Behavioral health emerges as a key concern in NFPA's most recent needs assessment survey of the U.S. Fire Service
BY ANGELO VERZONI
IN THE SUMMER OF 2015, city officials in Biddeford, Maine, a small, coastal city 20 miles south of Portland, sought benefit cuts for public safety workers, citing the need to lessen the burden on taxpayers. Labor unions representing Biddeford’s firefighters, police officers, and public works employees fiercely opposed the proposals and urged people to protest them.
In an interview with the Journal Tribune, Biddeford firefighter and union president Tim Sevigny said the proposal to cut health care benefits for retired firefighters specifically irked him, as many active and retired firefighters suffer from post-traumatic stress disorder (PTSD) and need behavioral health care. “The dead people we see [on the job] are not like the dead people you see at a funeral,” Sevigny told the newspaper, adding that the most difficult part of the job is “seeing people who’ve shot themselves in the face, hanged themselves, or overdosed.” Sevigny’s concern illustrates a problem facing fire departments nationwide: the need for behavioral health care for firefighters to treat PTSD, substance abuse, and other conditions brought on by the stressful and at times traumatic nature of the job.
According to the fourth and most recent Needs Assessment Survey of the U.S. Fire Service, conducted by NFPA in 2015 and published in November, it’s a need that the majority of departments is not addressing internally, with only one-fifth of fire departments reporting that they offer behavioral health programs. The same question was not asked in the previous three Needs Assessments, which include data from 2001, 2005, and 2010.
The 2015 Needs Assessment Survey was sent out electronically and by mail to 26,322 departments across the country. In total, 5,106 departments responded to the survey, and their answers were used to paint a picture of fire service needs in the U.S. and highlight areas that could use more funding.
One of the report’s authors, Hylton Haynes, a senior research analyst in NFPA’s Research Division, told NFPA Journal he was surprised by the behavioral health figures. “It’s an extremely stressful job, and only 20 percent of departments have a program,” he said.
The lack of implementation of behavioral health programs by departments comes at a time of increased calls to action. In September, for example, urban fire service leaders attending the annual Urban Fire Forum at NFPA’s Massachusetts headquarters endorsed a position paper that pointed to the “patchwork of ineffective services” most departments offer when it comes to behavioral health and the need for improvements. “Fire chiefs have an important opportunity to demonstrate leadership and implement a new, more effective framework for responding to their employees’ behavioral health needs,” the paper reads.
Similarly, an NFPA report published in November, which examines results from various research studies on suicide and behavioral health in the fire service, concludes that “it’s no longer a matter of ‘Suck it up and deal with it!’ It’s time to deliver firefighter suicide, behavioral health, and mental well-being awareness and prevention programs at the firefighter level.”
THE RURAL FACTOR
Behavioral health isn’t the only health care area where departments have room to improve, according to the assessment, which also found deficiencies in basic firefighter fitness and health programs that departments are required to maintain by NFPA 1500, Fire Department Occupational Safety and Health Program. Overall, only 27 percent of departments have such programs, the assessment shows. This is down from the 30 percent that reported having them in 2010. The 2015 figure translates to an estimated 716,000 firefighters currently working in departments without a program to maintain basic fitness and health.
In both behavioral health as well as general health and fitness, rural communities are driving averages down. Only 10 percent of departments in communities of fewer than 2,500 people have behavioral health programs, according to the assessment, whereas such programs exist in 76 percent of departments serving cities of 500,000 or more. Similarly, only 15 percent of rural departments said they had programs to maintain basic firefighter fitness and health, compared to 89 percent of departments in large cities.
In an interview with NFPA Journal, Mark Light, CEO and executive director of the International Association of Fire Chiefs, speculated that while departments might want to seek funding for health-related programs, they can’t because they still struggle to fund the more tangible, day-to-day needs like acquiring new personal protective equipment (PPE). For example, even though the largest share of federal Assistance to Firefighter Grant (AFG) program funding from 2011-14 was distributed for PPE, 72 percent of departments reported in the assessment that they had PPE that was at least 10 years old, up from 63 percent in 2010. In contrast, health and wellness programs were awarded approximately 1 percent of total AFG funds in those four years.
