Beals

How have mental health solutions for first responders evolved and how can they be
improved?

Baylee Beals
Senior Project Advisor: Christine Imming
Abstract

In this article I talk about the battles that many first responders face. As I uncover the truth about first
responders battling mental health and the solutions that are being provided. This article covers the history of
firefighting/ems and how mental health is becoming more and more of a discussed topic in society. But I
question the fact that it is becoming more of a discussed topic, but does that mean that the resources for
bettering mental health are being fully utilized, or even provided to all departments across the U.S.

12th Grade Humanities

Animas High School
--- April 2019
Beals

Part 1: Introduction

I am an 18-year-old female who grew up in a little town 30 minutes west of Durango, Colorado. It’s a

quiet town goes by the name of Hesperus, its got a little quiktrip store right at the edge of the little town and a

ski-area that is actually very well known. It also has a volunteer fire department, its a quiet department, they

don't get very many calls but when they do, it is nothing short of exciting and intense. When I was 16 the fire

chief signed me up for the junior firefighting program, and I fell in love. I have been in that department for two

years now and I love it now as much as I loved it when I signed up. However, it isn't as easy as everybody

might think it is.

Yes, there is a physical strain to it but that you can overcome with hard and constant training, but one

thing you can't overcome as easily is the mental struggle to it. When I first joined the department the feelings I

had were happiness, excitement, and all of this eagerness to just get out there and help, I didn't realize that this

job could take such a bad toll on your mental health. Then again not very many people do, but that is changing.

With the way, our society is today mental health issues are becoming more and more of a discussed

topic but I still see that our first responder's mental health is not getting as much of the attention as they may

deserve. Now our big town of Durango is a little more advanced as far as mental health solutions, I have seen it

in the fire department and I am joyous that our local heroes are getting the help that they need when they need

it. But I think the rest of the world needs a little help catching up.

With all of the research that I have done, I have found stories of firefighters committing suicide because

they either don't have the resources to get help or they are too afraid to ask. Sometimes a first responder can go

their entire career and be just fine but retirement is when they struggle because they don't have to hide it

anymore, “retirement can uncover or exacerbate alcohol, drug, and mental health disorders that may have been

masked or submerged during active duty.” (Staff, Par. 11 )

1
Beals

Part 2: Historical Context/Background Knowledge

The first fire department was built ​In 1736 when Benjamin Franklin established the Union Fire

Company in Philadelphia. The United States did not have government-run fire departments until around the

time of the American Civil War. But there is a history of organized firefighting dating all the way back to

Ancient Egypt. But the first EMT-A curriculum wasn't published until 1972. Ever since EMS/firefighting

became established there has been mostly men in the departments and with having men on the department it is

based solely on the “man box.”

When we are growing up we are being socialized by social media, magazines, models, tv, our parents

and our peers. Men are socialized to follow the rules that are in the “man box”. ​Attributes that are considered to

be in the “man box” are to never show that you are weak, do not cry and do not ask for help. With men growing

up with that type of socialization and then joining the fire department or becoming an EMT, it is harder for

them to maintain a healthy mental state because they believe that asking for help is showing weakness. ​Now we

have progressed in society with accepting girls into firefighter/EMT jobs as well as knocking down the

socialization walls that were built up during our childhood but there are still so many men and even women out

there that don't want to be “weak” and are not able to knock their walls down and their mental health is

struggling because of it.

One of the things that make being a first responder difficult is the HIPAA law. Now the HIPAA law is

the Health Insurance Portability and Accountability Act and it was established in 1996, it is basically a privacy

rule so first responders are not allowed to publicize patient private records, or talk about any details of a call

that could help other people that weren't on the call find something out about the patient like who they are or

what happened to them. Sounds fair right? It is, but its hard on first responders because they can go on a really

bad call and it could put their mental state in a pretty bad place. But when they are done with their shift or with

2
Beals

the call they have to go home to their families or friends and they can't say anything about it.

Now for full time first responders that go back to a station when they are done its not as bad because if it

bothered them they can talk to their fellow first responders because they are all bound by HIPAA, but

volunteers have to go home to people that are not bound by HIPAA so they cannot talk about it as much as they

could if they were full time. But with the progression of understanding the need for mental health issues more

and more, therapists are specializing in helping first responders that struggle with depression, suicide, and

PTSD.

Having more access to resources makes things a little easier for our first responders to better their health,

which can improve their performance in the field. It is also easier to have access to all these resources

accessible, especially to newcomers in the field because they can reach out to these therapists for ways to help

themselves be able to cope in the moment when dealing with intense/difficult calls.

Part 3: Research and Analysis

Since the beginning of the firefighter/ems career, calls have been getting more and more intense,

personable, and traumatic. With these factors playing into a situation that an EMT has to deal with can cause

many difficulties, such as depression, and PTSD being the two big ones. But there are little ones such as

alcoholism, drug use, and self-harm just to list a few.

