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To the Breaking the Stigma Podcast with McNeal and Company. The mission of this podcast is to offer education and resources for first responders, wellness, mental health, and resiliency. The hosts of this podcast are not mental health professionals, but all information shared will be in conjunction with either a certified training or mental health expert. We are here to break the stigma around mental health discussion. That being said, some of our topics may be triggering or upsetting to our listeners. If at any time you are overwhelmed, we encourage you to pause the podcast or forward to the end where we will list the hotline. You can call for immediate help and conversation with a professional. Please be safe and gentle with yourself. We need you here and we want to help

Everyone. Thank you for joining us for another segment of Breaking the Stigma. I'm Jason Salazar with McNeil and Company, and today I'm joined with Dave Lewis . Dave, thank you so much for coming on today, coming onto this podcast with us and talking about another subject with mental health. Dave, can you tell us a little bit about what you do?

Sure. Thanks Jason, and I'm glad to be here. Uh , I've been an emergency services provider and as a firefighter at E M T for , well, for 51 years now, although, I don't know , run on calls anymore. And I continue to support my local volunteer fire company in an administrative and support role for the last 20 years, have served as emergency services instructor. I call this my giving back time of life. So many people helped me succeed in my fire service career, but I wanted to reach out and help other future leaders develop their skills that they need to be successful. I've been honored to work through positions in my own department and serve as a past chief officer and as a company president. Not stopping there. I moved through the chairs and served as president of my County Firefighters Association and of by State Firefighters Association. I presently serve as one of the Maryland State Directors to the National Volunteer Fire Council. I also serve as chair for the Maryland Fire Chiefs Association Safety and Health Committee. Between my work as an instructor, as an N V S E Director and chair of the Safety and Health Committee, I find myself more concerned with the safety and health of our fire and e m s personnel. That's what piqued my interest in the challenges of mental health for our first responders. The last couple years I've worked hard to increase the mental challenges of being a first responder. I've delivered awareness training programs across my state, other state conferences and training events to increase this awareness. I guess it's kind of my passion now

In terms of mental health. What have you been working on directly , uh, for first Responder Mental health?

Well, I , you know, the first thing I've, I'm kind of looking at is a lot of, a lot of training, a lot of awareness , uh, participating with the Health and Safety Committee to try to increase the awareness across our state , uh, doing training awareness. I've probably, probably in the last six months, have delivered six or eight training programs on a program that I put together. It's called, it's Okay to Say I'm Not Okay. The work's become important to me. You know, the , the , the sad part of it is, is there , there's really no national level of reporting of firefighter suicide. Jeff Di Jeff Dill demonstrated to us . He looked at the mental health challenges to responders and after Hurricane Katrina in 2005, and Jeff was astounded to found that there was really no data collection system on these statistics. Since then, Jeff and what he formed as the Firefighter Behavioral Health Alliance has demonstrated to us that we lose more than twice as many responders each year to suicide than we do Line of Duty causes. In 2020 alone. We list 62 first responders as dying in the line of duty. In the same year, Jeff and the Firefighter Behavioral Health Alliance documented 125 suicide, and Jeff will even tell you that he considers those numbers to be less than half of probably the actual number of suicides. 'cause quite often the data, since the data's not collected, there's really no way to get it unless somebody kind of makes a phone call to Jeff. I've kind of taken that as a , a personal crusade, a personal passion of mine to make all first responders aware that our job is just as mentally demanding as it is physically demanding. No longer can it be acceptable that we hold those mental challenges behind closed doors. We need to bring it out to the forefront and realize that it is an occupational risk to us, and we need to have the tools, the resources, and the training to go with that.

You know, when you take a look at, I think, nationwide , um, the current climate for , uh, mental health, it's, it's getting there, but it's still not what it should be. It's still not what we, there's so much more we can do with those statistics. Is there anything state legislation is doing, or is there any kind of current stuff that they're trying to come out with to help make it more accessible or more, a little bit easier to talk about for first responders?

