Firefighters' Mental Health and Ways to Withstand the Dangers

Firefighters are given the resources they need to protect themselves physically, but we overlook the fact that death by suicide is more common than death by traffic accidents or assaults. As experts reveal, there is a shame and stigma surrounding mental health with professions, such as being a firefighter, that prioritize characteristics such as bravery and toughness while the public remains largely unaware of these issues.

Firefighters are heroes but who is watching out for them when it comes to suicide and mental health? We must give them the mental health resources they deserve. The focus should be focused on the prevention and treatment of signs and symptoms of mental health, which will be achieved by the program recognized as Firefighters Leading Awareness for Mental Education (FLAME).

Rescuing Firefighters: Fighting the Stigma of Mental Health

If you would ask a typical boy a simple question, “what do you want to be when you grow up”, most of them will answer immediately that they want to be a first responder, such as being a firefighter. When most of us, kids and adults, think of a firefighter, we think of someone who is “tough,” “brave,” and “strong.” Someone who is ready to face the most challenging and dangerous situations in order to protect properties, nature, and save human lives. We think of firefighters as being “bulletproof”, an invincible persona, or day-to-day real-life superheroes without any weaknesses or any negative emotions. Unfortunately, our “day-to-day real-life superheroes” are humans like everyone else and experience a vast amount of trauma, stress, anxiety on a regular basis. By the nature of the profession, many firefighters must compartmentalize, set aside the emotions of the moment to confront the emergencies presented on hand. Most of those emotions are not dealt with properly. Background and Environment Research shows that a large number of first responders don't get the necessary help when dealing with mental health, and the current system designed to help them is not as efficient and beneficial, as only 30-40% of firefighter suicides are just being reported (Agrawal, 2019).

Firefighters undergo the same issues the general public does, financial, marital, family but imagine compounding that with the horrors they see every day? Also, due to the nature of their work, firefighters have irregular and long working hours that lead to irregular sleeping patterns that contribute to depression and anxiety. It indicated that men account for more than 80% of suicides in the United States, and although with current diversity efforts the fire service still remains a largely male-dominated profession (Agrawal, 2019). Unfortunately, a combination of all of those factors places firefighters in the place for the highest suicide rates in the first responders.

To put it into perspective, in 2018, the International Association of Firefighters sent out an anonymous survey to thousands of firefighters around the country with nearly 7,000 responses proving that even though current efforts that its a culture still struggling to cope with mental health issues, specifically PTSD. Survey results reported that 95% experience critical stress on the job, 77% have unresolved emotional conflicts, 71% have difficulty sleeping, and 65% are haunted by unwanted memories of bad calls (Ushery, 2018). Most importantly, the survey revealed that 80% of firefighters are afraid to talk about mental health due to the stigma and perception (Ushery, 2018). The 87% that took the survey felt that if they sought help, they will appear as weak or unfit for duty which is why they don't seek out professional help (Ushery, 2018).The 2018 study found not only are first responders more likely to die by suicide than on duty, but rates of depression and post-traumatic stress disorders among firefighters have been found as much as five times higher than that of the general population (Powers, 2019). In reality, our “day-to-day real-life superheroes” experience a vast amount of trauma, stress, anxiety, leading to the highest suicide rates in first responders.

By the nature of the professions, many firefighters must compartmentalize, set aside the emotions of the moment to confront the emergencies on hand. Firefighters undergo the same issues the general public does, financial, marital, family but imagine compounding that with the horrors they see every day? We believe that there is not enough being done to help our firefighters when it comes to behavioral health, and more of them are dying by suicide than within the line of duty (Heyman et al., 2018). Firefighters are given the resources they need to protect themselves physically, but we overlook the fact that death by suicide is more common than death by traffic accidents or assaults. As experts reveal, there is a shame and stigma surrounding mental health with professions such as being a Firefighter that prioritize characteristics such as bravery and toughness while the public remains largely unaware of these issues. We must give them the mental health resources they deserve.

Customer Profile

Our customers are seeking a “specific” emotional need such as feeling secure and stable. Continuous exposure to stress and trauma leads to several forms of mental health such as heightened levels of depression, anxiety, PTSD, which can all result in thoughts of suicide or suicide. To better understand the needs of our customers we used the Value Proposition Canvas (Table 2) (Osterwalder, et al., 2014). The team also conducted a Root Cause Analysis identifying their true pains, gains, and job. It was important that we truly understood our customer as a whole, so add two active firefighters were interviewed. These tools allowed us to get the full picture and recognize the needs and wants of our customers to offer an effective and efficient solution with our proposal. Customer JobsPersonal/emotional. The Firefighters’ main role is to participate in their own mental health. No matter what way they go about bettering their mental health, it requires their active participation. Unfortunately, burnout and depression cause people to be apathetic, decreasing their drive to participate in helping their mental health.

