Leadership and Mental Health Initiatives: Denver Fire Department Case Study

Firefighters are a unique breed. They run into burning buildings when everyone else is trying to escape. They respond to gruesome medical calls. And they do it all as a team. There’s a brother/sisterhood that comes with being part of this elite crew, and while there are many positive things that result from that connection, it can also create a tough guy mentality that leads them to believe they can’t or shouldn’t seek outside help when they’re struggling. As one firefighter told me, “We literally depend on each other’s lives to be mentally sound. It is our strength to compartmentalize, stay decisive, and move on that is valued in this work.”

Juan Vigil, a member of the Denver Fire Department (DFD), experienced the consequences of that firsthand. On Super Bowl Sunday 2013, his captain, Steve Magana, a 30-year veteran of the department, died by suicide. Vigil was devastated. Not only was Captain Magana his respected supervisor and a firefighter’s firefighter, he was a friend. Over the years, the two had spent a lot of time together, hunting and fishing. Vigil couldn’t figure out how he’d missed the signs that his friend was wrestling with serious issues—and he vowed it wouldn’t happen again.

 9News: https://www.usatoday.com/story/news/health/2015/09/30/denver-firefighters-talk-suicide-prevention/73101858/

9News: https://www.usatoday.com/story/news/health/2015/09/30/denver-firefighters-talk-suicide-prevention/73101858/

Steve’s death wasn’t the first suicide the department experienced. Another captain died in a murder-suicide shortly after 9/11 and another four or five lives had been lost to suicide. But Magana’s death was a turning point. Afterward, Vigil, DFD captain Derrick Delgado, and other members of the DFD set out to find a program or service that would help prevent what happened to their colleagues from happening to others. The department already had a solid physical wellness program, with a physical wellness coordinator and two dedicated physical therapists, as well as a psychologist and a peer support group on the mental health side, but they wanted something more—something that would encourage members to know it was OK to reach out for help and provide additional resources. “Nothing was really immediately available for our members if they were in that emotional state where they were contemplating suicide as the only option,” Delgado says.

A few months later, they reached out to me. We dove in full force and, together, we developed a comprehensive, three-year plan for addressing behavioral health in the DFD; all recruits and 1,000 uniformed firefighters would be required to attend the annual training. The program wasn’t just about suicide, though that was part of it. Line of duty deaths and the tragedy of everyday calls weigh heavily on firefighters. The goal was to explore how these events can impact one’s mental health; explain that grief is completely normal; encourage help-seeking; and provide tools and resources. 

Scott Heiss, DFD’s division chief of safety and training, says members were hesitant at first and many pushed back. But when leadership read evaluations after the initial training, Heiss discovered “about 95% said, ‘Thank you, we needed this for a long time.’”

 DFD Training video: https://youtu.be/SskSfiMLxl8

DFD Training video: https://youtu.be/SskSfiMLxl8

One component of the new Total Wellness initiative was what I call a “lived experience video,” where people share stories of how suicide has affected their lives or their own stories of reaching out for psychological services. Initially, many of the firefighters didn’t want to speak publicly; they were worried about what their colleagues would think. But eventually, a handful came to realize that sharing their stories was, as Vigil put it, “the right thing.” (You can view the final product here.) “For our members to see that type of strength and leadership and commitment from somebody who had a difficult time making that video meant a lot,” Delgado says of Vigil.

By all measures, this program has been a success. Three months after the first training, referrals to the department psychologist tripled, and calls to the peer support team and health care provider also rose. Various senior members of the DFD have received calls from firefighters saying they had been thinking about suicide or struggling with substance abuse, but thanks to these programs, they knew where to reach out for help and had done so. Delgado has also watched as more departments have invested in mental health and suicide prevention efforts. The video has become a model for many other departments, both nationally and internationally.  

It’s crucial that all firefighters have access to trainings and resources such as what the DFD provides. A 2015 study by Thomas Joiner and colleagues stated that, “Firefighters report an alarmingly high career prevalence of suicidal thoughts and behaviors.” According to a 2012 CDC report, “Protect Service” ranked as the sixth highest for suicide death. In addition, as many as 37% of firefighters exhibit symptoms of post-traumatic stress.

