Suicide: This issue is real in emergency services

In late August, 2005, the warm Gulf of Mexico waters turned up a catastrophic category 5 hurricane that devastated New Orleans and the surrounding area – Hurricane Katrina, a storm that changed the lives of citizens and first responders from New Orleans to the Great Lakes. The storm cast a swath of destruction from the Gulf Coast to the Eastern Shore, and also shed new light on one specific area in EMS: how we deal with our own mental health and changing the associated stigma with getting help.

After Hurricane Katrina hit, Retired Fire Department Captain Jeff Dill found that firefighters who were deployed to aid with the relief were struggling upon their return. Dill went back to school and earned a master’s degree in community counseling. “Firefighters and EMTs needed mental health professionals that understood their background to talk to,” Dill noted. He began training chaplains and counselors around the country.

As Dill’s training continued, he began getting emails from around the world about EMT, firefighter and dispatcher suicide rates.

“In 2010, I started tracking and validating the data. I have now validated 1,684 of the tragic events and personally spoke to 1,634 chief officers of these departments,” Dill said.

In 2011, with that information, Dill and his wife founded The Firefighter Behavioral Health Alliance. FBHA was established to directly educate firefighters, EMS personnel and their families about behavioral health issues such as depression, PTSD, anxiety and addictions, as well as firefighter suicides.

Dill and those working with FBHA are dedicated to educating firefighters and EMS personnel on the importance of behavioral health and suicide awareness.

“I think it is a big issue with society, it is a mental health issue. We put this uniform on and we are expected to act in a professional manner. Be brave, courageous, give help, don’t ask for help and don’t show weakness,” Dill said. “It is cultural brainwash.”

“Many EMS personnel continue to fear the stigma that is unfortunately associated with mental health issues. This may delay someone from seeking help, which can prolong suffering and only worsen the situation,” says Dr. Matthew Levy, DO, MSc, NRP, associate professor of emergency medicine and associate EMS fellowship director at Johns Hopkins University School of Medicine. Both EMS system leaders and frontline EMS clinicians need to work together we need to recognize it is not a character flaw, it is an illness, that is treatable.”

Levy and Dill agree that mental health crisis’ go under-reported due to fears of being labeled too unstable to work in this line of work.

In the first 11 months of 2021, 70 firefighter, EMT and dispatcher suicides have been confirmed by Dill and FBHA. In 2020, Dill and his team confirmed 125 suicides.

“Tragically, all too often, many in EMS either known someone or know a story of someone that has succumbed to suicide. The very EMS clinician I knew was 19-years-old,” Levy said. “It is more common than people want to admit.”

Dill added that suicide rates go under-reported in the EMS and dispatcher professions.

The resources to help when someone is not OK

Dill, retired from the Palatine Rural Fire Protection District in Inverness, Illinois, is a member of the American Counseling Association and National Board of Certified Counselors. In July 2021, he accepted a position with the Las Vegas Fire and Rescue as their behavioral health administrator.

“I am a firm believer in education. We are about 100 years into the fire service, we are only 10 or 11 into the behavior health (service). It takes time. You can’t push this through. It is more than peer support. You must educate throughout their entire career and retirement,” Dill said. “It is more than policies and procedures. Classes should start in the academy and continue through to retirement.”

“We want to change the culture, the practice and behavior,” Levy said. Many EMS clinicians would rather avoid the topic and discussion then asking, “are you OK?’”

Levy, a 25-year veteran of emergency services, went on to say that clinicians need to be prepared and have the tools for when their friend, coworker or partner answers, “no, I’m not OK.”

“We need to give the clinicians the tools and resources to help when the answer is no,” Levy said. “In my opinion, many want to help, but unless they’ve sought out special training, most EMS clinicians don’t know what to do next, they don’t know the answer ... they don’t have the right skills to help.”

It’s OK to not be OK, Levy continued. Clinicians can be in crisis for any number of reasons.

Dill added that many stressors – work stressors, relationships, family, financial responsibilities – can make it difficult to handle things alone, and depression, PTSD, medical/physical health and addictions can contribute to suicide risk.

“This issue is real and there is no discrimination. It doesn’t matter if you are male or female, city or rural, career or volunteer, these issues are real. You need to talk about them to others and if it’s not to others, then chaplains or counselors. Talk to family members or friends. It is OK to say you are struggling,” Dill said.

“There are many stressors that we all have been through over the past two years, particularly with the pandemic, as well as continuing to navigate everything that has been expected of us,” Levy said. “It is even more critical now that we build a foundation to help our employees to be successful. We want to change the narrative; we want them to become more comfortable to talk and break down the stigma. Mental health and suicide are real occupational risks, just as certain cancers and back injuries.”