Stop, talk and console: Five things firefighters should change to maintain good mental health

Firefighters often talk about seeing trauma. But firefighters don’t simply see traumatic incidents; rather they experience these incidents by helping patients or dealing with families of those who are injured or burned. How often do firefighters show up to the fire ground and simply look at the scene? Never. If firefighters are to truly accept the impact of their roles as responders on their mental wellbeing, we must talk realistically about what firefighters do.
What firefighters do following a tough call matters. If responders attempt to numb feelings of frustration, anger and disappointment with drugs and alcohol, they are at risk for further mental harm. Instead of shutting down after a traumatic incident, if firefighters spring into action, engaging their bodies and minds, it is possible to recover from the traumatic events. Eating properly, sleeping, and regular exercise are what the body needs in times of stress.
Before you reach for an extra beer, there are things you can do – or stop doing – to help with the impact of those tough calls.

1. Stop judging yourself. The nature of our profession is one of competitiveness. Thousands of people are applying for a small number of available firefighting jobs. One of the ways that we try to sharpen our edge is through self-criticism. Calling ourselves out on our mistakes can help to prevent them from happening again. Unfortunately, this cognitive habit may create an unrealistic and impossible standard for us to maintain. This cycle of criticism has the potential to build mistakes up to be bigger. We turn the smallest errors into catastrophes, in our pursuit of god-like skill. These judgments chip away at our resilience. Firefighters may judge themselves, or experience feelings of uselessness, hopelessness or frustration; these are common thoughts for firefighters to experience after a traumatic incident, because the brain naturally seeks something that makes sense. Unfortunately, trauma doesn’t always make sense. When the brain is unable to make rational connections, the world can start to look unreal or unnatural; this can lead to dissociations, as the brain attempts to protect firefighters from the realities of the stressors at hand.

2. Stop minimizing the impact of difficult calls. Ok, truth time. Not every headliner call is going to upset you. We see a lot of difficult things and a certain level of normality begins to develop around emotionally difficult situations. Therefore, what a person who has no experience in our field views as traumatic, might be something we see every day. But, we need to be doing a realistic, honest check. Why? Because, the calls that shake us can also be those that are innocuous. These are the medical calls involving folks who remind us of our family members or friends, and that can hit us harder than the accident with fatalities. But, we often minimize the impact. When we sit around the table at the end of a call, we all take turns denying that anything happened to rub us the wrong way. “I’m fine” is the most common sentiment. What strikes me as particularly odd is the fact that firefighters go into burning buildings, trusting that colleagues with their lives, yet have difficulties disclosing the mental struggles of the job.

3. Don’t avoid talking about it.  Peers, friends and family are there to support us. Our partners are on our minds on every call. It becomes confusing if we return home distant, irritable, and still won’t talk to them. What should you talk about? Not the gory details. That won’t help. Consider talking about how that call made you feel. Telling to your partner or peers that you felt “hopeless” or “helpless” helps them understand your struggle. Humans process events, people, places and things collectively; the cognitive process naturally makes connections. This means when firefighters show up on scene, their brains automatically try to make sense of the situation – our brains search for similar past experiences. In some cases, the faces of loved ones may pop into firefighters’ minds during a rescue. These connections elicit an emotional response. These emotions can stick with firefighters when they return to the hall. The inability to compartmentalize these experiences is precisely why certain calls can affect firefighters. Understanding that our minds automatically gravitate to these connections is powerful insight.

4. Stop thinking of mental health struggles as showing weakness. The emotional impact of this job didn’t magically appear. It’s been known for a long time. And, many people continued to join the fire service or continue with their careers despite these struggles. Greater awareness has led to firefighters adopting healthier coping strategies. Some firefighters have relied on alcohol and other unhealthy ways to deal with the stress of the job, and unfortunately, some still do. But, we also have an untapped resilience within the service. We should ensure that members understand there is strength speaking up about these issues. Firefighters need to understand that weakness is actually allowing stigma to grow, being afraid to speak out. The true strength comes from our ability to identify that we are struggling and recover in spite of it. Weakness doesn’t seem to equal the constant battle of just trying to get out of bed, let alone get dressed and work an eight-, 12-, or 24-hour shift and with such pressures that are expected of us to work through.

5. Stop believing that everyone in the fire service has PTSD. This is the consequence of greater media coverage of post-traumatic stress disorder (PTSD) among first responders. A common misconception is that members of the fire service will inevitably develop PTSD. This line of work certainly increases the risk due to traumatic incident exposure, but it is in no way a guarantee that you will develop this disorder. This is perhaps the biggest understatement of the whole movement, and is frustrating that it isn’t spoken of more. PTSD is a complicated disorder to diagnose and has specific criteria. And, there are also other disorders that have similar symptoms that you could be experiencing.

Take care of yourself. I believe that self-care can be as difficult as any fire drill. Being able to identify and address mental-health concerns in a culture that is shy to new ideas takes grit. We need to give credit to those who are struggling. We can do that by standing with them, supporting them and taking care of ourselves to prevent future harms.

Nick Halmasy is a registered psychotherapist (qualifying) who spent a decade in the fire service. He is the founder of After the Call, an organization that provides first-responders with mental-health information. nickhalmasy@afterthecall.org,  @afterthecallMH