Ask, Care, Take

The stigma preventing firefighters from asking for help is based on fear and ignorance — afraid of being ridiculed or not knowing how to get help.

In fact, your department is three times more likely to experience a suicide than a line of duty death.  Because we are supposed to carry the “John Wayne, Superhero, Nothing Bothers Us, Don’t Talk About Our Feelings” mindset around with us everywhere we go, we are just now beginning to address this issue.  A few years ago, I wrote of an incident wherein a friend and neighbor of mine (a law enforcement officer) committed suicide in my other neighbor’s back yard and I was the first medical responder to arrive.  I would like to write this quarter on another incident that occurred to me when I was a newly promoted officer. 

An employee approached me and said, “I’m really struggling and I have been thinking about killing myself.”  I was relatively untrained in how to deal with this situation and was a bit taken aback by it.  I told the employee that I didn’t really know what to do, but I needed to make some calls to find out about getting them some help.  I asked if they were going to be alright while I made the calls and the employee replied that they would be.  Thank God I was able to get the employee assistance and they are still thriving in our service today.  Since that time, I have obtained quite a bit of training on firefighter behavioral health and suicide.  Looking back at the incident, I’m certain I could have handled it better.  I am also grateful that the situation presented itself like it did.

You see, many of us are carrying around the emotional burdens of the many terrible things that we have seen throughout our careers.  The “bad call tank” or “file folder” is where all of those terrible sights, sounds, and smells live in our minds.  I’ve often wondered, as my career has progressed, if that tank ever gets full.  Some in our service may be experiencing financial troubles, divorce, or other relationship problems.  If you throw in some “bad call tank” leakage you have an extraordinary burden that we must overcome.

A number of years ago, an instructor described the effects of violent video games on school shooters.  It was posited that the video games do not cause a young person to commit an act of mass violence; however, the repeated exposure to violence in the video games enables them to carry it out once the trigger, whatever that might be, occurs.  In the last year, I attended a presentation conducted by a captain in our service discussing firefighter suicide.  This instructor suggested that the decision to commit suicide is often caused by a myriad of factors.  The most prevalent among these are feelings of burdensomeness and loneliness.  The ability to complete suicide is achieved through repeated exposure to painful or fearsome events.  STOP. 

Know anyone that is repeatedly exposed to painful or fearsome events?  Firefighters, law enforcement, EMS, abused children, etc. are all potential candidates here.  If you add to this a sense of fearlessness and a loss of survival instinct and you will have a high-risk individual.  To be clear, it is not the repeated exposure to traumatic events that is causing us to commit suicide, any more than the video games are causing people to commit acts of mass violence.  Instead, they are enablers.  They are what allows us to complete a suicide.  The decision to complete a suicide is still rooted elsewhere and prevention is easier than one might think.

First, we have to be able to talk about it.  The stigma preventing firefighters from asking for help is based on fear and ignorance — afraid of being ridiculed or not knowing how to get help.  News flash – firefighters are dying, every year, from suicide.  Now that it’s out there, we shouldn’t have a problem talking about it.  If feelings of burdensomeness and loneliness are the biggest contributors to the decision to commit suicide, then social support and social connections will be the biggest preventers.  I know we still have to be the “I can handle anything, super-firefighters” that don’t talk about suicide, feelings, and stuff like that, but consider this.  If you have a firefighter who is normally pretty conservative operationally that is now taking extreme risks, that is a red flag.  If that same firefighter is talking about being a burden to the department and has withdrawn socially from his friends, that is three red flags.  Perhaps the firefighter is also going through a divorce, is financially struggling, and has developed a significant alcohol problem. That’s like six red flags.  You basically have two options.  You can ignore them because we’re not supposed to talk about stuff like this or you can ask them.  As uncomfortable as you might be talking about feelings, suicide, and the like, you are probably doing them a disservice if they are feeling lonely and you notice that and then walk away.  Ask them because you may not get another chance to ask them later.

So, what do we ask them?  The U.S. Army uses the acronym ACE — Ask your buddy, Care for your buddy, Escort your buddy.  The National Fallen Firefighters Foundation uses the acronym ACT (Ask, Care, Take).  They are identical in their meanings.  We have to ask them, “Are you thinking about harming yourself?”  An even better question is, “Are you thinking about killing yourself?”  This is harder than it sounds.

During a training session I attended, the instructor continually hit me in the head for doing it wrong.  First, I asked, “You’re not thinking of killing yourself, are you?”  The instructor told me not to frame it as a negative question.  Then I asked, “Have you been thinking about hurting yourself?”  The instructor hit me again and said I was shaking my head “No” while I asked the question.  Finally, after multiple attempts, I got it right.  The question is, “Are you thinking about killing yourself?”  Often people will say that they don’t want to ask the question because they don’t want to plant the idea in the person’s head.  You will not.  If they are having suicidal ideations, asking them about the ideations will not plant the idea in their head.  In fact, asking them shows them that you care about them, even if they are not having suicidal ideations.  This may be the first step to prevention.

Next, we want to care for them.  This should involve identifying if our firefighter has a plan and securing the means to complete that plan.  Caring for them also involves staying with them and listening to them.  This may seem mundane, but it again shows the individual that you care about them.  If they were lonely, they are not as long as you are there.  If they feel like a burden, you can reassure them that they are not.  Caring for them may also involve getting family members or friends involved, with our firefighter’s approval.  Care for them because you may not get another chance to care for them later.

Finally, we take them.  If we feel that they are an immediate danger to themselves and we don’t feel comfortable leaving them alone, we may need to take them to a medical facility.  It may require that we take them to a medical facility with which they don’t frequently interact to protect their privacy.  If our firefighter is not willing to go with us, it may involve law enforcement and can get pretty drama-filled quickly.  However, you would likely prefer to err on the side of your firefighter than to leave them and find out the next morning that they committed suicide.  Take them because you may not get another chance to take them later.

The incident that occurred to me was easy.  Not many people in our business are so forthcoming with their feelings.  If only they were.  Not every firefighter will be wearing a “help” sign.  We have to often figure it out.  It is important that we pay attention to our brothers and sisters.  Every one of these incidents has consequences that extend far beyond a firefighter committing suicide.  The department will be rattled by rumors and inuendo.  Supervisors will be forced to ask themselves if they did enough to help.  Colleagues will blame themselves and wonder why they did not do something to prevent it.  The responders will be forever plagued with the details of the incident in their “bad call tank.”  The fallout will also extend well beyond the fire service.  I recently learned of someone in our service that committed suicide.  Tragically, the individual’s father, plagued with the guilts described above, also committed suicide not long afterwards.  These incidents have consequences and they are not limited to an individual.

Please, let’s make it okay to talk about this stuff.  If you think someone is struggling in your department, remember to ACT (Ask, Care, Take).  If you are the one struggling, there are countless resources out there that can help.  You are a member of the greatest profession in the world, our fire service.  As a firefighter, you have countless brother and sister firefighters that care about you.  Please do not be afraid to ask for help.  I have a lot of experience with the Lowcountry Firefighter Support Team and they do incredible work.  If you do not know who to talk to, please contact them at www.firefightersupport.org or call them at 843-609-8300.  Even if you do not live in the Lowcountry, they can put you in touch with someone close to you.  We should all care as much as they do about the lives of every firefighter out there.

Be safe and do good.