'It's OK to not be OK': Firefighter focuses on breaking the silence around mental health
Captain Dena Ali draws from personal experience and data when educating firefighters about mental health and suicide
Growing up, Dena Ali always wanted to become a police officer. However, after serving five years, she realized the job was not for her.
She started volunteering with a local rescue squad and later applied for the Raleigh (North Carolina) Fire Department. Ali is now a captain with Raleigh Fire.
Facing a difficult colleague
While working at the department, a colleague on Ali's crew refused to speak to or even look at her. Determined to win him over, Ali kept her head down, worked hard and continually practiced kindness – even though the favor was never returned. In fact, her colleague's behavior only got worse.
"It got to the point where he would talk about me and mock me," Ali says. "Then, I realized all of the guys in the firehouse were starting to follow his lead."
Ali started looking inward, wondering if there was something wrong with her.
"I got really depressed during that time," she remembers. "I never talked about it. I kept it to myself. It really weighed on me and brought me down to the point where I just started withdrawing from the people that I cared about. I felt flawed to a point that I didn’t think I could relate to anybody."
It got so bad that Ali started having suicidal thoughts – until, unexpectedly, a new assignment changed her trajectory.
While working on her graduate degree in public administration from the University of North Carolina at Pembroke, Ali reached out to her safety chief for topic ideas for an assignment. He asked her to research firefighter suicide.
"I look back at how things were in 2015, and I'm so grateful,” she recalls. “If I didn't go through what I went through, and if I didn't get depressed, I wouldn't be as passionate. I don't think I would understand it as well as I do, because it's hard to understand how somebody can be there unless you have experienced those feelings."
Determined to make a difference, Ali started teaching a class on suicide prevention at a national fire service conference.
"Years in this career and life is going to impact us," she says. "And you might be the toughest person who can handle anything – until something happens that you weren't expecting, and that can change everything."
Building mental resilience, Ali says, is key, but understanding that it's OK to not be OK is even more important.
Understanding the need for human connection
Firefighters must have an understanding early on that they're going to fall, fail and struggle, Ali says: "It's kind of like parenting. If you give every kid a trophy, you don't teach them resilience. And, if you don't allow people, or kids in this example, to fail, the first time they do fail, it's so hard. By teaching kids to fail and allowing them to fail, but then letting them go again, it teaches them perseverance, grit and resilience."
She adds that firefighters can apply this same thought process.
“One of the most important things early in a career is making sure firefighters know they're going to have hardship,” she says. “There's going to be tough times. They have to know that that's common and that's OK. You'll get through it."
The best way to teach firefighters this mentality, Ali says, is to demonstrate it.
"The best people to demonstrate that are leaders," she said. "For leaders to be able to share experiences and model vulnerability, to be able to express, 'This is what I went through. This is a time where I struggled, and this is how I got through it.'" Leaders can make a huge difference by simply modeling vulnerability and their imperfection.
Moreover, Ali said it's crucial for firefighters to understand the need for human connection.
"When we get into the first responder world, for some reason, we get taught or we feel like we have to do it all on our own," she said. "that we are only fixers, that our job is to help other people. And, if we're struggling, it means we're a failure or we have to suck it up. That's not how it works."
Instead of viewing hardship as a failure, firefighters must understand it's OK to reach out.
"A lot of times, just by sharing your experiences with other people and having meaningful conversations, it will help you get through those hard times," Ali said. "None of us can go it alone; it's just not possible."
Unfortunately, if firefighters don't have this skill set or mental resiliency foundation in place, Ali warns, it could lead to depression, addiction or thoughts of suicide.
"It might have started off as being a simple anxiety, a simple feeling of depression," she said. "But through that silencing of it, it just grows – where all along, if they could have talked about it sooner, opened up or tried to understand it early, they could have stopped all that."
Natural responses to stress
The common denominator that leads to addiction, suicide, bullying, violence and depression, according to Brené Brown, a research professor and one of Ali's heroes, is shame – a universal experience of being unworthy of connection.
"Shame is simple," Ali says. "It's, 'I’m flawed, I'm defective.' And because of that feeling that there's something wrong with you, it silences people."
For instance, anxiety and depression, she says, are natural responses to stress.
"We're all going to experience it," Ali said. "It doesn't mean that you're weak or broken. It's a very normal response, and by being able to recognize it and understand it, we can get through it very easily."
However, she says, it can be difficult for firefighters who are struggling to let others know how they're feeling in fear of being reported or pulled off duty.
"We're afraid to let other people know, because they might think that we shouldn't be here," she said. "There's a big fear that if you express any sort of psychological weakness, you're going to be reported and pulled off the truck."