That's, that's another sad tale. You know, I , I , I get a chance to travel around the country and I , I find some, some areas have actually done pretty well, but most areas not , uh, you know, the fact that there is very little legislation at either state levels or federal levels to even acknowledge the issue, much less provide funding to address this in Maryland just yet , last year we passed legislation that acknowledges the value of peer counseling systems and charges that our Department of Health and our state e m s organization develop a report on best practices. Now, that's just a small step, but at least it's some legislative acknowledgement that says this, this is an issue that we need to , we need to be looking at. And it starts us in a direction that acknowledges those challenges and begins state support of the programs to address it. As I look in the federal side , uh, in the fiscal year 2021, department of Homeland Security Appropriations Act charges the US Fire Administrators to collect the data on firefighter suicide. Uh , Dr. Gloria Morell will tell you that , uh, that that's a little bit of a challenge because, you know, currently the US Fire Administration collects data through the Firefighter Fatality Program, but those are on duty deaths . And, and so it really doesn't include any data on suicides unless it was initiated on duty . So, if you looked at the US Fire Administration data on firefighter fatalities since 1976, there have only been six firefighter suicides, and we know the numbers are much greater than that. I just showed you some of Jeff DI's numbers. Problem is suicide doesn't typically happen on the job. You know , we take our struggles home, and it could be days, it could be weeks, it could be months or even years before we , uh, experience, you know , uh, years of experiencing continued trauma and death that a firefighter makes that decision to end his or her life. Even under the public safety, be Officer benefit benefits are paid to survivors of a public safety officer dies in the line of duty . Now, let's look at that. In 2003, the P S O B was expanded to include survivors of public safety officers who suffer heart attacks or strokes within 24 hours after strenuous line of Duty Act. Perhaps it's time to take a look at that with P S O B to recognize mental health challenges that re result in suicide. Obviously, 24 hours wouldn't, wouldn't be the right window of time, but sometime after, after they're duty there, I am intrigued. I've kind of looked at, looked at some things going on at the federal level. Uh , there's some, certainly some things going on in Congress right now , uh, with the helping emergency responders overcome, called the Hero Act, provide critical mental health resources to our nation's first responders. So legislations passed through Congress and now sits in the hands of the Senate for Action. So let me return to the question, you know, what should legislation look like? Well, each level of , of government, federal, state, and local must first acknowledge the mental stresses to first responders and provide the resources that are needed to combat these challenges. We had to expand our workers' compensation legislation to acknowledge mental issues as an occupational illness, much as we do with heart attacks and cancer. I've actually heard stories of emergency service personnel who were denied workers' compensation claims because claims in the risk management world, they weren't injured on the job. Well, that's far from the truth. They have been injured on the job. It's a brain injury. It may not be a physical injury, but it is a brain injury, and we need to acknowledge that . So our legislation needs to change, you know ? Yeah,

It definitely , it definitely sounds comparatively when you, when just listening to the statistics you gave of how they're not recognizing suicides or recognizing it more on actually on the job and actually not taking into account when you get off a shift. So it sounds like there's still, there's some fires in the , uh, irons in the fire, but it's still out there where it's taking a little bit of time to get some of these programs running, and like you said, with places not recognizing them because they said it wasn't an actual physical injury. You know, you raised a great point. When you think about, when you think about any kind of mental health issue, we do, we, you know, it's a, it's a battle that someone can't physically see, but I think a lot of places are still looking at it, is that, well, if I can't see it, it's not a real thing where it's a huge thing. And I think anymore in the first responder world, when you're taking a look at mental health issues, I think that's part of the problem is that so many people tell these guys that they're so used to seeing injuries, seeing stuff like that, that they're not really recognizing that, Hey, this is a huge issue for me. I know you said you're, you're a part of a statewide task force . Can you tell us, tell me more what that entails, what it is, and how essentially came about?

Absolutely. Uh , uh, under the leadership of the Maryland State Fireman's Association President Ben Kurtz , who just, just took office in June , uh, we established a , a statewide task force to address mental challenges to first responders in our state. So we're still a little bit in our infancy, but, but we're gaining some traction. Uh , our task force is jointly represented by the Maryland State Fireman's Association, the Maryland Fire Chiefs Association, the Maryland Fire and Rescue Institute, which is our state , uh, training organization and the Maryland Institute for Emergency Medical Services Support System, our state e m s system. And we established some goals , pretty , pretty straightforward goals , uh, number one , to increase the awareness of mental health challenges for all first responders. And number two , uh, address the needs of both responders and their families who suffer mental health issues. And number three, to provide tools and resources to departments to address these challenges. Number four, provide training to members and the leaders of the departments to increase awareness and help build a peer support system. And fifthly serve as an advocate for legislation to address these mental health challenges.

It's, so you said that you guys do have , um, you increase awareness, help these families out to have, give them the tools and resources. The thing that sticks out to me that you were mentioning was a peer support. We had Jim Hyde from Peer Support Central , um, he, it's a company that will come in, start a peer support program. Are you starting to see that there's more of a need for that out there, because I, you know, my old agency, we had a peer support program, but I'm starting to find out very quickly that not every place has them or has even heard of peer support. Is that something that you're starting to notice, that there's a greater need out there for that?

