First Responders and Mental Health

Source: Asa Don Brown

As a community, first responders have an invisible integrity that they believe differentiates them from the general public. In the community of first responders, there have been countless lives lost to suicide over the past few months. The most prevalent feature of a number of the first responder suicides is an underlying mental health issue often related to traumatic stress.

In the summer of 2009, Tim McLean, a 22-year-old passenger on a Greyhound bus traveling near Portage la Prairie, Manitoba, Canada, was unexpectedly and violently stabbed to death by a fellow passenger: Vince Li. Eventually, the courts would find Mr. Li not guilty nor “criminally responsible” due to evidence of mental illness. In the years to come, the experiences from that grave event would take a toll on the life of the responding RCMP (Royal Canadian Mounted Police) Constable Ken Barker. In the summer of 2014, Constable Barker would tragically take his own life. The presiding evidence has convinced many of his fellow officers that there was a direct relationship between his suicide and the events of 2009.

There is ample evidence to suggest that many first responders deny or resist seeking mental healthcare due to the longstanding stigmatization. Research literature suggest that for many, there is an underlying fear of being subjected to ridicule, prejudice, discrimination, and labeling. Sadly, the truth is that these issues are often perpetuated by those who lack a clear understanding of mental healthcare and mental illness.

The community of first responders are very critical of the stigmatization of mental healthcare, and much less the labeling of a mental illness. Therefore, the stigmatization alone has created a boundary between the first responders and the need for mental healthcare.

BATTLING A CULTURE OF STIGMATIZATION AND DISCRIMINATION

In February 2017, an Australian Police Officer committed suicide with no real indicator or significant decree behind her suicide. As with many law enforcement and first responder agencies, the Australian government has been pushing for a greater awareness for mental healthcare, but has often left it to the discretion of the first responder agency or department. While many are beginning to speak “out about the stigma that prevents first responders and police from speaking about their mental illness;” (Treadwell, 2017, Online) the stigma continues to plague the community of first responders.

As a global community, we are beginning to recognize that there must be a greater sense of urgency among the community of first responders. Our first responders are in critical need of mental healthcare. The stigmatization will remain, not only for those who serve as first responders, but the community at large, until we make mental healthcare and mental illness a safe and acceptable topic. While the stigmatization may have a different effect on those that serve as a first responders; the nature of the stigma remains the same. After all, the stigmatization is about placing a barrier between the "perceived normal" and the "perceived abnormal" of society. Ironically, if you were to take any person on the planet, there is no doubt that they could be labeled with psychological characteristics. Every human has his or her own idiosyncrasies that distinguishes them from another. It is not to say that they would have a profound psychological diagnosis, but the truth is, everyone has some psychological characteristics or features within their personality.

The nature of stigmatizing is to separate "us" from "them" and is a source of pride for many within the first responder community. There is not only a sense of pride, but a deeply ingrained fear that prevents many from seeking care. For many, the stigmatization has created a deep divide between the need for self-care and the willingness to seek care.

The Tragic and Preventable Loss of Life

In 2016, The Badge of Life, a Police Suicide Prevention Program, revealed that nearly 108 law enforcement officers took their own lives. According to the Firefighter Behavioral Health Alliance, an estimated 113 firefighters and paramedics took their own lives in 2015. While the numbers may not seem relatively high; any loss is a tragic and preventable loss. “The numbers, however, could be much higher because there is no official database tracking suicide by firefighters and paramedics. Very few fire departments report these incidents, and very few first responders ask for help—a product of a culture that stigmatizes showing any type of weakness, whether physical or mental.” (Bah, 2016, Online)

Source: Asa Don Brown

THE IMMEDIACY OF CARE

The immediacy of care is essential to begin the process of recovery. In the summer of 2015, Tim Casey, a 31-year veteran firefighter with the Colorado Springs Fire Department, began posting videos on Youtube. Mr. Casey’s video posts would describe the various and countless tragic events that he had encountered over his 31 years of service.

“In one of his posts to YouTube, the [veteran firefighter]...recounted his inability to save a toddler: ‘A mother had backed over, accidentally, the head of her baby toddler and squished its brain out. And we showed up on the fire engine, and she handed me a baby with its brain coming out—and the baby was still breathing—and said, ‘Save my baby.’ And I didn’t save the baby. I mean, obviously, it died.’” (Bah, 2017, Online)

Even as I pen these words; as a fellow firefighter, a clinician, and most-of-all father, I too begin to sob over this tragic and horrific loss. Can you imagine how helpless Mr. Casey must have felt? Can you imagine the heartache that was related to his loss? Now let’s layer that with 31 years of tragedy upon tragedy, loss upon loss, and you end up with a perfect storm of Posttraumatic Stress Disorder, PTSD.

“Because of calls like these, Casey started reliving harrowing incidents he'd seen in his dreams. 'Witnessing that kind of activity day in and day out starts wearing on you,’ he said in one of his videos. Casey was eventually diagnosed with (PTSD). He turned to alcohol to cope with his suffering. The 57-year-old ultimately killed himself on July 31 last year in his Colorado Springs home, inhaling fumes from his car as its engine ran in his closed garage.” (Bah, 2017, Online)

While tragedies and suicides will undoubtedly occur, it is of utmost importance that we begin eliminating the stigmatization and discrimination that is preventing many from seeking the necessary care.

