{"id":17722,"date":"2018-09-14T12:06:37","date_gmt":"2018-09-14T17:06:37","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=17722"},"modified":"2023-03-03T15:10:10","modified_gmt":"2023-03-03T20:10:10","slug":"the-push-to-get-firefighters-the-therapy-they-need","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/healthcare-trends\/the-push-to-get-firefighters-the-therapy-they-need\/","title":{"rendered":"The Push to Get Firefighters the Therapy They Need"},"content":{"rendered":"

When psychologist Jolee Brunton lectures classes of new firefighters and police recruits, she asks how many of them have seen a dead body outside of a mortuary. <\/span><\/p>\n

\u201cA few hands go up,\u201d she said, because some of them are ex-military. She increases the number. \u201cHow many of you have seen five bodies?\u201d Most hands go down. \u201cTen? Twenty?\u201d All hands go down. \u201cExcept for the officers around the room that are helping me teach the class,\u201d she said. \u201cI get to 100 dead bodies and their hands are still up. Their normal is not everybody else\u2019s normal.\u201d<\/span><\/p>\n

For first responders just starting out, Brunton believes an important part of the training for their chosen careers is anticipating the day-to-day stresses of the job they\u2019ll need to get used to. \u201cMost people thinking about being firefighters, they think about fighting the blaze, saving the house,\u201d she said. \u201cBut the trauma involved in seeing people injured or killed \u2014 they\u2019re not really prepared for that. There\u2019s no way to prepare. It\u2019s a skill set, and you can\u2019t really learn it until you start doing it.\u201d<\/span><\/p>\n

Firefighters, along with police officers, paramedics and lifeguards, make up the bulk of first responders. These populations have been at the center of Brunton\u2019s work since 1984, when she founded Focus Psychological Services in San Diego with the goal of providing mental health support to people who sometimes see more tragedy in a week than most people see in a lifetime. <\/span><\/p>\n

When Brunton started Focus, the mental well-being of first responders received little attention and even less funding. But things are changing, particularly in firefighting,<\/span> where the work is grueling and the emotional toll can be profound. Firefighters (as well as police officers) are more likely to die by suicide than in the line of duty, <\/span>according to a recent study by the Ruderman Foundation<\/span><\/a>. The <\/span>Firefighter Behavioral Health Alliance<\/span><\/a> estimates that only about 40 percent of firefighter suicides are reported, making the actual number of deaths significantly higher.<\/span><\/p>\n

Fire departments across the country are finding new ways to encourage people who\u2019ve traditionally resisted help to seek out therapy. Such increased emphasis on mental health stands out in a profession where a \u201ctough it out\u201d mindset has long been the norm. But it\u2019s a much-needed cultural shift, according to<\/span> leaders in the fire service.<\/span> Firefighters themselves are starting to embrace the same view. <\/span><\/p>\n

\u00a0<\/span>The perilous demands placed on firefighters have been on display in recent months, with the West Coast having one of its worst fire seasons in years. Already, wildfires in California have burned <\/span>over 600,000 acres<\/span><\/a>, almost three times as many as last year at this time. For firefighters across California, that means more time away from home, less sleep and extremely punishing schedules. But as many firefighters are quick to point out, battling fires and other extreme weather scenarios is only part of the job, and not necessarily the most traumatic.<\/span><\/p>\n

“People are hesitant to come forward, especially in our profession. We\u2019re supposed to be the people who help people, not the ones who need it.\u201d<\/span><\/p><\/blockquote>\n

\u201cYou can name certain incidents \u2014 child drowning, vehicle off the canyon, motorcycle into a tree \u2014 they all pop into my head,\u201d said David Picone, battalion chief and health and safety officer for the San Diego Fire Department. \u201cI\u2019m sure it\u2019s affected me. It sticks with you.\u201d <\/span><\/p>\n

Picone, who has been in the fire service for over 20 years, is now heading up efforts in San Diego to provide emotional and psychological support to firefighters and other first responders. When he looks back on the early days of his career, the need for mental health resources is glaring. \u201cWe just didn\u2019t realize the breadth of how bad it was,\u201d he said. \u201cWe knew we saw incidents, drinking \u2014 I\u2019ve noticed high divorce rates \u2014 but we took it as part of the job and didn\u2019t think much of it.\u201d<\/span><\/p>\n

Back then, it wouldn\u2019t have occurred to Picone to start a conversation at the firehouse following a particularly horrific call. Even as a captain, he would ask his crew if they were OK, and the firefighters would just say they were fine. \u201cNobody said, \u2018I wasn\u2019t able to sleep last night.\u2019 People are hesitant to come forward, especially in our profession. We\u2019re supposed to be the people who help people, not the ones who need it.\u201d<\/span><\/p>\n

Now the SDFD is<\/span> taking mental health as seriously as physical safety and cancer prevention. The department has a team of firefighters who are also trained as peer counselors. They assign chaplains to each battalion, and maintain a contract with <\/span>Focus<\/span><\/a>, offering free therapy to active and retired firefighters, as well as their families.<\/span><\/p>\n

Peer counselors are trained to be the first line of defense in a mental health crisis. Brunton teaches them to provide support in a few different ways, including by assessing first responders\u2019 levels of distress and keeping an eye out for marital issues. The phrase \u201cmy marriage is in trouble\u201d can be a red flag suggesting it\u2019s time for professional help: \u201cSometimes it\u2019s really hard to shift gears when you go home,\u201d Brunton said.<\/span><\/p>\n

Peer counselors can help firefighters through temporary bouts of anxiety or distress. But for serious or longer-term problems, counselors will refer firefighters to Focus\u2019 team of licensed therapists. <\/span><\/p>\n

