Running head: BEHAVIORAL HEALTH AWARENESS 1
Behavioral Health Awareness for the Raleigh Fire Department
Franklin C Hobson Jr
Division Chief
Raleigh Fire Department
Raleigh, North Carolina
BEHAVIORAL HEALTH AWARENESS 2
Certification Statement
I hereby certify that this paper constitutes my own product, that where the language of others is set forth, quotation marks so indicate, and that appropriate credit is given where I have used the language, ideas, expressions, or writings of another.
BEHAVIORAL HEALTH AWARENESS 3
Abstract
The problem was an increasing rate of behavioral/mental health issues within the Raleigh Fire
Department (RFD). Previous retiree deaths by suicide and multiple suicide attempts by active
employees created a condition of great concern. The purpose of this research was to identify
local and national resources that can be utilized to identify and evaluate the current
behavioral/mental health of the firefighters in the RFD. Descriptive research was utilized to
answer the question of identifying the current behavioral health resources currently in use and to
identify what local and national resources could be used in the future. This research answered
questions on the expected benefits from improvements to the behavioral health resources offered
to our personnel. The methods used in this research included a combination of a survey,
interviews, personal observations, and personal communications, and a literature review to
answer the research questions. The results of the research confirmed there is a previous and
current problem with behavioral/mental health care provided to the members of RFD.
Recommendations for improvement to the behavioral/mental health of RFD members include,
enhanced company officer training on how to recognize risk factors of potential suicidal
behavior and how to maintain a safe environment for employees to discuss behavioral health
concerns. Improvements should be implemented to the current professional counseling services
provided to RFD staff. Develop a pre-retirement transition training program to prepare retirees for retirement. Implement annual depression screenings during medical evaluations, and implement a peer support team program. These efforts will reduce the rate of behavioral/mental health issues faced by members of the RFD.
BEHAVIORAL HEALTH AWARENESS 4
Table of Contents
Abstract ...... 3
Introduction………………………………………………………………………………………..5
Background and Significance ...... 6
Literature Review...... 9
Procedures ...... 26
Results ...... 31
Discussion ...... 35
Recommendations ...... 37
References ...... 40
Appendix A ...... 44
Appendix B ...... 46
Appendix C ...... 49
Appendix D ...... 52
Appendix E ...... 54
Appendix F...... 56
Appendix G ...... 59
Appendix H ...... 62 BEHAVIORAL HEALTH AWARENESS 5
Behavioral Health Awareness for the Raleigh Fire Department
There is an alarming and sad trend developing in the United States Emergency Services,
which is the death of emergency responders by suicide. It is truly sad that any human being
could come to grips with suicide being the only way to cope with behavioral/mental health
struggles. It is especially alarming that the number of suicides within the fire service are higher
than the average public citizen and higher than the average line of duty deaths per year over the
last few years. This research focused on suicide events within the fire service but could be
applied to other emergency services fields, i.e. emergency medical services, police officers and
emergency telecommunicators.
The problem is an increasing rate of behavioral/mental health issues within the Raleigh
Fire Department (RFD). Throughout the years of this researcher’s career with the RFD many
conversations with other members have disclosed how multiple retirees and active members have taken their own life by suicide or attempted suicide (D. Poole, personal communication, August,
2017) (D. Boyette, personal communication, August, 2017).
The purpose of this research is to identify local and national resources that can be utilized to identify and evaluate the current behavioral/mental health of the firefighters in the RFD.
Descriptive research will be used to identify the current behavioral/mental health resources available to the firefighters in the RFD. Research will also identify current resources that are being utilized by the Department through surveys, observations, interviews and personal communications. A thorough literature review will identify additional resources that can be utilized in the future to improve the behavioral/mental health assessment and treatment opportunities provided to the firefighters of the RFD as well as what other departments are doing to combat this growing concern. BEHAVIORAL HEALTH AWARENESS 6
The research questions were (a) what is the history of mental health issues in the RFD over the past years? (b) what local and national resources are available to assist in the improvement of the resources and opportunities provided to our firefighters? (c) how is the RFD currently utilizing any local or national resources? (d) what are the expected benefits from improvements made to the overall behavioral/mental health of our personnel?
Background and Significance
The RFD has experienced four retirees that have taken their own lives by suicide.
Additionally, five active members have attempted suicide. These numbers are extremely concerning. Which raises the question of what resources the RFD is currently providing to help members cope with behavioral/mental health issues and are these resources actually being utilized. Are the resources easily obtainable, do they provide adequate services and are they familiar with firefighters and the job performance requirements of their duties?
From this researcher’s perspective, these questions can be answered from my own experiences with the battle of deep depression. This experience sparked the need for further research and changes to be made in the accessibility, quality and quantity of resources provided to our firefighters in regards to behavioral/mental health issues. It was found that access to the
Raleigh Employee Assistance Program (REAP) was difficult to access. While there is a link on the Raleigh Employee website to the REAP site, the link is buried in the bottom of the home page. The location of the link makes it very difficult to locate if not impossible without assistance.
The City of Raleigh is ranked 49th of the largest cities in the United States and the second largest city in North Carolina. From census data of 2012, Raleigh’s population was
423,179 covering a land area of 145 square miles. This equates to a population density of 4.5 BEHAVIORAL HEALTH AWARENESS 7
persons per acre within the corporate limits ("Raleigh," 2013, p. 2). The City of Raleigh employees just over 3400 total employees, with 612 employees in the fire department. The large number of employees within the city and the fire department contribute to the increased possibility of behavioral/mental health issues. Individuals, especially firefighters are not generally forthcoming with discussing behavioral/mental health issues that they may be having.
The fire service and the RFD have a deep tradition of being the provider of care not the recipient
of care. Firefighters are informed during the early stages of their career about the traumatic
incidents they could respond to during their career. However, the fire service and the RFD has
failed to provide responders with the tools and training necessary to cope with the stress that
responding to traumatic incidents produce.
The history of the RFD revealed numerous retirees have chosen to die by suicide and some active firefighters have attempted suicide. It is known that history will continue to repeat itself without intervention. During the Executive Development Course (ED) as part of the
Executive Fire Officer Program (EFOP) this researcher attended on the campus of the National
Emergency Training Center and the National Fire Academy (NFA) in November 2016
organizational culture and change were discussed. Behavioral/mental health issues have a
cultural stigma associated with them. Firefighters often believe revealing their personal
behavioral struggles will allow others to view them as being weak or unfit for duty. This is a
cultural change that must take place within the fire service and the RFD. Firefighters that reveal
their issues and seek the help necessary to allow them to process the events will ultimately yield
a stronger human being. Research has shown that help is available to deal with
behavioral/mental health issues, however the missing link has two sides. The first and the most
difficult, is reducing the stigma of help seeking behavior. As leaders exercising leadership, BEHAVIORAL HEALTH AWARENESS 8 leaders must pave the way for others to follow by leading by example (ED, 2016). Leading by example could include but is not limited to, adaptive listening, also covered in the ED course.
Adaptive listening involves actively listening to what individuals are actually saying and incorporating their body language and semantics (ED, 2016). Often times, individuals experience behavioral/mental health symptoms and will try to mask what they are going through.
Adaptive listening, with attention to details can allow leaders to identify underlying issues affecting personnel. Leaders have the opportunity to set the stage for cultural change and be a courageous leader.
The second missing link is the ability to create change in the organization, especially through the destigmatizing of help seeking behavior of personnel experiencing behavioral/mental health issues that can directly be tied to Goal five of the United States Fire Administration’s
(USFA) strategic plan. Goal five of the USFA’s strategic plan contains five key initiatives. Key initiative 3 states “Provide an environment that values and embraces the contributions and potential of every employee and supports ongoing professional development opportunities”
(USFA Goal 5, 2014-2018, p. 14). The only way to accomplish this goal of providing an environment that embraces the potential for every employee is to support their behavioral/mental health. Behavioral and mental health support will help all employees prepare for and achieve their future professional development potential.
The National Fallen Firefighters Foundation (NFFF) has developed sixteen life safety initiatives that are designed to reduce the line of duty deaths of our nation’s firefighters.
Initiative one states “Define and advocate the need for a cultural change within the fire service related to safety; incorporating leadership, management, supervision, accountability and personal responsibility” ("FLSI 1," n.d.). Exercising leadership in helping to create a cultural change BEHAVIORAL HEALTH AWARENESS 9 related to destigmatizing the help seeking behavior of personnel experiencing behavioral/mental health issues is a perfect example of achieving initiative one. It personifies all aspects of the initiative through exercising leadership, proper management of personnel, effective supervision and observation of personnel, accountability of the leader and the personal responsibility of the leader to create an environment conducive to creating a culture of change.
Initiative thirteen of the sixteen life safety initiatives states “Firefighters and their families must have access to counseling and psychological support” ("FLSI 13," n.d). Initiative thirteen is further reiterated in NFPA 1500, the National Fire Protection Association Standard on
Fire Department Occupational Safety and Health Programs chapter 11. NFPA 1500 requires that “fire departments provide a member assistance program to ensure availability of professional counseling resources for members and their family” (NFPA 1500, 2012, Chapter 11). For years employers have provided what has traditionally been known as Employee Assistance Programs or EAP, the trend for the future is to provide a more comprehensive Behavioral Health
Assistance Program or BHAP ("NFFF EAP to BHAP," 2014).
Literature Review
The literature review for this research began by gathering data from multiple sources to document the history of mental health issues in the RFD. While firefighter deaths by suicide is a growing concern in the fire service and the RFD, it is a difficult subject to research past history.
