Firefighter Suicide: The Need For Examining Cultural Change
It is well documented that first responders face profound physical and psychological demands on the job from multiple car pile-ups to child drowning's. The National Fallen Firefighters Foundation reported that fire departments are four times more likely within a given year to experience a suicide than a "traditional" line-of-duty death. Research suggests, that firefighters are not immune to the excessive stressful nature of their careers, making firefighter mental health a critical issue of firefighter wellness and safety.
Firefighter culture demands members be mentally tough as well as physically strong. Silence regarding personal problems and use of poor coping mechanisms (e.g. alcohol) are often found all too often within firefighter culture. Recently, during the National Fallen Firefighters Foundation Tampa 2 Summit in 2014, fire service personnel and researchers have further discussed and developed programs and concepts to combat the tragedy of suicide in the fire service. A small number of departments have created programs to address suicide, most notably Phoenix, Chicago, and Houston. Sadly, these programs were initiated following a number of suicides in their departments. It is becoming increasingly clear that Fire Departments need to have proactive programs for education, prevention, and intervention while also establishing policies and procedures in the aftermath of a suicide if they want to make a difference in the suicide rate.
At this time, there is an overall lack of understanding concerning suicide of fire service personnel. One problem doing such work in this area involves the classification of firefighter deaths. Out of respect for the deceased and their family, the existing stigma, as well as to shield the department, suicide deaths may be classified as something else such as "accidental" or "other". Also, a national database to track suicide by firefighters is lacking and needed. In 2011, Captain Jeff Dill attempted to combat this problem by creating the Firefighter Behavioral Health Alliance website to facilitate efforts to track firefighter suicides. The website reports that from the information they gathered between 2000 and 2013, there were 360 confirmed firefighter suicides. Even with this website, the true numbers of yearly deaths by suicide are under-or inaccurately reported.
Challenges within Firefighter Culture
Similar to law enforcement, an "us vs. them" mentality exists towards those not in the fire service, creating camaraderie with their peers, but isolation from outsiders. This brotherhood can function as a protective factor against post-traumatic stress and depression, by providing support and understanding of the stresses and challenges encountered on the job. However, this mentality can both function as a risk factor, creating isolation for firefighters who feel they cannot talk to anyone other than fellow first responders about job stress, ultimately inhibiting them from seeking help from mental health professionals or other non-uniform personnel. The fear of seeking services from mental health professionals "who don't understand" leaves the door open for tragedy.
Silence and refusal to discuss mental health issues that are common, such as depression and anxiety, compound the problem of addressing suicide among firefighters. Firefighter culture dictates that mental health problems are a sign of weakness and failure. Mistrust of a member who admits to these problems is a possibility, as fellow firefighters may feel the person is not stable and a risk to their personal safety on calls. Also pervasive within firefighter culture are traditional male values and machismo identity. There are aspects of the culture that are part of being an effective firefighter, but when they inhibit help seeking behaviors they become a contributor to suicide rates.
Cultural codes in the fire service that inhibit help-seeking behaviors and create a negative attitude toward seeking mental health services will require change. The message from fellow fire fighters (who have been there) needs to endorse a cultural shift change, that proactively addressing mental health problems in general, and suicide in particular, is actually a life saving intervention and not a sign of weakness.
Similar to military personal, first responders are a unique group of individuals who rely on each other for survival while placing their lives on the line everyday to protect communities. Part of the job is responding to a variety of challenging situations that are potentially traumatic. The frequency and ambiguity of these calls create a stressful environment that can take a huge mental and physical toll. Chronic exposure to these potentially traumatic events and critical incidents increases the risk for post-traumatic stress disorder and subsequent coping mechanisms like alcohol abuse.
The following are known risk factors for suicide for firefighters:
- Expressing feelings of hopelessness and helplessness,
- Feeling as if they are a burden
- Previous suicide attempts
- Increases in alcohol or drug use
- Changes in sleeping pattern,
- Social withdrawal or isolation
- Anxious or agitated behavior.
