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Why don’t more firefighters use their EAPs?

Fire service leaders can take action to increase awareness, access and applicability of these potentially lifesaving programs

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EAP Employee Assistance Program written on memory papers

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Does your department have an employee assistance program (EAP)? Do members know how to access it? Do they trust that the program is a valuable resource?

These questions were asked as part of FireRescue1’s 2023 survey of firefighters – and answers were a bit disheartening.

Nearly three-quarters of respondents said they had EAPs available to them and knew how to access them, yet only about one-third of the same respondents said that they trusted their EAPs to provide meaningful support.

What is the basis for this disconnect? And what can be done about it? I spoke with several fire service leaders to hear how they’re working through this issue in their departments, and three clear takeaways emerged.

3 barriers to fully realizing EAP potential – and solutions

1. Lack of awareness. Full awareness of what EAPs offer is the first hurdle leaders need to tackle. While survey results show that most firefighters are aware of a program existing, many may not understand the scope and offerings available from their department’s program.

Survey results found that while some departments provide comprehensive training to all members on what’s available through EAP, others share little or nothing. One chief officer commented, “There was very minimal training on it. Just a PowerPoint.” Another said, “I suspect we may need to ‘advertise’ it more … let the staff know what services are available beside the usual health issues … financial planning advice, that sort of thing.”

Uniformity in promoting the benefits of the EAP was a clear hurdle, another found: “We need to have a consistent message from leadership about its importance and to get informal leaders to help market ‘the product.’”

2. Lack of access. Improving access to a program is another challenge. Several fire service leaders commented that there are cultural barriers to asking for help among firefighters, especially when it comes to mental health. One said, “I feel this is due to the cultural stigma that firefighters cannot show emotions, they cannot show weakness, they have to keep their feelings to themselves.”

Another leader referenced the importance of tiered access for mental health support services: “The personnel in our department with large fire backgrounds and little mental health training are awareness-trained – they are trained to recognize mental health signs and symptoms. Next are mental health clinicians who are trained primarily as mental health professionals, but with a connection to fire and EMS. The last are technicians that are true psychologists.

Sometimes the problem is confusion about what an EAP is and the intentions in recommending it. One chief said, “I’m sure some employees confuse EAP with critical incident stress debriefing (CISD). Years ago, we were trying to be proactive with CISD. Any time there was a SIDS call or something similarly stressful, we were mandating that the crew participate in CISD. But the personnel felt it was more punishment than anything else.”

Skepticism may also reduce access for certain responders, one leader found: “Many EAPs are provided on a contract basis administered by the local government. I suspect that for some, there are issues of distrust. They may not want to share financial or emotional information that they perceive could be used by the employer.”

Access is also affected by logistical issues, according to one officer: “Half the battle is just being there, so ensuring that when members call at oh-dark that there is a live voice on the other end of the line. Our previous provider failed miserably in this regard which led to their ouster.”

Every EAP operates a little differently, and this can also lead to confusion. Some provide virtual access; some require in-person appointments. Some keep business hours; some are available 24/7. One department’s program only allowed for one free session, while other departments offer dozens of visits at no cost to the member.

3. Lack of applicability. The biggest barrier to effectiveness of EAPs in the fire service seems to be relevance or applicability of the program to the profession. Everyone I talked with cited the need to have providers specifically vetted for working with emergency responders, with several referencing the issue with “generic clinicians.” One fire service leader who had a positive personal experience with EAPs said “it truly helps having therapists who have an understanding of fire and police jobs.” That sentiment was echoed by others: “I have seen well-set-up programs with a clinical psychologist who has ridden the apparatus and responded to calls to get a first-hand understanding of the issues faced by firefighters.”

The idea of industry-trained clinicians was also explored in a 2023 white paper by the Fire Service Psychology Association, “Clinician Training: Fire Service Cultural Competency Training Program.” In this paper, the authors discuss why firefighters may be hesitant to engage with mental health services and propose a detailed program to develop clinician cultural competency. This program includes classroom training, practical fire operations, ride along and task book objectives, and consultations with experienced fire service psychologists. It also includes evaluation and certification components.

Successful EAPs require leadership and accountability

In addition to the barriers to access, analysis of EAP use and support from public safety leaders are keys to increasing buy-in from members.

Evaluation of EAPs is historically lacking. One leader from a small department “concluded that we should get rid of our EAP. It wasn’t being used, and if it were, there would be no way to evaluate its effectiveness.” Another chief officer added a similar observation: “Frankly, EAPs often aren’t very good. Municipalities usually go for the cheapest option available, and you get what you pay for. I have personal experience with this.”

The success of EAPs depends on awareness, access and applicability, but it also requires leadership. One person said, “Our officer development programs emphasize the use of EAP and offering it to the members whenever there is a health or wellness issue, but very specifically for behavioral health concerns.” Others emphasized the need to lead by example: “Chief officers need to participate in EAPs. If they understand the process and can ensure that there is anonymity, that will reassure the personnel as well as provide some empathy.”

Championing your department’s EAP

Even with the difficulties and challenges, most industry insiders I talked with agree that EAPs and similar programs can be a valuable resource, even, according to one leader, life-changing: “I sent someone to get help, after explaining to them that the stigma was misinformation, and they later thanked me and told me that I saved their life.” Another said their program was vetted through a state firefighter safety and health collaborative, and that they had personally found value in using the services.

EAPs have been around for a long time but are a relatively new addition to fire and emergency services. Providing access for relevant mental health support needs to be both prioritized and normalized at all levels of the organization. This can be facilitated through good planning and administration, careful vetting of resources, training, partnering with other advocacy groups such as unions, and good leadership, especially through example-setting. As one chief said, “We get our eyes checked annually, we see a dentist every six months. Why should taking care of our mental health be any less important?”

Watch: How to shift your focus

Take your department in the direction you want. Get expert advice on how to effectively lead your fire department. 20-year veteran Linda Willing writes “Leading the Team,” a FireRescue1 column about fire department leadership.