Peers helping firefighters change culture

Working to eliminate stigma associated with mental health issues

This is the second of a two -part series covering the mental/behavioral health issues affected by firefighters. Nov. 26: Mental health issues often unreported in

fire service

Nov. 27: Changing the culture and breaking down barriers

Bill Mastroianni, a lieutenant for Euclid Fire Department, believes that changing the culture of the fire department is a key step in eliminating the negativity associated with mental/behavioral health issues in the industry.

“We need to start by changing the stigma in the fire service that we are all tough guys

and don’t have feelings,” said Mastroianni, who also is director of operations for Ohio Association of Professional Fire Fighters. “To make this happen we need to have a significant change in the culture as well. We need to recognize the signs of behavioral health issues amongst our brothers and sisters and get them the help they need.”

The lieutenant realizes that this won’t happen overnight, but he said that they have made a significant step in the right directions with their peer to peer support teams.

The International Association of Fire Firefighters and OAPFF are taking a hard look at the mental/behavior health issues occurring in the fire services industries by working to break down the barriers and remove the stigma associated with the mental health issues faced by firefighters through a relatively new peer support program.

The peer-to-peer support program is comprised of firefighters who receive training in active listening skills and crisis intervention. They learn the signs and symptoms, and they learn things to say that will work and things that should avoid saying because they might be a trigger or create more barriers and they provide a bridge to the services that the firefighter may need, according to Jim Brinkley, director of Occupational Health and Safety at IAFF.

“I may be reluctant to go in and speak to a clinician with the employee assistance program because I don’t trust them, they are a part of management,” Brinkley said. “But if I work with another peer, a fellow fighter who knows and has worked with that clinician and can tell me what to expect… and that my chances of coming back to the job full time are in my favor if I seek that help (then) that helps break down the stigma and helps build that trust.”

“We are taught a lot during those few days of training. A lot of it is the same skills a counselor or therapist would use — active listening, empathy towards the individual you are speaking of and talking about education,” said Matt Askea, a lieutenant in the Akron Fire Department and a peer support leader.

He describes the program as being proactive

as opposed to reactive and notes that mental health in the fire service has been historically reactive with critical instances stress management.

There have been a lot of support models out there in the past, according to Brinkley, most of which he describes as being employee assistance programs which are employer clinical based programs where employees could reach out to clinicians if needed.

“Firefighters do not trust anybody but themselves especially when they are hurting and they need help,” Brinkley said. “What we learned many years ago was that the peer support model is the most effective, not only does it reduce the stigma, it helps build resiliency.”

He also notes that it’s a system firefighters are already used to. They rely on their peers, rely on each other in the firehouse for everything that they do including sharing their deepest darkest secrets to telling about the stuff that makes them the happiest.

“So having a peer based model that has clinical oversight is the key to successful treatment and is the key to breaking down that barrier,” he said.

Ohio currently has 30 firefighters throughout the state who are able to deploy to stations across the state or the country to assist with peer support services when firefighters are in distress, whether from a traumatic incident they responded to, line of duty death or suicide of a co-worker.

“The program just rolled out in Ohio this year, so with it being in its infancy, it’s still to early to measure its effectiveness,” Askea said. “Basically we are trying to figure it out, it’s all a work in progress right now.”

Mastroianni noted that the peer support team has only done a few things at a local level as they are trying to get more people trained as peer supporters.

“We haven’t had a huge need for it in Northeast Ohio, but if we do have something we are ready to be dispatched out there to help them with whatever behavioral needs they may have,” he said.

If a firefighter needs more assistance than what a peer can provide, the IAFF has teamed with Advanced Recovery System to open the IAFF Center of Excellence for Mental Health Treatment and Recovery just outside of Washington D.C.

According to Brinkley, almost 160 firefighters have been treated at the 64-bed facility which just opened this in March. Approximately 40 percent of the 160 were treated for PTSD.

“That is a high number, 40 percent,... No one would of thought the number would of been that high when we first opened,” he said.

Brinkley feels that what makes the Center of Excellence different from other treatment programs besides it being just for firefighters, is that it offers an aftercare program.

“From the minute the firefighter enters treatment in the Center of Excellence,we start working on the aftercare program,” he said. “A case worker starts to identify resources back in the firefighter’s local community...see what services are available and start to establish connections.”

All firefighters treated at the center leave there with a written, 18-month aftercare plan.

In addition to the peerto-peer support group and the Center of Excellence, the IAFF includes in all its events, programming on behavioral health, everything from their “Stamp out Stigma” education program to addressing PTSD through peer support and a session on the Center for Excellence.

Brinkley notes that five years ago a behavioral health class was the least attended session at events, but now they are the highest attended.

“I think the stigma is going away. I think we are breaking down that barrier,” Brinkley said. “The battle isn’t over, but I think the education up front, building the resilience, the peer support, and then having the safety net of a center where you can go where other firefighters are being treated is going a long way.”