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Firefighter therapy: Your questions, answered

The FireRescue1 community asked several great questions during our recent live podcast focused on firefighter therapy

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During FireRescue1’s recent live podcast event, “Firefighter therapy: Busting myths and stopping stigma,” I took the Better Every Shift hosts inside a first responder psychologist’s office, tackling a variety of common misconceptions about therapy and detailing the most common questions firefighters have about therapy. The event garnered a lot of great feedback and thoughtful questions from the audience – questions I seek to answer here.

I encourage you to watch the on-demand event to learn more about firefighter therapy.

How can volunteer departments offer help? Employee Assistance Programs (EAPs) are for paid staff.

Volunteer fire departments can support the mental health of their members through several effective strategies:

  • The National Volunteer Fire Council (NVFC) offers the First Responder Helpline through Provident. This service provides immediate assistance, confidential counseling, resources and referrals for a variety of issues, such as stress management, depression, anxiety, family conflict, substance misuse and more. It’s available to all NVFC members and their household family members without the need for enrollment.
  • Establish a peer support team within the department. These teams can offer direct support to their colleagues, providing a confidential and understanding platform for those who might be struggling. They can also guide members to appropriate resources and help identify when professional assistance might be needed.
  • Compile and maintain a list of mental health providers and resources. Make sure that all members are aware of available resources like the First Responder Helpline. Information should be easily accessible, ideally through the department’s internal communication platforms. Even if you have community resources that are not covered by the department, having access to a curated list can encourage members to seek help on their own. This list should include contacts for a range of issues, from psychological support to financial and legal consultation services.
  • A chaplain, often serving in a volunteer capacity, can be a pivotal asset in supporting the mental and emotional wellbeing of fire department members. With advanced listening skills and training in providing emotional and spiritual support, chaplains are adept at creating a confidential and compassionate space for individuals to share their experiences and challenges. They play a crucial role in the early identification of those who may benefit from additional professional help, acting as a bridge to more specialized services when necessary. Their presence within the department can offer a sense of comfort and community, enhancing the overall supportive environment.
  • Ask local clinicians if they are willing to collaborate with the department to lead educational programs and awareness workshops, focusing on mental health issues, coping strategies and the importance of seeking help. Such initiatives not only equip members with the tools to manage stress and emotional challenges but also work toward destigmatizing mental health issues within the department.

These strategies collectively foster an environment that supports mental health and wellbeing, even in the absence of a dedicated budget or EAP. By utilizing external partnerships, peer support, and accessible information, volunteer fire departments can provide significant support to their members.

How might I as a chaplain/counselor be able to implement a department program?

A fire chaplain plays a pivotal role in breaking the stigma of mental health within a fire department, leveraging their unique position and trusted relationships to foster a culture of openness and acceptance around mental health. Here’s how they can effectively utilize their role:

  • Presence and relatability: Being on scene and embedded within the department, chaplains often share experiences with the firefighters, making them highly relatable figures. Their firsthand understanding of the challenges faced by fire service personnel enables them to approach sensitive topics in a way that feels relevant and respectful.
  • Open conversations: Chaplains can initiate informal, one-on-one conversations about mental health in a way that feels natural and non-threatening. By sharing stories or insights that highlight the importance of mental wellbeing, they can gradually change perceptions and encourage individuals to open up about their struggles.
  • Role-modeling: By openly discussing their own experiences with stress or mental health challenges, chaplains can set an example that it’s OK to talk about and seek help for such issues. This role-modeling is crucial in normalizing the conversation around mental health.
  • Confidentiality and trust: The confidentiality and trust inherent in the chaplain’s role ensure that firefighters feel safe discussing their issues without fear of judgment or repercussions. This safe space is essential for members who may be hesitant to seek help.
  • Educational initiatives: Chaplains can organize or advocate for mental health workshops, training sessions and awareness campaigns within the department. By focusing on the benefits of mental health support and highlighting how it can improve both personal wellbeing and job performance, these educational efforts can shift perceptions department-wide.
  • Linking to resources: Chaplains can act as a bridge to mental health resources, providing information and referrals to professional services when needed. By guiding members on how to access support, they play a critical role in the help-seeking process.
  • Peer support facilitation: Encouraging the development of peer support networks within the department, chaplains can help create a community of care. These networks reinforce the idea that seeking help is a sign of strength and that mental health is a collective responsibility.
  • Feedback loop: By providing feedback to department leadership about the general mood and mental health needs of the crew, chaplains can influence policy and practice, ensuring that mental health considerations are integrated into the department’s operations and culture.

