Over the past several years, mental health concerns that are related to emergency response work have grown dramatically. The days of pushing aside mental health as “part of the job” are, thankfully, behind us.
However, meeting the mental health needs of personnel has proved to be more daunting than some estimated. According to “The Fifth Needs Assessment of the US Fire Service,” which was released by the NFPA in December 2021, nearly 75 percent of responding fire departments don’t have a behavioral health program. Additionally, the likelihood of a department having a behavioral health program appears to be predicated on the size of the population that’s protected. Larger departments tend to have more access to a variety of resources, including PPE, newer apparatus, academy-based training and administrative support, but the fundamental nature of the fire service isn’t dependent on the size of the department. This departmental resource discrepancy, according to the NFPA report, also can be found in other aspects of firefighter health and wellness, including fitness programs, medical evaluations and the implementation of cancer-reduction best practices.
An effective behavioral health program is essential, regardless of department size, and can be implemented effectively by correcting a few misconceptions.
Misconception 1: On-staff professional
Although it can be true that a behavioral health program requires an on-staff mental health professional, simply hiring a mental health professional might not be the best strategy for all departments.
Large-scale behavioral health teams of licensed professionals are expensive. Furthermore, they aren’t required for an effective program. A recent trend for larger departments is to employ a licensed mental health professional to serve as the entirety of the behavioral health program. However, the expense of a clinician might not be reasonable for smaller, rural departments.
It also is important to note that these programs aren’t without risks. A primary concern that’s associated with this single-provider strategy is the ease by which this resource can be overwhelmed. A series of major incidents easily would tip the scales for even a moderate-size department.
Even when a department hires a full-time mental health professional, it’s essential for that provider to engage a growing network of quality, culturally competent providers in that community, although this network might be difficult to establish.
Misconception 2: Expensive
As noted above, some strategies for developing a behavioral health program can be expensive, but it’s important to remember that simply throwing money at a program doesn’t make it successful. Systems that overly strain a department’s resources might be a detriment to both the system’s effectiveness and utilization. Instead of lamenting about a minimalistic budget, it might be more beneficial to focus on identifying the best interventions that make the most financial sense.
Also, it’s easy to become discouraged when starting a behavioral health program if one evaluates larger and often more financially supported organizations. Remember, any model, no matter how small, is a step in the right direction if your department doesn’t have a behavioral health program. Departments that serve exceedingly small populations also might consider partnering with surrounding areas to develop regional peer support teams or to share the cost for a quality training.
Misconception 3: Complicated
Yes, meeting the needs of people is complicated, but an effective behavioral health program doesn’t have to be. Some of the most effective systems are based on the model of simplicity. Consider building your program within the three tiers of intervention.
Primary Intervention. In an effective behavioral health program, the number one goal of the program’s development should be that of a primary intervention: keeping healthy people healthy. Programs should focus on high-quality education in regard to stress and stress reactions as well as on tools that can help to increase psychological resiliency.
A major component of this phase is the humanization of the department. Program champions can model this using genuineness in their communications with others. Often, simply knowing that one has a support system can serve as a buffer when that individual is faced with difficult circumstances.
Find useful and engaging speakers who are culturally competent of the fire service and its members’ service to deliver your department’s annual mental health training.
Just as it’s easier to teach CPR before it’s needed than it is to teach it when it’s needed, it’s easier to teach psychological resiliency to someone before it’s needed than during a crisis.
Secondary Intervention. One of the best protectors of positive outcomes is early detection. Unfortunately, secondary intervention often is one of the most overlooked aspects of any behavioral health program. Granted, it can be difficult to determine a way to evaluate potential needs that’s economical but yet not overly burdensome.
In the same way that an annual physical becomes a part of a department routine, so should mental health “physicals”. One way to implement such a program is to empower personnel to critically evaluate their own levels of mental health. Additionally, education as to the early warning signs of mental health struggles (part of primary intervention) enables peers to detect others’ potential issues more easily. Secondary intervention is akin to structural firefighting smoke-reading classes: Someone who is well-trained quickly can identify “interior” conditions that might become rapidly hazardous to a member.
Tertiary Intervention. The vast majority of all behavioral health program resources is dedicated to this level of intervention. From critical incident stress models to trauma-informed psychotherapy and medical assessment, tertiary intervention deals with a department’s response to someone who is in trouble. This level of intervention is vitally important and requires a network of trained professionals to assist.
Plans for responding to suicidal ideation, alcohol and drug abuse, and post-traumatic stress reactions are part of this phase.
Tertiary intervention is similar to responding to a commercial structure fire that was preplanned: Sure, there will be some surprises, but you arrive on scene with an array of effective tactical options.
Misconception 4: No development resources
Fortunately, the misconception that there are no behavioral health program development resources is the easiest to correct. There are hosts of people and organizations who are happy to assist a department to gain usable and comprehensive information to better navigate emergency services behavioral health support.
For example, recently, the First Responder Center for Excellence began to work on a road map to guide department champions—from chief to firefighter, from director to EMT—through the process of program development and implementation.
The first step
Gaining input from a variety of means is an excellent plan for finding options that fit both your department’s needs and its budget. Remember, the most crucial step that you can take to develop an effective program is the first one.
Derrick Edwards
Dr. Derrick Edwards is a Tennessee Licensed Professional Counselor and a mental health service provider. He received his master’s degree from Tennessee Tech University (TTU) and his doctoral degree from Trevecca Nazarene University. Edwards currently serves as an assistant professor of psychology at TTU, where he operates the TTU Responder Health Lab. His research focus surrounds the psychological effects of being an emergency responder. Edwards joined the fire service in 2004 and is a licensed AEMT.
