When someone is openly suicidal, there’s a checklist most of us walk through to assess how serious they are. The paramedic in my office hit nearly every hot button on the list: Her girlfriend had broken up with her, the dog she’d had for seven years was put to sleep the week before and she’d stopped in to say goodbye before ending it all.
She said, “I don’t want to live anymore. I’ve given everything I own to Goodwill except for my car. There’s a long straightaway on the highway near us without much traffic. I figure that going over 100 miles per hour, I can hit the concrete bridge abutment head-on without my seatbelt. That should do it, don’t you think?”
She agreed to talk with a professional and I dialed the number for our Employee Assistance Program from my office phone. I told the person that answered, “I’m an EMS manager and I have an actively suicidal employee in my office with a clear plan.” He asked to speak with the medic and I handed her the phone.
She gave her name, address, social security number, place of employment and said that she maybe drinks too much, but doesn’t take any drugs. She answered a few more questions and then handed the phone back to me. I put the phone to my ear, heard the dial tone and asked her what the plan was? She said, “I have an appointment to see a counselor a week from Thursday. Thanks for trying.”
Realizing that we were not getting what we needed from the EAP, I loaded her into my car and drove her to closest hospital with an in-patient psychiatric unit for a voluntary admission. After getting her situated, my impulse was to pick up the phone and fire our EAP provider; however, my boss talked me out of it and together we worked with them to implement a performance improvement process that helped turn things around.
Optimize your EMS EAP
To help understand what leaders in our industry can do to optimize their EAP programs, I reached out to Dr. Sara Gilman. A licensed marriage and family therapist, Gilman is the CEO and clinical director of Coherence Associates, Inc., a group of mental health professionals that specialize in working with first responders, public safety professionals and the military on PTSD, CISM, anxiety, addiction, peak performance and more. She’s also worked as an EMT and a volunteer firefighter.
EMS1: What’s the purpose of an EAP in EMS?
Dr. Sara Gilman: Organizations typically provide EAPs as part of their employee benefit package. They provide short-term counseling for all kinds of issues including stress, relationship problems and financial issues. They also provide emergency interventions for employees and their family members.
Why do EMS folks sometimes find that the counselors from their EAP don’t understand them?
Most EAPs cover general issues, faced by most employees, who work in “normal” jobs. A general EAP counselor is trained for the general public and may not have received any training in cultural competency of first responders. First responders’ cultures and occupational hazards are by far unique to any other profession.
The challenge for many general EAP counselors is that most of us in EMS, fire service and law enforcement have made adaptations and developed coping skills to deal with shootings, stabbings, cardiac arrest, death and the like, so that our level of actual distress is harder to assess behind our cool, keeping-it-together appearance. This may cause an under-diagnosis of the severity of our distress. They don’t have this same level of challenge when caring for insurance agents, hotel employees or people that work in manufacturing plants.
The general counselor may also over-diagnose PTSD and other disorders when listening to the stories of human carnage, life threatening calls and violent encounters, which are part of the on-duty experience of first responders. If a counselor is unfamiliar with the job and culture, it can create a sense of disconnect with the responder. This is not conducive to feelings of trust and understanding, which are imperative for a successful counseling experience.
|More: ‘Any of us can suffer': Working through post-traumatic stress
What else makes those of us in EMS and public safety challenging for mental health professionals?
First responders have a keen “BS” and danger meter, constantly assessing the person they are with and the situation they are in, and this can be intimidating for some counselors. Meanwhile, the responder fears that something they say might get back to their boss and impact their job, potential for promotion and judgement or distrust from peers. So, they may withhold important information. Confidentiality is essential and responders need to be assured, perhaps more than once, that what is said stays between them.
First responders have some of the highest occupational hazards of any job, however, they are often not aware – because they have not been taught – of the negative impact of this cumulative stress and how to develop positive coping strategies and build resilience. The chronic exposure to traumatic stress and human suffering impacts them in a variety of ways including physically, emotionally, psychologically and spiritually, yet the stress symptoms may be subtle and build up over time.
Most first responders sign up for the job because they feel called to serve and protect, and it is truly the career that brings them meaning in life. They train like elite athletes who give it their all. Their families make a commitment to support and live with the impact of shift work, danger and time away. This is not to be taken lightly and must be honored by the counselor, while helping them to learn how certain things are impacting them and how they can recover, reboot and restore themselves along the way.
Can you describe the qualities of a therapist that is EMS, fire and law enforcement compatible?