Retirees that have committed suicide are gone and have taken the knowledge of how they reached the decision to die by suicide with them. What does remain is the recollection of the individual by current members still alive. However, this was a challenge as well, due to the number of years that have passed since the retirees committed suicide. Only a few active members remain that could provide documentation of the attitudes, personality traits and BEHAVIORAL HEALTH AWARENESS 10
dispositions of the lost members. This information was obtained through private
communications both face-to-face interviews and through email written formats. Interviews that reveal the past history and current conditions of RFD can be found in appendix C, D, E and F.
Observations were utilized during multiple class sessions of the course entitled
Behavioral Health Awareness in the RFD (Ali & Hobson Jr, 2016). During the delivery of this
course, this researcher held the position of Battalion Chief/Safety Officer of the RFD. The two
main critical job duties of the Safety Officer were to implement measures necessary to ensure
that all members return home to their families following their tour duty and to implement
measures necessary to ensure all members live a long and happy retirement. Past knowledge of
the suicidal history of members of the RFD presented a need for behavioral/mental health
training and program improvement. The combined efforts of this researcher, along with
Lieutenant Dena Ali the course Behavioral Health Awareness for the RFD was created and
delivered to all operations personnel during the month of July 2016. This course of instruction
was later renamed Emergency Responder Suicide Prevention - Awareness Level and submitted to
Wake Technical Community College for dissemination to all county departments (Ali & Hobson
Jr, 2016).
During course delivery to operations personnel many cultural elements of personal
conduct were observed and noted. While the subject is difficult to discuss and obtain student
interactions, this course resulted in overwhelming support. Almost daily operational personnel
would openly express their appreciation for delivery of sensitive material. One noted
observation was, an extremely limited number of personnel knew where to locate REAP contact
information. Even less personnel knew there was a website link to the contracted company that
provides assistance to City of Raleigh personnel. BEHAVIORAL HEALTH AWARENESS 11
A dramatic observation noted during course delivery was the shock of learning the statistical data in the number of firefighter suicides over the past years. There had been 89 suicides up to course delivery in 2016, 138 in 2015 and 118 in 2014 (Firefighter Behavioral
Health Alliance [FFBHA], 2017). These numbers are particularly shocking when compared to the average number of line of duty deaths which was below 100 for the corresponding years.
Additional information provided by the Firefighter Behavioral Health Alliance (FFBHA), the only known organization collecting and verifying data on firefighter suicides states that the expected reporting data is less than 50% of the actual number of firefighter deaths by suicide
(FFBHA, 2017). The possibility of low reporting is due to there being no current regulations regarding the reporting of death by suicide. All information reported by the FFBHA is voluntarily submitted for inclusion in the statistical data. The observation noted when this information was presented during course delivery was the facial expressions of shock that the numbers were this high. Often time’s questions and discussion were asked to validate the information. Actual current data could easily be displayed through website access to the
FFBHA.
Further disturbing observations noted were the regular occurrences of someone revealing during class their own personal struggles. Sometimes students would speak up during course delivery and share their personal testimonies and other times the student would reveal their struggles confidentially after class through phone calls or emails of appreciation. It was overwhelmingly validated that there was a need for improved behavioral/mental health resources and programs to assist members of the RFD.
During the development of Behavioral Health Awareness for The RFD many local experts were utilized to validate information presented in the course. Dr. Mark Holland the BEHAVIORAL HEALTH AWARENESS 12 author of The Dangers of Detrimental Coping in Emergency Medical Services presents information on significant stress exposure to emergency responders when exposed to personally disturbing incidents (PDIs). Post-traumatic Stress Disorder (PTSD) is a common term for a behavioral health disorder that was first recognized through research in the military. PTSD can also be experienced by emergency personnel. Identifiable symptoms include “intrusive memories, avoidance, withdrawal and unrelenting psychologic stress arousal symptoms for more than thirty days” (Holland, 2010, p. 331). PTSD symptoms for emergency responders were found to exceed the level of the general population. Negative outcomes include disassociation and interpersonal relationship difficulties. Additionally, improper coping mechanisms used by emergency responders further aggravate PTSD symptoms.
Dr. Holland’s research consisted of a survey that exposed 180 emergency responders to evaluated stress levels associated with seven different traumatic PDIs. Results of the survey concluded that age, gender, ethnicity, marital status, position, or years of experience did not differentiate the stress symptomatology after exposure (Holland, 2010, p. 335). Some coping mechanisms identified of responders were “escape/avoidance, distancing, confrontive coping, accepting the responsibility, and self-control” (Holland, 2010, p. 336). It was also noted that there are some potentially optimal coping methods, such as positive social support, problem- solving, and positive reappraisal (Holland, 2010, p. 336). It is noted that throughout this literature review positive social support was a primary method of stress reduction and tool for creating a positive behavioral/mental health environment and culture.
In the article Firefighter Depression: Top 5 Signs You Need to Watch For published in the Firefighter Mental Health Guide listed unusual outburst of anger is the first sign to be aware of. Unordinary impulse behavior was listed second, signs of sleep deprivation was third, loss of BEHAVIORAL HEALTH AWARENESS 13
self-assurance or confidence came in fourth and lastly isolation was the final sign (Firefighter
Mental Health Guide [FMHG], 2014).
FireRescue magazine published an article entitled Our Stress is Real that described a
painfully obvious realization associated with the job of being a firefighter. Which is “life-and-
death decisions are a routine part of our day” (Dreiman, 2017). It also covered the regularly
reoccurring fact that positive social support is a leading tool in managing responder stress. Many
of the recommendations were presented as strategies for maintaining mental health. These include self-performing well-being examinations. Individuals are encouraged to ask questions of
themselves. Are you “irritable, exhausted, sad, happy, relive unpleasant past events, avoid
locations where bad memories occurred and am I currently getting quality sleep” (Dreiman,
2017).
The article also encouraged responders to spend time with loved ones. Become involved with activities outside of the firehouse to create a sense of balance. Activities with family help establish positive behavioral health. Another strategy was to use support services, seek out and utilize professional counselors as needed. Begin to establish life beyond the fire service which includes having some non-fire friends. It’s especially important as we near retirement to prepare for the loss of the social network associated with the fire service. If all our emotional contacts for social support are centered in the fire service, this could have devastating consequences when we are no longer part of a fire service organization. There are many ways to establish friends and contacts outside of the fire service. Relationships established in a spiritual/church environment could be a positive alternative to establishing friendships outside of the fire service.
As well as, a means of establishing an alternative positive social support network. The article BEHAVIORAL HEALTH AWARENESS 14
also reiterated the fact that we need to continue to support destigmatizing mental health seeking
behaviors of department personnel (Dreiman, 2017).
Another article published by FireRescue magazine was entitled Will You Raise Your
Hand? This article examined the realization that we live in a media friendly world where
information is readily available. The fire service is often stricken by vicarious trauma because of
our drive to learn from the experiences of others through various media formats. These
experiences further expose firefighters to the trauma suffered by others. Because firefighters are
inherently empathetic, continuous exposure to media releases of others trauma can have the same
level of detrimental behavioral health implications as a firefighter responding to a traumatic
event (Dreiman, 2017).
The article also provided a list of suicide risk factors common to firefighters, such as
“alcohol or drug use, divorce and separation, unresolved grief, exposure to trauma and access to
firearms” (Dreiman, 2017). The number one method of firefighter suicide is by firearms. The
author encourages firefighters to seek help through various measures. Employee assistance
programs often provide many levels of assistance. Assistance can be found with finance
planning, marriage counseling and other daily life struggles. Another important means of
providing positive social support was through the establishment of peer support teams. Peer
support has often been considered a component of Critical Incident Stress Management (CISM).
However, peer support can cover a more widespread array of behavioral health issues.
Valuable information was also provided on how to ask the two most important questions you may ever ask to a peer that is struggling with behavioral health issues. “Are you thinking about killing yourself? Do you have a plan” (Dreiman, 2017)? These questions can be particularly difficult to ask, however they must be asked as directly and straightforward as BEHAVIORAL HEALTH AWARENESS 15 possible. More importantly is being prepared for any answer you may receive. Individuals are not likely to tell you any untruthful response just to circumvent the question. Often times, individuals that are planning a suicidal attempt will find relief and comfort from being asked their intentions. When an individual responds to either of the questions with a “yes”, help must be immediately rendered. There were many suggestions noted, such as dialing 911 and having the individual immediately picked up by law enforcement to ensure their safety. Less dramatic options were connecting the individual with appropriate peer support members that could help them through their situation. Providing other resources, like the phone number for the National
Suicide Prevention Lifeline. The best strategy when asking the two important questions is to be prepared for the long haul. Whatever the answer is, provide the appropriate response to the circumstances (Dreiman, 2017).
An interesting fact presented in the article was “suicide is not the behavioral health issue that needs to be treated. Rather, suicide is the result of an underlined behavioral health issue, whether it be post-traumatic stress disorder, depression, bipolar disorder, addiction, or psychosis” (Dreiman, 2017). There is no other brotherhood like the one that exist in the fire service. Firefighters will typically go to extreme measures to protect the brothers and sisters that are struggling with any issues, including behavioral/mental health.