Continuous exposure to stress and trauma leads to several forms of mental health such as heightened levels of depression, anxiety, PTSD, which can all result in suicide or thoughts of suicide. Customer PainsCulture. Tough guy stigma is where one feels like they cannot admit weakness or admit needing help because they fear they might lose their job or seem unfit to handle duties (Sivak, 2016). The interviews with Firemen Berny Davidson and Mitchell Ellington expressed that the biggest and most severe obstacles are the current culture of having an alpha male mentality which is fostered by our customers' environment, this could largely prevent them from seeking help or receiving that emotional stability.

Significant change can only be achieved if there is an about-face on the current culture, which can be achieved by the way solutions are presented and the way we reach out. Difficult and Irregular Work Schedules. As previously stated, firefighters face long hours away from home, and facing repeated exposure to stress and trauma significantly impacts their mental health and wellbeing. It’s reported that the top known contributors to firefighter mental health issues and suicide are marriage and family challenges, depression, and PTSD (Sivak, 2016). These concerns were also expressed by one of our interviewees, Mitchell Ellington, sharing that being gone from home for long periods of time increases stress overall in the family.

An article published by The Atlantic also indicated that some firefighters face a great amount of trauma that reentering family life can be extremely difficult and stressful for them (Hansman, 2017). When issues like clinical depression and anxiety are left untreated and unrecognized, it can dramatically impair simple firefighter duties leading and cause family distress.

Antiquated Support System Structure

A study by the Ruderman Family Foundation highlights that there are 18,000 law enforcement agencies across the United States, but only approximately 3-5% have suicide prevention training programs (Heyman et al., 2018). Currently, training programs are concerned with issues such as fire behavior, search and rescue, ladders, and tools, but there is a current gap and follow up on how some of these day-to-day calls might affect the firefighter (Sivak, 2016). The National Wildlife Fire and Aviation Critical Incident Stress Management program recommends that the three areas focus on are prevention, intervention, and postvention when working with professions with higher risks for that could experience a great amount of stress and suicidal tendencies. There is a current lack of education and training available for our firefighters. Customer GainsRequired Gains. To improve the mental health and well being of our customers, the Firefighters.

Expected Gains

An expected gain is the educational benefit, cost, and lifesaving opportunities with the new resources provided by our solution offered. The goals are for our customers to recognize, be trained, and have the tools necessary to identify when a peer or self is having a difficult time while encouraging an open dialogue with peers. Desired Gains. With the solution offered the desired gain is to increase mental awareness while decreasing the negative stigma and building a great and accepting company culture. While destigmatizing mental health in our customers' culture presents as a challenge, we can work on providing them with the resources they much deserve. Our solution will promote a culture where it's acceptable to talk openly, have a discussion, and encourage our customers to seek help when necessary.

Unexpected Gains

Better performance, interpersonal relationship benefit.Proposed Solution: Products and services as technology advances, so should the way to target and educate our Firefighters to live their best and healthy lives. The solutions offered are a program/application recognized as Firefighters Leading Awareness for Mental Education (FLAME). FLAME is designed to be a wellbeing incentive program targeting the mind, body, and spirit of our users. FLAME provides our users with effective, easy tools to support all aspects of their overall health and wellness while offering valuable financial rewards and health incentives. FLAME is designed to make our first responders feel empowered with the resources, training materials, and support to talk about mental health while reducing the stigma within their team, family, and friends. It can reduce healthcare costs, improve individual and group performance, improve company culture, and integrate and optimize benefits. FLAME allows our users to connect and share with other firefighters and even participate in friendly competitions all while watching their progress together.

Incentive Program

The program provides our users with an annual financial reward for daily participation in activities such as behavior tracking, physical activity tracking, and completing daily knowledge cards. The FLAME financial health incentive is a great opportunity to pay out of pocket expenses and reduce medical costs. This may be achieved by working with Virgin Pulse, Firefighter Leadership, Healthcare Groups/Providers to offer to FLAME. Depending on the medical plan the firefighters can either earn a health incentive or a cash reward. If the incentive is categorized as a “Cash Reward”, the participant will have the payment added on their paycheck at the end of the year. If categorized as a “Health Incentive”, the user will have their payment placed into a health reimbursement or a health savings account by the end of the year to use for next years out of pocket costs, such as co-pays, deductibles, and prescriptions.

Point System

The program offers four different levels our firefighters can reach throughout the year and when the fourth level is reached, they receive the maximum benefits in return. There is a maximum of 10,000 points per level, while the goals and deadline are to reach 40,000 points to receive the most from the incentive program. Tools & Resources FLAME will include links to join support groups and schedule appointments with therapists, psychiatrists, and primary care physicians. Application users will receive a notification once a month for a short mental health questionnaire. The questionnaire that they will be completing is a PHQ-2, a standardized questionnaire that is used for depression screening. If the patient scores a 3 or more the app will give them another questionnaire (PHQ-9). The PHQ-9 questionnaire is a further screening tool for depression and suicidality. The user will then be given the recommendation to make an appointment with their physician and given a link to do so. If the user indicates suicidality, the app will send a notification to their supervisor. This will be the only time medical information will be shared within the app, because of the potentially life-threatening consequences. Users will be required to agree to share this information when first using the app.

