What Would We Do to Stop Them?
Forbes Magazine recently reported that in 2017 more firefighters committed suicide than were killed in the line of duty, suggesting that the rate is more than ten times that of the general population.
The 2016 death of Fairfax County, Virginia, firefighter Nicole Mittendorff reverberates to this day after her suicide was linked to workplace bullying.
The current discussion around firefighter/paramedic suicide rates is partially obscured by a haphazard use of the term; suicide is legal in seven states and the District of Columbia, so it is hardly inappropriate in every case.
Australian firefighter Troy Thomton is one example. Thomton was suffering from a progressive neurological disease and took his life, using legally-assisted methods.
“Unforeseen suicide” more accurately explains the idea that responders take their lives early and in the absence of a rational motive such as a terminal diagnosis.
The assertion is more and more that such suicides are an occupational issue; if they are, they should be treated as such, i.e., in the line of duty with the attendant survivor benefits.
But the prime objective should be to reduce the number of unforeseen suicides and the way to accomplish this is a rigorous and thoroughgoing analysis and investigation followed by an institutional willingness to change where necessary.
Data collection and accuracy are serious problems. The Centers for Disease Control (CDC) has, in the past, attempted a count but readily admits the results were not fruitful because of classification difficulties.
We need to acknowledge that many suicides result from a combination of issues so that an effective investigation must examine any and all relevant factors; nothing may be excluded.
All unforeseen suicides are tragic and excruciatingly painful and those in the responder community are almost always investigated, if at all, as largely private affairs.
Once law enforcement determines that homicide is not the cause, the actual reasons for the suicide may be seen as a private matter and the complex underlying reasons are not scrutinized.
Learning more about, and potentially preventing, unforeseen responder suicides means adopting a new openness to exploring causes, recognizing that there may be both a variety of factors and a triggering event.
Such an approach is bound to present privacy and healthcare confidentiality concerns in the search for factual information.
In a generic sense, all of the causes of suicide are already known; they may be grounded in untreated mental illness and can be exacerbated by a host of factors such as life stress and the use of legal and illegal substances to blunt pain and despair.
Terms like “life stress” embody a long list of factors such as personal relationships and financial pressures which can contribute to severe depression.
Untreated (or undiagnosed) depression is likely to be a factor in most of these suicides.
These contributing causes are in play before a discussion of potential occupational factors is considered.
Potential occupational factors include:
- Adjustable environmental ones (burnout, work hours, shifts, atmosphere)
- Responder psychological make-up
- Post Traumatic Stress Disorder (PTSD).
Some occupational environmental contributors to mental stress are not necessarily viewed as negative and certainly not a cause of suicide if evaluated outside the context of mental health.
Chronic fatigue caused by excessive shift length and forced overtime is but one example. Duty schedules which regularly include a workshift of 24 hours or more (some are 48) lead to sleep deprivation, abnormal sleep cycles and could be the incubator for relationship stress outside the workplace.
Fire stations where employees are bullied or hazed or treated with disrespect are breeding grounds for stress and worse.
Burnout, especially with paramedics and other EMS personnel, is yet another concern.
How much responsibility is management and labor willing to take for a workplace as free as possible from factors which are shown to contribute, even minimally, as potentially causative agents for unforeseen responder suicides?
Shift schedules and overtime are hot topics for both union bargaining and fire department operational management; would either group be willing to view such matters first through the prism of suicide prevention?
How much change would they tolerate or participate in to save a life?
The issue of psychological make-up is also very relevant. The basic characteristics of mental and emotional stability, and resilience can be identified and measured; hiring such people often runs afoul of the strong desire to employ family members even when they are wholly unsuited to either the work or the environment.
Managing the short and long term effects of traumatic stress is the never-ending challenge of creating a work environment where mental and emotional well being receives the same emphasis as physical fitness. This is the age old issue of being able to momentarily ignore the natural impulse of profound shock at human suffering while finding ways to process the event properly later. That requires emotional resilience and instilling or maintaining it in first responders is difficult, expensive and crucial.
There is, of course, no bright line between off-duty and on-duty stressors; progressive employers are more likely to adopt a holistic approach to what will keep responders well which means decentralizing some decision making in a profession not known for it.
Which ultimately raises the issue of the psychology of the fire/rescue service, which is a conundrum in itself.
The service is largely made up of folks happy with the absolutes of emergency medicine and application of fire/rescue tactics which are not especially abstract.
Mental and emotional well being, on the other hand, can be quite complex and elusive.
If fire/rescue service labor and management leadership are really serious about eliminating unforeseen responder suicides that goal must be both foundational and over-arching, beginning with the hiring process and transistioning through retirement.
Cherry picking only convenient solutions which are noncontroversial is both a moral and leadership failure.
Eric Lamar has been involved in the fire/rescue service for 45 years, serving as a firefighter, EMT, health and safety advocate and union leader. He lives in Washington, D.C.