First responders kill themselves at approximately twice the rate of the general population. Why is this the case when many 24/7/365 resources are available to those who are experiencing suicidality? When there are real people on the other side of the call. When entire organizations are devoted to awareness and prevention. We haven’t figured out why because of the complexities that are involved.
The demands and tolls of the various first responder jobs have a lot in common. They are capable of breaking down the body, soul and spirit over time. They can throw members into “persistent bereavement,” or a way of looking at life with virtually no hope, no happiness, no help and, most importantly, no end.
Hurdles
Persistent bereavement doesn’t emerge quickly. Nevertheless, it’s pervasive. It saps energy spiritually, physically and mentally and creates a slow normalization of sadness. Because people become accustomed to feeling melancholy, and because the feeling lasts all day every day, no matter what activities people do, on the surface, these people look as though they are functioning well to their friends, family and coworkers.
People who contemplate suicide repeatedly might “practice” in their head exposing themselves to painful aspects of self-harm. This is so much so that, according to Kimberly Van Orden and her fellow authors of “The Interpersonal Theory of Suicide,” which was published in Psychological Review, the idea of dying by suicide becomes more and more palatable over time. Suicide becomes a comforting thought that affords a way out of the entrapment of persistent melancholy.
Simply bringing up suicide and giving it visibility doesn’t mean that it becomes solvable. In the clinical world, assisting clients with insight into their issues can cause increased anxiety and depression, because they begin to understand the effect of these things on their life and the lives of loved ones. It is no different with suicide—except for one key thing: Resources for help with suicidality often are fragmented, unstandardized and harmful in their own right. A disembodied voice on a phone doesn’t have the same effect that sitting face-to-face does. In one-on-one sessions, the ability to connect is easier, confidentiality is assured and conversations can happen on a deeper level.
Leadership lacks resources
Why hasn’t the self-annihilation of firefighters, EMS providers, dispatchers and others been affected significantly by the availability of effective Help Lines? A few reasons might be:
• By the time that someone could reach out, the decision to self-destruct already was made
• Reaching out implies cognitive awareness, which someone who is on the verge of dying by suicide rarely possesses
• Admitting to feeling suicidal still brings with it too much stigma and fear
• Mistrust in resources
There are no easy answers. However, there undoubtedly should be more emphasis on taking a proactive approach, but how? What does it take to implement a proactive approach? How do we get in front of something that’s so deep and hidden?
Many challenges in first responder organizations hinder help-seeking. Leadership, although well meaning, doesn’t have the capacity to face the suicide issue head on. This mainly is because it doesn’t have the resources that it needs to embed suicide awareness into the culture. That said, a suicide among the ranks results in the perception of leadership’s inability to “save” the employee and leaves the organization in a state of shock, grief and guilt.
Recruit-level training rarely if ever teaches potential personnel how to take care of themselves, particularly in the area of psychological well-being. Learning the external elements of firefighting and EMS takes the focus away from giving students tools to identify emotional responses and how to enlist help.
Stigma and fear must be dismantled. Getting in front of the suicide issue requires a complete and consistent plan of action, from members’ beginning in the job all the way to retirement. Normalizing the psychological toll requires all ranks to be thoroughly knowledgeable about how to start the conversation and to ensure that it becomes a vital component of organizational design.
Where do we start?
For decades, peer support teams have trained their staff in many ways to interact with individuals and work groups before, during and after critical events. This training has been instrumental in positively affecting members by supporting them through the expected emotional responses that materialize.
Why not give trained peers the ability to detect when personal issues that aren’t related necessarily to a traumatic event are more present? In other words, if an individual brings up a pending divorce, a problem with a child or another personal concern, trained peers can shift their focus from the event that brought a member to them to the more urgent problem that’s articulated by the member. What if when that occurs, the trained peer can point the individual in the direction of immediate help with that personal issue—not discounting the effect of the traumatic incident but, rather, giving equal time to a pending divorce, a problem with a child, etc.?
Teaching peer teams the trauma-informed skills to elicit critical information assists them in helping an affected member to get the help that person needs. This proactive approach is an organic one, because these skills already are part of their lexicon.
A robust and active trauma-informed peer team has the opportunity to make those crucial connections, thus affecting helplessness, hopelessness and isolation. Members of a trauma-informed peer team have the opportunity to identify specific areas of concern, with the goal of providing an immediate step for affected members. According to David Kondrat and Barbra Teater in “Solution-Focused Therapy in an Emergency Room Setting: Increasing Hope in Persons Presenting with Suicidal Ideation,” which was published in Journal of Social Work, peer training in brief, solution-focused conversations homes in on the problem(s) with effective and appropriate goal-oriented solutions. This also increases the feeling of control that so often is missing when one feels entrapped in hopelessly unsolvable problems.
More tools
Peer supporters have the means to connect with affected personnel on an empathic level to ease the effects of psychological “injury.” Why not give them extra tools to be able to extract information that might lead them to believe that someone is at risk of self-harm?
We know that one-on-ones are where deeper conversations take place. When one peer connects with an affected peer, communication is more meaningful and engenders those critical buffering influences that can affect the potential for self-harm. Using this opportunity to increase hope can create an environment in which positive and immediate change can occur. This simple and practical idea might be the ultimate missing connection that can save countless lives.
