression, anxiety, PTSD 

  • Emotional exhaustion 

Addressing each of these is crucial to maintaining a healthy and resilient workforce.

[Next: Addressing your concerns: COVID-19 resources for firefighters]

3. Create flexible plans that can accommodate everyone  

According to Leto, it’s important for leaders to ask themselves, “What can we do to protect our members here?” 

Leto suggested thinking through how different protocols could be exerting pressure onto members during an already stressful situation, and determining how they can be relaxed, modified or adapted to fit the moment and provide relief.  

Additional resources for assisting behavioral health needs of fire and EMS members 

Learn more about protecting members’ mental health and providing behavioral health resources to fire and EMS with these resources: 

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