March 27, 2019
central massachusetts health

Mental health worries override stigma as first responders address growing need

Photo/Edd Cote
The Ruderman Family Foundation, a Boston nonprofit whose philanthropy focuses on the disabled, commissioned a study last year and found firefighters and police officers in the country were more likely to die in 2017 of suicide than in the line of duty.

After Worcester police officers responded to a grisly car accident on Vernon Street in late February, the police department did something it had never done before.

It required all responding officers to sit down and talk about how they were processing what they had experienced.

In a profession leaning heavily toward developing a thick skin and not acknowledging weaknesses of mind or body, such an initiative marked a sharp change from the past.

"We let them talk," said John Mahan, the coordinator for the Worcester Police Department's stress program.

"It goes around the table," he said. "We watch them and see what they have to say."

The Feb. 24 car accident, in which a pedestrian lost his legs when struck by an alleged drunk driver, was not so unusual in a profession used to seeing and hearing traumatic incidents – and that's when their own lives aren't put in danger.

But the incident ushered in a new era for the Worcester Police Department. Mahan said he can recall early in his four-decade career when few officers would talk at all about their emotions and were much more likely to turn to alcohol to cope.

The Worcester Police Department isn't alone. Surveys have shown high rates of depression and suicide have forced first responders across the country to overcome stigma around mental illness and directly address what is now widely seen in the field as a major health issue.

Martin Dyer, a deputy chief in the Worcester Fire Department, has seen a drastic improvement in how firefighters have become proactive in talking about the emotional damage the job can have.

"We're very cognizant on the toll this can have on our firefighters," said Dyer, a 15-year veteran of the department. "The stigma is pretty much gone in this department."

For Worcester firefighters in particular, it isn't hard to wonder why the job can take a mental toll.

The department suffered the death of firefighter Christopher Roy in a house fire in December. In 1999, six firefighters were lost in the infamous Worcester Cold Storage and Warehouse fire on Franklin Street. In 2011, firefighter Jon Davies Sr. was killed in a triple-decker fire.

Troubling data

For many first responders, stresses of the job go beyond what a typical office worker will experience during a shift.

The Ruderman Family Foundation, a Boston nonprofit whose philanthropy focuses on the disabled, commissioned a study last year and found firefighters and police officers in the country were more likely to die in 2017 of suicide than in the line of duty.

The foundation found 243 firefighters and police officers who died of suicide that year, but even that total may be low. The Firefighter Behavioral Health Alliance, based in Arizona, estimates roughly 40 percent of firefighter suicides are reported.

The Ruderman Family Foundation's results can be surprising, said Miriam Heyman, a senior program officer for the foundation, in part because many find responders to be indestructible. Deaths to suicide are hidden enough, she said, that police officers who take their own lives aren't included in a national monument to officers killed in the line of duty, keeping the issue largely hidden and one often not seen as a common occupational hazard.

"These forces of shame and stigma and secrecy are especially ingrained in these professions of bravery and courage," Heyman said. "Of course the job exerts a toll on people's mental health. We'd be surprised if it wasn't."

Other research shows widespread cause for worry.

A team of Florida State University professors reported in 2015 a study 47 percent of firefighters had thought about suicide at some point in their careers. Nearly 16 percent reported attempting suicide. Firefighters at lower ranks and with less career service were found to have higher rates of suicidal thoughts.

A report the International Association of Fire Fighters published in 2016 said stress levels for firefighters and paramedics was comparable to that of combat veterans.

"When you see something acutely traumatic, it's normal to have some kind of effect of that in the time immediately following the incident," Sean Britton, the chair of the National Association of Emergency Medical Technicians' emergency medical services workforce committee.

There are signs nationally more could be done to respond to first responders' mental health needs.

A 2016 survey of nearly 2,200 emergency medical technicians, paramedics and others in the industry by the the National Association of Emergency Medical Technicians found 46 percent of respondents' employers provided mental health services and 59 percent said they knew were to turn for help at their workplace if they needed it.