The National Fallen Firefighters Foundation (NFFF) Everyone Goes Home Initiative has published many resources on behavioral/mental health. The NFFF has sponsored two symposiums on behavioral health awareness. The first in Baltimore Maryland in 2011 and the second on the campus of the National Fire Academy in 2013. Following the Baltimore symposium a media report was released entitled Issues of Depression and Suicide in the Fire
Service which was the focus of the symposium. Along with leaders of the United States Fire BEHAVIORAL HEALTH AWARENESS 16
Service, three subject matter experts (Dr. Matthew Nock, Dr. Thomas Joiner and Dr. Alan
Berman) were also in attendance to discuss the current state of behavioral/mental health issues in
the fire service. Dr. Nock began the discussion by correlating statistics of civilian America in
relation to data pertaining to fire service suicide. Which was difficult due to the limited data that
was available on documented fire service suicides. His data reported that 70% of US suicides
are among white males, the predominant gender of the US fire service. And that 57% of all
suicides are caused by firearms, other noted avenues of suicide are poisonings, hangings and
suffocation (Gist, Taylor, & Raak, 2011, p. 10).
Dr. Thomas Joiner presented the results of his research in the field of suicides. Dr. Joiner
is a well-known researcher and author of many articles and books on the personal association of
suicide and behavioral/mental health. Dr. Joiner states that “suicide is not a condition or
disorder, but rather an outcome that may result from the presence of many risk factors, including
underlined conditions, individual dispositions, interpersonal dynamics, social interactions, and
other factors” (Gist et al., 2011, p. 12). From Dr. Joiner’s book Why People Die by Suicide he
presents a three sided approach that when all three components come together suicide is a
possible outcome. The first component is a thwarted belongingness. In this component the
individual feels that they are alone in the situation. Which means they no longer considered
themselves a part of the social setting. The second component is perceived burdensomeness. In
this component the individual feels that they are a burden to the social network. Often times, this feeling of burdensomeness results in the individual developing feelings that their world would be
better without them. The third and most powerful component is the capability for suicide.
Firefighters possess the capability for suicide because of their relentless exposure to painful
stimuli associated with death. Additionally, firefighters regularly engage in impulsive behaviors BEHAVIORAL HEALTH AWARENESS 17
such as the use of firearms and other dangerous activities. Firefighters that have experienced
unsuccessful attempts at suicide will continue to develop the capability to complete a successful
attempt (Joiner, 2005).
During the 2011 symposium Dr. Joiner stressed “the lack of acknowledgment of suicide
within the fire service is problematic” (Gist et al., 2011, p. 12). Fire service leaders should create an environment that promotes the destigmatizing of firefighter suicide by removing the ignorance of the issue while maintaining a level of fear towards suicide (Gist et al., 2011, p. 15).
Dr. Lanny Berman followed with discussion on the application of the Public Health
Approach to Suicide Prevention, prevention cost less than intervention. The Public Health
Approach is a five location circular approach consisting of, “defining the problem, identify and causes, develop and test interventions, implement interventions and evaluate the progress” (Gist et al., 2011, p. 16). Dr. Berman pointed out that alcoholism increases the possibility of a completed suicide because it increases impulsive behavior and amplifies the effects of depression.
The 2011 symposium concluded with multiple recommendations for departments to improve behavioral/mental health. Such as; determining prevalence of suicide, identifying occupational risk factors, continue to explore current science behind suicidal behaviors, establish priorities and create action plans (Gist et al., 2011, p. 22-24).
Reference material from the 2013 Suicide and Depression Summit was released by the
NFFF in the article Confronting Suicide in the Fire Service; Strategies for Intervention and
Prevention. Three new subject matter experts (Dr. Kimberly Van Orden, Dr. Patricia Watson and Dr. Angela Moreland) in behavioral/mental health presented information during the symposium. Dr. Orden reported suicide as a public health problem. A problem that can best be BEHAVIORAL HEALTH AWARENESS 18
handled through a population based approach. Her presentation suggested an in-depth surveillance program would be successful in reducing the mortality rate of firefighter deaths by suicide. Surveillance programs help identify the true underlying issues of suicidal behavior
("NFFF Confronting Suicide," 2014, p. 5-6). Dr. Watson presented information that could assist peer support suicide surveillance and prevention initiatives entitled The Stress First Aid Model
(SFA). SFA is a three level program consisting of awareness, operations and technician level training in surveillance of suicidal intentions ("NFFF Confronting Suicide," 2014, p. 6). Dr.
Moreland engaged the group in discussing and providing feedback on an ongoing project
sponsored by the NFFF. The project is an interactive smart phone app that is designed to provide
peer supporters ongoing continuing education opportunities in various skills needed to improve
peer support functions ("NFFF Confronting Suicide," 2014, p. 7).
The 2013 symposium also focused on the development of specific tools that would be
effective, applicable, executable, affordable and acceptable to the fire service for improving
behavioral health strategies and initiatives. One tool that was presented was the creation of the
ACT (Ask, Care and Take) campaign. ACT is a modified version of the Army ACE (Ask, Care
and Escort) strategy to assist Army enlisted and veteran soldiers suffering from
behavioral/mental health issues ("NFFF Confronting Suicide," 2014, p. 9).
Fire service leaders present at the symposium rallied together to advocate for adding
basic mental health screenings to NFPA 1582 Standard on Comprehensive Occupational
Medical Program for Fire Departments. Some example screenings include the 10-item Trauma
Screening Questionnaire, WHO-5 for depression screening and Wintersteen protocol for suicide screening ("NFFF Confronting Suicide," 2014, p. 9). Some examples for implementation of these screenings usage were, conducting depression screenings for new hires and during annual BEHAVIORAL HEALTH AWARENESS 19
medical evaluations. It was also recommended that physicians would add suicide screening and
prevention questionnaires to annual medical screenings.
Additional information was presented on the need for the fire service to develop plans for
addressing the impact of a completed suicide within the fire department. This is especially
important given the fact that “a fire department is three times more likely to experience a suicide
in a given year than a line of duty death” ("NFFF Confronting Suicide," 2014, p. 1). In the event
the Fire Department member did complete suicide the impacts could be devastatingly traumatic
to the surviving members with long-lasting effects. We should be prepared beforehand to treat
any members adversely affected. Additionally, the fire service should prepare policies and
procedures for funeral arrangements involving the completed suicide of a member. The death of
a member by suicide can easily be treated differently when compared to a line of duty death. A
firefighter’s death by suicide should be treated with the same respect given to any line of duty
death ("NFFF Confronting Suicide," 2014, p. 11).
In the article Suicide: What you need to know was prepared by Dr. Kimberly A. Van
Orden and published by the NFFF as a guide for Fire Chiefs in the event of a firefighter death by suicide. The article printed several interesting facts related to suicide; such as suicide is the tenth leading cause of death in the US with approximately 30,000 people dying by suicide each year
(Van Orden, 2013, p. 3). Men die by suicide more than women in the US and more suicide deaths are caused by gunshots than any other method. Additionally, individuals with underline mental health disorders including, depression, anxiety and substance abuse are more likely to attempt or die by suicide (Van Orden, 2013, p. 3). Dr. Orden stressed the need for Fire Chiefs to be aware of the warning signs for suicide. A mnemonic IS PATH WARM from the American
Society of Suicidology was presented as a tool for Fire Chiefs to use in recognizing the warning BEHAVIORAL HEALTH AWARENESS 20 signs of suicide. IS PATH WARM stands for “Ideation, Substance abuse, Purposelessness,
Anxiety, Trapped, Hopeless, Withdrawal, Anger, Recklessness and Mood changes” (Van Orden,
2013, p. 5). Other helpful tips provided to Fire Chiefs in the article included not leaving any member alone that has expressed interest in personal harm. Any member presenting suicidal signs should be restricted access to lethal means of suicide completion. And yet again, information was provided that peer support teams are a valuable means of providing positive social support to department members (Van Orden, 2013, p. 7).
The December 2016 publication of Fire Engineering Magazine contained three articles on behavioral/mental health. In the first article, Firefighter Mental Health: The Job is Killing Us by
Jeremy Hurd was a review of the many behavioral health classes offered during the 2015 Fire
Department Instructor Conference (FDIC) in Indianapolis Indiana. The 2015 FDIC was also this researcher’s first time attending this national instructor conference and was in attendance at many of the seminars recapped in the article. Many leaders in the fire service behavioral/mental health endeavor presented quality information on the growing problem of behavioral health issues. Like Battalion Chief Dan DeGryse of the Chicago Illinois Fire Department (CFD) who has been instrumental in developing behavioral health programs in the CFD following the suicide deaths of seven Chicago firefighters within an eighteen month period. Chief DeGryse helped establish the Florian Program at the Rosecrance Institute in Chicago that specializes in the psychological treatment of emergency responders suffering from behavioral/mental health issues.
Retired Bellevue Washington Fire Department firefighter Dr. Beth Murphy (a psychologist who specializes in treating emergency service personnel) described in her FDIC class how she basically retired from the fire service due to bullying. Her mental health struggles led her to focus her doctorial treatment in the field of psychology. And Fire Chief Pat Kenny of the BEHAVIORAL HEALTH AWARENESS 21
Western Springs Illinois Fire Department who shared the experiences of his son who suffered
from a battle with depression which ultimately led to his son’s suicide. Chief Kenny’s testimony
of the struggles his son Sean faced with depression is truly heart-wrenching. During his son’s
struggles, Chief Kenny keep his personal struggles isolated from his department members. He
states that looking back it was the wrong decision for him and his members. Chief Kenny is
quoted in the article “we don’t need to be Superman wearing a cape trying to save the world; all
the while, the Cape is choking the life out of us” (Hurd, 2016, p. 52). The article captures
conversations with the leader stated above as to how their efforts to improve the mental health of the US Fire Service appears to be taken like sips of water from a thimble due to the slow progress in constant reminders of firefighter suicides in the news media. The author summarizes
that a continued message will be enough thimbles to create spoonfuls that will have the ability to
empty oceans of possible improvements. Ironically, the author states that prior to the publication
of this article Battalion Chief David Dangerfield of the Indian River Florida Fire Rescue
Department took his own life after a long battle with PTSD. Before Chief Dangerfield’s suicide
he made one final social media post which is relevant to include.
