Introduction:
About one month ago, on April 22, 2019 Laura Knoy, moderator of New Hampshire Public Radio’s (NHPR) “The Exchange”, interviewed a panel of 4 knowledgeable professionals from diverse backgrounds to discuss mental health in First Responders and especially bring public attention to the stigma surrounding First Responders’ access to mental health treatment for PTSD and other trauma-related conditions.
Laura framed the discussion as sharing information about the growing concern across NH communities regarding the effects of daily stress on First Responders. She noted that in recent years more attention has been given to the psychological challenges of coping with cumulative, chronic stress and, in particular, PTSD. She provided statistics from a frequently quoted research article that indicates PTSD is prevalent in the First Responder community. She was especially alarmed to learn that the suicide rate is estimated to be about 20% higher in First Responders than in the general population.
Panelists included:
1.) Major Russell Conte (Retired) is a former Major in the NH State Police. He is on the Board of Directors for NAMI (National Alliance for Mental Illness) New Hampshire. He works in Peer Counseling and Behavioral Health and Co-Chairs the state’s Suicide Prevention Council.
2.) Todd Donovan is a current Firefighter and Paramedic in the Derry, NH Fire Department. He serves as a Data Specialist for the Division of Fire Standards and Training in Emergency Medical Services. Todd has been speaking with First Responders about his own personal story of mental health challenges in order to increase awareness about the benefits of treatment for PTSD, depression, and other mental health conditions and, importantly, sharing a message about suicide prevention.
3.) Chief David Goldstein is the current Chief of the Franklin, NH Police Department. Chief Goldstein has previously worked for the State Police, has served on the Franklin police force for 10 years, is a longstanding Instructor at the Police Academy, and, importantly, holds a PhD in Clinical Psychology.
4.) Dr. Nicole Sawyer is an experienced Clinical Psychologist in private practice in the seacoast area of NH. She specializes in providing services to Veterans and First Responders who have survived one or more traumatic events. She serves as Vice Chair of the NH Legislative Commission on PTSD and TBI (Traumatic Brain Injury) and offers psychological support to the NH State Police Peer Support Unit.
This is an impressive panel!
National Suicide Prevention Lifeline
As the discussion got underway, Laura spoke briefly about the importance of suicide prevention and reminded listeners about the National Suicide Prevention Lifeline: 1-800-273-8255 (TALK).
Let me begin this review by observing that this is the first public forum on PTSD in First Responders that I have heard in all my years as a psychologist. I applaud NHPR’s and Laura Knoy’s efforts to shed light on this compelling subject which impacts the lives of so many law enforcement officers, firefighters, paramedics, emergency medical personnel, and dispatchers throughout our state. I was impressed with both the breadth and depth of Laura’s coverage and the range of topics she included in this panel discussion.
In this podcast, not only do we hear the voice of an experienced psychologist who is well-versed in understanding the impact of trauma exposure on Veterans and First Responders and knowing about effective treatments, but also represented are the perspectives of a local veteran Police Chief, a former leader in the State Police, and importantly, a first-hand account in the courageous voice of a local First Responder himself who knows first hand what it means to overcome the daily psychological challenges in his roles of Firefighter, Paramedic, and family member. All of these individuals vigorously promote the elimination of stigma in order for First Responders to have an easier time accessing psychological support when needed.
A Few Highlights from Each Panelist:
Major Conte:
Major Conte spoke from first hand experience and reminded listeners that PTSD in the First Responder community is not new and in fact has been present in the lives of police officers, firefighters, EMS personnel since they first began providing safety to the public. He noted how uncommon it was in the past to give attention to the psychological needs of First Responders and how it has only been in the last 10 years or so that the profession has given the subject the sufficient credence. He lamented the fact that in his 33 years of service, he has witnessed many First Responders become “casualties of their professions because they didn’t get the help they needed.” By casualties he did not mean a person had to actually lose his/her life in order to become a casualty. “I have friends and colleagues that I work with who didn’t come through the profession very well.”
He admitted that the First Responder professions can be taxing on the lives of those who choose these jobs, and they change people over the course of their careers. In particular, he raised concerns about the number of completed suicides in the First Responder community, noting that the number of suicides far exceeds the number of deaths in the line of duty. He shared how painful it is for co-workers to witness one of their own colleagues commit suicide, have a serious alcohol problem, or succumb to any number of other terrible outcomes when a person doesn’t receive mental health treatment. He acknowledged that it took a number of tragedies before leadership finally began to take notice and take action. “It was time for us to look at it, but it’s not easy.”
