Lessons learned from the second annual Rosecrance Florian Symposium
By Dena Ali
In September 2017, public safety members from across the nation converged in Rosemont, Illinois, to learn about emotional wellness, recovery, support, and solutions at the Rosecrance Florian Symposium. Many came to learn solutions surrounding mental health disorders, suicide, and the stigma behind behavioral health in public safety. The simple motto for this year’s symposium was, “We all need help sometimes.” However, its implications were complex. Battalion Chief (Ret.) Richard Dory said it best during the Florian advisory committee dinner: “We’re all broken, some more, some less, and at times, we will all need a little help.”
Over the past several years, members of the fire service have learned that mental health disorders and suicide are more prevalent than once thought. Mental health disorders affecting fire service members include depression, anxiety, substance abuse, sleep disorders, post-traumatic stress (PTS), and post-traumatic stress disorder (PTSD). Because of inherent organizational factors such as sleep disruption, firefighters become more susceptible to these disorders. However, firefighters are not only more susceptible to these disorders but they are also more reluctant to admit when they need help.
This reluctance often translates into isolation, alienation, and maladaptive coping strategies. Unfortunately, these all have been confirmed as risk factors for depression and suicide. When first researching the rates of suicide within the Chicago Fire Department, Battalion Chief Dan DeGryse learned, “Suicide is just one outcome of serious internal struggles for an individual that can manifest for some time before a person reaches the decision to die by suicide.”
This realization compelled him to seek solutions that eventually led him to his position as the director of the Florian unit at Rosecrance, a private not-for-profit treatment center in Rockford. Rosecrance has been treating first responders since 1995, opened its Florian unit dedicated to firefighters and paramedics in May 2014, and in January 2017 broadened its mission to treat all first responders and military personnel for addiction and co-occurring disorders.
The Florian unit specializes in treating addiction and co-occurring disorders such as depression, anxiety, bipolar disorder, and PTSD through evidence-based practices. In his opening statement at the symposium, DeGryse discussed factors that made the Florian unit unique such as a structured schedule aimed at getting people healthy and back to work as quickly as possible. He explained that the unit specializes in cognitive behavioral therapy (CBT) for PTSD. Responders can display symptoms of PTSD without a full diagnosis, he noted. The goal of CBT is to help normalize a person’s thoughts and prepare him to return to duty.
DeGryse compared our lack of understanding of mental health in the fire service today to the early days of self-contained breathing apparatus (SCBA) and the advent of rapid intervention teams—their need was not fully understood. His hopes are that through education, awareness, and understanding, the fire service can continue to implement protective factors and members can become more apt to reach out when they need help. He commended the 200 people present for their willingness to be visionaries and help develop solutions for the future of the fire service.
DeGryse closed his opening remarks with his signature question, “How are you doing?” He encouraged us to be there for each other. As he said, by simply and sincerely asking, “How are you doing?” one person can make a huge impact on another.
A diverse selection of 16 speakers over the two-day symposium included law enforcement officers, firefighters, a paramedic, a spouse, university professors, counselors, and the education director for the Fire Department Instructors Conference (FDIC) International. They each shared their knowledge and experience. Piece-by-piece, attendees and presenters could begin to solve the complex puzzle surrounding first responder mental health.
Many of the speakers were also students. When not presenting, most speakers attended the other sessions. Quite simply, no one person had all the answers. There were several opportunities for attendees and presenters to interact during sessions, meals, and a social gathering hosted by F.O.O.L.S. International with entertainment from John Preston. A veteran of the Marine Corps from 2000 to 2004, Preston uses his music to share his personal journey through PTSD and to help heal others who are suffering. For me, a lot of the lessons learned came from other attendees like Chief Jim Purl and Lieutenant Rich Stack during the after-hours patio chats.
The symposium included several breakout sessions and four powerful keynote presentations. One that particularly stuck out to me was Scott Robinson, who responded to the tragic Station Nightclub fire in West Warwick, Rhode Island, in 2003. He shared an emotional personal story of resiliency along with solutions that he and his department had to learn the hard way from the tragedy. The major learning point from his presentation was that, because of the bond structure ingrained in the fire service, returning to work as soon as possible and not being left alone with few coping mechanisms are critical. His presentation closed with the following: “Even highly emotionally resilient professionals will be unable to survive, let alone thrive, if they are not provided with adequate resources, sufficient job control and support, or role clarity.”