“PTSD for firefighters is real. If your loved one is experiencing signs, get them help
quickly. 27 years of deaths and babies dying in your hands is a memory that you will
never get rid of. It haunted me daily until now. My love to my crews. Be safe. Take
care. I love you all” (Hurd, 2016, p. 53).
The second article from the December 2016 Fire Engineering Magazine entitled
Strategies for Preventing Suicides in the Fire Service also presented information from Chief
DeGryse of the CFD. A statement from Chief DeGryse reads “suicide is one outcome of serious,
internal struggles for an individual that may manifest for some time before he or she reaches the BEHAVIORAL HEALTH AWARENESS 22
decision to die by suicide” (Ali, 2016, p. 55). The validity of this statement was further validated
by the realization that firefighters in particular are not comfortable revealing their vulnerability
to their peers. Firefighters often see themselves as pillars of the community. Retaining or suppressing these feelings can manifest in suicidal behaviors. The results from a study conducted in North Carolina noted in the article that suicides occurred three times more often than line of duty deaths (Ali, 2016, p. 55).
The article goes on to describe how firefighters turn to alcohol as a coping mechanism.
Depression and alcohol are extremely dangerous and when mixed they can exaggerate the depression leading to suicidal behaviors. This condition is often further complicated by the negative stigma associated with help seeking behavior. As reported in many other reference material firefighters are reluctant to share their struggles fearing that they may not be able to continue their career. There is hope that individuals can become fit for duty even after unsuccessful suicide attempts. These individuals just need professional help in dealing with the
behavioral/mental issues that are consuming them. Positive social support and destigmatizing
help seeking behavior was once again noted as a positive technique for improving behavioral
health (Ali, 2016, p. 56).
Interestingly, the author noted company officer training is the key to creating a successful
and safe environment for fire service personnel to perform their duties. Company officers should
exercise leadership and adaptive listening techniques to insure a safe workplace environment is
sustained (Ali, 2016, p. 57).
The third article from the December 2016 Fire Engineering Magazine entitled Behavioral
Health Training for Fire Rescue Personnel was authored by a group of 5 fire service advocates
of behavioral health. This article reported that emergency responders are at a greater risk for BEHAVIORAL HEALTH AWARENESS 23
depression than civilians due to the traumatic incidents they are exposed to over their career.
Additionally, first responders were found to have substance abuse issues at a rate twice that of
the civilian population with their substance of choice being alcohol. Outcomes from other
studies reported emergency responders are three times more likely to die by suicide than a line of
duty death. Depression coupled with sleep disorders is a combination for disaster.
The authors of this article, who are also researchers, designed and implemented a preventative Behavioral Health Training (BHT) program for the Boulevard Sheriff’s Office in
Brevard County Florida. The BHT program involved 250 responders and the results presented
were divided into six sections: Introduction, Stress, Depression, Sleep, Substance Use and
Suicide (Steinkopf, Klinoff, Van Hasselt, Leduc, & Couwels, 2016, p. 60). The introduction
section provided documentation of how behavioral health problems are interrelated. Such as
how stress increases the use of coping mechanisms such as alcohol and other substance abuse.
This fact coupled with poor quality sleep makes it difficult for an individual to control their
mood. The introduction wrapped up with information on the importance of observation of
fellow responders and identification of risk factors associated with behavioral health issues
(Steinkopf et al., 2016, p. 60).
Stress was identified as both positive and negative, or stress can have positive and
negative effects on the body. In many ways stress is what keeps people motivated. Four types of
stress were reported in the article, physical, mental, emotional and behavioral. Different
individuals have different ways of coping with stress. This could be through social support,
hobbies, self-care or through professional interventions such as, relaxation and cognitive
reconstruction (Steinkopf et al., 2016, p. 60). BEHAVIORAL HEALTH AWARENESS 24
The article stressed that “depression is an illness and not a weakness” (Steinkopf et al.,
2016, p. 60). Depression manifests itself in different ways from different individuals dependent on background and influential factors. Firefighters can experience significantly different affects from stress due to their job exposure and the possible influencing factors of substance abuse. As with any illness, depression can be cured with treatment and time for processing (Steinkopf et al.,
2016, p. 61).
Sleep quality and quantity plays a huge roles of influence on first responders with both short-term and long-term effects. Emergency responders should monitor their sleep habits and make provisions to assist in achieving quality sleep when possible. Suggestions noted for improving sleep hygiene include restricting the bedroom for sleep, sexual activities and recovering from sickness. Other suggestions to improve sleep quality is controlling the temperature and the lighting of the room along with restricting the use of caffeine and alcohol prior to sleep time and schedule adequate time for rest and recuperation (Steinkopf et al., 2016, p. 61).
It was noted in relation to substance abuse that 29% of emergency services personnel compared to 5.5% of the general population have substance abuse issues. There were also several myth’s reported as false statements. Such as. “Alcohol well help you sleep better” and
“you are only an alcoholic if you have a beer belly” (Steinkopf et al., 2016, p. 61).
In the last section on suicide, warning signs and risk factors were emphasized. A myth about suicide was also dispelled as untruthful “if a person is suicidal, there is nothing we can do to stop them” (Steinkopf et al., 2016, p. 62). Thankfully, with proper intervention and treatment a suicidal person can be helped if we are willing and able to provide the necessary resources. BEHAVIORAL HEALTH AWARENESS 25
In the discussion section of the article it was noted that there is a need for training
professional counselors that work with members of emergency services to train and understand
the emergency services culture. Emergency services personnel are extremely reluctant to openly
discuss traumatic experiences with individuals of any kind who do not understand the culture of
emergency services providers (Steinkopf et al., 2016, p. 62).
The article Why Firefighters Take Their Own Lives published in Fire Chief Magazine
reported that there is a direct link between suicide and on the job stresses. Other types of stress
can also be linked to suicidal behavior, such as the stresses found in daily life. The fire service
has placed great emphasis on learning fire behavior and fire growth changes over time the same
efforts must be placed on learning the effects of stress on the behavioral health of our
firefighters. Firefighters like any other worker often bring their non-work related stress to the
fire station with them. While at work they are exposed to individuals experiencing the worst day
in their lives due to traumatic events. The combination of these exposures places enormous
pressure on the firefighters to absorb and cope with the effects. Positive social support in the fire
house work environment is reported as an important factor in helping firefighters deal with the
challenges of the job. As healthcare providers, firefighters must accept the challenge of reaching
out to help a firefighter in need (Sivak, 2016).
The article Recognizing Suicide Warning Signs in Firefighters and EMTs published in
Fire Engineering Magazine tragically reported a fact that is common among departments that have experienced a fire fighter suicide, we did not recognize the warning signs until after the incident. The top five signs of possible suicidal behavior are outlined using the mnemonic
RAILS. Reckless/impulsive behaviors, Anger, Isolation, Loss of confidence and Sleep BEHAVIORAL HEALTH AWARENESS 26
deprivation (Dill, 2015, p. 2). Fire service leaders must exercise their due diligence in
recognizing the signs of possible suicidal behavior and react to them proactively and directly.
In the Fire Service Suicide Prevention Approach Research Proposal the author reports
“efforts to reduce suicide should be directed at change in the individual’s life trajectories before they become acutely or severely distressed and suicidal” (Ali, 2015, p. 5). Warning signs noted that a person may be suicidal include “anger, aggressiveness, sleep deprivation, impulse behavior, isolation, lacking a feeling of purpose, alcohol abuse, divorce in the presence of a firearm in the home” (Ali, 2015, p. 7). Lack of purpose can be viewed as a warning sign and a risk factor. When an individual feels they have no purpose in life they can lose all willingness to live. Other risk factors noted were the unusual shiftwork of emergency responders which can negatively affect their quality and length of sleep. It was also noted that alcohol is the most common substance use by emergency responders in coping with depression. Alcohol and depression are extremely dangerous when mixed. Protective factors noted in the proposal include “establishing a sense of purpose, occupational post trauma support, positive coping skills, self-esteem, social support and destigmatize and help seeking behavior” (Ali, 2015, p. 9).
It was noted that training company officers to recognize the warning signs and risk factors of suicidal behavior is key to successful suicidal prevention initiatives. It was also noted that while an individual may be suicidal, they can remain fit for duty with proper treatment (Ali,
2015).
Procedures
In order to address the problem statement of this descriptive research: The problem is an increasing rate of behavioral/mental health issues within the RFD. Multiple methods to collect data of the past and present conditions related to behavioral/mental health issues were conducted. BEHAVIORAL HEALTH AWARENESS 27
The methods used were a survey, documented interviews, documented personal observations, information collected through personal communications, and a thorough literature review.
The procedures outlined in this section were specifically designed to gather data helpful
in answering the problem statement of this descriptive research: The problem is an increasing
rate of behavioral/mental health issues in the RFD. The purpose of this research procedures is to
identify local and national resources that can be utilized to identify and evaluate the current
behavioral mental health of the firefighters in the RFD.
A survey was distributed during the course Behavioral Health Awareness for the RFD
that contained fifteen questions to gather demographic, current behavioral health diagnosis, peer
support team projected support, current understanding and perception of working alongside
coworkers experiencing behavioral health issues, and the overall current health data in the areas
of mental and physical health condition. The survey, found in appendix A, was distributed
following the introduction to the course before participants input in the survey could be altered
by information covered in the course. The survey was designed to answer the research question,
what is the history of mental health issues in the RFD over the past ten years? The survey was
distributed to over 400 attendees of the course. A random sampling of 100 responses were selected to gather the data representing just under 25% of the attendees. The data outcomes from the survey were to provide clear unaltered past and present conditions of behavioral/mental health concerns. The outcomes of the survey can be found in appendix B.