"There's been a lot more recognition in the industry that mental health is something that needs to be addressed," Britton said.

"By virtue of the work that we do as EMS professionals, it exposes us to a lot of things that can cause acute stress on someone," he said.

More is being done nationally, including by organizations like the Badge of Life, which trains law enforcement on mental health and suicide prevention, and the Firefighter Behavioral Health Alliance, which is working to provide behavioral health workshops to fire departments and EMS organizations. The Code Green Campaign has distributed resource cards to providers and collected stories from first responders to help spread awareness.

Heyman advocates for more support from fire chiefs, who can have significant influence on policies for mental health. Some departments have routine mental health check-ups, but such reviews should be mandatory, she said.

In Massachusetts, the Department of Fire Services has established a network of 17 teams responding to stress management from on-the-job incidents. The department provides training for each of the teams and supports the OnSight Academy, a residential treatment facility for firefighters in Westminster.

"They're critically important to the first responder community," State Fire Marshal Peter Ostroskey said of those services, which he called indicative of a more proactive mindset among public safety officials that starts with firefighter recruits while they're still in training.

Ostroskey, the Massachusetts fire marshal since 2016, said he's seen a major shift in attitudes toward mental health in the profession that tracks with a broader recognition that's taken place in society more broadly.

Officials better understand the culmulative psychological effect of a career of traumatic events, not just particular instances, he said, contrasting mental health dangers to the more widely known physical dangers of the job.

John Mahan

"It was an expectation that firefighting is a dangerous job, but sometimes some of these dangers are hidden," Ostroskey said.

An open-minded response

Broader acceptance of help – and new ideas for keeping stress away – has brought firefighters to do things they maybe wouldn't have before, like yoga.

"A few years ago, I'd say you're nuts, but there's a buy-in to do anything that will help," said Michael Papagni, a lieutenant in the Worcester Fire Department. "There's certainly a culture change in the last number of years."

Worcester firefighters took yoga and learned breathing and other relaxing techniques last year at the UMass Medical School's Center for Mindfulness in Shrewsbury. Those courses complemented existing ongoing training that includes physical and mental wellbeing exercises.

"That was a fantastic program," Dyer, one of the department's deputy chiefs, said. Firefighters learned how they can take a moment before heading out to an emergency to relax themselves, or to decompress a bit afterward.

"They can just take a few deep breaths to collect themselves and they feel more prepared for the call that way," he said.

Papagni has seen strides both locally and statewide. Papagni serves as the president of the local firefighters' union, Worcester Firefighters Local 1009, and is a member of the executive board of the group Professional Fire Fighters of Massachusetts.

Better recognition of warning signs of stress or emotional harm has been critical to helping firefighters get the help they need, Papagni said.

"That has enabled not only our firefighters to see the signs of stress in themselves but also those they work with, and those at home as well," he said. "We tend to bring home a lot of stress in our jobs."

Much of that response occurs in-house.

Firefighters aren't trained mental health professionals, but they understand the toll the job can take better than anyone who hasn't rushed into a burning building.

"That's where our efforts have changed," Papagni said. "We're not necessarily therapists but peers. We train firefighters to help each other."

The Worcester Police Department was one of the first to recognize a problem. When the department started its stress program in 1978, it was third in the state to do so, behind only the Boston and the Massachusetts State Police, said Mahan, the department's stress program coordinator.

Mahan took over his current role in 1981, working all the while with the psychologist Dr. Leo Polizoti to help the department's roughly 460 police officers. Mahan attributes the program's longevity to the constant support it's received from the department's leadership.

The department plans to soon begin psychiatric evaluations on officers who do undercover work to ensure their particularly challenging assignments aren't proving harmful.

Like the Worcester Fire Department, the police's mental health program treats those from surrounding, smaller departments without the capacity to have such programs themselves.

"We don't refuse anybody," Mahan said, calling mental health needs an ongoing concern, not necessarily in response to any single incidents a responder would come across. "You don't work for 30 years doing what we do and think it's not going to affect them."

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