Blog

I want to start with an emotion. Imagine, right now, in your department, that you get the call that one of your members has killed him or herself. It might be someone who you’re close to, gone on hundreds of calls with, shared dark fire department humor. Maybe, someone you thought of as a rock. Maybe (like in our department) you responded to a 911 call that was the suicide of a member.
I promise you two things. First, there is the deep and numbing grief, the pain of losing someone to suicide, which is a pain like no other. Second — and I again promise this — is the search for clues. Why, as an officer, didn’t I figure this out? What did I miss? Did she say anything? Was there a change in how he was acting? Could we have done anything?
Nights of this, I promise.
Our first “gut” reaction to this might be that it could never happen here. But that is like holding the belief that a Line of Duty Death could never happen here. We know because our work is often dangerous that we don’t believe that.
The facts are that more firefighters die from suicide now than die from Line of Duty Deaths. Since 2009, LODD’s have steadily decreased while deaths by suicide have increased In fact, in 2019, deaths by suicides represented 30% more fatalities than LODD’s.
Yet, like most volunteer departments, I bet the time spent training on emotional health and suicide prevention is pale or non-existent compared to the time spent training to be safe on the fireground.
Like understanding the factors that lead to exertion deaths and deaths by vehicle crashes, we need to know how suicides happen and what we can do about them. Our goal as officers and firefighters should be reducing death and harm for our brothers and sisters no matter where it may arise.

The Sea We Swim in
Firefighters swim in the same sea as the rest of society, so it is essential to understand what is going on in the rest of the country before we dive into the firefighter world.
According to the CDC, in the United States, suicide is the SECOND leading cause of death for individuals between the ages of 10 and 34 (unintentional injuries are the leading cause) and the 4th leading cause for individuals between 35 and 54. In 2017, 47,000 individuals died via suicide (almost twice the number of homicides)
In data obtained by the American Psychological Association, the rate of suicides has increased by nearly 33% since 1999, with a sharp uptick in 2006.
Further, suicide rates tend to rise during times of recession, especially in middle age and older men.
It is too early to understand how the pandemic, recession, and social unrest we are now experiencing might affect the suicide rate. But in one study out of Cook County, Illinois, the 2020 suicide rate is “on pace to double” last year’s, with an alarming increase in the number of suicides among African Americans.
There is another way that individuals are taking their lives, and it is just as tragic. These are the deaths of despair. As our economy and society are transforming, many individuals feel left behind and are killing themselves by drinking, overeating, and unintentional overdosing on drugs and suicides. One source noted that 65,000 deaths a year could be categorized as deaths of despair (and a concurrent decline in life longevity in the US).
Why do individuals attempt Suicide?
Researchers mostly agree that there is rarely one reason why someone might attempt suicide. It is usually a confluence of factors. Common reasons are changes in life circumstances like:
Being laid off or fired
Divorce
Economic hardship
addiction (and alcoholism)
Depression (and PTSD)
Abuse

The Firefighter World.
Against that backdrop, look at the unique set of circumstances that we face as firefighters. In the civilian world, firefighters, EMS, police, doctors, nurses, and social workers experience the world differently. Although it is a choice we make, it comes with a set of similar challenges, emotional and psychological, that put us at a higher risk for depression, PTSD, and suicide.
“PTSD and depression rates among firefighters and police officers have been found to be as much as five times higher than the rates within the civilian population, which causes these first responders to commit suicide at a considerably higher rate (firefighters: 18/100,000; police officers: 17/100,000; general population 13/100,000).”
An important note is that first responder suicides are likely undercounted. According to Jeff Dill at the Firefighter Behavioral Health Alliance (FFBHA.org), only 40% of First Responder suicides are reported. For volunteers, this is probably even more of an understatement because only one profession is listed on death certificates.
What can we do?
Let’s cut to the chase. We have a mental health crisis in the country. Almost 45 million Americans report some kind of mental illness, from severe depression to PTSD to schizophrenia. Next, as a culture, we are in denial that we have a problem.
The fire service, in many ways, is a microcosm of this. As firefighters, we deal with some of the worst circumstances, the life-changing crises that people encounter. What we see, a single terrible call or the years of cumulative tragedy, can cause us temporarily (or sometimes permanently) to lose our bearings.
Often it can lead to depression, PTSD, and even suicide. These are just the facts.
And yet, we as a culture, an old and proud culture dating back to 1736, are largely in denial of this.
If you listen to our culture, the message is to be superhuman, suck it up, not be affected, and not admit “weakness.”
Generation after generation of firefighters have absorbed this message. Although we’ve always paid the price in depression, substance abuse, and suicide, it is now 2020, and we have come a long way in our understanding of the stressors that plague us and what we can do to help.
Denial is not the answer.
I’ve written previously about what we can do as individuals to help minimize the possibility of getting and reducing the symptoms of PTSD. In this article, I want to suggest a few ideas for officers about preventing suicides.