This was the first Behavioral Health Course offered in the history of the RFD. The course was conducted on eighteen days throughout the month of July 2016. Each day consisted of a morning and afternoon session held at various fire stations throughout the RFD.
Approximately 5 companies would attend a class held near their first due territories. Each course BEHAVIORAL HEALTH AWARENESS 28
delivery ranged between two and three hours depending on the amount of discussion from
attendees. A local mental health professional, Dr. Mark Holland attended 80% of the training
sessions to offer his support of the program and provide a brief background of his qualifications
and research in the behavioral health field. Dr. Holland also shared a powerful message of his
personal connection with an intended firefighter suicide where his intervention prevented the
attempt.
Interviews were conducted with four RFD members to gather detailed information about each individual’s personal connection with behavioral/mental health issues and concerns. Each individual was chosen due to their previously shared information during the two classes
Behavioral Health Awareness for the RFD and Raleigh NC Firefighter Peer Support or from personal communications following the courses of instruction. The interviews were conducted to assist in answering the research question of, how is the RFD currently utilizing any local or national resources? And, what are the expected benefits from improvements to the overall behavioral/mental health of our personnel?
Multiple interviews with Captain Dena Ali have occurred over the past year related to the development of a behavioral/mental health program for RFD. Captain Ali is a researcher, author and presenter of behavioral health information on a national level. She has an article published in Fire Engineering Magazine and another will be published in future additions. She was a presenter at the 2016 FDIC in Indianapolis, Indiana where she delivered a presentation on
Suicide Prevention on an Awareness Level. Captain Ali has conducted considerable research in the area of suicide awareness and prevention and is an advocate for behavioral health improvements in the RFD. Captain Ali’s interview is found in appendix C. BEHAVIORAL HEALTH AWARENESS 29
Lieutenant Chris Holcomb was interviewed following an email correspondence after his
attendance to the behavioral health training in RFD. Chris shared his experience with a divorce
and the path his behavioral health took following the event. Lieutenant Holcomb’s interview is
found in appendix D.
Firefighter Blaise Harris was interviewed prior to course delivery of Behavioral Health
Awareness for the RFD due to his role in the training program. Blaise offered to share a video
presentation of his struggles following a divorce and his suicide attempts. Blaise received
treatment for his depression and has a successful outcome. Blaise is currently pursuing an
education in behavioral health counseling. Firefighter Harris’s interview is found in appendix E.
Retired Captain Tim Duke was interviewed to obtain the perspective of the social change
connected with retirement. Captain Duke retired May 1, 2016 and expressed an interest in
remaining a part of the behavioral health program in the RFD to assist other past and future
retirees in the maintenance and improvement of their behavioral health. Captain Duke’s interview is found in appendix F.
Multiple documented observations were made during the delivery of the course
Behavioral Health Awareness for the RFD. This researcher and lead instructor for the course had many reservations prior to course delivery. Behavioral/mental health discussions are a difficult conversation to have in a private setting. Discussing behavioral health issues in a classroom setting could be extremely challenging. With the known retirees deaths by suicide and the unsuccessful attempts of current members, discussions on behavioral/mental health issues were extremely needed. With the goal of preventing such tragic events in the future.
Reservations prior to course delivery included how would the information be received, would participants openly participate in the course, would there be large-scale opposition, would there BEHAVIORAL HEALTH AWARENESS 30
be members currently experiencing an overwhelming behavioral health issues and find the
training environment uncomfortable, would there be members present that had experienced
suicidal behavior in the past or the death of a significant person in their life by suicide.
Additionally, this researcher revealed his vulnerabilities and struggles with behavioral/mental
health issues of depression, sleep disorders, alcohol abuse and the effects on family, friends and
career. This was completed during a time of healing. Presenting this information was extremely
difficult in the beginning but became less emotional near the end. These documented
observations can be found in appendix G.
Documented observations were also completed during a 2 day training session entitled
Raleigh NC Firefighter Peer Support conducted by members of the Illinois Peer Support Team
(ILFFPS). Executive Director Matt Olson and Clinical Consultant Jada Hudson delivered the
training session on the campus of Wake Technical Community College, Raleigh NC. Members
of the class consisted of firefighters, paramedics and police officers throughout Wake County
including ten members of the RFD. The course provided an overview of the ILFFPS
development and current capabilities. Class participants were given the opportunity to share
their reasons for attending during course introduction. Instruction was presented on proper peer
support techniques and opportunities were provided to practice one-on-one interactions of peer support. These documented observations can be found in appendix H.
A thorough literature review was conducted to answer the research question of what local and national resources are available and what are the expected benefits from improvements to the
overall behavioral/mental health of our personnel? Through Internet searches on Google,
Google Scholar, Microsoft Edge, and Yahoo, a significant amount of information was gathered
to address the research questions. Information located included books, journal articles, trade BEHAVIORAL HEALTH AWARENESS 31
magazine articles, information provided on national fire service organizations websites and
previous research presented through white paper releases, and personal communications needed
to document the history of mental health issues within the RFD.
Results
The procedures used in this descriptive research provided ample documentation to
answer the research questions presented in the introduction of this applied research paper. The
first research question; what is the history of mental health issues in the RFD in the past ten
years? This question was answered through personal communications that documented four
retiree suicides. Three of the suicides were from firearms and the fourth was self-inflicted cutting (D. Poole, personal communication, August, 2017). Interestingly, the retiree who committed suicide by cutting was a knife enthusiast. He was known for sharpening knives during idle times around the fire station. He was even known to have sharpened butter knifes that traditionally have a dull edge.
It was also determined through interviews and personal communications that multiple active firefighters had attempted suicide. One firefighter shared his story of suicidal behavior in the course Behavioral Health Awareness in the RFD through a powerful video content where he personally recounted his struggles with behavioral/mental health issues, see appendix C.
Personal communications recounted a previous active firefighter suicide attempt that tragically led to his disability retirement as a result of his injuries. This firefighter shot himself with a forty-four magnum pistol through the roof of his mouth and lived. The bullet went through his nasal cavity and split the lobs of his brain as it continued to exit the top of his head. The day he chose to make the suicide attempt was a day following his tour duty. A crew from his fire station answered the call. Because of the extreme facial trauma his coworkers did not recognize him in BEHAVIORAL HEALTH AWARENESS 32 the beginning. This firefighter went home to recover from the traumatic brain injury but was not able to return to duty, see appendix C.
During course delivery of Behavioral Health Awareness in the RFD some of the firefighters came forward willing to share their personal struggles with suicidal behavior or were asking for assistance to deal with current struggles. A survey was administered during the introduction section of the Behavioral Health Awareness in the RFD course that provided statistical data on the current behavioral health issues present within the RFD, see appendix B.
The survey was presented to over 400 attendees during the course. A random sample of 100 responses was processed for data collection represented a 25% sampling of respondents. This was an adequate sample to provide accurate projections of total outcomes. Male respondents totaled 93% while 7% were females. Which is an accurate account of our male dominated workforce. The largest percentage of respondents in age range was 22% in the 41 to 45 age group, 3% were 21 to 25, 17% were 26 to 30, 17% were 31 to 35, 19% were 36 to 40, 11% or 46 to 50, and 11% were over age 50, see appendix B. These numbers appear to be inaccurate, that could be due to the random sample.
Of the respondent’s, the largest percentage in years of service were 21% with 16 to 20 years on the job. The next three questions of the survey were directed at previous diagnosis of behavioral health issues of anxiety, PTSD, and depression. There were 32 total respondents that reported the previous diagnosis. With a random sampling of 25% of the attendees, there could be 128 RFD personnel with professional diagnosis of behavioral health issues, or roughly, one third of the attendees which is an alarming number. There is an even more alarming number coupled with the 38% of respondents that would possibly seek help from our agency provider and 34% that would probably not seek help, see appendix B. BEHAVIORAL HEALTH AWARENESS 33
During the literature review multiple sources stated that positive social support was the
most successful suicide prevention technique. Positive social support can come in many ways,
peer support teams is one avenue to provide positive support. However, only 40% of the
respondents stated they would possibly seek help from a peer support team member and 36%
responded they would probably not.
The next two questions in the survey were structured to gather opinions based on a firefighter’s ability to perform while facing a mental health crisis and how likely they are to return to duty after treatment for a mental health crisis. The largest majority responded neutral to a firefighter performing while facing a mental health crisis at 40%. Encouragingly, 28% reported they would be able to perform during the crisis. Overwhelmingly, 75% reported that a firefighter would be able to return to duty after receiving help for their crisis. Crisis intervention can come simply by having someone to discuss the crisis with, 43% reported they always have someone to talk to, see appendix B.
The last three questions of the survey were structured to gather general information on how the respondents felt about their current mental and physical health along with gathering data about the use of healthy diet plans. Respondents reported that their overall mental health was split evenly between good, very good, and excellent with an even 30% across the board. This data supports the idea that approximately 25% of the respondents could have behavioral health diagnosis. When asked about the firefighter’s physical health, 41% rated their health as good,
37% very good, and only 11% as excellent. This data provides an area of improvement that could improve overall behavioral health. During literature review multiple sources reported physical fitness as the most productive stress reducing activity. Increase physical fitness will improve overall mental health. Closely linked to physical health is a healthy diet, 50% of the BEHAVIORAL HEALTH AWARENESS 34
respondents reported their diet as only good. Another area improvement can be made. The last
question of the survey was how often respondents participate in physical fitness activities, 55%
reported they participate in physical fitness activities 3 to 5 times a week which is a productive
response, see appendix B.