Oh, absolutely. And , and the studies done by the International Association of Fire Chiefs and as well as the International Association of Firefighters , uh, looking at it on, on the career fire service side, more , more so than the volunteers have , have really looked at that and, and got the value of, of a peer support system. There's no one that understands a firefighter better than another firefighter. And, and that's the value of a peer support system. Uh, we've looked at what people have been able to do with employee assistance programs, which are available through most government entities, but most, most EAPs employee assistance programs don't understand the , the fire and emergency services, who we are, what we do. And, and quite honestly, you know, it's almost like they need counseling by the time they get done, talk to us, and we talk about the, the death and destruction that we've experienced . So nobody really understands us better than we do Now , that's not to say that everybody can or should be a peer counselor. Uh , there was , there was an , an initial effort in our state to immediately jump into peer counseling. And I , and I said , whoa , whoa , you know, let , let , let's pull the reins back a little bit here. Start with the boots on the ground and make sure that every firefighter is aware of these challenges, and we accept those challenges and we understand that there's resources available. Then we pick the next level of people and, and , and , and identify that these next level of people can and should serve as peer counselors. And we give them the adequate training, guidance and tools in order to, to do their job. And , and that really, really kind of be becomes, if you would, kind of the first tier, because there are some people that are going to have to get into, into clinical care systems, you know, whether it be inpatient or outpatient, but they're, they're gonna , they're gonna require some, some expert medical assistance. 'cause a lot of that , what happens in the mental wellness, it's a brain injury and it's a chemical imbalance that occurs within your brain. And quite often, I mean, people put it down and says, well, they're just treating these people with drugs. Well, they're put treating 'em with drugs because they have to alter the chemical balance of their system because there's just something in there that causes them to trigger a little bit more than others. And therefore, therefore, the, you know, pharmacology that goes behind that is meant to create, create a , you know, the correct chemical balance with inside the brain. It, it , it is an illness. I'm , I'm

Glad you opened that up more because it, it definitely does seem like there's such a huge need out there. What , you know, what you said, no one understands a firefighter better than a firefighter. I think that is such a great example. Um, because it's, it's one thing to talk to a counselor, a therapist, psychiatrist, but it's another thing talking to someone who said, I've, I've been there. I've, whether I've been on a , uh, a call like that, I've gone through this with my family or what have you. I think think it does, it , it opens up , uh, more of a open dialogue, a better open discussion forum. Because too , I think the other thing that people are, you know, you get nervous about is, you know, well , am I fit for duty ? Is this gonna affect my job? Um, that's the great thing with peer support is you do have someone to kind of vent, not only just vent to, but I , it's, it's therapeutic. It's a good therapeutic process that someone can go through with a coworker or someone who's been in their shoes , um, or someone who just is , at least I get the job for the task force . What is the training approach for mental health and wellness in the task force ?

Uh , great question there. You know, if you look in , uh, I I , I look at the, the mental health education and mental health awareness as in a multi-tiered approach , uh, very similar to what we do in, in hazmat training. First is the awareness level. Uh , every firefighter and e m t needs to understand the mental health challenges of the job and the resources that are available to them when they struggle. Then the second tier is the operations level, the company leadership, the lieutenants, the captains, the chief officers needs to know how to address these challenges. When a member comes up to me and say, Hey, Kat , you got a minute, can we talk? You know, because quite honestly, some of 'em say, I don't, I don't wanna say yes because I don't know what to do. I don't know what to tell them. And so that officer needs to know, you know, how to address those challenges and what resources they have within their department that can be offered to these members. And then our third tier is the technician level. That's kind of our peer counseling system, right? They've been specifically trained to support the members and need , need a clinical care. Um, and, and, you know, the , the there. So, and kind of where we are right now is, is on that awareness level. Like I said, I've, I've had that opportunity to take my program , um, throughout the state of Maryland and, and even other states, probably six or eight times this year. I've kind of lost count already. I I did two of 'em this week, a matter of fact. Uh, because it's, I , it's that important that we, we at least start with the boots on the ground, let them know. Then our next steps are gonna be, you know, hit that operations level and that technicians level.

What, what stands out to me too is we, we've talked to in previous podcasts of leadership, when we look at leadership, when we look at a good leader or someone that you can go to talk to, it is definitely hard too , because I think it's, it's a , it's a two-way street. You're afraid possibly to go to your lieutenant , uh, to your chief, what have you, to talk about these things. But is it also a two-way street? Where is having that open door policy, how much of having an open door policy and saying, let's talk about these things, let's get 'em out in the open. How much of a key does that play into starting getting these guys and gals , uh, help out there for mental health?

