OPINION: Why PTSD focus isn’t enough

Missing the point about mental health in firefighters

BY: Nick Halmasy

It has been several years since the reality of Post-Traumatic Stress Disorder (PTSD) exploded into public knowledge. This closeted reality within the fire halls is now widespread knowledge. PTSD is no longer a taboo topic to arise over coffee or at the back of the trucks. Yet, or perhaps in spite of this knowledge, the frontline fire service has little understanding of exactly what it is.

Even worse, symptoms of other major disorders have collided with the black dog of PTSD, to fall squarely under that umbrella. It would seem that, far and wide, firefighters are impervious to any other disorder. Or that any other disorder is just PTSD not neatly fitting them. I’ve often spoke of the view that firefighters (and the tri-services at large) have become “martyrs for their communities” in the eyes of civilians, media, and mental health advocates at large. In various stages it would seem there is a unanimous chiming of “it’s only a matter of time” nagging away at would be hopefuls and seasoned vets alike.

While this alone is troublesome to mental health professionals like me who wish for accurate information on mental health, I’ll drop that bone for a second to illustrate how this uni-diagnostic approach is problematic in other ways.

The research climes are beginning to note a shift in focus towards more holistic approaches. As FIREWELL contributor, Robin Campbell, identified in her summary of some of the mental health research, “There is a need to shift the culture among PSP and researchers beyond focusing solely on PTSD as a result from trauma exposure”. I echo this sentiment—this was the main reason that After The Call would not be a “PTSD” site. Our natural shift towards finding ways to be proactive, instead of reactive, will undoubtedly lead us to the need to treat all mental health. Right now, we are asking firefighters to wait until they are really bad to seek help. Why else would we only mandate a PTSD treatment, and no other issues that stem from stress and trauma exposure as well?

I’m a member of one of the three “psychos”: psychotherapists (health professionals who have training in psychological counselling), psychologists (research-based (PhD) doctors who have training in clinical psychology and also has the ability to diagnose), and psychiatrists (medical doctors who have additional training in mental health and the ability to diagnose). Most people have no idea the differences between the three. This is important because I’m no stranger to phone calls from desperate first responders requesting a diagnosis of PTSD from me. As a psychotherapist, my scope of practice does not include diagnosing PTSD. I can relate to these frantic and desperate calls from individuals who are so obviously hurting. Yet, there is a reason that other psychiatrists or psychologists haven’t given these people a PTSD diagnosis yet.

They don’t meet that criterion.

I get it. If you’re hurting, you should be able to get help any way you can. Yet, the clinician and educator in me sees how carte blanche diagnosing firefighters with PTSD makes a system—already unable to handle the demand—even more strapped and unable to help those who do meet their limited criteria. One can have other diagnoses or mental health issues beyond PTSD. But right now, the message being sent is that this is NOT ok. As far as I can tell, this desperation then becomes focused on two extraordinarily important points:

Their culture won’t accept a member having any other diagnosis other than PTSD and;

The Government won’t offer support to any first responder with any other diagnosis other than PTSD.

The inevitable happens: people feel forced to seek PTSD diagnoses. Desperate times, after all, call for desperate measures.

This is where we’ve missed the point.

As educators: we’ve missed the point that while PTSD is certainly extreme, severe, and no joke, is it truly what affects the most people at any given time? What if we trained individuals to identify the genesis of mental health languishing? Effective mental health training can contradict the standard PTSD awareness by including what you may feel physically or emotionally, or what thoughts you might have when beginning to feel the pressures of stress.

As leaders: we’ve missed the point that PTSD is simply one in a whole continuum of mental health issues. While this one diagnosis has a huge price point attached to individuals on sick leave due to it, education on PTSD alone might not necessarily be an effective prevention of PTSD. Years of studies in fire behavior have showed that things don’t often work linearly and we may have to work to control various factors in order to ensure proper fire suppression. Taking those lessons, leaders need to be educated on the nature of stress, trauma, and the rest of the gamut of mental health concerns. Sometimes, ensuring someone has a proper hold of maladaptive coping measures (like when we distract ourselves from something hard or uncomfortable, or avoid it altogether) will pay extraordinary dividends to frontline workers before PTSD grips them. Indeed, this may even develop a healthy amount of resilience.

As frontline firefighters, we’ve missed the point: swallow hard and keep moving; strive to be salty; dig deeper and have grit. These adages are standard in the culture of fire suppression, but also detrimental. What if we stopped with trying to implement a misunderstood definition of the “stoic” and we worked to teach effective decompartmentalization of standard emotional experiences to a group of individuals that have learned through culture and community to repress and forget? This would require us to squarely face these difficult and hard to manage emotions. But facing it and overcoming it is the paradoxical answer here.

What if we took a different approach? What if we worked towards proactively treating mental health that fall anywhere on the continuum? In fact, what if we worked efficiently to treat our firefighters at the start of that continuum? I wonder if this approach would help reduce instances of hurt firefighters and mentally struggling brothers and sisters.

Our current approach is clearly not working. Although there are countless places a firefighter can go for help, instances of PTSD don’t seem to be in a landslide decline. I’m certainly not suggesting we tear down what we have. Instead, we should build on our knowledge laterally to gain a better understanding of the range of mental health issues in the firehouse.

ABOUT THE AUTHOR: Nick Halmasy is a former firefighter and fire instructor with a decade of experience in the service. He has completed a Master’s of Arts in Counselling Psychology and is a Registered Psychotherapist with a clinical practice specialty in first responders mental health. Nick started After the Call to develop and disseminate free mental health resources to both First Responders and their Families.