The literature review provided answers to the research question; what local and national
resources are available? The National Volunteer Fire Council Share the Load Program provides
a 24-hour toll-free hotline for emergency responders to call 1-888-731-FIRE (3473) ("NVFC," n.d.) which is printed in all their Helpletter publications (National Volunteer Fire Council
[NVFC], 2014) (National Volunteer Fire Council [NVFC], 2016) (National Volunteer Fire
Council [NVFC], 2017).
The National Fallen Firefighters Foundation Everyone Goes Home Campaign provided
an abundance of useful resources. The ACT campaign to help a firefighter struggling with
suicidal thoughts is a tremendous resource. ACT, Ask, Care, Take is a simple tool with color
posters that can be placed throughout the fire stations to remind everyone to watch out for one
another. The NFFF sixteen life safety initiatives provides national resources. Initiative thirteen,
firefighters and their families must have access to counseling and psychological support provides
many different resources for identifying risk associated with suicidal behavior ("FLSI 13," n.d).
Personal communications provided answers to the research question; how is the RFD
currently utilizing any local or national resources? The City of Raleigh currently contracts the
employee assistance program to a company based in Baltimore, Maryland. In an email from
firefighter Greg Ceisner describing his experience with the contract company, the level of service
is extremely poor (G. Ceisner, personal communication, July, 2016). BEHAVIORAL HEALTH AWARENESS 35
The answer to the research question; what are the expected benefits from improvements
to the overall behavioral/mental health of our personnel is found in appendix C, D, E, and F.
Captain Ali is hopeful that no local first responder organization would experience a death by
suicide in the future. This goal would be accomplished by the efforts of a highly functioning
regional peer support team, see appendix C. Lieutenant Holcomb envisions the future to have
multiple resources for any personnel struggling with behavioral health issues to find the
assistance they need. Improvements to that behavioral health will not only improve their quality
of life but will enhance job performance as well, see appendix D. Firefighter Harris has a similar view of the future with a highly successful functioning peer support team enhanced by readily available behavioral health support, see appendix E. Retired Captain Tim Duke offered his view of the future from a retiree’s perspective. Captain Duke envisions a training program to prepare retirees for the life-changing event that comes with retirement, see appendix F. All of these visions for the future ultimately would produce a happier less stress season firefighter capable of making critical decisions under extremely adverse conditions.
Discussion
The results of this descriptive research were comparable to the information gained from outside resources. Multiple personal accounts confirmed there is significant issues with the past and present state of behavioral health in the RFD. Data collected from the Behavioral Health
Survey further confirmed that a high percentage (32%) of active firefighters have been diagnosed by healthcare professionals with behavioral issues such as anxiety, depression, and PTSD, see appendix B. The alarming statistic retrieved from the survey was respondents would not likely seek help through an agency provider or from an active peer support team even when facing a behavioral health crisis, see appendix B. As the researcher, I believe these numbers were low BEHAVIORAL HEALTH AWARENESS 36
due to the timing of the survey. At the time of the survey, respondents had little knowledge of
what current resources were available from the city professional healthcare provider. Likewise, they had little background knowledge of what peer support would look like. My hypotheses is, if a second survey were distributed today the results would be overwhelmingly likely to pursue help from an agency provider or peer support team when facing a crisis. I base my hypotheses on the fact that approximately 30 individuals have expressed interest in serving on the peer support team. Additionally, a faith based support group has emerged in the last few months.
The faith-based group is providing similar support as a peer support team would, positive social support, just in a faith-based atmosphere that is non-denominational.
Research reported that firefighters seeking treatment for behavioral health issues could continue to perform their job duties efficiently (NVFC, 2016, p. 3) (Ali, 2016, p. 56) (NFPA
1500, 2012, Chapter 11). However, the outcome of the survey was overwhelmingly neutral at
40% of the responders feeling that firefighters facing mental health crisis are able to perform
their duties see appendix B. Overpoweringly, responders believe that once a firefighter has been treated for a behavioral crisis they can return to work after receiving help. Again, I believe these
numbers are not accurate in comparison due to the limited knowledge respondents had before
taking the survey. My hypotheses would be, given a second survey that a higher number of firefighters would feel a firefighter facing crisis could perform their duties effectively.
There were no other large discrepancies noted between the relationship of study results and the specific findings of others. The research produced a clear history of the past member conditions related to behavioral health and the present increasing rate of behavioral health issues.
The research identified multiple local and national resources available to assist the RFD
("NVFC," n.d.) (FMHG, 2014) ("NFFF TSG," 2014) ("FLSI 13," n.d). And it provided BEHAVIORAL HEALTH AWARENESS 37
documentation of how we currently are using the limited available resources provided by the professional healthcare provider contracted by the city benefits team (G. Ceisner, personal communication, July, 2016).
Recommendations
The results of this research confirms a past and present issue with behavioral/mental health issues. Continued training of personnel on recognizing and identifying the signs and symptoms of fellow firefighters experiencing behavioral health issues are necessary. Annual continuing education on behavioral health should be a minimum requirement. Emphasis should be placed on training Company Officers. Company Officers have the responsibility of maintaining a safe environment for personnel to work, free of excessive ridicule and bullying.
No one should be allowed to isolate any employee for any reason from the social group. Positive social support was found to be the key prevention technique to reduce the possibility of suicidal behavior.
RFD command staff should work with city leaders to improve the professional counseling services provided to all city employees. When an employee decides they need to make the call for help someone should answer the phone with access to sufficient resources to address the employee’s needs. The professional counseling services provided should have background knowledge and training on the culture of the fire service to allow the counselors to interact on a personal level with the firefighters. Professional counseling services should be readily available in the local area and allow employees seeking assistance to obtain help in a timely cost effective manner. Accessibility to behavioral health services should be easily identifiable on the city employee webpage along with adequate signage posted in every fire BEHAVIORAL HEALTH AWARENESS 38
station facility. All local and national resources identified for behavioral/mental health
counseling should also be posted for easy access in every facility.
The RFD should support the development of a local peer support team with representation from all ranks of the Fire Department. Access to peer support should be offered twenty-four hours a day seven days a week. Peer support should include resources for current and past members.
The RFD should develop a program that prepares upcoming retirees for the life-changing event of retirement. Future retirees should be planning for the adjustment to civilian life well in advance of their planned retirement date. The RFD should continue to support group functions that include retiree attendance. Multiple opportunities should be provided annually that encourage retirees to participate so they never think they are no longer a part of the organization.
Officer development and Company Officer Training should include components that insure retirees that visit fire stations are treated with the respect they deserve.
Entry level and annual depression screenings should become commonplace. These can
be added to the annual physicals and reviewed by the city Doctor. Early detection is the key to
successful treatment before minor issues become traumatic events. More research is needed on
what constitutes a firefighter to be unfit for duty because of behavioral/mental health issues.
This decision should be supported by healthcare professionals trained in the application of
limitations to job duties.
Command Officers and Company Officers should continuously strive to create an
environment for cultural change. Cultural change takes time and support at all levels, but it is
especially important in destigmatizing help seeking behaviors. Firefighters are human beings
that are regularly exposed to traumatic incidents unlike the general population. It’s okay for BEHAVIORAL HEALTH AWARENESS 39 them to not be okay, but it’s not okay to not feel safe about discussing traumatic events and the effects with your coworkers. BEHAVIORAL HEALTH AWARENESS 40
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http://www.everyonegoeshome.com/wp-content/uploads/sites/2/2014/04/FLSI13TSQ.pdf
United States Fire Administration Strategic Plan: Goal 5 [Strategic Plan]. (2014-2018).
Retrieved from
http://www.usfa.fema.gov/downloads/pdf/publications/strategic_plan_2014-2018.pdf
Van Orden, K. A. (2013). Suicide: What You Need to Know a Guide for Fire Chiefs. Retrieved
from https://www.everyonegoeshome.com/wp-
content/uploads/sites/2/2014/01/SuicideGuide_Chiefs.pdf
BEHAVIORAL HEALTH AWARENESS 44
Appendix A
Behavioral Health Survey
1. Responded Gender: Male Female
2. Responded Age: 21-25 26-30 31-35 36-40 41-45 46-50 >50
3. Years of Service: 0-5 6-10 11-15 16-20 21-25 26-30 >30
4. Has a doctor or other healthcare professional ever told you that you had anxiety?
Yes No
5. Has a doctor or other healthcare professional ever told you that you had PTSD?
Yes No
6. Has a doctor or other healthcare professional ever told you that you were depressed?
Yes No
7. How likely are you to seek help from an agency provider if you are facing crisis?
Definitely Not Probably Not Possibly Very Probably Definitely
8. If a peer support team was available, how likely would you be to seek help from the
peer support team if you are facing crisis?
Definitely Not Probably Not Possibly Very Probably Definitely
9. Do you feel the firefighters facing a mental health crisis are able to perform their
duties?
Not at All Not Likely Neutral Somewhat Able Able
10. Do you feel that a firefighter who has faced crisis can return to work after receiving
help?
Not at All Not Likely Neutral Somewhat Able Able BEHAVIORAL HEALTH AWARENESS 45
11. Is there someone available whom you can count on to listen to you when you need to
talk?