Kevin Quinn, chairman of the National Volunteer Fire Council, had a slightly different take on why rural departments in particular aren’t seeking funding for health programs and other resources: A pattern of denied grants has left them feeling discouraged, thereby leading fewer departments to even apply for grants. When rural departments do apply for grants, Quinn said, applications are often poorly written or are filed improperly.
“You read some of these grants and you’ll know the department needs this money, but they’re not following directions or not writing it clearly and concisely enough, and so they don’t score well,” he said. “They aren’t funded.” Quinn said the NVFC is determined to combat this issue through a continued push for federal funding for rural departments and education efforts to improve rural department heads’ grant-writing skills.
Asked about behavioral health programs specifically, Light pointed to a number of other challenges preventing the implementation of effective programs, such as a lack of data pertaining to firefighter suicide attempts and suicide mortality rates. “There has to be some way of dealing with that issue and tracking that issue and not creating an environment that puts a stigma on a firefighter who admits they’ve thought about suicide,” he said.
Volunteer firefighting presents a special challenge to quantifying this issue, according to Light. “What happens when you get someone who’s an electrician who’s also a volunteer firefighter who commits suicide?” Light said. “How do you then make sure that triggers someone to realize he was also a volunteer firefighter? I think that’s very difficult to do when you have people from all walks of life serving as volunteer firefighters.”
On a positive note, Quinn said he believes the percentages reported in the Needs Assessment do not reflect the number of rural departments that do provide their firefighters with behavioral health care or other resources. For example, he said, if firefighters in a rural department have seen something horrific, the chief would likely connect them with community resources to handle the effects of such a situation—an informal process that isn’t typically documented. Quinn also contends that in some ways, rural departments have an advantage over urban departments when it comes to behavioral health care because of the tightknit nature of small communities, which he said can provide emotional support to those suffering from behavioral health conditions.
Outside of health care–related topics, Haynes said he was surprised the assessment showed a lack of community risk reduction activities. For example, 89 percent of departments said they did not conduct a wildfire safety program, and 88 percent said they did not conduct an older adult fire safety program. In these areas, the differences between urban and rural communities were less pronounced; less than one-third of departments in communities of 500,000 or more reported conducting wildfire safety programs and only about half reported conducting older adult fire safety programs.
Overall, the 2015 Needs Assessment contains nearly 40 percent more information than the last three assessments conducted by NFPA. This is due in part to an extended question set to address emerging concerns, such as fire service response to active shooters.
Photograph: International Association of Fire Fighters
The IAFF partners to open a landmark facility to treat firefighter behavioral health issues
The International Association of Fire Fighters will soon open the first-ever in-patient treatment facility catering exclusively to firefighters suffering from post-traumatic stress disorder (PTSD), substance abuse, and other behavioral health conditions. The IAFF Center of Excellence for Behavioral Health Treatment and Recovery is slated to open its doors in March on a 15-acre property in Prince George’s County, Maryland, just outside of Washington, D.C. The center is a collaborative effort between the IAFF and Advanced Recovery Systems (ARS), a Florida-based behavioral health care management company.
The new facility addresses a growing need in the fire service, according to Pat Morrison, assistant to the general president for health, safety, and medicine at the IAFF. The rates of PTSD and suicide among firefighters have been increasing for the last decade or so, Morrison told NFPA Journal, and when an article on the issue appeared in the winter 2016 edition of the IAFF Fire Fighter Quarterly, the response from readers illustrated just how rampant the problem is.
“Our phones rang off the hook,” Morrison said. “We had people calling us who said they had issues they didn’t realize they had until reading [the story]. Now they knew they needed to get help. They needed to talk to somebody about the feelings they had suppressed throughout their career. It was crippling them.”
The reaction to the article, titled “Bringing PTSD Out of the Shadows,” came at a time when IAFF General President Harold Schaitberger had been hearing a lot about the behavioral health problems facing firefighters as he visited with them throughout the United States and Canada. “As I travel across our two great countries, I hear firsthand about the struggles some of us face with post-traumatic stress,” Schaitberger said in a statement posted on IAFF.org. “It’s a condition that affects our members at double the rate of the general population. But there have been few programs to address it.”
Over the summer, IAFF and ARS met for the first time to begin planning the center, which will include 56 beds and be staffed by a combination of behavioral health professionals and firefighting peers from the IAFF and ARS, Morrison said. The IAFF hopes the center, which is available only to IAFF members, will flourish into a large-scale program with multiple locations.