9/11’s Far Reaching Impact
The second keynote presentation was a collaboration between retired Fire Department of New York (FDNY) Captain Mike Dugan and Firefighter John Walters. Both lost fellow firefighters on 9/11, worked the pile at Ground Zero, and attended far too many funerals. Dugan opened the presentation with his story, describing a path that led to anger; maladaptive coping strategies; and, finally, counseling. He concluded with the important message that seeking counseling and reaching out for help when it’s needed are critical for recovery. Hearing such an iconic person share such a personal experience was very powerful in teaching that any of us could need help sometime—and that’s okay.
Walters shared his story from riding toy fire trucks at age three to his selection as a member of the elite FDNY Rescue Company 1. He was assigned to squad 288 on 9/11 when his firehouse lost 19 members. He talked about how 9/11 affected him, about the accident in 2006 that cost him his leg and nearly his life, and finally a difficult divorce that caused his coping mechanisms to fail.
Fortunately, Walters reached out for help and was connected, by Chief Bobby Halton, with DeGryse and was admitted into the Florian unit at Rosecrance for treatment. Walters shared that the unit emulated the brotherhood from his firehouse, from the way members greeted each new arrival to how they interacted daily. He arrived expecting to stay just a couple of days and ended up staying for 35. Walters now works with Sons of the Flag and travels the nation sharing his story while also helping support burn survivors. His story was a true triumph in the face of unbearable tragedy.
Treatment and Stigma
Erica Gilmore, LPC, started the second day of the conference with a discussion of concerns for uniformed personnel and their treatment options. She opened by explaining that, while she has never been a member of public safety and could never fully know all they face, she has dedicated her work to understanding the best practices to support them. Her lecture on first responder mental health, one of the most informative of the conference, explained the top three conditions diagnosed and treated at the Florian unit: depression, anxiety, and PTSD. When mental health illness is not addressed, she explained, it often leads to unhealthy coping skills, poor relationships, divorce, and career loss. We learned that treating co-occurring disorders is as complex as attempting to understand whether the chicken or the egg came first.
The second day ended with Chief Halton discussing the stigma surrounding behavioral health in society that is mirrored in the fire service. He opened by explaining, “There are courses and persons who will tell you that they can show you how to prevent mental health issues and solve behavioral health problems. This is not one of those courses, and I am not one of those people. I am simply a firefighter with no expertise, agenda, or purpose. I appreciate your understanding and kindness.”
Halton shared a very personal experience and stated, “Mine is not PTSD.” Through leading by example and expressing vulnerability, he empowered attendees to not be ashamed of the road they travel and to be willing to accept help when it’s needed. The public stigma attached to behavioral health treatment hinders firefighters, he noted, and prevents them from seeking treatment. Instead of seeking help, those affected try to protect themselves through disassociation, which leads to a loss of connection and purpose. Shame becomes internalized and inflated, and suicide is seen as a better alternative.
Halton explained that he despises the word prevention as it relates to suicide in the fire service. Instead, we should dismantle the stigma associated with mental health disorders. Defects are part of the landscape and cannot be wholly prevented, so the fire service “zero defect mentality” must be erased. We must learn to celebrate failing forward, he notes, because nobody is immune to failure. Defects are acceptable, can be corrected, and often lead to a stronger foundation.
As the symposium closed, we learned that mental health disorders, suicide, and stigma are emerging topics in public safety. There are no concrete answers, but we are getting closer every day. The most important point emphasized throughout the symposium was that, when needed, reaching out for help can make a huge difference. Addressing problems and providing early support can prevent a crisis from becoming a tragedy.
Moving forward, we must encourage and support open disclosure through discussion because we all benefit by learning from the path others have traveled. Every firefighter must be empowered to share their issues in a safe and supportive environment without fear of retribution. Successful mental health programs build on the foundation of the very structure and just culture of the organization.
“Will your department offer a safe opportunity to admit and enable help when it’s needed?” concluded Bobby Halton.
Dena Ali is a captain with the Raleigh (NC) Fire Department and, prior to becoming a firefighter, she served five years as a police officer in North Carolina. Ali has a degree from North Carolina State University. She is a graduate student at UNCP, and her research focuses on firefighter suicide. Ali taught her class on suicide prevention at FDIC International 2017. She is an avid cyclist and founding member of the Carolina Brotherhood. Ali also serves as an advocate for 555 Fitness.