None of the time A little Sometimes Most of the time All of the time
12. Now thinking about your mental health, which include stress, depression and
emotional problems. Would you say your overall mental health is:
Poor Fair Good Very Good Excellent
13. Now thinking about your physical health, would you say your overall physical health
is:
Poor Fair Good Very Good Excellent
14. How healthy is your diet?
Poor Fair Good Very Good Excellent
15. How often do you participate in physical fitness activities?
Never A few times a month Twice a week 3-5 times a week More than 5 times
BEHAVIORAL HEALTH AWARENESS 46
Appendix B
Behavioral Health Survey – Outcomes
1. Responded Gender: 93/Male 7/Female
2. Responded Age: 3/21-25, 17/26-30, 17/31-35, 19/36-40, 22/41-45, 11/46-50, 11/>50
3. Years of Service: 20/0-5, 17/6-10, 13/11-15, 27/16-20, 15/21-25, 6/26-30, 2/>30
4. Has a doctor or other healthcare professional ever told you that you had anxiety?
13/Yes 87/No
5. Has a doctor or other healthcare professional ever told you that you had PTSD?
7/Yes 93/No
6. Has a doctor or other healthcare professional ever told you that you were depressed?
12/Yes 88/No
7. How likely are you to seek help from an agency provider if you are facing crisis?
5/Definitely Not 34/Probably Not 38/Possibly 10/Very Probably 12/Definitely
8. If a peer support team was available, how likely would you be to seek help from the
peer support team if you are facing crisis?
8/Definitely Not 36/Probably Not 40/Possibly 5/Very Probably 11/Definitely BEHAVIORAL HEALTH AWARENESS 47
9. Do you feel the firefighters facing a mental health crisis are able to perform their
duties?
0/Not at All 23/Not Likely 40/Neutral 9/Somewhat Able 28/Able
10. Do you feel that a firefighter who has faced crisis can return to work after receiving
help?
0/Not at All 0/Not Likely 24/Neutral 21/Somewhat Able 75/Able
11. Is there someone available whom you can count on to listen to you when you need to
talk?
2/None of the time 4/A little 26/Sometimes 25/Most of the time 43/All of the time
12. Now thinking about your mental health, which include stress, depression and
emotional problems. Would you say your overall mental health is:
0/Poor 5/Fair 33/Good 32/Very Good 30/Excellent
13. Now thinking about your physical health, would you say your overall physical health
is:
0/Poor 11/Fair 41/Good 37/Very Good 11/Excellent
14. How healthy is your diet?
0/Poor 25/Fair 50/Good 24/Very Good 1/Excellent BEHAVIORAL HEALTH AWARENESS 48
15. How often do you participate in physical fitness activities?
0/Never 12/A few times a month 18/Twice a week 55/3-5 times a week
15/More than 5 times
BEHAVIORAL HEALTH AWARENESS 49
Appendix C
The verbiage documented below is accurate to the best of my ability in recalling information from conversations with Captain Dena Ali over the past year. The results documented are posted as results from an interview format. While this data was not collected in the traditional interview format (on a planned specific day and time) it is the result of multiple face-to-face conversations and discussions comparable to a formal interview as we have worked towards the improvement of behavioral/mental health programs in the RFD.
What got you interested in researching behavioral health?
While attending grad school at UNC Pembroke we were given an assignment to do an action research proposal. While exploring research topics, I contacted you as our Department
Safety Officer for any topics that you could provide worthy of research to benefit the Raleigh
Fire Department. You immediately proposed the topic of behavioral health as an area of concern. We continued to discuss opportunities at finding adequate background information to review. You also provided information from previous classes and seminars that you have participated in and some lessons learned. I was reluctant at first because of the highly sensitive information knowing this would be a topic difficult to discuss. Within a short time I developed a deep passion for the subject and was completely shocked at the severity of the problem in the fire service. In recent years more firefighters had died from suicide than line of duty deaths. How could we protect our members from the devastating consequences of considering suicide.
What have you learned about the history and current issues our personnel are having with behavioral health?
During the delivery of our course in July 2016 I learned that at least four retirees took their life by suicide after retirement from the department. During my research and learning about BEHAVIORAL HEALTH AWARENESS 50
the risk factors of suicide I recognized a questionable social media post from one of our fellow
firefighters. At the time I was not completely sure what to say or even if I should make contact
with individual. Weeks later I ran into the firefighter unexpectedly and decided to ask, hey man
are you okay. And he responded, that I’m getting better every day but every day is a struggle.
He went on to explain how he had attempted suicide twice because of a nasty divorce he was going through in the loss of his family at home. He had two small children that he loves dearly
and they are no longer living with him which placed a huge feeling of failure on him. Later he
agreed to prepare a video to be included in the awareness training for RFD where he will share
his experience.
The most disturbing outcome from delivering the awareness level training was the numerous firefighters that approached during or after classes to express their appreciation for delivering a sensitive but vitally important topic. Many of whom had their own story of
behavioral health issues, some with suicidal thoughts and some with suicidal intentions that
thankfully were never carried out.
I also remember an active firefighter that attempted suicide by gunshot wound to the head
some years ago. I remember hearing people say that no one could see that coming. He
attempted the suicide in the first due area of his station assignment. I can only imagine what it
was like for the crew that answered the call when they realized who the patient was. I would bet
they are still experiencing the adverse effects of that traumatic call.
What will the future of behavioral health in the RFD look like to you?
You know my passion is the development of a peer support team with multiple members
of our Department from all ranks participating in the team. I would like to see the team provide
peer support services on a regional level in order to help prepare first responders with the skills BEHAVIORAL HEALTH AWARENESS 51 necessary to develop their own teams or become a part of our team. I hope we can continue to expand our team to include professional counseling services. I envision a resource list of counselors that are willing to provide services to emergency responders. I would like these counselors to have training that would enable them to understand the culture of first responders.
This would help them reach firefighters in need on a personal level. Ultimately, I hope to see the team become self-sufficient with enough interest to maintain the services needed without tremendous burden on just a few members. I would also hope that no local first responder organization would experience a death by suicide in the future.
BEHAVIORAL HEALTH AWARENESS 52
Appendix D
The verbiage documented below is accurate to the best of my ability in recalling information from conversations with Lieutenant Chris Holcomb over the past year. The results documented are posted as results from an interview format. While this data was not collected in the traditional interview format (on a planned specific day and time) it is the result of multiple face- to-face conversations and discussions comparable to a formal interview as we have worked towards the improvement of behavioral/mental health programs in the RFD. Lieutenant
Holcomb sent me an email describing his behavioral health history, actions he made during his low point, and suggestions for the future. The email is what led to multiple conversations with
Chris over the past year with dialogue on where we are and where we are headed in the future in regards to maintaining and improving the behavioral health of the members of the RFD.
Tell me what you would like to share about your behavioral health?
Several years ago I went through a pretty nasty separation and divorce that was completely unexpected in a very difficult time. It left me wondering what I had done and where we went wrong. After the divorce I began to hang out at bars and various parties around town which ultimately led to excessive drinking. Many times I would even drive while drinking with no worries about the consequences. Luckily or by the grace of God I never hurt anyone or myself. I finally realized I had hit my low point.
What strategies did you use to improve your overall behavioral health?
As a military vet and a firefighter I had been trying to not show any weakness. I decided to pull myself together and refocus my life on job and self. I started working out again and eating a healthy diet with less alcohol and beer. I find that physical fitness is a good way for me to reduce stress. I began to study for the promotional exam and ultimately was promoted to BEHAVIORAL HEALTH AWARENESS 53 lieutenant. Thankfully, I have met a new soulmate and have recently remarried which put the final touch on my life returning to normal from what was once utter chaos.
What will the future of behavioral health in the RFD look like to you?
My hope is that the department will continue to provide additional resources to assist members struggling with any kind of behavioral health issue. The fire stations need well publicized documents and resources that make it easy for personnel to find. You mentioned posters during the class last year and I would love to see them completed with pictures of our personnel that have shared their stories of success. Ultimately, from first-hand experience when a person is dealing with behavioral health issues it makes them difficult to focus on daily job duties. We owe it to our personnel to provide every resource possible to assist them in reaching their personal goals not only in the job but in life in general.
BEHAVIORAL HEALTH AWARENESS 54
Appendix E
The verbiage documented below is accurate to the best of my ability in recalling information from conversations with Firefighter Blaise Harris over the past year. The results documented are posted as results from an interview format. While this data was not collected in the traditional interview format (on a planned specific day and time) it is the result of multiple face-to-face conversations and discussions comparable to a formal interview as we have worked towards the improvement of behavioral/mental health programs in the RFD.
Tell me what you would like to share about your behavioral health?
Chief, as we have discussed on multiple occasions and what I expressed in my video I went through a terrible time where I reached my rock-bottom. I lost all sense of purpose when my wife decided she did not want to continue our marriage and ultimately she took my two children out of the home. I experienced feelings of failure, I failed to provide for my family.
These feelings led me to the decision to attempt suicide, what I viewed as the only way out.
What strategies did you use to improve your overall behavioral health?
I decided I could not handle this on my own and voluntarily had myself committed to a local mental hospital. There I received counseling and medications to help me survive. As I stated in the video every day is still a struggle and some days are worse than others. But through positive social support coming through regular counseling visits and my crew at the fire station
I’ve been able to slowly turn my life around. I am now studying in college to become a mental health counselor.
What will the future of behavioral health in the RFD look like to you?
Like you, and many others in the RFD I am excited about the potential of our peer support team. It is frustrating that it takes so long to get a positive program operational. I’m BEHAVIORAL HEALTH AWARENESS 55 sure there are many legal aspects that must be considered but the longer we wait the more people that are struggling the more risk we have of a horrific event occurring. I hope we see today and the future that any firefighter struggling can easily obtain help and support to get their life back on track. Help is out there is just a matter of finding the right place before it is too late.
