Behaviorial Health
The Company Officer’s Role in Addressing Mental Health
Dena Ali Six years ago, I unknowingly began to travel down the path of addressing suicide in the fire service.Today, I am grateful for the experiences that led me down this path, but at the time, it was the most excruciating and alienating experience of my life.This was due to a negative firehouse atmosphere coupled with a company officer who turned a blind eye to the contributing factors. Unintentionally, my company officer conveyed the message to me that I was not worthy of his energy.Among other personal factors, those feelings of worthlessness led me down the dark path of depression and suicidal ideation. Luckily, they also led me down the path towards understanding suicide. I quickly learned that thoughts of suicide often manifest from a feeling of insufferable emotional pain, disconnectedness and shame. Shame is the universal and primitive experience that tells us that we are defective or flawed to a point that we deserve our pain, and worse, cannot connect with others (Brown, B., 2018). In shame, you not only feel responsible for your pain, but you also feel humiliated to a point of silence because shame tells you that you are alone in your experience. Fear of judgment manifests from feelings of self-hate, self-blame and liability.These feelings are unbearably painful and found to be associated with not only suicide, but also depression, anxiety and addiction. Early in a career, firefighters develop a sense of purpose and responsibility that leads them to believe that they should never show any sort of vulnerability. The fear of weakness when one is experiencing thoughts of suicide or any other perceived weakness can become alienating and further intensify thoughts of suicide. Dr. Craig Bryan calls the circumstances that lead to suppressed emotions for first responders a catch-22, and says,“we train our warriors to use controlled violence and aggression, to
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suppress strong emotional reactions in the face of adversity, to tolerate physical and emotional pain and to overcome the fear of injury and death … these qualities are also associated with increased risk for suicide.”This is because those virtues necessary to perform well in high stress incidents are also the same qualities associated with an increased capability for suicide. According to the QPR institute, the majority of people who died by suicide were suffering from depression at the time of their death.The FSU laboratory for the Study and Prevention of SuicideRelated Conditions and Behavior has discovered that nearly 100 percent of people who died by suicide had a diagnosable mental health disorder at the time of their death. Mental health disorders are so common that they will impact nearly 50 percent of people in their lifetime, and due to the nature of firefighting, firefighters are more susceptible to certain ones. Understanding the commonality and treatability of mental health disorders should become the norm for firefighters. Through this understanding, we may shift towards a fire service that encourages help seeking behaviors among their members. Mental health disorders commonly found among firefighters are associated with organizational stress — to include harassment and bullying — sleep disorders, sleep deficiency, posttraumatic stress symptoms, substance abuse, financial stress and relationship problems. Firefighters suffering stress from these often fear judgement, so they suffer in silence. Rather than addressing the underlying issues, they find themselves numbing negative emotions with maladaptive coping, such as alcohol. Sadly, numbing the negative also numbs the positive.The use of negative coping skills to address stress often interacts in a synergistic fashion and further builds into a crisis.The use of alcohol to manage stress often leads to poor choices and poor health, and if
unaddressed, can become deadly. This is why it’s so important for leaders model the behaviors they wish to see in their people. Leaders must be willing to admit that they too need help sometimes, and it’s OK to reach out.Truly, the best-case scenario would be for a leader to have the courage to share their journey from struggle, through help seeking, to healing.This is because hope is the antidote to shame and suicide. Hope is a learned process that develops from understanding that the path ahead is possible.There are simple skills firefighters can learn early in their career to help them to become more resilient to stress.These include sleep hygiene, the power of meaningful conversation about difficult experiences and finally mindfulness. Each of these have been studied extensively, and all found to prevent suicide, depression and PTSD. Company officer training has the potential to yield the greatest impact for our firefighters. Emphasis must be placed on training officers to recognize changes in their employees, and to develop open relationships to where the employee always knows that he/ she can go to their officer. Company officers should notice when an employee is acting unusual and foster an environment that is supportive and inclusive to all members of the crew. The officer must be aware of when an individual is being isolated, taunted, or simply ignored by the rest of the crew.Additionally, they must foster a safe environment that allows individuals suffering or struggling in silence to be able to open up and share their struggles.They are responsible for ensuring their members know they are available any time that the employee is in need. More importantly, the company officer must be willing to initiate difficult conversations when they notice changes in behavior. Trust should be established early in relationships and nonjudgement about mental health and stress must be the norm.While many officers fear they are not equipped to deal with members dealing with overwhelming stress, they generally can make an impact. People suffering or struggling don’t always need the right answers, they often just need an opportunity to open up and be heard. The most prominent researches in the field of suicide have found that a little intervention can go a long way in terms of healing. People simply need hope, and to know that their situation is not permanent. Evidence-based intervention is used to prevent suicide by helping recognize people who are feeling suicidal, and to have the courage to ask them directly about suicide. Often, people in suicidal crisis don’t discuss their thoughts because they don’t want to worry or burden others.They may also feel humiliated, ashamed, or fearful of their thoughts, and dread the response they may receive from those who lack compassion and understanding.
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However, by asking directly about suicide, you give them permission to tell you how they feel. People who have felt suicidal will often say what a huge relief it is to be able to talk about their experience. Once people are able to talk about suicide, they experience the first step toward healing — that is, discovering alternatives to suicide.A common interpersonal feeling of those who are suicidal is intense hopelessness, and an anecdote to this hopelessness comes from meaningful social connection. But remember, as long as judgement exists, meaningful social connection cannot. The best-case scenario would be to ensure the company officer has the training, knowledge, and willingness to be the first line of defense for an employee in need of help. It is not enough to refer individuals struggling to mental health services. Experience has taught us that fear of referral is the main reason first responders suffer in silence. Company officers must have the courage to be willing be there for their members and create an environment where the individual feels safe opening up about their struggles. Open disclosure through discussion is truly the best way to help an individual connect, understand their experience, and find solutions. Every firefighter and every human should be able to share their struggles in a safe and supportive environment without fear of retribution.As long as our firefighters fear their careers and that their reputations will be in jeopardy, they will continue to suffer in silence. In my years of researching this topic and searching for solutions, I have found that it is an absolute profound human tragedy that people die by suicide because it’s much harder for them to ask for help. If we truly want to see rates of suicide decrease, we must find a way to make it easier for people who are suffering to reach out.We rarely have to have the right answers if we are just willing to sit in the darkness with somebody until they can find the light. As powerfully explained by Pema Chodron,“Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Only when we know our own darkness well, can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity.” If you have been blessed by traveling down a dark path before finding your way to healing, you have the sacred opportunity to light the path for others by simply sharing your story and being courageous enough to sit in the dark with another. Dena Ali is Captain of Engine11 for City of Raleigh Fire Department, Operations, B Shift. Brown Brené. (2015). Daring greatly: how the courage to be vulnerable transforms the way we live, love, parent, and lead. New York, NY: Avery. Washington, M. T. /. (2010, April 13). Is the U.S. Army Losing Its War on Suicide? Retrieved from http://content. time.com/time/nation/article/0,8599,1981284,00.html.
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