Peers within a firehouse can observe many of the risk factors for suicide, so if firefighters are able to learn and recognize signs of possible suicidal behavior, there is an increased likelihood that a tragedy may be prevented.
Specific to the fire service, Caucasian males ages 18-24 and 40-55, those who have experienced a history of trauma, as well as acute and chronic stress have been shown to be at an increased risk for suicide. Personal life challenges, such as chronic health problems or illness, interpersonal relationship difficulties, death of a close friend or family member, substance abuse, aggression, and impulsivity all are contributing risk factors for suicide as well. Interestingly, the above mentioned age ranges are typically towards the beginning and end of a fire service career. This may be due to difficulty adapting to the stresses of the job including increased trauma exposure, transitions of adjusting to retirement, and the feeling of a loss of identity. Firefighters not only experience stress from calls for service, but from real or perceived internal organizational pressure, lack of administration support, negative media coverage, and a lack of balance between work and family life. It is clearly apparent that a vast number of risk factors are evident in this population that may increase suicide potential, therefore there should be a greater focus on protective factors to combat suicide.
Numerous studies have identified risk factors for suicide, but little has been conducted on protective factors against suicide among firefighters. One important protective factor that has been identified is having a social support system such as family and friends as well as a religious community. As mentioned previously, firefighters think of each other as family; thus, this bond may act as deterrent from suicide. Firefighters derive a sense of purpose from their career, which has also been shown to function as a protective factor decreasing the likelihood of suicide. Consequently, firefighters who have disciplinary leave, job loss, or retirement may lose a vital protective factor against suicide. Future efforts need to be focused on protective factors and causal linkages.
Recommendations for Future Initiatives
The unique risk factors for suicide that are found within the fire service need to be further researched in order to tailor education and prevention programs. This information is imperative for peers and personnel to be aware of in order to actively recognize a fellow firefighter who is exhibiting signs and symptoms of suicide risk. As underscored by BSO Fire Chief Todd LeDuc, "2015 is a year for the fire service leaders to confront the cultural stigmas head on and develop programs designed to ensure the behavioral health and safety of our firefighters on the front line and those who support them" (LeDuc, 2015).
The emotional and physical cohesiveness related to the strong bond among firefighters is important for researchers to recognize and integrate into programs targeting firefighter wellness. Departments need to adopt peer counseling or support programs that aim to recognize signs and symptoms of suicide risk and increase the willingness of firefighters to seek professional help. Goals of such programs should include: raising awareness of suicide risk and protective factors; letting others know they are not alone; and developing a more educated, understanding, and supportive environment. Fire Department Suicide Awareness Programs need to be created to reach every firefighter with the goal of addressing suicide in a direct and non-judgmental manner. Resources should consist of: Employee Assistance Programs (EAP's), easily available psychologist resources, availability of mental health agencies, consideration of a Chaplaincy Program, and peer support efforts. These resources should be made available for firefighters and their families. Fireacademies should also devote time to psychoeducation on stress and stress management to point out and support the use of proactive coping mechanisms, so that new firefighters are better prepared and equipped to handle their new career. Finally, retirees should not be forgotten, as they are also a group that is at a higher risk for suicide.
Firefighters are used to solving other people's problems; it can often be a challenge for them to address their own, particularly with regard to their self-care and wellness. The experiences that firefighters endure every time they bunker out can overwhelm even the most resilient firefighter and strongest coping strategies. Compounding the situation is a firefighter culture that embraces an attitude of suspicion and resistance towards anything that may result in the suspension or loss of their careers, including seeking mental health services. Resources and policies take time to implement; however, what can and needs to change is the fire service attitude towards mental health. Although the fire service has begun to take a more accepting view towards mental health services, further gains are needed. Firefighters need to know it is not an admission of weakness to ask for help. The fact that greater recognition of suicide within the fire service is indeed a problem, helps start the discussion of what can be done to prevent the continuing alarming number of firefighters who die by suicide.