Oh, I mean , that absolutely needs to be there. I mean, because, you know, not only is does it ha had to be that the , the responder themselves, you know, needs to feel comfortable going into their leadership without that , as you said earlier, without, without fear of retribution and that they're immediately gonna send, send me off and , and put me in a rubber room or something like that. Uh, the , the , the company leadership too needs to know that it's okay to go to approach a member and say, how are you doing? You seem a little down lately, you know? 'cause some of them are afraid to do that because they're afraid that the member member's gonna come out and say, I'm not doing good, and then they don't know what to do. So yeah, it absolutely has to be a two-way street. And, and, and there's a lot of things that's , you know, part of the Maryland legislation, you know, there is that, you know, this program has to be treated with, with confidentiality and, and privacy, because essentially it's me medical information. And, and just like any medical information, we have to treat that with privacy and confidentiality. So, so there, there has to be that, and maybe it's not, not so much the , the open door policy, but the willing to, to maybe even meet offsite somewhere because maybe going into the chief's office sometimes gets the other noses route up and saying , why is Joe going in there? So, so there's a lot of things to consider there in terms of, you know, how do we best address that immediate there so that that member is not a , doesn't have fear of coming forward and that officer or even, or even other, other members, you know , there's nothing wrong with another member that , you know, who notice a member of their crew not quite the same as they usually are having that talk. 'cause maybe they're more willing to open up to them more so than they would be going to their lieutenant, captain or chief. Um , so there's , there's a lot to be done there. The

Question that pops up, talking about the task force . Now, do all states have a task force? Is there, some of 'em do, some don't. How does that , uh, work?

Well, I think, you know, some states have , I , I don't think they , every state has a task force, but I think every state, you know, certainly I , I think United across the fire service, we understand, I think we understand this is a challenge and we've had to figure moving , you know, the International Association of Firefighter really does a great job of addressing these challenges for the paid service. You know, they have the resources available. Uh, they, they routinely go out and do the peer training programs, but we had to look at, you know, almost 70% of America's fire Services volunteer and they don't have access to these type of systems. So, you know, some of the things that we've done, as I said earlier, I'm , I'm one of Maryland directors to the National Volunteer Fire Council. Uh , the National Volunteer Fire Council has a program we call Share the Load. And, and we've done a lot in the last, you know, 10 to 15 years in addressing this, in providing tools and resources mainly to help our state members. 'cause , you know , membership in the , in the National Volunteer Fire Council is primarily at a state level, but they're also individual there. And through the Share the Load program, we've been able to provide that. Uh, we , we've actually recently generated a compendium, if you would, of clinical resources that are available in each and every state. And so there's an online reference that I could look up Maryland and they'll gimme seven or eight people that they have vetted that are out there and available to us. Uh, we also have a , uh, a booklet that we put together and , and a training program that comp companies that look for , uh, developing a psychologically safe , uh, fire, fire department. There's some things being done, you know, with us at , at the N V S C level to try to help our state membership. And, and, and we're getting deeper into that too. Uh , we're partnering closely with the International Association of Fire Chiefs, the volunteer and combination officer section. Uh, they published in, in 2017, they published what we call the Yellow Ribbon report, which is looking at the , the , the mental health issues in , in , in the fire service. Uh, just in 2022 , uh, the Yellow Ribbon Report went through an update, and in that update is, are 11 best practices that have been defined , uh, that departments should consider and kind of putting together support programs for that. So, so there's some things coming out at a national level to really help the states and help the individual departments , uh, get on board with this. You know, unfortunately we don't have the, the power of the, of the International Associates of Firefighters, but we we're making headway and, and , and I'm, I'm really excited about where we're headed.

If there could be a lesson, I mean, I that , and that is something that I would love to see across nationwide, is see a task force like you guys work on, you know , talking about the task force and you said, you know, not every state, you know, has that, is there a way, even if it's not directly the exact task force you have, what is a way that more states can get on board with these kind of best practices? When we talk about peer support, when we talk about training, getting that recognition out there, and also getting the awareness out there. How, how is it that we could see more states get on board with this?

Well, I , I think for us, in , in the volunteer side of the service, that's sort of the National Volunteer Fire Council, and I think it's , uh, incumbent upon , uh, each of the state directors and, and we have state, state director representation by almost all the 50 states. Uh , and for those state directors to get that information back to their state leadership and , and their state fire associations and their state fire chiefs associations and take advantage of that, you know, NV N V S C has , has made the offer to not only provide the publications, but also if need be when you , you have a state conference or state weekend, send somebody out and deliver , deliver the training program that goes with that. So I think, you know, I think that , you know, the N V S C is, is, is gonna help these states put, put together these programs, but, you know, it kind of, kind of has to, has to , has to flow downhill , you know, the information has to flow downhill to get there.