In the past years having a few drinks after a shift at the department was normal. Not talking about how a

call affected them was considered normal behavior. But that was considered normal, because nobody fully

understood, or wanted to talk about what mental illnesses could arise because of the job. As we started

advancing in our understanding of maintaining mental health we focused mainly on our military veterans. Just

recently researchers have started focusing on first responders mental health as well. With more and more people

3
Beals

realizing the physical strain of being a first responder it has encouraged them to look more into the mental strain

“For firefighters and first responders, maintaining optimum mental wellness is a critical part of

remaining active and effective on the job as well as at home. Constant exposure to trauma,

life-threatening situations, and the physical strain of working long hours on little to no sleep can

negatively impact overall mental health, increasing the vulnerability and risk of substance abuse and

addiction among firefighters and first responders.” (Editorial Staff, Par. 1 )

Now with the knowledge that we have gained on how to better our mental health, we are starting to get

more and more resources accessible to our first responders, such as healthy dietary planning, mental brain

exercises, therapists specializing in helping first responders, as well as promoting “its okay, to not be okay.”

From what I have seen, heard, and experienced, Durango fire & rescue department as well as the Upper Pine

River fire department, are the biggest promoters of maintaining mental health. The departments start with

helping their first responders be more aware of what mental health issues are and what the signs are. They then

provide resources to help their first responders while also providing help with maintaining other daily activities

such as healthy eating, exercising, and maintaining friendships/relationships. But in the end its up to the

individual to decide whether he/she wants the help.

Some of the struggles that first responders face are putting their patients care above their own. helping

others before they help themselves, but sometimes after helping others its too late to help themselves. One story

that moved me to my core was about a fire chief that went by the name Kyle Ienn.

“Kyle Ienn was one of the new breeds of Fire Chiefs. A 23-year member of the fire service, he

led a progressive volunteer fire department in his hometown of Ralston, Nebraska, a suburb of

Omaha. He was active on the state and national level with the Nebraska Fire Chiefs Association

and the International Association of Fire Chiefs’ Volunteer Combination Officers Section. He

served the National Fallen Firefighters Foundation “Everyone Goes Home®” program, an

4
Beals

initiative to prevent firefighter line-of-duty deaths and injuries. As founder of the Nebraska

Serious Injury & Line of Duty Death Response Team, Ienn was first on the scene to help fire

departments with the death of a firefighter.

In a 2010 interview for Omaha.com, when asked what kept him motivated, Ienn replied,

“Knowing I have helped someone.”

On the morning of January 31, 2012, just days before his 41st birthday, Ienn’s body was found

hanging from a bridge in an Omaha park. A fire department vehicle was parked nearby. Omaha

police concluded that Ienn committed suicide. He left behind his wife, who worked as an

administrative assistant with the fire department, and three teenaged children, two of whom

participated in the fire department’s Explorer program.” (Wilmoth, Pars. 1-3)

Kyle helped his first responder peers deal with the deaths of their peers even helped a program where

“everybody goes home” but nobody asked how he was doing. That's the way things are nowadays no one wants

to be the first one to open up and talk about what they are going through, so sometimes it helps to be asked: “hi

my friend, hows your world today.” But that doesn't always work. In a lot of the battle stories that first

responders give about mental health, they talk about how they knew they were struggling and they saw the

impact it had on their family and peers. So they decided to get the help they needed in order to get better, they

themselves decided to get the help they needed so they could better themselves, their work performance and the

relationship between friends and family.

Now like I have said before, our state of Colorado is very well educated in mental health, and we have

multiple resources for teenagers, kids, adults, first responders and other types of stressful jobs. But just because

we have a lot of it figured out, does not mean that everybody else does. Yes there are alot of people out there

that are aware of what mental issues are and what they look like. But you would be surprised at how hard it is to

5
Beals

find a good legitimate article on mental health in first responders. Kim Van Orden;

“an assistant professor of psychiatry at the University of Rochester Medical Center, aren’t

convinced that behavioral health issues are actually increasing among emergency responders,

arguing instead that the growing awareness around the issue is finally shedding light on

long-buried problems. “We’re just becoming aware of a problem that’s been there all along,” she

says.”

If what she says is true then we are all behind. First responders have been dealing with mental health

problems since it became a full time job. But we didn't have the understanding, resources or even the solutions

to help first responders maintain a good mental health, and I do strongly believe that is because in the old days

people were taught to “suck it up, buttercup.” There are still people to this day that believe that first responders

wouldn't be taking care of others if they couldn't take care of themselves.

