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Time To Talk About It

“You know, I’m really anxious right now,” Tom shared. His 6-foot frame slouched forward, seemingly trying to melt into the bench we shared. A humid June day stretched across the plaza in front of us leading to Independence Hall, where the Framers founded America.

If I had been a stranger strolling past, Tom might have seemed tired or overwrought from the heat of the day. But I was aware of his recent past. Tom and I met because he was planning to kill himself.

He reached out to me on social media one afternoon, about a year before actually meeting in Philadelphia to talk in person. A normal conversation between strangers about history and current events and books progressed until he shared, “I think about killing myself every day.” The Internet was a safer place to share his worst thoughts and fears than his firehouse, where stigma, heroic machismo, and fear lived. And so he told me about them.

Tom served in command roles during the response to 9/11 in New York City, led teams into Louisiana after Katrina devastated New Orleans, and served in high-level positions in Washington, DC during his career. He began suffering from PTS, anxiety, and depression from his experiences.

His attempt to take his life is not so unique among first responders. Even with incomplete data on first responder suicide completions and attempts in the United States, suicide completions by first responders outpace line of duty deaths. In a 2015 study, 15.5 percent of firefighters had attempted suicide, versus 4.6 percent of the general public. It was further found that firefighters have 5.2 percent higher odds of attempting suicide throughout their careers.

A multitude of factors contribute to first responders’ difficulties with mental health. It’s no secret that it’s a difficult job to respond to the public’s “worst day,” and to try to fix the issues at hand, on an endless basis.

Most people imagine one horrific incident as the sole reason for PTS and suicide, but during a conversation I had with Jeff Dill from Firefighter Behavioral Health Alliance (FBHA), he reveals that PTS is not the most common cause of first responder suicide, based on voluntary suicide reports his group validates for firefighters and EMS providers. Dill states that difficulties in marital or family relationships, depression, physical or other mental health issues, and addictions are more likely causes of first responder suicide than PTS.

Congressman Ami Bera of California introduced H.R. 1646: The Helping Emergency Responders Overcome (HERO) Act to the House a few weeks ago to help address suicide among first responders. The HERO Act addresses a few needs the first response community requires to begin improving mental wellness and combating suicide.

If signed into law, the bill would direct The Centers for Disease Control and Prevention (CDC) to collect data on suicides among first responders and publish this data annually on its website. This is necessary, as there are hurdles to acquiring these numbers by merely reviewing death certificates; many EMS providers and firefighters volunteer their services but hold other jobs. Death certificates list the decedent’s profession, not volunteer activities, leaving many first responders unaccounted for in some studies.

FBHA has been collecting a variety of data on completed suicides of EMS providers and firefighters, but these reports are completed on a voluntary basis. Dill estimates a 45 percent participation rate in this program.

The HERO Act would also address awareness education for responders and clinicians who treat affected first responders. Resources would be developed for mental health professionals to understand the culture of first responders, gain the trust of the community, and establish evidence-based treatment for mental health issues prevalent among first responders. A grant program to establish and provide peer-to-peer support services for EMS providers and firefighters would also be enacted as a part of the HERO Act.

Tom is doing well. His successful journey from mental health issues to his attempted suicide and working on his mental wellness was related to his access to treatment and regular appointments with a therapist. Having access to mental health providers with the training to work with first responders was vital to Tom’s success.

Some first response agencies are early adopters and support their responders by developing preventive programs addressing the stressors related to our profession, but unfortunately these are few and far between. The HERO Act normalizes access to mental healthcare for first responders and legally legitimizes the issue of mental health among first responders. This is the first step in ensuring all first responders are able to access the care they need after continually caring for others.

Your fellow first responders are in need of your help. Please support the HERO Act by contacting your congressional representative and urging them to support this bill.

Amy Eisenhauer, "The EMS Siren," is a presenter, writer, and EMS educator and training officer in New Jersey. Follow her blog at 

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