Before Patrick Morrison worked for the International Association of Fire Fighters, he was a firefighter himself. He’s experienced the horrifying and profoundly saddening events that first responders see every day. And like many other firefighters, he turned to alcohol to deal with the accumulating mental trauma.
Fortunately, Morrison got help and considers himself “in recovery” today. But many firefighters don’t. In fact, an August 2016 IAFF report noted that even though firefighters experience a post-traumatic stress disorder (PTSD) rate that’s similar to soldiers returning from combat, many fire departments don’t have the behavioral health services necessary to address the problem. Research has found that up to one-fifth of fire fighters and paramedics have PTSD. This study found in a survey of firefighters that nearly half had thought about suicide and nearly one-fifth had suicide plans.
IAFF hopes to help fill that mental health service gap with a new behavioral health center designed by and for firefighters. On March 5, the IAFF Center of Excellence for Behavioral Health Treatment and Recovery officially opened its doors in Upper Marlboro, Maryland, just outside Washington, D.C. The one-of-a-kind treatment facility was specifically created to help firefighters struggling with addiction and other behavioral health conditions, including PTSD and depression, and to exclusively serve the IAFF’s more than 303,000 members. Opening week, staff welcomed the first seven patients to the center, where active and retired firefighters can stay for more than a month of inpatient treatment.
“This has become an overriding priority for IAFF,” said Morrison, assistant to the general president for health and safety at IAFF. “If you had talked to me just five years ago, I would’ve said there wasn’t really a willingness to talk about this problem. But it’s reached a pinnacle — people are realizing that we’re all in this together and we need to find a way to address it.”
The center isn’t IAFF’s first effort on the behavioral health front. The labor union has been involved in a number of efforts to increase capacity on the issue, such as training firefighters to recognize the signs of mental crisis in their peers and offer help. However, Morrison said the magnitude of the problem came into even clearer focus in January 2015, when the IAFF’s magazine published a cover story about PTSD and the stigma that prevents firefighters from seeking help. He said reader reaction was overwhelming — “the phones rang off the hook” with firefighters asking where to find services.
“They were calling in droves with the realization that they were struggling too,” he told me.
Not long after, IAFF was approached by Advanced Recovery Systems (ARS), a behavioral health care management company, about a new facility it was opening in Upper Marlboro. ARS proposed making the facility exclusively for firefighters. IAFF said yes, as long as the center addressed both addiction and PTSD.
“That was the concept,” Morrison said. “We wanted to do it, but it had to focus on PTSD with co-occurring addiction.”
On the center’s opening day in March, more than 300 firefighters showed up in support. Everything about the 64-bed facility was built with firefighters in mind, said Abby Morris, a psychiatrist and medical director of the ARS/IAFF behavioral health center. The dorm areas are referred to as station houses, patients eat together at a long table in the kitchen like they would at work, and every morning begins with chores just like it would at the firehouse.
On the flip side, medical staff from the center were brought to IAFF’s training facility and put through the same exercises a firefighter would tackle — doing CPR, cutting a car open — to help them understand the stress of the job.
“Firefighters have a very unique culture,” said Morris, who worked as a medical consultant for the Montgomery County, Maryland, SWAT team. “They work as a team, it’s like a brotherhood. They spend days away from their families — they’re home away from home is the firehouse. …We wanted them to feel at ease (at the center).”
The center has three tracks, she said: one for addiction only, another on PTSD, depression and anxiety, and a third that addresses dual diagnoses. When I talked with Morris shortly after the center opened, she said there had been a lot of interest from firefighters dealing specifically with PTSD. The center’s aftercare goal is to use telemedicine to follow up with patients for up to 18 months after discharge as well as connect them with outpatient services where they live. Morris said everyone will leave with an outpatient plan.
Some firefighters will come to the center of their own will, others at the insistence of their employers, but Morris said a huge component of the center’s work will be safely returning firefighters to the job.
“We need to build resilience,” she said. “We want to give them the skills to manage what they have to face. These are people who have multiple layers of trauma and they have to go back into traumatic environments. So (resilience) is a huge part of our programs.”
Morris went on to say: “I want to make sure every person who comes here is treated as a human being first. The came in this world as human beings and they’ll leave as human beings and I want to make sure that part isn’t lost within their identity as a firefighter.”
Morrison at IAFF said the center will engage in research and training as well, with an ultimate goal of disseminating best practices on dealing with issues like PTSD and resiliency. He described the center as a “beta test” — in other words, if the center does result in better outcomes for firefighter health and well-being, it could prove a model for additional centers around the country.
Both Morrison and Morris acknowledged that while states and municipalities often provide for mental health services for firefighters, it’s simply not enough to meet current needs.
“This center can be a catalyst,” Morrison said. “If we do this right, we can save jobs, save families — we can save firefighters.”
For more on the new center, visit www.iaffrecoverycenter.com.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.