Through these efforts, chaplains can significantly contribute to shifting the culture of a fire department toward one that recognizes mental health as integral to overall wellbeing, encouraging members to view seeking help not as a weakness but as a vital aspect of maintaining their readiness and resilience.

How do you break a culture so that people are receptive to help?

Though changing any culture takes time, leadership plays a critical role in setting the tone for organizational culture. Leaders who openly prioritize mental health, share their own experiences, and actively seek out support services model the behavior they wish to see in their teams. This top-down approach helps normalize help-seeking behaviors and can cultivate an environment where individuals feel safe to express vulnerabilities without fear of judgment or professional repercussions. When combined with various other strategies aimed at dismantling the stigma, as outlined below, this approach can significantly enhance individuals’ openness to receiving help.

  • Regular training sessions, workshops and seminars that educate members about the importance of mental health, the impact of stress and trauma, and the benefits of seeking help.
  • Effective peer support teams. Knowing that help is available from those who understand their experiences firsthand can make individuals more receptive to seeking help.
  • Easily accessible and trusted resources. This includes internal resources, like chaplains or peer supporters, and external resources, such as counseling services or mental health hotlines.
  • Open discussions about mental health, including regular check-ins with crews, debriefings after stressful incidents and other forums for sharing experiences. Hearing peers dialogue about mental health challenges and coping strategies opens others up to share or be willing to seek their own help.
  • Member recognition. Recognize members who openly discuss mental health, seek help or support others to reinforce positive behaviors.
  • Supportive policies and procedures such as providing mental health days, ensuring confidential access to mental health support, and integrating mental health training into the regular training curriculum.

By implementing these strategies, organizations can begin to break down the barriers to seeking help, fostering a culture where mental wellbeing is prioritized, and support is readily sought and offered.

What do you see down the road from state and federal legislation to address mental health and wellness for first responders?

The increasing awareness of mental health challenges among first responders is guiding more robust and focused legislative actions, showcasing a wider dedication to the wellbeing of those who serve our communities. We’re witnessing an uptick in states enacting and broadening presumptive laws that acknowledge PTSD, streamlining the process for first responders to obtain workers’ compensation and additional benefits for service-related mental health issues. Additionally, there’s a shift toward mandates on mental health and resilience training tailored for first responders. This evolving legislative landscape suggests an upcoming trend where more laws mandate continuous mental health and resilience training for first responders, aiming to enhance early detection, develop effective coping mechanisms, and diminish stigma surrounding seeking mental health support.

Related to culture, what if the union is fighting against such programs? How do you ensure that no information is being given to the department and that it is safe for people to use?

The concern a union might have regarding annual mental health check-ins stems from apprehensions that such information could be misused against employees. The focus should be on ensuring that leadership views these check-ins as tools to support their staff, not as mechanisms for punitive actions. Misuse of sensitive information can deter individuals from seeking help early, which is counterproductive to the overall wellbeing of the department. For peer support programs to be effective, they must be led by trusted individuals within the department, known for their discretion and supportiveness, rather than those prone to spreading gossip. Similarly, when engaging with therapists, it’s crucial for cultural competence to be a priority, and for there to be clarity from the outset about what information is collected and its confidentiality. It’s essential that all parties understand these protocols to ensure informed consent, thereby fostering a safe environment for individuals to seek the help they need without fear of repercussions.

What are your thoughts on mental health providers having a background in working with first responders?

My observations indicate that first responders tend to have significantly better therapy experiences when their mental health providers possess either direct experience working with first responders or a strong connection to their culture, such as having family members who are first responders. Many first responders have shared with me that they often feel misunderstood by providers without this background, believing that key aspects of their experiences are overlooked, leading to advice or interventions that don’t resonate or, worse, are counterproductive. This mismatch can discourage them from continuing therapy. However, there is a solution: Departments can enhance clinicians’ understanding of the first responder culture through initiatives like station visits, ride-alongs or by encouraging them to participate in training specifically designed for clinicians working with first responders.

I had a coworker seek help and the word got out. He was eventually put on leave and locked out of the building. They forced other employees to show Command text messages from the employee seeking help. They called him mentally unstable (he was depressed over some calls), and we were instructed not to reach out to him. How do you recommend repairing that damage within the department and with the other employees?

