By Cathy Sivak from the Fire Chief.enews
On-the-job stresses have a direct link to the highest risk of death for firefighters and EMTs: Suicide.
Firefighters and EMTs are statistically more likely to die of self-inflicted injuries than in the line of duty, with 87 line of duty deaths and 108 suicides in 2014 verified by the Firefighter Behavioral Health Alliance.
A total of 729 firefighter/EMT suicides include 100 suicides verified in the 1899-1999 time period by FFBHA. While line of duty deaths are reported by government agencies and widely available, prior to FFBHA inception in 2010, there was no official collection of data. Suicides include 510 active fire service members, 146 retirees, 16 on disability and eight who were fired from the service.
A recent FFBHA assessment of the fledgling reporting and data-gathering process suggests only about 30 percent of fire service suicides are currently represented. FFBHA verifies confidential reports and cross-references data and other resources with other agencies including the Code Green Campaign and the National Fallen Firefighters Foundation.
The data does, however, make the challenge clear.
“The horrific calls, the lack of education and training, the stresses at home … it can stack up,” says Jeff Dill, founder of FFBHA, a 26-year fire service veteran and a licensed counselor.
Results-oriented tactics training, certifications and physical conditioning counter the physical dangers of the fire service. Widespread mental health fitness will help firefighters to address the more insidious risk of self-harm, Dill says. “We understand backdrafts; we know what to look for. We need to understand behavioral health; we need to know what to look for — it’s the same thing, a danger,” Dill says.
Firefighters top the list of 200 highest-stress occupations by CareerCast, ahead of even enlisted military personnel, military generals, airline pilots and police officers. The annual analysis tracks the impact of deadlines, travel, growth potential, compensation, competitiveness, physical demands, hazards, environmental conditions and risk to one’s own life or to others.
“A firefighter is a job description. We’re human beings. We can’t always handle our issues on our own. It’s more impressive that we can ask for help,” Dill says. Preliminary data shows marriage and family relationship challenges, depression and PTSD as the top known contributors to firefighter and EMT suicide, with “no one knows” as the primary unknown contributor, Dill says.
Current certificate training addresses fire behavior, search and rescue, tools, ladders, and the like, but lack a “how these calls may affect you” component, Dill says. “The clear path to reduce firefighter suicides is obviously awareness and training,” he says, ticking off areas such as academy classes, department behavioral health programs and training of department chaplains.
Mental health issue media coverage and discussion on social media platforms combined with formal fire service efforts to record and address firefighter suicide have raised awareness. The fire service as a whole is taking notice and action to support mental health. “But there are still people out there who don’t realize the fire service has a problem or that there are treatment options out there geared towards first responders,” says Dill.
Firefighters and EMTs face the additional challenges of long hours away from home as well as repeated exposure to traumatic and stressful events, says Ann Marie Farina, NR-P, president of the Code Green Campaign, a 911 transport medic, EMS1 editorial advisory board member and former volunteer firefighter/paramedic. “Firefighters are exposed to trauma, and placed in situations where they feel helpless,” Farina notes.
Familiarity with trauma can, in turn, lower fear and resistance, says Ron Siarnicki, executive director of NFFF, retired fire chief and Fire Chief editorial advisory board member. “Firefighters, like all workers, bring their non-work problems to the firehouse. But, unlike other workers, firefighters have enormous exposure to people who are having the worst days of their lives. Most firefighters have been exposed at one time or another to a medical call involving a suicide. It is for many, unfortunately, a very familiar event. This may lower the protective shield,” he says.
A grass roots movement highlights the inherent challenges and stresses of a fire service career and promotes open discussion of mental health and behavior health at training conferences as well as through departmental training and peer support teams. Some firefighter academies even have implemented mandatory suicide awareness classes.
The fire service culture must encourage first responders to ask for help without fear, a shift from the traditional “do not admit weakness or admit to needing help,” Farina says. “People won’t get help if they are afraid they’ll lose their job or be shunned by their peers. Make it clear that this is a house effort. Just like we all sit down at the table to eat together, and just like we all watch each other’s backs, we need to take care of each other’s mental health.”
Proactive implementation of peer-support teams at departments across the country as well as improved access to lay and licensed mental health resources show the fire service is taking the mental health and suicide awareness challenge seriously.