\u201cThe more severe your symptoms, the more likely you are to need professional help,\u201d said Brunton. \u201cIf you run to a call and it\u2019s distressing and you have nightmares the first night, feel a little sick to your stomach the next day, but after three or four days, you\u2019re back to normal, talking to a peer counselor would be fine. But if it\u2019s a week or two later and you\u2019re still having nightmares, you\u2019re not able to eat \u2014 it\u2019s probably time to check in with someone.\u201d<\/span><\/p>\n

It\u2019s crucial for mental health professionals who work with first responders to understand their specific needs<\/span>. Focus favors short-term, results-oriented therapies. \u201cThese guys are pragmatic,\u201d Brunton explained. \u201cYou\u2019re not going to do psychoanalytic psychotherapy with them. They want to fix things. They want you to give them tools to use.\u201d<\/span><\/p>\n

Most of the treatment employs cognitive behavioral therapy, dialectical behavior therapy and a practice called <\/span>eye movement desensitization and reprocessing<\/span><\/a>, or EMDR, which has proven effective for treating <\/span>PTSD<\/span><\/a>.<\/span><\/p>\n

Familiarity with firefighter culture and vernacular is useful too. Telling a firefighter who\u2019s having trouble sleeping to take a hot bath and go to bed at 9:30 p.m. isn\u2019t that helpful. \u201cYou have to have enough experience to know that firefighters are at work for 24 hours, and they\u2019re not going to have regular sleep cycles,\u201d Brunton said. \u201cSo you\u2019ve got to find ways that they can enhance their sleep given how they work.\u201d <\/span><\/p>\n

Then there\u2019s the matter of what firefighters want to discuss in therapy. \u201cSome of the things they want to talk about are pretty overwhelming,\u201d she said, so having a therapist who won\u2019t flinch helps. \u201cI have images burned in my head from hearing it secondhand \u2014 car crashes, people on fire they can\u2019t get to, shootings \u2014 I can only imagine what it\u2019s like to have actually experienced.\u201d<\/span><\/p>\n

Mickey Stonier, a chaplain with both the SDFD and the San Diego<\/span> police department, has spent more than two decades working with first responders. Over the years, he\u2019s earned their trust by spending time with them, hanging around the firehouse, becoming part of the furniture. \u201cEarly on, I was doing a lot of ride-alongs,\u201d he said. \u201cIt\u2019s being visible, being around.\u201d <\/span><\/p>\n

Stonier thinks some people feel comfortable opening up to him because he\u2019s a chaplain. But he also has a PhD, and is <\/span>trained in trauma. He\u2019s conducted interventions to get responders to talk about on-the-job experiences, explaining to them how the brain integrates trauma and what they can do to mitigate the impact of stress.<\/span><\/p>\n

\u201cBack in the day, the culture was: If you can\u2019t handle it, get another job. Buck up,\u201d he said. <\/span><\/p>\n

Little by little, that attitude is shifting, and Stonier is seeing more receptivity to mental health services. \u201cSome of the older firefighters were like, \u2018Wow, I wish I had this when I was younger,\u2019 or \u2018You younger guys need to take care of yourselves. I\u2019m on my third marriage, end of my career, I don\u2019t sleep well.\u2019 There are a lot of those stories.\u201d\u2019<\/span><\/p>\n

Cal Fire, California\u2019s fire protection agency, is now bringing peer counselors to the scene of big wildfires, like the Carr and Mendocino fires this summer, so that trained ears are available if firefighters want to talk. \u201cThe whole program is confidential,\u201d said deputy chief Mike Ming, who heads up Cal Fire’s employee support services. \u201cWe want to make sure that the employee feels there\u2019s a safe container that they\u2019re able to express their vulnerabilities, right away on the fire line. If we don\u2019t talk about it, that sits inside of us.\u201d<\/span><\/p>\n

To preserve confidentiality, SDFD doesn\u2019t track the number of people who use peer counseling or professional services, but they do track hours \u2014 which have consistently risen. \u201cWe know people are calling,\u201d said Picone, and he\u2019s encouraged by the response: \u201cMore and more people are using the service; they\u2019re going, \u2018Wow, I actually feel better.\u201d\u2019<\/span><\/p>\n

For newer firefighters, Brunton hopes to normalize self-care and mental health counseling as simply another part of career training. \u201cThey don\u2019t know any different. It\u2019s just part of being here,\u201d she said. \u201cYou\u2019ve got shift work, you\u2019ve got a captain, you\u2019ve got a psychologist, this is how you run the rig \u2014 it just becomes part of the culture.\u201d <\/span><\/p>\n

But there\u2019s still a long way to go. Funding for mental health support isn\u2019t always readily available to departments. And reports of firefighter deaths by suicide across the country continue to surface. Just last month, a <\/span>Los Angeles Country fire captain died<\/span><\/a> by a self-inflicted gunshot wound.<\/span><\/p>\n

\u201cI\u2019m not na\u00efve,\u201d said Brunton. \u201cThere are still some people who would never walk through my door. That\u2019s why peer support is important. They can maybe help persuade people who need professional care to come in, and take away the stigma. But when I see an uptick in people who are retired coming in, that tells me we\u2019re getting to them. They\u2019re beginning to understand it\u2019s not rocket psychology. It\u2019s not that you\u2019re crazy.\u201d<\/span><\/p>\n

\u201cI think we\u2019ll be able to help a lot of people,\u201d Picone said. \u201cUltimately, if I can prevent one person from doing something that we\u2019d all regret, that makes it all worthwhile.\u201d<\/span><\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

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