This predicament is a Catch-22, according to research from Craig Bryan, a board-certified clinical psychologist and suicide expert. His research, which focuses on veteran suicide prevention, can also be applied to first responders.
"He says our warriors are trained to have that fearlessness, to ignore strong emotional responses," Ali notes. "When we're at work and see something awful, we're trained not to show emotion. We're trained to be tough."
Those things that make firefighters better in the field, such as not showing emotion or being able to handle extra stress, are the same things that can cause problems off the job, according to Bryan.
"Those things that make us better in the field also make it so much harder to ask for help when we need it," Ali explains. "Everything that makes you a great firefighter can also make
s you more at risk for suicide."
'It's OK to not be OK'
Viewing firefighters as healers or fixers, and patients as the wounded or need-to-be fixed, is a mentality Ali says she wishes would fall to the wayside.
"The only way that we're going to make any change – the only way that people are going to do better and feel better and find resources – is if they know that they can reach out and that it's OK to not be OK," she says.
Ali highlights two things that stop firefighters from reaching out: the feeling of being a burden and admitting weakness or perceived failure. She admits to falling prey to these feelings herself.
"Even through this process and everything I've learned, I've had setbacks," she said. "I've had times in the last year where I've been down, and I know the best thing to do is reach out and talk about it, but when I have those hard times, I find myself isolating and pulling away."
Building good habits to cope with stress
The biggest challenge, Ali says, is making it easier for firefighters to find resources when they need them and to reach out when they need to. It's equally as important for firefighters to understand the importance of "upstream tactics" – the building blocks for good physical and mental health like good sleep habits and mindfulness – she says.
When Ali tells firefighters that they need an average of seven hours of sleep per night, or that they need to start practicing mindfulness, she says they often look at her like she's crazy.
"Firefighters want to hear how it's going to impact them," she said. "One of the coolest things about mindfulness is there have been several military studies, specifically with the National Guard. They did an eight-week mindfulness-based stress resilience training where they taught them the skill and helped build that habit."
As a result, the National Guard found that members who had completed the mindfulness training experienced a 50% reduction in depression, PTSD and anxiety.
"That shows how powerful mindfulness is," says Ali, who adds that this practice teaches firefighters that there's a space between "the stimulus and the response."
"That space is truly ours to own and savor," she explains. "Through practicing mindfulness every day, you break those automatic responses, and that's why it works with anxiety, PTSD and the depressive cycle. Through mindfulness, you realize, 'This is the stimulus, this is why, and it doesn't define me,' or 'This is why I shouldn't react.'"
Firefighters must look at mindfulness like another skill to practice and have in their back pocket in case of emergency, Ali says.
"It's a skill that will transform and improve your daily life," Ali explains. "It comes in handy in situations where you just don't have time to respond. Through that practice, your mind slows down and hits the pause button. It gives you an extra minute to savor before your reaction."
Another important skill that's essential for firefighters to be able to use during times of stress – and one used by Navy SEALs – is the ability to breathe deeply and purposefully.
"Navy SEALs use box breathing," Ali shares. "They breathe in for four, hold for four, breathe out for four, hold for four – and through box breathing, they activate their parasympathetic nervous system, which turns off the fight-or-flight response."
This breathing technique helps them stay calm in dangerous situations and allows them to make better decisions.
Getting buy-in from firefighters, however, requires leaders to be vulnerable and share their stories. This is a lesson Ali learned after she shared her own story.
Persevering and pushing through hardship
The chief who initially asked Ali to start researching firefighter suicide was, unbeknownst to Ali and the rest of her crew, depressed himself.
"He was drinking and going through a rough time," she shares.
As soon as she completed her research and wrote her paper, the chief asked her to create an awareness class for the department.
"He insisted that I help him do it and later told me that he couldn't have done it himself because he just wasn't in a good frame of mind," she says. "When we did our awareness class, he ended up speaking and sharing his story."
By modeling vulnerability and sharing what he had gone through, the chief was able to connect with other members of the department, Ali says, and members of the department who were struggling, had struggled or knew others who were struggling realized it was OK and that they weren't alone. In turn, Ali was able to open up and share her own story.
"I started to slowly share bits and pieces of my story, and I realized that when I shared my story and my connection to it, it drew people in," she says.
Firefighters who are experiencing hardship, Ali adds, must remember the importance of perseverance: "As firefighters, we must recognize that we will have setbacks, but that we can push through.”
Editor’s note: Suicide is preventable. If you are feeling suicidal, call the National Suicide Prevention Hotline immediately 1-800-273-8255 or visit suicidepreventionlifeline.org to chat with a counselor.