Mental Health in Firefighters
Stigmas About PTSD, Depression, and Anxiety Can Lead to Alcoholism and Suicide in Firefighters
The Fire Station 38 crew is in good spirits tonight. Not too many calls, full bellies from the captain’s famous pulled pork tacos, and an exciting competition underway.
Two rookies do push-ups on the ground, as the rest of the crew yells, “36 … 37 … 38!,” a typical activity on slow days at the station. The loser will have to buy ice cream for the whole station, and endure relentless teasing for a few days. They continue without hesitation. The rest of the crew shout words of encouragement.
Suddenly, the alarm rings. Every face in the room changes. Ear to ear grins turn into stern looks of despair. The rookies pop up from the floor, looking less determined and much more anxious.
As some of the nation’s most established heroes, firefighters are under immense pressure to maintain their unemotional, hard-as-nails, ultra-masculine personas. A little known secret, however, is that many will suffer the consequences for years after their time in the fire department. Some will even pay the ultimate price.
The stressful nature of the fire service can lead to the development of mental and behavioral health conditions including PTSD, depression and anxiety, alcoholism and suicidal tendencies.
These problems often go untreated as a result of stigmas about mental health in the department. If these stigmas persist, experts are concerned that the rate of alcoholism and suicide in firefighters will continue to rise.
Firefighters experience intense psychological stress on a daily basis. PTSD may be triggered by various work experiences, as they witness dying patients, disastrous fires, critical injuries, and other forms of human suffering.
Fire Engineering, a popular and esteemed magazine among firefighters, found that 16-24% of firefighters suffer from PTSD, as compared to the national average of 6.8% for U.S. adults.
The symptoms of PTSD can be life-altering. Individuals often re-experience horrific traumas, leading to social isolation and harmful coping mechanisms, according to the National Institute of Mental Health.
Although the LAFD has employed a psychologist for many years, PTSD is becoming a bigger problem. “It goes mostly undiagnosed,” said LA City Deputy Chief Graham Everett, an LAFD firefighter with 30 years on the job. “As it becomes a more prominent issue, more people are coming forward,” he said.
Firefighters who regularly face job-related trauma may also develop depression or anxiety. According to the Anxiety and Depression Association of America, those who suffer from these conditions may experience feelings of hopelessness, insomnia, fatigue, panic attacks, unhealthy eating habits, and even suicide.
Despite high rates of mental health conditions in firefighters, most do not seek professional help. This stems from stigmas surrounding mental health problems, causing firefighters to “suffer in silence,” according to the International Association of Firefighters, a lobbyist organization with over 300,000 fire service members.
“I have had plenty of coworkers, mentors even, who showed clear symptoms, but never went in for help,” Everett said. “This has become so ordinary that no one says a thing,” he said.
The IAFF found that 92% of firefighters view seeking treatment as a sign of weakness. In a predominantly male profession, individuals fear that getting professional help will threaten their macho persona. “People are too ashamed or embarrassed to admit that they need help,” said Everett.
There is also a department-wide belief that revealing one’s mental health conditions will have a negative impact on individuals’ careers, which further deters firefighters from seeking professional or peer support. “People fear that others will find out, and that it will hurt their promotional opportunities,” said LA City Fire Chief Ralph Terrazas.
However, personal health information is not included in the promotional process, and all LAFD psychologists are sworn to confidentiality. “People just don’t understand how the system works,” said Chief Terrazas.
LA City firefighter Eric Steiger explained why he would not reach out for support in the department. “I’d feel like I was being judged, and these guys depend on me in dangerous situations,” said Steiger. “If you show you can’t handle the job, they can’t trust that you’ll be able to function on more stressful calls.”
No matter the reasoning, the fact remains that the 80-90% of firefighters with mental health conditions will remain untreated and without social support, said the LAFD’s professional psychologist Krystle Madrigal. Over time, these conditions may become exacerbated and continue to affect individuals’ quality of life, she said.
Those who remain untreated often turn to alternative coping methods, usually through alcohol or drug abuse. Fire Engineering estimated that the rate of alcohol abuse in firefighters ranges from 25-30%, as compared to 7-9% in adult Americans.
Among firefighters, alcohol abuse is a “culturally accepted way” to deal with on-the-job stress, according to Fire Engineering. The LAFD averages about 24 DUIs per year, said Chief Terrazas.
“You hear of people getting arrested for DUIs, not showing up for work, then next thing you know they’re getting divorced and going bankrupt,” said Deputy Chief Everett. “That’s the standard pattern.”
While some firefighters cope by drinking, others may develop suicidal tendencies. Suicide has become a significant issue in the fire service, with the LAFD averaging one suicide per year during the past five years.
This trend shows a drastic increase in the suicide rate, said Chief Terrazas. He identified this increase as one of the most pressing issues in the LAFD. For the first time ever in 2018, “there were more suicides across the country than line of duty deaths,” Terrazas said.
Research confirms the LAFD’s suicide problem, reporting an “alarmingly high” rate of suicidal thoughts and behaviors in firefighters, as compared to the general population. Results showed that 15.5% of participants made at least one suicide attempt during their fire service career, about 6.8% higher than the national average.
In fact, the IAFF reported that firefighters are three times more likely to die by suicide than in the line of duty. “This is definitely a cause for concern, and reinforces the need for progress in the mental health division,” said Everett.
To combat the problem, the LAFD has three mental health professionals that work together to create department-wide awareness of symptoms associated with firefighters who may be contemplating suicide.
There is also an Employee Assistance Program, or EAP, which guarantees confidentiality, and pairs volunteer firefighters with trained mental health professionals to provide an open space for conversation and support, Madrigal said.
On the other hand, “You can’t avoid exposing people to traumatic events,” said Deputy Chief Everett. “The stress is unavoidable, which is why most of our programs are for treatment rather than prevention,” he said.
While the fire service has succeeded in creating multiple rehabilitation programs and avenues for awareness, the LAFD has done nothing to combat the stigmas surrounding mental health conditions in the department.
“We must treat these stigmas as the root of the problem and find new ways to normalize mental health issues in the department,” said Madrigal. “Without this, firefighters will continue to oppose treatment for their conditions, and the department will suffer,” she said.
You can lead a horse to water, but you can’t make him drink. As long as there are stigmas about mental health in the fire department, alcoholism and suicide rates will continue to rise.