Confronting Behavioral Health Issues in the Firehouse

Issue 8 and Volume 8.

This week, the IAFC and the NVFC is holding the ninth annual International Fire/EMS Safety and Health Week. Fire departments have been taking this “safety stand down” since 2005, but this year’s theme was a bit different: “Saving Our Own … An Inside Job.”

I want to focus on this theme because it is of extreme importance for new and upcoming leaders in the fire service. The first part of the motto, the “Saving our Own” part, should be a familiar concept to all of us. The “An Inside Job” part deserves further exploration.

In the fire service, emotional and behavioral health is a subject we seem hard-wired to avoid. By nature, we are problem-solvers who are traditionally rewarded for bold action on the emergency scene. Talking openly about our feelings isn’t exactly a proven method for building “street cred” in the firehouse. And yet, we know there’s a link between behavioral health problems and poor job performance, attitude problems on the job, safety violations and even workplace violence.

None of Your Business?
Allow me to offer one example. I’ve been through three divorces in the past 15 years. Well, not me personally, but vicariously through firefighters I worked with. Those of you who have experienced this know exactly what I’m talking about.

Some of you are no doubt thinking, “That’s a personal problem. It’s none of your business.” Technically, it may not be “your business,” but when you live in the firehouse with someone who’s going through a divorce, trust me, you’re involved—whether you like it or not.
Which leads to some questions: How does the stress of divorce impact a firefighter’s attention to duty, attitude and focus while on the job? How does this affect the overall performance of the team?

The ability of any one individual to handle stress is contingent on their personal resiliency. But firefighters often experience extreme stresses that present unique challenges to maintaining a well-balanced life, despite possessing a relatively high level of inherent resiliency. Shift work, physical stress and danger, and traumatic calls are all obvious examples. And, if we’re being honest with each other, the practice of working two, three or even four jobs adds strain to our efforts at creating balance and wellness in life.

Focusing in on the Problem
It’s no surprise that increasing attention is being focused on the incidence of depression and suicide by firefighters. The National Fallen Firefighters Foundation (NFFF) has identified depression and suicide as real issues for firefighters, but ones that need further research. Because of the way suicide data is tracked, it’s impossible to quantify (nationally) whether suicide is more of a problem for firefighters than for the general public. Our brothers and sisters in the armed services are experiencing historically high levels of suicide, possibly linked to post-traumatic stress disorder. The growing awareness of this association, combined with our anecdotal experiences regarding firefighter suicide, is leading us to become more proactive in recognizing the risk factors of suicide and to intervene appropriately.

The issue of suicide is an extreme example of the consequences of inadequate behavioral health. But many more common examples are seen on a daily basis in fire departments. Many of the performance, conduct or attitude problems that we see in the fire service are directly related to underlying problems the firefighter is struggling with in their life. Depression, financial stress, relationship problems and substance abuse all take a real toll on real people. We think of ourselves as “stronger” than these problems, and in many cases we are able to conduct a “self-rescue.” But not always.

And as a leader in the fire service, this concerns you. When you begin to address a performance problem with an employee, if you really listen to what they are telling you (or not telling you), it can be like peeling back the layers of an onion. Are you prepared for this conversation? How do you handle a situation where the firefighter’s poor performance has little or nothing to do with their fire service training and skills? What do you do when the root cause is something much more personal and complex? As a supervisor, if you’ve had no training in this area, or if you’ve never been exposed to the same kinds of problems, it’s very difficult to effectively deal with these problems.

Don’t Brush It Off
Maybe you think firefighter emotional and behavioral problems can be easily handled by a referral to the employee assistance program (EAP). Although EAPs are valuable resources, this is simply not enough.

If we truly want to ensure that everyone goes home, if we want to develop a team where the members have each other’s backs, then we must learn to recognize and properly engage behavioral health issues. This is not to suggest that firefighters and officers should attempt to provide professional counseling services, but we do all have a responsibility to each other to be aware of changes that are going on, to communicate (which includes listening), to be empathetic, and to offer direction or resources to individuals who might benefit from professional treatment. Ignoring the problem with the hope that it will go away is not a solution. Let me share two examples of how we as fire service leaders can embrace this responsibility.

First, Henrico County (Va.) Division of Fire participates in a collaborative Crisis Intervention Team (CIT) with our local mental health authority. Police, fire, EMS and the behavioral health authority all co-sponsor and participate in the program. The original intention of the CIT was to divert individuals with mental health problems from the court system or incarceration setting, and instead provide them with the treatment and help they needed to return to a healthy and safe environment. In Henrico County, the fire/EMS agency responds with police to mental health emergencies, and as a result, our firefighters and medics are frequently involved in de-escalating the crisis and then safely transporting the patient to the appropriate medical facility (not jail).

The Henrico CIT program has been very effective in directing people experiencing a mental health crisis toward the most appropriate resource. But the CIT has also borne unexpected fruit for our fire department members. The program helps students develop better listening skills and communication strategies—skills that can be used in the firefighters’ interpersonal relationships, both at work and at home. The same communication and listening skills that help to de-escalate the citizen in crisis can also help us “be there” for our friends, co-workers and family members when they are feeling stressed out, hopeless or upset. These basic methods include active listening, being non-judgmental and being empathetic.

Second, the Virginia Fire Officer Academy, an annual week-long company officer development program, stresses the theme “Safety Through Leadership.” The truth is that it is often hard for officers to engage in conversations with firefighters about their attitude and behavior, especially when the underlying issues fall outside our personal experience or comfort zone. This is a real leadership challenge. It’s comparatively easy to correct an unsafe behavior that is the result of a lack of training, but when a company officer is dealing with an employee who is unfocused because of a personal problem, that conversation can be much more difficult. During the week-long officer academy, students participate in role-playing scenarios that help build their communication skills and confidence in confronting behavioral health issues in the firehouse.

A Final Word
The focus on firefighter health and safety has improved our industry. It has also grown and expanded beyond firefighting skills and safety equipment. We have grown to recognize that physical fitness is only one component of wellness. We must also focus on emotional and behavioral health as an integral component of overall wellness. Are we prepared to acknowledge that a firefighter who is going through a personal crisis might not be fit for duty? Are we prepared to pull that firefighter off the floor, provide basic psychological first aid, and help them back to health, just as we would with a medical problem?

These are just some of the questions existing and upcoming leaders in the fire service must be prepared to address. Are you?