The 2013 loss of a 30-year veteran to suicide mobilized the Denver Fire Department to seek assistance from a local suicide awareness and prevention foundation that helps male-dominated organizations (95 percent of DFD’s 1,000 employees are men). The Spokane Fire Department taps the expertise of a psychologist with additional education in trauma and first responders. Peer-support teams are in place in departments including the Anchorage Fire Department. The Austin Fire Department uses a blended approach, with a staff psychologist and a chaplaincy program combined with access to the Austin-Travis County EMS peer-support team.
Smaller departments — both paid and volunteer — may be left behind, a concern the experts hope can be addressed by regional sharing of resources and programs. Those with fire service careers who also serve as volunteer firefighters and EMTs in their communities may face special risks, Dill says. “From one role to another, they don’t get a break.”
A study of fire service ideation of suicide (preoccupation or recurring thoughts of suicide) in a partnership between NFFF and Florida State University found nearly half of 1,000 fire service respondents reported encountering suicidal thoughts at one or more points in their firefighting career, and another 15 percent reported one or more suicide attempts.
General life issues like marriage or financial challenges, addiction, clinical depression and chronic health issues are potential contributors to any suicide. More people die of suicide each year than car crashes, with a steady rise in general population suicide rates since 2000 that includes a sharp jump among the middle-aged, according to research presented by the New York Times. Suicides of Americans ages 35 to 54 increased nearly 30 percent between 1999 and 2010; for men in their 50s, it rose nearly 50 percent.
Access to a means of self-harm is a contributing factor to any suicide. Gun suicides in the general population are now nearly twice as common as homicides with guns; meanwhile, two out of three (405 of 729) of tracked fire service suicides involve a gun. Men account for 80 percent of all suicides, and despite efforts to become more diverse, the fire service remains largely a male-dominated profession. The average age of the firefighter or EMT suicide victim is around 40 years old, but ranges from 20 to 60. While there are no clear trends emerging related to department size or career vs. volunteer, tracking volunteer firefighter suicides is particularly challenging, as secondary occupations are not typically captured on basic autopsy forms.
Recent retirees appear to be at particular risk: within the first week of retirement, 35 of the 146 retirees represented in the FFBHA data took their own lives. The impact of the change in routine for the retiree’s family, the retiree’s potential loss of identity and lack of purpose can each play a role, Dill says. Skills valued in the fire service often don’t translate to available second career opportunities, he adds. Support for retirees can involve an extension of employee/member assistance programs or even continued department involvement such as roles in certifying response team members or fundraising efforts, Dill says.
“The fire service can be very insular, and both our work and social lives often revolve around being a firefighter. Retirees face a loss of this identity, and a loss of the social support that is a natural part of being a firefighter,” Farina says. “Leaving the firehouse as an honored retiree does not mean they’ve left the family.”
FFBHA’s new workshop, Saying Goodbye, provides details on how the sense of detachment, of no longer belonging to the fire service community, can impact the mental health of retirees and urges departments to help members prepare 18 months to two years prior to retirement.
Overall, firefighter mental health and suicide awareness is on the rise compared to 10 or even five years ago, Farina says. “Personnel and management are both more inclined to have effective conversations about scenes and about what may be going on in each other’s personal lives without the conversation turning punitive.”
If the unthinkable has happened and a department member has committed suicide, department chiefs often turn to Dill for assistance. “How you handle this with your department members is how you will be remembered for the rest of your career as a chief,” Dill says. He urges chiefs reluctant to bring in behavioral health programs to assist in the aftermath of a department-related suicide to be aware of the danger to their own mental health and to share the hurt with others, to “get down into the trenches for the healing process.”
Chiefs and support teams should watch for indicative behaviors that include: recklessness/impulsiveness; anger/discipline issues (anger can mask fear, and typically the reaction to anger is discipline); isolation; a loss of confidence in abilities and skills; sleep deprivation; and retirement.
Suspect someone is thinking about or planning a suicide? “Asking them will not precipitate a suicide, it can prevent one,” Siarnicki says. Assess potential to reach out to local mental health professionals or fire department peer team or EAP, but if suicide seems imminent, take the person to a local emergency room; do not leave any person contemplating suicide alone.
“One suicide is too many, but we can help prevent many of these deaths through recognition and intervention,” Siarnicki says. “We must all be courageous enough to speak up if we are pre-suicidal and to reach out if we see someone in trouble.”
Cathy Sivak is a freelance writer and award-winning journalist who spent several years covering the police, fire and emergency response beat for a daily newspaper.