The Tampa 2 Summit demonstrated that we've made many inroads on the firefighter health and wellness front. However, much works remains to be done. Behavioral health specifically is increasingly being recognized as an area of significant threat to our firefighters due to the rigors of the profession.
Current Trends
The Firefighter Behavioral Health Alliance, which tracks firefighter suicides in the United States, reported that the number of firefighter suicides increased from 65 in 2013 to 88 in 2014.
Between 2011 and early 2013, nearly 300 firefighters committed suicide, according to a 2013-published article in the Chicago Tribune. Five of them were women; 13% consisted of murder-suicides. Sadly, the number of suicides has grown since that report was published.
It's widely believed that these numbers vastly underreport the incidence of suicide in the fire and emergency service due to the lack of robust reporting systems and the stigma associated with suicide.
At-Risk Characteristics
Typically, firefighters have many of the defining characteristics that those at risk for suicides have, and these may be compounded by the stressors first responders typically are exposed to. There are the challenges of acute and chronic stress and personality traits of aggressiveness and impulsiveness.
Substance abuse, which reportedly has a high incidence within first-responder communities, has also been linked to a higher risk for suicide. Some studies have indicated an addiction rates for alcohol at 29% compared to 5% for general population as well as elevated rates of other precursors to firefighter suicide.
Many compounding variables, such as higher rates of post-traumatic stress disorder (PTSD), depression, sleep-cycle disturbances and altered coping mechanisms, may further place members of the fire service at risk for behavioral health issues and suicide ideation.
Warning Signs
It has been reported that more than 75% of those suffering from behavioral health issues in general and suicide risk factors in particular show some warning signs that can be discerned, even if subtle. Signs may include withdrawal, giving away possessions, mood changes, acting impulsively and abusing drugs and alcohol.
For this reason, it's important that awareness training be offered to all levels of a department on a regular and ongoing basis. This training should include identifying altered coping mechanisms, such as stress, alcohol abuse, steroid usage and sleep cycle disturbances, and early warning signs of behavioral health issues, as well as information about early-intervention assistance.
Establishing healthy and appropriate resiliency mechanisms is also an important topic to educate fire service personnel about.
Peer-Awareness Training
Peers who are properly trained about the sometimes-subtle changes and signs of behavioral danger are often the first line of defense, enabling early recognition and appropriate behavioral health intervention. Training about signs, symptoms and risk factors creates a community best suited for providing early warnings about possible behavioral health trouble on the horizon. They can make a real difference in protecting the health, wellness and safety of members of our service.
Adequate peer-level awareness training and training for healthy coping mechanisms and resiliency are essential, but just as important is addressing cultural stigmas that may exist. The reality is that suicide and behavioral health issues often remain stigmatized within fire service culture as signs of weakness.
Resources for Departments
The challenge for many departments is to identify what systems and resources exist to assist prevention and provide resources in the area of behavioral health and to make these resources widely available.
The National Fallen Firefighters Foundation offers resources and tools specific to behavioral health on the Everyone Goes Home portal, specifically in Firefighter Life Safety Initiative #13.
The behavioral health experts within our communities serve as another resource. They can help train peers on how to recognize early warning signs and what actions to take to help members who may be at risk.
2015 is a year for fire service leaders to confront the cultural stigmas head on and develop programs designed to ensure the behavioral health and safety of our firefighters on the front line and those who support them.