Key Partners Virgin Pulse

FLAME will be powered by Virgin Pulse, a daily well-being program providing the daily tools necessary to help create habits that improve the users' body, mind, and spirit. In collaboration with Virgin Pulse, the application program will be designed specifically for Firefighters to receive the most in return. By using FLAME daily, it tracks the user's behavior patterns, goals, and caters the application content specifically to support their individual goals and needs. A personalized experience is offered to them to help the firefighters achieve overall wholeness of mind body and spirit which is achieved by the integration of our customers’ data such as physicals, biometrics, interests, questionnaires, and more. The behavior patterns and data recorded can be tracked by activity trackers of choice such as an Apple Watch, Fitbit, or Cellphone, or simply by inputting information directly to the program. This is achieved while maintaining integrity when it comes to our customers’ private information.

Leadership/Administration

Change is difficult and comes in several ways, by having the Fire Chiefs lead by example it will create that open dialogue. A 2016 article found in the Magazine, “Fire Chief”, states the importance of how Fire Chiefs play an important role when it comes to creating a culture that makes it okay to talk about mental health and the willingness of the firefighter to seek help (Willing, 2016). The Fire Chief must take a leadership role by working to help change the culture while still working to improve their mental wellbeing (Willing, 2016). The commitment to this new opportunity of using FLAME will provide leadership with the tools necessary to identify changes in the behavior of one of their peers such as recklessness, impulsiveness, discipline issues, and more. It will provide the leadership staff with a sense of empowerment. As FLAME rolls out and becomes part of the onboarding system for new firefighters, it is imperative to receive full support from the Fire Chief and Administrators.

Healthcare Groups/Providers

We will need to work to assure we partner with dedicated and passionate Healthcare Groups, Providers, and Insurances, to offer such services as counseling and screenings. Partners that will put the needs and wants of our customers at the highest priority.Conclusion As we said in the beginning that firefighters are modern-day heroes that all of us, kids and adults, look up to. We feel much safer and calmer when they arrive to help with any emergencies or challenging situations in order to protect, to rescue, and to save. However, they are humans like all of us with weaknesses and emotional needs. Difficult work schedules, sleep deprivation, depression, anxiety multiply by struggles in personal lives are only a few factors that cause “day-to-day real-life superheroes” to take their own lives. Suicide rates are the highest among firefighters than any other first responder. They are prepared to handle the challenge physically. We believe that we must give them tools that would help to protect, to rescue, and save firefighters from suicide. FLAME is one of the solutions for that. It is an app that provides mental health resources and education about depression and anxiety that is the main cause of suicide. It will connect them to the right doctors, therapists, or support groups among his or her team. In addition to that, it will have healthy lifestyle tips that could be customized to one's needs. No one should suffer along. FLAME can be a great tool for reducing suicide among firefighters.

References

1. Agrawal, Nina. “Must Reads: Firefighter Suicides Reflect Toll of Longer Fire Seasons and Increased Stress.” Los Angeles Times, Los Angeles Times, 1 Mar. 2019, https://www.latimes.com/local/lanow/la-me-ln-firefighter-suicides-20190302-story.html.
2. Hansman, Heather. “A Quiet Rise in Wildland-Firefighter Suicides.” The Atlantic, Atlantic Media Company, 31 Oct. 2017, https://www.theatlantic.com/health/archive/2017/10/wildland-firefighter-suicide/544298/.
3. Heyman, M., Dill, J., & Douglas, R. (2018, April). Ruderman White Paper: Mental Health and Suicide of First Responders. Retrieved December 1, 2019, from https://issuu.com/rudermanfoundation/docs/first_responder_white_paper_final_ac270d530f8bfb.
4. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606–613. DOI:10.1046/j.1525-1497.2001.016009606.x
5. “National Wildlife Fire and Aviation Critical Incident Stress Management .” National Wildland Fire Critical Incident Stress Management Website - Https://Gacc.nifc.gov/Cism/Index.html, Bureau of Indian Affairs Branch of Wildland Fire Management, Dec. 2019, https://gacc.nifc.gov/cism/suicide.html.
6. Osterwalder, A., Bernarda, G., & Smith, A. (2014). Value Proposition Design. (T. Papadakos, Ed.). Hoboken, New Jersey: John Wiley & Sons, Inc.Powers, K. (2019, September 23).
7. Firefighters are heroes, but who's watching out for them when it comes to suicide? Retrieved December 1, 2019, from >https://www.delmarvanow.com/story/life/2019/09/23/firefighter-suicide-mental-health-culture-maryland-delaware-virginia-salisbury/1300515001/.
8. Sivak, C. (2016). Why Firefighters Take Their Own Lives. Fire Chief, 2(1), 4–18. Retrieved from http://online.fliphtml5.com/jncs/vsfx/#p=1Ushery, D. (2018, July 31).
9. Firefighters Have Unmet Emotional, Mental Health Need: Study. NBC New York.Willing, L. (2016). The Fire Chief's Role in Firefighter Mental Health. The Fire Chief, 2(1), 15 -17.