A clinical counsellor and music therapist in Vancouver General Hospital’s burns and trauma unit has some recommendations for how fire departments do better at supporting firefighter mental health.
Gemma Isaac began by helping the people firefighters save, but soon realized the helpers themselves need mental health support. So Isaac started a private practice focusing on first responders.
At an inaugural conference on first responder mental health in Richmond earlier this year, Isaac presented a research paper detailing 12 concrete ways fire departments can do better.
It comes at a time when first responders across the province are taking a hard look at the factors that contribute to their elevated rates of mental illness.
Nearly half of Canadian firefighters, police and paramedics surveyed in a 2017 study presented clinically significant symptoms of a mental illness, and firefighting’s historic culture that prizes toughness and stoicism can make it difficult for them to admit they need help.
“My hope with the 12 recommendations is that (fire departments) don't have to do too much work. They can just look at the list and say hey let's tick these off,” Isaac told the Richmond News. “I pretty much wanted to leave it in their lap, and say here it is.”
Richmond Fire-Rescue already has five of her recommendations in place, and has made it clear mental health is a priority after two of its own died after battling PTSD in the last two years.
|Recommendation||Implemented in Richmond?|
|Include coverage for registered clinical counsellors in addition to psychologists through extended health benefits||Yes|
|Include group counselling through extended health benefits||Yes|
|Provide education (e.g. ride-alongs, hall visits, table talks) for mental health providers||Yes|
|Continue to conduct psychoeducational training (e.g. Resilient Minds) throughout a firefighter’s career, every 2-3 years as part of a training cycle.||In progress|
|Provide education for firefighters’ spouses and families on the effects of occupational stress, signs and symptoms to look out for and family resources||In progress|
|Provide a transition program for retired firefighters||In progress|
|Educate supervisors on signs and symptoms to look out for within subordinates. Encourage supervisors to check in regularly, especially after critical incidents. After a criticle incident, a table talk should be initiated and a confidential vote conducted and tallied for a CISD to be taken||Yes|
|Adequately screen, staff and train Critical Incident Stress Management peer support teams. Have peer nominations on CISM peer support teams||Yes|
|Educate WorksafeBC, Back to Work Employers on mental health and occupational awareness||In progress|
|Maintain and up-to-date list of psychological service providers familiar with firefighters. The list should be easily and confidentially accessible. Check in periodically with mental health professionals to adjust recommendations as needed based on wait times and firefighter feedback||No|
|Consider implementing mandatory counselling sessions every one to two years for active firefighters||No|
|Consider adopting the Canadian national standard for psychological health in the workplace or connecting with the Veteran Affairs Canada as a national network of mental health supports for first responders||In progress|
The department and the union are working to implement another five of Isaac’s recommendations.
Providers who ‘get it’
Isaac begins her recommendations by making sure firefighters have financial support to access mental health professionals. Ensuring counsellors, not just psychologists, are covered under benefits plans is crucial, she said, since they’re more common and more affordable.
She also explained that mental health professionals who help firefighters should be occupationally trained. That means knowing what first responders go through on a day-to-day basis—the traumatic and sometimes grotesque scenes they’re exposed to, the shiftwork that makes for an irregular sleep cycle and having to constantly be “on” in case of an emergency.
“It really helps to understand the culture of the firefighter life,” Isaac said. “It's very much based in military culture as well as macho culture.”
To that end, she recommends fire departments actively train mental health practitioners through things like fire hall visits, ride-alongs and table talks. That way, mental health providers and first responders can get on the same page.
The BC Professional Fire Fighters’ Association has set up a mental health task force, and they’ve already had about 200 mental health professionals go through training they’ve offered.
A list of mental health professionals
Next, Isaac said fire departments should create a list of psychological service providers familiar with firefighters.
It needs to be easily and confidentially accessible, and updated regularly to reflect current wait times and firefighter feedback.
“My ideal, my dream would be that it's on the wall of every toilet,” she said.
That’s not something Richmond Fire-Rescue has, but Cory Parker, president of IAFF Local 1286 (Richmond’s firefighter union) thinks it’s a good idea.
To reduce stigma around seeing a counsellor, Isaac suggests departments consider implementing mandatory counselling sessions every one or two years for active firefighters.
Similar to a physical checkup, it no longer becomes a stigmatized thing if everyone needs to do it, she said.
Parker didn’t know how open firefighters would be to mandatory counselling, and said suggesting a counselling session every one to two years might be more appropriate.
Mental health training
Isaac also stressed the importance of preventative mental health training for professionals in a line of work with stressors known to contribute to illnesses like post-traumatic stress disorder.
That means continuing to conduct mental health training throughout a firefighters’ career, including retirement, and educating their spouses and partners.
All Richmond firefighters recently completed the Resilient Minds program, and by the end of 2019 everyone will have done the Road to Mental Readiness too.
Isaac says it’s important to keep conducting these trainings every two or three years.
Retirement can also be a tricky time for firefighters, since their cumulative traumatic experiences span upwards of 30 years. Firefighters in Isaac’s study with 20 or more years of service reported the second highest stress levels of any group. It’s also a time when extended health benefits can be reduced, and life slows down giving them more time to ruminate on the difficult calls they’ve responded to.
Parker said the union recognizes an “immediate need” to help retirees, and while Richmond doesn’t have a formal program in place, there are some new initiatives in the works.
Support for families
Firefighting is a career that’s notoriously hard on a marriage. But social supports are crucial for mitigating the effects of PTSD. A 1999 U.S. study also found that marriage was a protective factor against the disorder.
Isaac wants departments to bring families in to discuss effects of occupational stress, and signs and symptoms that a loved one is suffering.
“This area is in its infancy, with some education being provided to new employee families,” Richmond Fire-Rescue Chief Tim Wilkinson said. “(It) is identified as an outstanding need.”
Parker agrees it’s important, and the union was in the midst of organizing something for spouses and families last year before shifting gears to focus on retirees.
Mental health built into the workday
Fire departments also need effective ways to deal with occupational stress on the job, Isaac said.
Critical Incident Stress Management sessions, which are essentially de-briefs after stressful calls with trained peer leaders, are one important department-led initiative.
“When you bring people in, this group of people who have just shared a traumatic event, it’s important they talk to someone who they can trust. And feel like they’re not going to be judged,” Isaac said.
Richmond’s department was the first in B.C. to have a CISM team, and they’re screened and trained by professionals, Chief Wilkinson said.
Isaac says those sessions also need a confidential survey method for firefighters to indicate whether they need further support.
“I don’t think anybody’s going to put their hand up in front of everybody and say ‘that bothered me’. Especially someone who’s fairly new to the job,” Parker said.
He’s been a firefighter for 26 years, and said the new recruits coming in now are going to have more mental health resources than he’s ever had in his career.
“It makes me feel really good inside that we’re recognizing now that we are more susceptible to occupational stress injuries, mental health injuries. And things are actually being done about it.”