Implementing these programs requires buy-in from higher ups. From the beginning, when Vigil and company set out to incorporate behavioral health into the firefighters’ training, the DFD chief and other senior members were on board. “It really came from the chief down,” Heiss says. “You have to have that top-down support, otherwise you’re going to be lost.”

Delgado offers this advice to other departments looking to implement similar initiatives: “It’s important, especially in the fire service, that your leadership—if they believe in something, and they believe it’s the best thing for their personnel and their members—has to make that commitment 100%. And you have to have members within your organization that are leaders, regardless of rank, to be a big part of the development of that curriculum and the disposition of that information, in combination with the professionals.”

Early DFD trainings were led by in tandem by my team and members of the department who had undergone “train the trainer” instruction. Having colleagues standing at the front of the room addressing the importance of this effort—and saying it’s OK to ask for help, and to need help—made a huge difference. “I think that showed [this was] a genuine thing within our department, and people were much more accepting. People identified with them,” Heiss says. “The messenger sometimes is so important.”

Delgado agrees: “We made it very clear that this class is driven by our members, for our members,” he says. “It wasn’t a mandate from the city. It wasn’t a mandate from the department or administration saying this is just a check-box saying we did it. This actually had a lot of teeth to it and it came from our members.”

As the DFD enters its fourth year of total wellness efforts—the next training will be held in spring 2018—the organization is starting to think about where it wants the program to go from here. The DFD has added a performance psychologist to the team, expanded from one department psychologist to about 12, boosted its peer support efforts, worked with its health care provider to increase access to their psychologists, and incorporated spouses and significant others into some of the programs. Heiss would like to see a behavioral wellness coordinator added to that list; the DFD has requested money for from the city to do so. “To be a good firefighter, you have to be both physically and mentally at the top of your game,” he says. “[We tell recruits and members] in this job, it’s not if but when that things will start to bother you—but know, it’s not a weakness but a strength to talk about it.”

Resources

 

If you have been affected by suicide in your role as a firefighter, you are not alone. This educational video to help firefighters overcome the tragedy of suicide. The video illustrates the many ways suicide affects firefighters, showing a need to develop resources to support people in its aftermath.

 White paper: http://mantherapy.org/pdf/First-Responder-White-Paper-July-2016.pdf

White paper: http://mantherapy.org/pdf/First-Responder-White-Paper-July-2016.pdf

About the Author

Sally Spencer-Thomas is a clinical psychologist, inspirational international speaker and an impact entrepreneur. Dr. Spencer-Thomas was moved to work in suicide prevention after her younger brother, a Denver entrepreneur, died of suicide after a difficult battle with bipolar condition. Known nationally and internationally as an innovator in social change, Spencer-Thomas has helped start up multiple large-scale, gap filling efforts in mental health including the award-winning campaign Man Therapy and the nation’s first workplace suicide prevention initiative. Because of these efforts, she was an invited speaker at the White House in 2016.

Her goal is to elevate the conversation and make suicide prevention a health and safety priority in our schools, workplaces and communities. Spencer-Thomas has also held leadership positions for the National Action Alliance for Suicide Prevention, the International Association for Suicide Prevention, the American Association for Suicidology, and the National Suicide Prevention Lifeline. She has won multiple awards for her advocacy including the 2014 Survivor of the Year from the American Association of Suicidology, the 2014 Invisible Disabilities Association Impact Honors Award, and the 2012 Alumni Master Scholar from the University of Denver, the 2015 Farbarow Award from the International Association for Suicide Prevention and the 2016 Career Achievement Alumni Award from the University of Denver’s Graduate School of Professional Psychology.

She has a Doctorate in Clinical Psychology from the University of Denver, Masters in Non-profit Management from Regis University, a Bachelors in Psychology and Studio Art with a Minor in Economics from Bowdoin College. She has written four books on mental health and violence prevention. She lives with her partner and three sons in Conifer, Colorado.

Connect with Dr. Spencer-Thomas by visiting her website: www.SallySpencerThomas.com and following her on Facebook @DrSallySpeaks, Twitter @sspencerthomas and LinkedIn. To learn more participate in her monthly podcasts, blogs and twitter chats!

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Courage is being seen