Author(s): Gregory Cade. Published on July 1, 2014.

In its May/June issue, NFPA Journal looked at behavioral health issues in the fire service and how depression, post-traumatic stress disorder (PTSD), and suicide are finally being acknowledged and discussed openly by at least some emergency responders.

This new openness is long overdue—recognizing and dealing with the potential underlying mental health issues of first responders has been difficult, especially for responders themselves. Those of us who’ve been in the fire service know the difficulties all too well. We were expected to be “tuff” and unaffected by the rigors of the job. Gallows humor was the order of the day.

We all know that deep down there are experiences that leave scars, and I’ve had my share during my 46-year career in the fire service. One of them occurred 42 years ago, but I can still close my eyes and describe in minute detail the aftermath of that fire: the house, the stairs, the color of the smoke, and what those two children looked like in the burned remains of their cribs.

One of the topics at last year’s NFPA Urban Fire Forum addressed firefighter behavioral health, and it was obvious from the quiet stares and uncomfortable looks of remembrance that a lot of people in the room were wrestling with painful memories of their own. As the topics were introduced—“Phoenix Fire Department Taking Care of Fire Fighters: A Positive Approach to Optimum Mental Health Program,” for example, or “A New Consensus Approach to Firefighter Behavioral Health: Firefighter Life Safety Initiative #13,” by the National Fallen Firefighter Foundation (NFFF)—participants began to recount their experiences with losing members of their departments to suicide. It was stunning to hear how every current and retired chief there had dealt with the issue. One chief recounted a story of a “death row” at one of his stations because several members had slept in that area prior to taking their own lives. Another chief described the shock of a coroner’s accident investigation, which concluded that a firefighter had died by purposely driving his private vehicle into a tree.

Opportunities exist in state and federal government to help with this problem. The majority of the legislative efforts have been at the state level and focus primarily on including first responders under worker’s compensation benefits in cases where PTSD can be shown to be connected to stressful incidents. In Congress, we are working with the “committees of jurisdiction” over the Department of Health and Human Services and the Department of Homeland Security. Committee staff on both sides of the aisle have been open and helpful with suggestions when we have met with them to explain the scope of the emergency responder behavioral health problem, and several staffers have approached us with ideas.

Working with members of Congress, we are trying to ensure that programs like those developed by the NFFF and the Phoenix Fire Department are available to the other 33,000 fire departments in the U.S. through grant eligibility. At the Department of Defense, we are connecting with mental health care providers working in the special operations community, people trained to be self-reliant in solving difficult problems—there are a lot of lessons that are directly transferrable to the first responder community.

We’ve seen the value of providing mental health support following large-scale incidents involving first responders. We need to expand those efforts to responders who may suffer from the long-term effects of smaller, continuous impacts that can build quietly until they explode. Investing early can save us from wondering how it happened, and why no one noticed.

Gregory B. Cade is division director of Government Affairs for NFPA.