You know if you ask your grandparents who grew up in hard times what they think about ADD, PTSD,

and other mental issues they will tell you that they believe they are just excuses to “get out of school” or say

“that's not actually real” well that's the attitude that many people have about many mental issues now, “​The

condition was real, he knew, but as a diagnosis he saw it being dangerously overemphasized.” (Dobbs, Par. 3)

He is talking about the “PTSD​ trap” now PTSD as he said is a real condition no doubt about it but many people

will say that PTSD is just a mental crutch that people use so they don't have to go to work or they don't have to

socialize or go out of the house. But when its diagnosed people say that your not actually diagnosed with it your

just pretending, and you know what they are wrong because I did not find one article that talked about over

diagnosing PTSD or how first responders aren't affected by mental health issues. But when I did it was such an

unreliable article that I found once and when I went back the website was shut down. Mental health issues are

real and they affect everybody. Its not something that should be taken lightly and the people that think first

6
Beals

responders should “suck it up” need to be educated on what mental health really means because I honestly don't

think that they would be saying that unless they actually knew what it means and what it can do to a life and the

lives that surround it.

Part 4: Discussion and Conclusions

With all the research gathered and everything laid out onto the table, then yes the mental health solutions

provided for first responders has evolved. But there are still some departments that have a ways to go. Our big

town of Durango, Colorado is doing a fantastic job at understanding mental health and providing enough

resources to its community so everybody knows the options that they have. But it took our county to go through

some drastic times in order to reach this point. My point for writing this paper was not to tell everybody what

they may already know, it was to tell a story about a profession that I care so deeply about. Because gosh darn it

everybody should care about our first responders. Every day they are out there showing up on peoples worst

days and their jobs are to make their bad days better. But at the end of the day when they don't have to wear a

smile on their face whos gonna be there to help make their possibly worst day better?

“It’s important to note, too, that there are various aspects of the job that can contribute positively

to mental health. These include:

Positive relationships with coworkers, Meaningful and important work, Productive and/or

positive atmosphere in the workplace, Livable wages, and benefits

Finding balance when the negative issues begin to outweigh the positive is essential to maintaining

optimum mental health.” (Editorial Staff, Par. 2)

7
Beals

The fire department prides itself on teamwork, you dont pull a hose without a partner you don't show up

in an ambulance without a partner, you don't climb a ladder without a partner and you certainly do not and

cannot fight a fire without a team behind you. What the research suggests is we use that teamwork skill that the

fire departments pride themselves on so much to better our mental health. Because we can always be improving

our solutions for mental health but really we may need only one and that's fellow first responders. Now I know

that everybody deals with problems different and that's why we will continue to improve our solutions for

mental health but I still don't think that everybody fully understands what it is. Now right now your probably

thinking “well I know what it is” and yes you probably do because Colorado is further along in the process of

helping our first responders maintain their mental health but I still struggle to find articles that solely talk about

first responders. I struggle to find where departments in other states have worked as hard as ours to better

maintain their first responders mental health. That's why I wrote this because I want other states to see this

article, Yeah it may not be the best article ever written on the face of the earth but it gets the point across doesn't

it? To conclude and put it in layman's terms, I don't want other states to have to go through the troubled times

that we went through with mental health to get to the point to where we are.

8
Beals

Works Cited

Stone, Adam. “Beyond Debriefing: How to Address Responders' Emotional Health.”

Government Technology State & Local Articles - E.Republic,​ 30 Sept. 2013,

www.govtech.com/em/training/Beyond-Debriefing-Responders-Emotional-Health.html​.

Crane, Michael A, et al. “The Response to September 11: A Disaster Case Study.”

Annals of Global Health​, No Longer Published by Elsevier, 25 Nov. 2014,

www.sciencedirect.com/science/article/pii/S2214999614002926​.

Skogstad, M, et al. “Work-Related Post-Traumatic Stress Disorder.”

OUP Academic​, Oxford University Press, 26 Mar. 2013,

academic.oup.com/occmed/article/63/3/175/1413569.

Wilmoth, Janet A. “NFPA Journal.”

Special Report: Firefighter Behavioral Health - NFPA Journal,​ June 2014,

www.nfpa.org/news-and-research/publications/nfpa-journal/2014/may-june-2014/features/specia
l-report-firefighter-behavioral-health​.

Staff, Reviewed by Editorial. “Firefighters & First Responders In Need of Treatment.”

American Addiction Centers​, Oct. 2015,

americanaddictioncenters.org/firefighters-first-responders.

Dobbs, David. “The PTSD Trap: Our Overdiagnosis of PTSD In Vets Is Enough to Make You Sick.”
Wired,​ Conde Nast, 22 Mar. 2012, ​www.wired.com/2012/03/the-ptsd-trap/​.

HHS Office of the Secretary, Office for Civil Rights, and Ocr. “Summary of the HIPAA Privacy Rule.”
HHS.gov​, US Department of Health and Human Services, 26 July 2013,
www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html.

9
Beals

Staff, EMS1. “Fla. Cities Oppose First Responder PTSD Bill.” ​EMS1​, 7 Feb. 2018,
www.ems1.com/legislation-funding/articles/374872048-Fla-cities-oppose-first-responder-PTSD-bill/.
SAMHSA. May 2018,
www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf​.

10