To be effective, therapists will need to understand the individual and the EMS culture in which they live and work. The best way to gain cultural competency is by being involved in the actual work environment. Therapists who do ride-alongs, spending time within the culture, gain greater understanding and can use these experiences with their clinical skills. The ability to gain trust and ensure confidentiality is vital when you’re working with people in EMS and public safety.
A therapist should be able to handle descriptions of gruesome details without being overwhelmed. Knowing how cumulative stress impacts the brain and nervous system is imperative and being able to explain it in ways that make sense to the responder. Using their language and going with the unique sense of humor that will undoubtedly emerge at what might seem like the strangest times. EMS, you know what I mean!
There are evidence-based treatments that have been shown to efficiently reduce the negative impact on the brain and body such as Eye Movement Desensitization & Reprocessing (EMDR), Somatic Experiencing (SE), Heart Rate Variability Training and Mindfulness Training. Therapists must have additional training and certification in these methodologies before using them. They also need to understand how mental health treatment may impact the first responder’s job status, workers’ compensation claims and other work-related issues.
If you were going to interview a therapist to see if they would be a good person to help your crews with work and personal issues, what would you ask and how would you evaluate their answers?
I look specifically for trained therapists who are certified in trauma-focused methods, who have a passion for first responders, who can offer rapid response times when a responder is in distress, who are willing to step into the work they do and learn from them what the job entails. Also, those who have a strong basis regarding the unique issues of the first responder family.
If an EMS, fire, or law enforcement organization already has an EAP what would you recommend that they do to make sure it’s providing the best service for your folks?
First, survey personnel to see what is working and what isn’t. Find out what enables them to utilize their EAP and what causes them not to. For general counseling, not specific to on-duty related stress, the general EAP counselor can meet the needs of the employee and their family. For issues of post-traumatic stress, injury symptoms or addiction issues, a specialist may be warranted. I would ask the EAP provider for a list of their trauma-trained therapists, including CISM training. Then, schedule a meeting with each of them where you can ask about their experience with employees like yours, their training and what they do to stay up on current treatments.
Chances are good that you’ll be able to tell which of them will be most helpful and which will not. Then, ask your EAP account manager to only refer your folks to the people you’ve vetted. It is really OK to develop an “A-list” of providers that are experienced, even if you go outside the EAP program to contract with additional providers. This is a more recent trend in first responder agencies, where they will have more than one contract so the responders have a choice.
Is there anything else that leaders in our industry should think about?
It’s helpful to think about ways that you can help the people on your team build their baseline resilience, their healthy “bounce,” so that life’s stresses are less likely to throw them off-kilter. That’s a subject for another article, about the ways resiliency is built up over time. It is important to remember that taking a proactive approach to investing in your employees will strengthen your teams, increase productivity, decrease workers compensation claims and improve retention.
A proactive approach to a healthy workforce is done through ongoing education and training in stress management and psychological resilience. When people are taught how to better maintain their health – mind, body and spirit – they are better able to manage the unique cumulative stress of being chronically exposed to trauma. When a work culture is built on taking care of one another, while being of service to the greater community, society as a whole benefits.
Qualify your EAP before you need it
It’s worth the time and energy to make sure that your EAP works well for your team before you need them to perform. You don’t want to discover that they are not up to speed when you really need them.
About Dr. Sara Gilman
Dr. Gilman is a licensed Marriage & Family Therapist, specializing in the areas of Traumatic Stress, Addictions and Peak Performance with athletes and other performers. She is the co-founder and president of Coherence Associates, Inc., a professional counseling corporation. Gilman graduated in 1983 from California State University, Fullerton, with a Masters of Science degree in Clinical Psychology, and in 2017 from California Southern University with a Doctoral degree in Psychology with a Sports Psychology certification. She holds certifications in EMDR Therapy, CISM, NLP, hypnosis, and HeartMath. Gilman is a former San Diego Rural Firefighter/EMT and served on the San Diego Critical Incident Stress Management Team for over 10 years. She is a diplomat in Forensic Traumatology, holds Fellowship status with the American Academy of Experts in Traumatic Stress, is an EMDR (Eye Movement Desensitization & Reprocessing) Approved Consultant, former president of the EMDR International Association Board of Directors, and is currently serving on the EMDRIA Board. With her passion for assisting first responders, she consults with agencies to build strong peer support teams, and trains personnel in “Peak Performance and Mental Toughness for the First Responder.”
This article was originally posted October 18, 2018. It has been updated.