Absolutely. Just getting that , getting the word out, getting that awareness raised. I think definitely, like you said, I think it'll definitely bring some great awareness out there. It'll, when, when we're looking at, if we look at the nation as a whole, what are, are there some great good trainings that, let's say there's an agency , uh, on the West coast that they're trying to figure out with mental health. What are some trainings that agencies across the country, anything else out there that they can look into or a piece of advice when dealing with mental health? If they're not used to really having a peer support program, what is a piece of advice you would give them?

Uh , that , that's a good question because, you know, all, every, every National Fire service organization, whether it be the M D S C , whether it be I S C and dcos , whether it be I s F , whether it be the National Paul and Firefighters Foundation, every , all the national organizations are there, and they've kind of, kind of gone down their own lane, if you would. At least they're a parallel lane. They're , they're not going off in different directions. But, you know, there really would be, you know, part of , part of what got done, you know , probably in the last five years was to kind of, kind of maybe bring like a consortium or have a summit between those organizations together that says, how do we maximize all of these efforts together? And, and , and maybe we need some kind of, you know, mental wellness summit . Just like we had a cancer summit within the last couple years where , where those organizations talk about what are you doing? What are the best practices, and what can we all learn from it? And what can we, what can we work together? And, and especially in that advocacy part, how can, how can we push together in order to influence federal legislation to bring, increase the awareness, increase the level of , of support that's provided to these programs. So , so there , there , there's more that can be done, you know, at a , at a national level. And I think, you know, bringing, bringing those national organizations together to make that happen , uh, you know, might be the key to, to, to really making a big leap.

Absolutely. No, that's, it definitely sounds like a lot of this depends on not only a single organization, but it also depends on your neighboring department is kind of having that open forum, getting together, getting those ideas out in the open. You know, Dave, as, as we kind of start wrapping up a little, what, what is your piece of advice? The, the first thought that comes to my mind, you've, you know, you've been doing firefighting for, you know, 51 years and you've seen so many different things. You're involved in so many different levels. What is a piece of advice you can give to an agency, to a captain listening, a lieutenant listening, a chief listening. What is a piece of advice that when it comes to, we're starting to look at mental health of how much more it's growing and how much more we're learning about that. What is it? Yeah ,

Let me first say, you know, change doesn't come easy and, and this requires a change in the culture. And, and the national fallen firefighters found that out in 2004 when they came out with the 16 firefighter Life safety initiatives and said , how do we reduce the line of duty deaths amongst firefighters , uh, life safety initiative of number one was we had to change the culture. We need to change attitudes, beliefs, and behaviors relative to safety on the fire ground and whatnot. Well, the same thing comes here. You know, we, we , we need to change the culture. We need to change the attitudes, beliefs, and behaviors relative to mental wellness. You know, we can't come in there when one of our members is having a bad time. We can't tell 'em, suck it up buttercup, leave it at , leave your egos at the door. You know, we really have to have , have to accept, you know, as leadership, we have to accept the responsibility that this is a challenge. The boots on the ground also must also accept their responsibility to understand that there may be challenges in their head, and there may be a time that they need to reach out for help, and that should be okay. It's not a sign of weakness. We are all human and we all have feelings. It's a change in our culture, and we have to pave, pave the path ahead for that future. So my party words would kind of be, if you're a responder or if you know a responder that's having mental challenges on the job, get help. You're not alone. We're all in this together. We must accept that . It's not just a responsibility of the job, but we need to be able to address the effects of our job. We have to be safe, take care of ourselves , and take care of each other.

Dave, I can't thank you enough. That is, I've learned a lot about what the current climate is, what, what we're looking like and what, what the needs are out there. Thank you so much for coming on today and shedding that light.

Like I said , it's , it's, it's become not just something I do right now, but almost a passion or a crusade for me. And, and like I some talk to people around my state. I said, I will take my, take my training program anywhere, anytime . And I'm, I'm not asking for a nickel. I'm not making a nickel onto it because it , I think the , the need is that strong.

Yeah. Well, and , and trust me, we need more people like you out there, and I, I'm sure we'd love to have you on again. And , uh, we can't thank you enough for coming on another episode. And thank you again and be safe.

This concludes this episode of Breaking the Stigma with McNeil and Company. If you or someone you love needs to speak to someone immediately, please reach out to the National Suicide Prevention Lifeline at 1-800-662-FOUR 3 5 7. We look forward to you joining us for future episodes of breaking the Stigma, be well and go safely.