1. May Day for Mental Health UK Fire Chiefs Association

2. May Day – When do you call for it? Feel life endangered? Save a Life? Need to expand that concept!!!! The 13 th Life Safety Initiative: “ Firefighters and their families must have access to counseling and psychological support”? What are we doing about it?

3. UK Fire Chiefs Association Some questions and certainly not all inclusive list will include: Is the concept of Mental Health in our curriculum at our academies at the entry level? Are recognition of signs and symptoms part of our Company Officer Training? Are recognition of signs and symptoms part of our company officer training? Is there a psychological/counseling component part of our annual physicals? How do volunteer/combination departments deal with this issue with no EAP? Who is your EAP and what training do they have about the fire service culture? How do we prepare to add valuable ex- military personnel to the fire service who have already been exposed to horrific situations?

4. How do volunteer/combination departments deal with this issue with no EAP? Who is your EAP and what training do they have about the fire service culture? UK Fire Chiefs Association (Questions Cont.)

5. UK Fire Chiefs Association Is there a psychological/counseling component as part of the annual physical? How do we prepare to add valuable ex- military personnel to the fire service who have already been exposed to horrific situations? As we go through definitions do you see someone in the organization who fits into one of these categories? Maybe you?

6. UK Fire Chiefs Association THIS IS NOT INTENDED TO BE A CISD PRESENTATION!!!!!! MENTAL HEALTH IS A KEY COMPONENT OF OVERALL FIREFIGHTER SAFETY NO ONE MAGICAL ANSWER! MANAGE VERSUS CURE SOME MATERIAL SENSITIVE

7. What qualifies me to speak?

8. Goals Keep it simple. Identify and agree on the need for addressing Life Safety Initiative #13 in its’ entirety. Examine current practices in your jurisdiction already in place beyond CISD teams. Go home with at least one idea you realistically think you can make happen.

9. Coping Mechanisms: Drugs Pain Medicines Alcohol Smoking Eating CAN BE COUNTERPRODUCTIVE AND MAKE US MORE REACTIVE (SENSITIVE )TO FUTURE STRESS

10. Management Tools: Stress best managed by: Regular Exercise Meditation or other relaxation exercises Structured “Time Outs” Learning new coping strategies “The management of stress depends mainly on the willingness of the person to make changes necessary for a healthy lifestyle.”

11. Post Traumatic Stress Syndrome Posttraumatic stress disorder (PTSD) is an emotional illness that develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience. PTSD sufferers re-experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event (avoidance), and are exquisitely sensitive to normal life experiences (hyperarousal).

12. Post Traumatic Stress Syndrome Almost half of individuals who use outpatient mental-health services have been found to suffer from PTSD. As evidenced by the occurrence of stress in many individuals in the United States in the days following the 2001 terrorist attacks, not being physically present at a traumatic event does not guarantee that one cannot suffer from traumatic stress that can lead to the development of PTSD.

13. Post Traumatic Stress Syndrome " Approximately 7%-8% of people in the United States will likely develop PTSD in their lifetime, with the lifetime occurrence (prevalence) in combat veterans and rape victims ranging from 10% to as high as 30%.

14. Historical Examples Our Lady Of Angels Fire Chicago, Illinois December 1, 1958 95 Killed, 93 children FF Richard Scheidt 10 year old John Jankowski

15. Houston Fire Department 2009 Way too common of a scene. Where are those hugs after the fact? How far have we really come since 1958?

16. Chicago video

17. Historical Examples “Baby Jessica McClure's rescue was credited mostly to paramedic Robert O'Donnell and police officer William Andrew Glasscock Jr., both of whom received tremendous media attention. In 1995, O'Donnell shot himself to death while suffering from posttraumatic stress disorder. In 2004, Glasscock was sentenced to 15 years in prison on charges of sexual exploitation of a child, sexual assault, and improper storage of explosives.

18. Historical Examples Chicago FD FDNY US ARMY MGM Grand Fire Hinsdale FD

19. FF in distress video

20. Where do we usually turn for answers? NFPA Standards Fire Service Organizations Training Institutions

21. NFPA Standards NFPA 1021 (Fire Officer Professional Qualifications) NFPA 1500 (Occupational Health and Safety) NFPA 1521 (FD Safety Officer) NFPA 1583 (Health Related Fitness Programs)

22. Health and Wellness Guide for Volunteer Firefighters Revised February 2009 (USFA and NVFC) Volunteers need direction also! Covers areas like: fitness, strength training, diets smoking cessation. Noble goal of “reducing the primary cause of on-duty deaths in the volunteer fire service – heart attack and stress.” What’s missing?

23. IAFC Safety, Health and Survival Section Joint Labor Management Wellness Fitness Initiative IAFC SHS Strategic Plan 2009-10 Not there Joint Labor Wellness Fitness Initiative There!!! Revised 2008 CHAPTER 5 — Behavioral Health Management and Labor shall support the provision of a behavioral health plan, which may be delivered either through internal or external sources, based on specific elements.