1. First, as officers, we need to educate ourselves on the facts about suicides in the fire service.
2. We need to educate our firefighters and EMS personal about suicides, the causes, what the signs are, and where and how they can get help.
3. Remember, “Leaders go first.” As officers, we need to be open about our experiences with hard calls and how they affected us. We want to give firefighters permission to open up and talk about what they’ve gone through or are experiencing. When leaders go first, it provides “air cover” for others to talk.
4. Depression, PTSD, and suicide ideation are NOT SIGNS of weakness. As officers, we need to hammer this home. We need to be “tough” on scenes, sometimes detached, but having an emotional reaction to what we see is normal. Expressing those feelings, not repressing them, is healthy.
5. The best way to communicate all of this to firefighters is through stories. When you tell a story about a call, how it affected you, and what you did about it (or didn’t) is how we learn.
6. Have an informal and formal process for firefighters to get help. Most importantly, make sure that peer counseling is available. Firefighters (like Police and Military) are reluctant to talk to individuals who don’t “get it.” Talking to other firefighters is more comfortable and often more productive.
7. Our responsibility is to ensure that there is no bullying, abuse, or sexual harassment in our departments. They have no place in a professional volunteer department.
8. Finally, I’ve listed resources at the end of this article that we can have readily accessible as officers in case we need them.
   We know that firefighting and EMS are not just “normal” vocations. They come with a risk to both our physical and emotional health. As officers, it is our responsibility to assure that our firefighters and EMS personal are as safe — physically and emotionally — as possible. We want them to stay in the vocation for a long time and retire intact.
   A large part of that equation lies in having vibrant, healthy, open, and trusting cultures. You know those cultures as soon as you walk into the bay. Firefighters greet you, they’re happy and purposeful, there is little blaming and lots of stories. Those cultures make you want to belong there.
   It takes work as officers to build and sustain those kinds of departments. But the payoff is immense. The right culture, where it is “normal” to talk and share about bad experiences, does a lot of the work for us. The right culture, where we are looking out for others’ emotional safety, will help us spot and be able to help those in trouble. The right culture, where we are open about firefighting and EMS’s emotional risks, will help everyone stay healthy.
   The goal is not to get that call in the middle of the night that one of our brothers or sisters has taken their own life. In the end, it is not about statistics. It is about looking each of your firefighters and EMS personal in the eye and letting them know you have their back. That no matter how hard it can be, no matter how painful, there is a way back.
   Finally, in the Talmud, it’s written that all men are responsible for one another. For us, it starts with our brothers and sisters. We can be the difference makers. Learn about mental health and suicides. Have the conversation about suicide. Do the trainings. Organize a peer counseling program. Remember, leaders go first. We are the ones responsible for starting.

Be Brave. Be Kind. Fight Fires.
This is dedicated to Travis Ashkee Daily, Hondo VFD LT. 1970-2009.
And
Nate Blaser, Hondo Firefighter, 1993-2014
Rest in Peace, Brothers, we’ll take it from here.

Resources:
FFBHA.org
NVFC.org (Share the Load program)
codegreencampaign.org