First-responders suffered a double blow during Hurricane Harvey, working rescue operations around the clock despite the fact that many of their own homes were under water.
“It’s the emotional exhaustion. It’s everything you see,” said Elizabeth Anderson-Fletcher, a faculty member at the University of Houston’s Bauer College of Business and Hobby School of Public Affairs. “I am really concerned about emotional and behavioral health. There are so many firefighters and other first-responders whose homes have been flooded. You’ve been rescuing people for three days without sleep, and then you have to go home and deal with that. How do you cope?”
Anderson-Fletcher, who is also a volunteer firefighter with the Cypress Creek Fire Department, is co-author of a report on the mental well-being of firefighters, including a heightened risk of suicide. The Yellow Ribbon Report, “Under the Helmet: Performing an Internal Size-Up, a Proactive Approach to Ensuring Mental Wellness” was written at the request of the Volunteer & Combination Officers Section of the International Association of Fire Chiefs and was released at the IAFC annual conference earlier this summer.
Among the recommendations:
- Change the firehouse culture by encouraging discussion of emotional health, including talking about reactions to disturbing calls.
- Train officers and command staff to reach out to firefighters who may show symptoms of distress and to get them help.
- Include a behavioral health component in education and training programs, including the recruit academy.
The report also calls for mandatory reporting of firefighter suicides, noting that suicide rates are substantially higher for firefighters than among the general population. A U.S. Department of Health and Human Services study found 4.6 percent of the adult population had attempted suicide; a recent study of current and retired firefighters found 15.5 percent had attempted suicide.
That study also found that firefighters in departments that respond to emergency medical service calls were six times more likely to attempt suicide than those in non-EMS departments, Anderson-Fletcher said.
She and her collaborators are working on an initiative to help departments – especially smaller departments with limited or no access to chaplains, psychologists and other support staff – implement the recommendations. She noted that about 70 percent of the nation’s 1.1 million firefighters are volunteers, although many, including those with the Cypress Creek department, serve in so-called “combination” departments, which use a mix of career firefighters and volunteers.
“Over the decades, the fire service has changed,” she said. “Fire is not the majority of what we do. We respond to motor vehicle accidents and cut people out of cars. We set up landing zones for LifeFlight and help package patients for transport. We respond to medical calls, including shootings and stabbings. We deal with suicides. We also rescue people during floods.
“It’s no longer, Big Red rolls, you put out the fire, you’re a hero, and you go home. We do a lot more than that, and sometimes Big Red is a boat.”
The calls can take an emotional toll, colliding with the traditionally macho firefighting culture, and changing the “suck it up, Buttercup” culture that underlies many of the Yellow Ribbon Report’s recommendations.
But encouraging firefighters to ask for help without fear of reprisal is only one piece of the puzzle. Those providing the help – including peer counselors, chaplains, psychologists and other behavioral health professionals – have to understand the conditions under which firefighters work, including the grim reality of some calls, Anderson-Fletcher said.
The macho culture is changing slowly, she said, partly in response to the growing recognition that fire departments have to operate like a business, with processes in place to address funding, customer service, even public relations. Anderson-Fletcher said that cultural change regarding behavioral health has to come from the top, but also needs to come from the ground up, starting with conversations in the firehouse, along with education and training.