Editor's note: Find Firehouse.com's complete coverage of the COVID-19 pandemic here.
With the increase in industry suicides in the past few decades, monitoring the mental health of firefighters and EMS workers has become a focus for many departments.
Fire service and health officials have seen post-traumatic stress disorder and other issues stemming from on-the-job experiences affect countless first responders, which has made National Mental Health Awareness Month in May an especially important time. And last year, a new threat to first responders' mental health arose: the COVID-19 pandemic.
"In the data we collect through firefighter suicides and just through interviews, we really didn't see a lot of issues until probably six months in," said Jeff Dill of the Firefighters Behavioral Health Alliance. "That's when all of the isolation, the heavy lockdowns (set in), which caused a lot of depression, relationship issues, as well as brothers and sisters turning to addiction."
The unknowns of the virus and potential for on-duty exposures—especially early on in the pandemic—also were factors that plagued many firefighters. How can I be infected by a patient? What PPE is effective against COVID? What happens if I get the virus?
"They were scared that they would get it and bring it home, so a lot of them were quarantining away from their family members," said Marie Guma, a psychologist who was on the clinical response team following the Parkland, FL, school shooting in 2018. "They were afraid because their spouse had an underlying health issue or that they would give it to their children."
Guma runs the South Florida-based Command Counseling Center, a mental health practice with clinicians who work with first responders. She also provides consulting and education for fire departments around the country through the center.
While COVID's direct physical effects were among the initial worries of firefighters and EMS workers, Guma saw other stressors indirectly related to the virus begin to manifest as the pandemic went on.
"It was very, very tense at first. Then spouses started losing their jobs," said Guma, adding that issues involving their children, including an increase in risky behavior and finding care during work hours, also provided significant stress as schools and day care centers shut down.
"It was a complete change of lifestyle, I think, for the entire world. But for first responders and firefighters, they weren't able to hide away in their homes because they had to continue working," she added.
Some first responders responded negatively once those factors set in. Depression could be a problem, as well as tensions at home and substance abuse.
"Anger is in our top five warning signs for people in the fire service who struggle with depression and suicidal ideations," Dill said. "We already have a tendency to become negative people from the things that we see and do, so COVID would absolutely enhance that attitude in regard to life and going to work and seeing people struggle, seeing people die from it."
Because of social distancing and other COVID preventive methods, a feeling of isolation has been a large problem during the pandemic. In order to combat that, as well as the other mental health stressors created from the global outbreak, many departments were urged to use peer support groups, an approach Guma and Dill had already advocated pre-COVID.
While peer support teams can be beneficial, it's important that departments realize that those first responders who are listening to and aiding their colleagues also need their own outlets, said Dill, who starts as Las Vegas Fire and Rescue's mental and emotional wellness administrator in July.
"In the last six months in numerous firefighter suicides, we see that they're on peer support teams," he said. "And so we all jumped to wonderful peer support teams—which they are—but we forgot to take care of those members. We preach that if you're on a peer support team, mandatory, you will go twice a year to a counselor to take care of yourself. Because not only are you going on those calls and have issues in your own life, now you're absorbing it from your brothers and sisters, and it can become very overwhelming, so we need to practice a lot of self-care for those peer support teams."
One of the biggest benefits of peer support groups is that it can help even reluctant first responders open up about what is troubling them. In fact, talking can be an important cornerstone to treating mental and emotional stress before it reaches crisis levels.
"We always tell people do not bury what burdens you," Dill said. "Because it will come back to bite you to some degree in the future. Talking to people has been one of the greatest assets that we've seen in the fire service in regards to behavioral health."
Guma recalls being contacted by the Boynton Beach, FL, Fire Department in July about a tall, physically imposing firefighter who couldn't stop crying. Although she works with the department, she had never met with this particular first responder before.
Even so, Guma sat down with the very guarded firefighter, who slowly began to tell her about the things that had finally pushed him past his emotional threshold.
"I was there for three hours with him, and by the end of the thing, he said, 'I've told you things I've never told anyone, and I've only known you today," she said. "Still to this day, we talk all the time."
Although the light at the end of the pandemic tunnel can be seen, that doesn't mean mental health awareness among firefighters and EMS workers should lessen. Dill says doing an internal size-up is important in order to identify mental health warning signs. Those can include increased anger, recklessness, isolation, sleep loss and a drop in confidence.
If a first responder feeling overwhelmed does seek help, it's important they find a mental health professional attuned to their background, Dill said. Guma echoed those sentiments, adding that not all therapists know how to apply their expertise to address a first responder's specific mental health needs.
"These things that (mental health professionals) learn, we cannot carry them into the first responder world because they don't work," Guma said.
"Clinicians have to be very experienced to be able to handle this type of level of care," she added. "(First responders) have to feel like they can trust you right away. And they don't want to talk about their childhood or whatever. They want to know what's the plan. Give me the plan. What do I have to do? They're solution based."
As National Mental Health Awareness Month winds down, the Firefighter Behavioral Health Alliance will be holding its 7th annual Those Left Behind weekend retreat in Florida. The event, which runs May 18-23, is for the families of firefighters, EMS workers and dispatchers who died by taking their own lives.
Agencies around the country also are urged to participate in the We Remember event at 9 p.m. May 21. At that time, departments will run emergency lights or light a candle for one minute in support of the families affected by the suicide of a first responder.
Dill says keeping mental health at the forefront for first responders is vital. He credits that focus on awareness as a key factor that helped firefighters and EMS workers to better cope with the pandemic.
"When we founded FBHA in 2010 and started dealing with PTSD in the fire service, there were not a lot of organizations—in fact, there were hardly any—that talked about behavioral health until FBHA introduced it," he said. "And it quickly picked up steam. …I think the foundation was laid prior to COVID, which I believe has really helped."
First responders looking for help can go to a directory of behavioral health specialists created by the Firefighters Behavioral Health Alliance, the National Volunteer Fire Council and the American Psychological Association.