Dr. Sawyer:
Dr. Sawyer has been working with First Responders now for a number of years and finds that as a group, they are an “incredibly resilient population”. She has observed that difficulties tend to develop very slowly, over a long period of time and believes this is because First Responders are such effective problem-solvers. Yet, over time the day-to-day challenges can build up to the point when a person feels overwhelmed in his/her ability to cope any longer. She added her voice to others on the panel regarding suicide prevention: “If there’s no opportunity to ask for help, or if asking for help is not embraced, not supported, if weakness comes to their mind when they need help, then the thought of suicide becomes more prevalent.”
While she acknowledged that at times it can be the case that a particularly extreme traumatic event may exceed a person’s ability to cope, more commonly it is the accumulation of stress gradually over time that overwhelms First Responders. “Its like a thousand cuts. It’s the day in, day out difficulties they face. They face people at their worst times on their worst days – day after day. And they’re encountering children and the elderly and situations that claw away at your soul.” She concludes that it is more the accumulation of stressors and traumatic events over time, the “slow chipping away” of a person’s reserves, contrasted with they way the diagnosis of PTSD was originally conceived of referring to a person’s reaction to a single traumatic event.
She also spoke about some of the challenges First Responders experience when seeking Workman’s Compensation for psychological conditions such as depression and PTSD. Physical injuries like a job-related broken leg are easier for insurance adjusters to see and easier for providers to predict the recovery time frame, compared with how slow the system has been to recognize the less visible job-related emotional injuries associated with traumatic events and how much more challenging it can be to try and predict when a person is likely to recover fully and be ready to return to the job.
Mr. Donovan:
Mr. Donovan shared a deeply personal story about having received a diagnosis of Major Depressive Disorder when he was 18 after having made several suicide attempts. He is acutely aware of the strong reluctance of First Responders to seek mental health treatment when it is warranted. He said, “I go around and talk with First Responders about how treatment works….I touch things. As a Paramedic, I smell things. I see things. I feel things that are unnatural on a daily basis. And I want people to know that treatment works.”
He acknowledged how well he used to hide his depression from others. “I was a master at it. The only people who knew about my depression were my family. And they didn’t know how to deal with it either. There wasn’t a lot of support. Now we’re trying to change that.” He shared that a staff member of NAMI helped him shift his thinking about the concept of “stigma” in seeking mental health treatment, and now he thinks of it more as “discrimination.”
Todd is doing everything he can to encourage First Responders to understand that “treatment does work. And it’s a lot safer and easier to nip it in the bud early in your career than later in your career so that’s what I try to tell people.” I appreciated Laura’s astute question when she wondered aloud how department managers would be able to help nip these problems in the bud if people are going to hide the difficulties. Mr. Donovan responded that people do give out clues that others need to pay attention to and address: “There were signs I put out. I told my physician that I didn’t think I was going to survive, and he just let it slide. I really didn’t want anyone to know but in a moment of weakness, I let it slip out. But it’s very tough to say there’s a problem.”
Chief Goldstein:
Chief Goldstein noted that his police department is pretty typical of all police departments. “The struggles that we all have are the same. We have to respond to these incidents. You can come out of the Academy, be brand new on the force, and on your first day of work, you could find yourself in the middle of something you never expected, even though it was discussed at the Academy. That along with all the normal stresses and strains that go along with police work.” Coming from perspective of a Police Chief with a PhD in clinical psychology, it seems he has provided longstanding leadership in the state about the emotional impact of First Responder experiences over the course of their careers.
He provided some historical context looking back over the last 40 or 50 years in the field. “In the old days in the 60s and 70s, it was all substance abuse related, something we’re familiar with today, not drugs necessarily but alcohol. Police officers were well known for being alcoholics on the job, until the time it became necessary to intervene.” Excessive alcohol use can still be seen today.
He acknowledged that it has taking a great deal of effort by many different people to overcome the the stigma and prejudice all these decades later. “We have policies and procedures now that we can access. We have teams we can use in order to intervene when necessary. We have professionals like Dr. Sawyer, and it is an incredible relief to know I can pick up the phone and say, ‘I have an officer in trouble, can you help?’”
In Summary:
This is a powerful 1-hour podcast that provides numerous insights into the historical reluctance of First Responders in seeking treatment for PTSD and other trauma-related conditions compared with more recent efforts to eliminate the stigma and discrimination associated with it. In particular, Todd Donovan is to be applauded for the courage he demonstrates in sharing his personal story in the service of helping others understand that mental health treatment can and does help.
As soon as you can make the time, click on the link here and have a listen to the full NHPR podcast. You will be glad you did!