It’s deeply unfortunate when individuals who proactively seek help are exposed, criticized, penalized or labeled as unfit. This not only represents a profound betrayal of the individual who took steps that ultimately benefit the department but also sets a detrimental precedent for others within the department. Such actions may lead to a pervasive reluctance to seek help, with many delaying or altogether avoiding the support they need. Recovering from such incidents can be exceedingly difficult for both the individuals affected and the department as a whole. Repair may not be feasible until there’s a change in leadership that brings about a new ethos, one that genuinely rebuilds trust among employees and affirms that seeking help is not only acceptable but encouraged.

To bounce back from something like this, it’s going to take time and as many of the things as possible listed from the answer above on “How do you break a culture so that people are receptive to help?”

How do you convince the seasoned/veteran/old timer that therapy can benefit anyone and everyone?

Convincing seasoned veterans about the benefits of therapy can be challenging, given the preconceived notions and stigma that often surround mental health. Changing these deeply ingrained beliefs requires patience, persistence, and ongoing support and reassurance.

A helpful strategy might be to discuss therapy in terms of “tools,” “strategies” or “techniques” for managing stress, enhancing problem-solving skills, and improving personal and professional relationships, making the concept more approachable. Sharing personal success stories from other respected individuals can also be influential. Veterans and long-time members are often viewed as role models, and the idea that embracing therapy can set a positive example for peers and younger colleagues might resonate with them.

Framing therapy as a means to build upon existing strengths, rather than merely addressing weaknesses, can appeal to their sense of self-improvement and resilience. It’s important to acknowledge that they may not be ready for therapy or that therapy isn’t the only path to improvement. Supporting them in exploring other coping mechanisms or alternative approaches can be part of their journey towards wellness.

Approaching these conversations with empathy, understanding and respect for their experiences is crucial. This approach can help pave the way for more open discussions about the benefits of therapy, fostering an environment where mental health is viewed as an integral aspect of overall wellbeing.

Are there specific insurance carriers that work with first responders?

The availability and scope of services tailored to first responders vary widely across the country, making it difficult to generalize. A key consideration is whether insurance plans or EAPs include services provided by culturally competent clinicians specifically trained to address first responders’ needs. Although many EAPs may not initially offer first responder-specific services, departments have the opportunity to discuss their unique needs with these programs, potentially collaborating to enhance the support and services available. Alternatively, departments might consider seeking out EAPs that already specialize in first responder support or directly contracting with specialized providers in the community to ensure a broader range of appropriate and supportive options.

As a former clinically trained hospital chaplain and educator, how can I be of assistance to first responders in my community?

Numerous organizations dedicated to law enforcement and fire chaplains offer guidance, training and consultation, equipping chaplains to serve first responders effectively. Through cultural competence and specialized training, chaplains can offer much-needed and well-received support to our first responders. This preparation ensures that chaplains are not only familiar with the unique challenges faced by first responders but are also adept at providing the appropriate emotional and spiritual support to meet these challenges. Take a look at what is offered from the Federation of Fire Chaplains and the International Conference of Police Chaplains.

I am a firefighter and a chaplain for my department but am rarely called in my chaplain capacity! How can I break this culture?

The underutilization of chaplains in fire departments often stems from a lack of familiarity with their role. To address this and increase the utilization of chaplain services, proactive steps are likely necessary. Consider consulting with seasoned chaplains for insights on integration, educating the department on the chaplain’s multifaceted role in providing spiritual, emotional and mental support, and pursuing further training in areas like crisis intervention. Additionally, developing a clear program that details the services offered by the chaplain, boosting visibility within the department, and forging partnerships with mental health professionals can cultivate a more supportive environment. Highlighting success stories of chaplaincy’s positive impact and actively seeking feedback can also refine and tailor services to the department’s needs. Implementing these strategies can significantly bolster the chaplain’s role as an invaluable component of the fire department’s support system.

Again, I encourage you to watch the on-demand event to learn more about firefighter therapy. We cover a lot of ground there, including when to see a therapist, how to find the right therapist, what to expect in therapy, the benefits of therapy, and much more. Here’s a short clip to check out:

On-Demand Webinar: Firefighter Therapy

Dr. Rachelle Zemlok is a licensed clinical psychologist in California, specializing in work with first responder families. She serves as the strategic wellness director at Lexipol, supporting the content and strategy related to first responder mental health and wellness, with a special focus on supporting spouses and family members through the Cordico Wellness App. Prior to joining Lexipol, Zemlok founded First Responder Family Psychology, which provides culturally competent therapy to first responders and their family members. She is the author of “The Firefighter Family Academy: A Guide to Educate & Prepare Spouses for the Career Ahead.” For more information on Dr. Zemlok or to connect with her please visit her website.