24. IAFC - IAFF Wellness Fitness Initiative This chapter highlights the following: Introduction Qualifications of the Behavioral Health Specialist Periodic Behavioral Health Evaluation Comprehensive Counseling Services Incentive to Access Services Behavioral Modification

25. IAFC - IAFF Wellness Fitness Initiative Employee/Member Assistance Program Substance Abuse Stress Marketing and Awareness of Program

26. ISSUES?

27. ISSUES!!! COST ACCESS TRAINED PROFESSIONALS CULTURAL ACCEPTANCE INSURANCE LIMITATIONS

28. Fire Service Training Be prepared Fire Behavior Suppression Water Supply Saving Our Own Mental Health?

29. Course Feedback Dept type (Vol./Comb./FT) Comb – “Not sure about this topic!” Vol – “Mental Health was very good, need more” Vol – “I think the final portion was excellent. Needs to be incorporated in future classes and expanded upon.” Comb – “This should be a must at this class” Comb – “Glad this was added to the class” Vol – “This is needed. I have experienced it in my Department and need training and need places to send firefighters in Southern Illinois.

30. Course Feedback FT – “Should be in every class and in conjunction with conflict resolution this is an eye opener for me as a company officer in my own feelings as well as others.” FT – “Excellent addition with the mental health part. Needs to be fully integrated into the program. FT – “Mental health – Important but scares the hell out of me. FT – “The FF mayday was the best of the weekend.” Vol – “The Mental health issue was very good. Please add it to the course.”

31. Senior Officer Roles Be familiar with signs/symptoms Watch for behavioral changes-use your gut feelings Learn about your Employee Assistance Programs/Local counseling services What are the advantages/disadvantages? Limitations of EAP Know your personnel- young or new firefighters/women/ethnicity/culture

32. What are you doing about it?

33. MAY DAY SOP We must create a MAY DAY SOP! Mental health just as important as physical health The “heroic persona” that enhances a firefighter will work against them in this arena. Look locally for help (local counselors, ministers) Educate Mental Health Professionals: Sit with Fire Service Personnel Provide Department history Ride time Add to annual physical evaluation? What is covered in health insurance?

34. Lessons Learned Do you have a trained therapist you or your people can turn to? You can impact how accepting the culture is in your organization for those to seek help by role-modeling Take the cape off before it chokes you! Those with mental health issues are great people who deserve our respect!

35. MAY DAY SOP Need to address all 16 Life Safety Initiatives. Do not neglect #13 “ Firefighters and their families must have access to counseling and psychological support”. Unlike other potentially fatal diseases, there are no physical signs of mental illness. I did not see it until the end.

36. Contact Information Chief Patrick J. Kenny, Retired Assistant Executive Director Illinois Fire Chiefs Association 5812 Plymouth Downers Grove, Illinois 60516 W 630 964-0894 C 630 774-0320 pkenny@illinoisfirechiefs.org

37. For all you can help Sean says “Thanks!”

38. NFFF Executive Summary A framework and protocol for dealing with occupational exposure to potentially traumatic events has been developed and published (see references in handout). These guidelines represents an evidence informed best practices approach that is designed to be integrated into existing organizational activities. Workshop programs and continuing education materials are under development.

39. NFFF Executive Summary Psychological First Aid, an evidence informed best practices model developed under the guidance of the National Center for Post Traumatic Stress Disorder with support of the Substance Abuse and Mental Health Services Administration, has become the standard of care for early support. It has been adapted for use military and Medical Reserve Corps applications, and NFFF has contracted to develop modules to train firefighters and EMTs in applying its principles to help the citizens we serve and, as a part of active peer programs, to help one another.

40. NFFF Executive Summary Web enabled, interactive programs for self-help and education on behavioral health impacts have been developed for military and veteran use (see, for example,) http://www.afterdeployment.org. NFFF is working with developers of pertinent platforms (such as NCPYSD) to adapt these platforms to provide similar assistance to firefighters and their families regarding behavioral health implications of their duties. http://www.afterdeployment.org

41. NFFF Executive Summary Industry standards for health and safety require that all departments provide a member assistance program but it does not specify what services should be provided by what level of provider, nor does it provide guidance with respect to protocols for assessment or evidence based standards of treatment.

42. NFFF Executive Summary Recommendations are being prepared to help departments write specifications for behavioral health programs that will meet their specific needs. Work is also underway on resources to assist potential providers in developing effective proposals and programs to satisfy those specifications.

43. NFFF Executive Summary Web enabled, interactive resources to help fire and EMS organizations build, prepare, and support effective peer support programs. Building on successful programs and strategies from a variety of departments, this effort seeks to help organizations use peer personnel effectively to support the various objectives of a comprehensive behavioral health program and facilitate proactive utilization of its resources by firefighters and their families.

44. NFFF Executive Summary The behavioral health personnel working with firefighters and their families need cost-effective, accessible ways to acquire skills in current evidence based treatments if they are to be prepared to provide the highest standard of care. The National Crime Victims Research and Treatment Center at the Medical University of South Carolina developed a well researched platform to deliver training in Cognitive Behavior Therapy (CBT), the current standard of care for conditions such as PTSD and depression, to providers caring for victims of abuse.

45. NFFF Executive Summary NFFF is working with NCVRTC to fund the creation of a similar platform to bring this level of training, focused on fire service needs and issues, to mental health professionals working with firefighters and their families.