Mr. Casey is not alone, nor will he be the last first responder to commit suicide. His loss and the loss of other first responders should be a battle cry for the community. After all, we describe ourselves as a “community.” What is a community? According to the New Oxford American Dictionary, it is “a feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals.” As a fellow first responder, I want to ask “what are the attitudes, interests, goals, and perceptions within your community?"

ELIMINATING THE STIGMATIZATION

The first responder community must begin recognizing that mental healthcare and mental illness are no different than any other health care need. In fact, there is clear evidence that indicates that many physiological issues have a direct link to psychological diagnostics. For instance, did you know that bruxism, the condition with which an individual grinds or clinches his or her teeth; has a direct relationship to stress, anxiety and many sleep disorders, which are known psychological conditions?

As a community, we must begin to recognize the stigmatization and discrimination that has long plagued our mental healthcare profession. Furthermore, we must begin to eliminate this egregious stigmatization and discrimination by bringing an awareness of the normalcy of mental health. For the prevalence of mental health issues, are as common as a bird in the sky or an ant on the ground. Those who are diagnosed with a mental health condition, are not the exception to the rule, but are within the norm of the human population. According to the National Alliance on Mental Illness (NAMI) and the Substance Abuse and Mental Health Services Administration (SAMHSA) 4 out of 5 adults living within the United States, or approximately 42.5 million adults, suffer from some sort of mental illness. Now that is not to say that there is not a greater number of individuals living with some sort of mental illness; for the statistics are only stating those who are “suffering” from a mental illness compared to those who have learned to cope and manage his or her mental challenges.

For first responders, the time has come to stop being the tough guy. You no longer need to stand behind the shield as a source of defense. While “the predominant culture in the fire industry dictates that mental health issues are a sign of weaknes” (Bah, 2017, Online) we must begin to recognize that mental health issues and concerns are a sign of being human. After all, the human condition is about accepting our humanity, our frailty, and our strengths. As a clinician, and a fellow first responder, I implore you to consider finding the help you need through the strength that resides in you.

Source: Asa Don Brown

MOVING BEYOND THE STIGMATIZATION

As first responders, we have far too long allowed for the disparaging of those suffering from a mental illness or condition. I have personally heard the disparaging of mental health practitioners and mental illness by those who are serving as leaders and officers throughout the community of first responders. Regrettably, a number of those who are serving as officers and leaders in various first response fields believe that mental illness is an issue of the weak and vulnerable. As a clinician and a first responder, I am adamant about eliminating the stigmatization of mental healthcare and mental illness.

Eliminating the stigmatization within the community of first responders will take time, but doing so will improve the overall health and wellbeing of those serving as first responders. The most important step is accepting mental healthcare and mental illness as normal.

Mental healthcare and mental illness must become acceptable. For those that have a mental illness are not mentally deficient, nor are they of a weak mind and stature. In fact, research has shown that many who suffer with a wide range of mental illness have higher than normal intelligence. We must begin treating mental illness as we treat all other forms of physical illness and conditions. If someone has a broken leg, we do not send them away for an amputation, rather we send them to the hospital to receive a thorough examination, medical treatment, x-rays, and physical care. Likewise, those who are in dire need of mental health care should not avoid seeking a mental healthcare provider, rather they should be encouraged to seek the proper therapeutic care.

The community of first responders must begin by accepting mental healthcare and mental illness as normal. The following are recommendations for eliminating the stigmatization:

1. BE EDUCATED with the facts concerning mental illness.
2. First responders must be taught to be EMPATHETIC not only to the public, but to those that are serving with them.
3. Avoid the stereotyping of those who have a mental condition.
4. First responders should be encouraged to have an accountability partner. An ACCOUNTABILITY PARTNER is someone that you can lean upon, have your voice heard, and they too can mirror the same needs in times of desperation. Hearing of someone else’s challenges can reinforce the idea that you are not alone, as well as strengthen your integrity.
5. Being involved in your community will allow you to see that you are not alone in this game called life and will provide you insights into how others will face personal challenges.
6. AVOID THE COMPARISON. Do not compare yourself unto others.
7. MONITORING YOUR CONVERSATIONS Deny room for conversations that are belittling or disparaging another’s character. Encourage conversations that are uplifting and inspiring. Discourage any conversations that are rooted in the belittling of mental healthcare or mental illness.
8. We must begin to CHANGE THE PERCEPTION OF MENTAL ILLNESS. After all, mental illness is is an illness and should be treated as all other physiological illnesses.
9. The community of first responders must become better informed and educated on the concepts of mental illness and mental healthcare.

As we begin treating mental illness as a normal condition and mental healthcare as a normal avenue for treatment; we will begin the process of promoting a healthier life among those that serve as first responders. The community of first responders have been neglected and now they are beginning to show the consequences of such neglect. The immediacy of care is of the utmost importance for all individuals suffering with a mental illness or condition. The community of first responders must begin accepting mental illness as they would any other physiological condition.