BEHAVIORAL HEALTH AWARENESS 56
Appendix F
The verbiage documented below is accurate to the best of my ability in recalling information from conversations with Captain Tim Duke over the past year. The results documented are posted as results from an interview format. While this data was not collected in the traditional interview format it is the result of multiple face-to-face conversations and discussions comparable to a formal interview as we have worked towards the improvement of behavioral/mental health programs in the RFD. However, a telephone interview was conducted on August 17, 2017 at 9:00pm.
Prior to retirement, did you consider how retirement could have an effect on your behavioral health following retirement?
Not during the time leading up to retirement, but it became a huge consideration shortly after retirement day. The months leading up to retirement are an exciting time. Something you plan for and considered thoroughly for thirty years and the moment is just around the corner.
Coworkers are constantly congratulating you on your accomplishments and best wishes for the future. The first couple of weeks after retirement seems like you’re on a long vacation. Then reality sets in that you no longer will go back to the fire station and you will no longer see the group of men and women you worked with for thirty years on a regular basis. Depending on your role or rank in the fire service, as I was a Captain that made decisions daily in regards to personnel supervision and provide directions to the crews work in emergency scenes. No longer are you technically the person in charge. You are transitioning to a civilian life. You begin to realize that you cannot un-see the things you have witnessed at traumatic incidents and that you no longer regularly have to see those horrific things again. Unless, an unfortunate incident arises BEHAVIORAL HEALTH AWARENESS 57
that you just happen to come across in your daily travels and you relive a lifetime of horror in a
short time.
Your priorities have taken a major change in life. You just completed spending one third of your life with a different family in a different home. Now, you are spending your entire life in the same home with your family around you. It is comforting to have a quality home life to take
the place of what you have walked away from. It’s hard to explain, but during the time you are
away from home it is just part of the job. When you don’t have to be away from home anymore
you don’t really want to. Retirement is a huge adjustment, much larger than I ever imagined
prior to leaving the department. Now that I have made the adjustments necessary to cope with
the changes, I would not take anything in place of the experiences I have.
What strategies did you use to improve your overall behavioral health?
One of the most helpful things for me was to find another sense of purpose. However, even that was a difficult change and transition. Ultimately, I was able to take on a part-time job doing logistics for my County EMS department. I was just there to provide the equipment the
EMS crews needed to perform their duty. In the fire department I was the one making the data decision on the crews work activities. In my new role I had nothing to do with supervision of the crews working. This was a new role, even though you witness things that you were not allowed in your previous career I now had no authority to interject. Just provide the equipment they need to do their job.
I also found I had extra time to spend with friends in the community and do things that I enjoyed on a more regular basis. Soon there was a new circle of support that still had many familiar faces but they were some fresh ones as well. Retirement is a huge transition, one that everyone needs to prepare for. Retirement day is coming faster than you think. BEHAVIORAL HEALTH AWARENESS 58
What will the future of behavioral health in the RFD look like to you?
In the future, RFD should continue to support the development of the peer support team program. There should be many volunteers willing to be a peer supporter and assist of the members in their time of need. It is the grassroots of what we as firefighters are here to do, support those in need. Additionally, the fire department should prepare a pre-retirement program to help members prepare for the adjustment of retirement from a behavioral health perspective.
The program should have resources and information to help future retirees develop a plan for what they would do when they’re no longer an active member of the organization. The plan should include professional counseling resources that are familiar with the culture of the fire service and the brotherhood that exist. The program should contain a debriefing session with senior members of the department to allow the upcoming retiree to recap his/career accomplishments and contributions to the department. I was able to do this with Chief McGrath and it really made a great difference by allowing me to leave the department with a sense of accomplishment.
RFD should continue to support retiree functions and potentially add more events to encourage retiree participation. The chicken and rice luncheon is a huge success every year, do not let that end. The luncheon is a spring event, consider adding something similar in the fall. I think these events allow retirees to have the social connection that they are still a part of the organization. We just need to know we are welcome to return to any fire house and visit.
Although it does not feel the same coming into the fire stations as a retiree, but it fills a tremendous need to a large group of people who spent a third of their lives there.
BEHAVIORAL HEALTH AWARENESS 59
Appendix G
Documented Personal Observations
These observations were observed during course delivery of Behavioral Health Awareness for the RFD throughout the month of July 2016. The actions I wanted to observe include; what was the overall atmosphere of the group, would there be class participation or opposition, would any members find the information uncomfortable, would there be members present that had dealt with suicides in their close circle of friends or family, and how would the students react to me sharing my vulnerabilities and personal struggles?
What was the atmosphere of the groups?
The general culture of the fire service is a happy and friendly environment. Typically, groups meeting for training are joking and picking with one another on a fairly regular basis.
These classes begin similarly, but changed as the month went on. Word must have spread about the seriousness of the information. Rarely, would there be students who interrupted course delivery by inappropriate joking. I felt that most attendees were initially shocked that we were presenting information on a sensitive subject like suicide. I also felt everyone understood the need but were somewhat uncomfortable to engage in conversation. The few students that did share emotional testimonies were obviously in the healing phase of their behavioral health journey. I believe in my heart, by the look on the faces, that there were many others in attendance who wanted to share their own personal struggles but were not ready at the moment.
Or they were reluctant to do so in front of a group.
Would there be class participation or opposition?
Over the course of the month there was limited participation and no open opposition that
I witnessed. From the look on the faces, there were attendees that appear to be taken in the BEHAVIORAL HEALTH AWARENESS 60
information and there were others that appeared to believe this information did not apply to
them. I personally understand their feelings. Early in my career when everything in my life was
going as planned I would never have imagined I would ever experience a deep, truly all-
consuming battle with depression. The most participation observed as during the explanation of
the statistical data compiled on firefighter suicides of the last few years. There were often
questions about the validity of the data. A quick Internet search would show attendees where the
data originated, there was no opposition to the source. There was regular appreciation for
presenting information of sensitive nature.
Would any members find the information uncomfortable?
Every class was informed during the introduction of the sensitive nature of the
information plan to be discussed. Attendees were encouraged to just leave the room if anything
discussed was uncomfortable or brought back bad memories. No one left the room and there
were several that would have had a valid reason. One firefighter responded to an accident scene with his volunteer department where his daughter was tragically killed in an auto accident.
Another firefighter lost a baby daughter months after she was born which led him to a deep state of depression. Both firefighters shared their experiences and success after treatment and processing.
Would there be members present that had dealt with suicides in their close circle of friends or family?
Every class was asked at some point if they had known anyone in their personal life that had committed suicide. Someone from almost every class had experienced suicide firsthand.
We have an active firefighter whose father is a retiree that committed suicide after retirement. It was difficult to ask the question with him sitting in the room. I decided to ask him if he was BEHAVIORAL HEALTH AWARENESS 61
comfortable with me asking the question to others with him present, and he replied sure I would
like to share my experience.
How would the students react to me sharing my vulnerabilities and personal struggles?
I was particularly nervous about sharing my experiences in the beginning. I was still healing from a deep depression state of feeling like a total failure in life. Circumstances outside of my control contributed to the disappointments and shortcomings I had experienced. I knew I had failed my family and myself in many ways. Early in my struggles, I thought I could save myself from this devastating journey. But I was not able to do it alone. I truly worried what my
reputation would be like after revealing my vulnerabilities to the whole department.
What I observed was a repeated degree of shock and disbelief. The majority of attendees
stated they would have never known I was in the dark place that I described. My struggles were
something that was only shared with my closest circle of friends. Some of them did not truly
understand the severity until after the presentations. Many attendees would come by after class
with words of encouragement and appreciation for sharing. I have instructed thousands of hours
of fire service training throughout my career, but this was the most difficult class I have ever
delivered. However, I observed the greatest feeling of attention from the group than any class in
the past. What started as extremely difficult ended with an overwhelming sense of
accomplishment.
BEHAVIORAL HEALTH AWARENESS 62
Appendix H
Documented Personal Observations
These documented observations were completed during a 2 day training session entitled Raleigh
NC Firefighter Peer Support held February 28-29, 2017 on the campus of Wake Technical
Community College. The actions I wanted to observe include; what would be the overall mood
of the room, and would the idea of peer support be truly accepted?
What would be the overall mood of the room?
The overall mood of the two-day course was fairly somber. Discussions on firefighter
suicide are depressing in general. Interestingly, the instructor opened the floor after a very brief
introduction for all students to introduce themselves and explain to the group why they were
there. No instruction was given to share your personal behavioral health background or
struggles, but everyone did. Everyone in attendance had experienced some challenging
behavioral health issue in their life or career. There were thirty students and it took almost 3
hours to complete introduction. That was three powerful hours that truly set the mood for the
rest of the class. Somber because of the difficult subject and tragic stories that were shared, but
positive in that everyone was gaining information to make a difference in the future.
Would the idea of peer support be truly accepted?
What I observed coming into the class about the acceptance of peer support was totally
different than what I observed leaving the class. I observed the students and myself came into
the class with an understanding that peer support was just having a conversation with a coworker
about a distressing topic. I observed everyone leaving the class, including myself with an
understanding that peer support was much more than just a conversation. Peer support is truly
creating an environment to help people feel safe and willing to have the conversation. Peer BEHAVIORAL HEALTH AWARENESS 63 support is not about being the communicator, it is more about being an active listener. I observed in my one-on-one opportunity to practice being a listener and a presenter, it was much more difficult to be a good listener. We all came back to the classroom and provided feedback from both sides and the consensus was that listening was the most difficult and required discipline to not add conversation to distract the presenter, but truly listen to what they were presenting to you.
I observed peer support was highly accepted with an understanding that it would take time and practice to provide quality, effective support to struggling coworkers.