Recently, a group of well-seasoned firefighters gathered at the National Fire Academy and were asked to participate in a forum to generate strategies and materials to support suicide intervention and prevention in the fire service. The response from several was one of surprise at the scope of the issue and disappointment in how few of us were aware of or had a good handle on the issue. Presentations were made by several well-educated, kind, and sensitive people who shared their knowledge and wisdom on the topic in a passionate and compelling way.
The issue of suicide is inextricably bound with the issue of behavioral health. Behavioral health is something that everyone should be concerned about but that very few of us invest a lot of energy in understanding unless we are directly impacted by a behavioral health issue. There has always been a kind of stigma attached to behavioral health issues. Many of us were taught that people who struggled with depression or mental health issues were not well, were not strong, and were somehow defective. That teaching was not isolated to us in the fire service; that indoctrination came to us from society as a whole.
As children, we are exposed to television and movies that depict the mentally ill as psychopathic killers or demented and dangerous people. Some of the greatest people of all time have struggled with mental health issues; the list includes people like Sir Winston Churchill. Churchill is probably the most important singular figure from World War II; without his tenacity, without his wisdom, and without his courage and character, the National Socialist German government could have easily achieved its goals. Churchill suffered from depression his entire life. When he wrote about it, he used the metaphor of a black dog to describe the times when he was dealing with his depression.
The list of famous and important people who have dealt with depression is extensive, from our second President John Adams to President Abraham Lincoln to Director Woody Allen. The list includes thousands of people who have made contributions from which we all still benefit today. But nonetheless, we tend to still treat those who are dealing with depression as different or broken. They may just be the truly sensitive among us; they may just be the truly kind among us. But one thing's for certain: Dealing with a mental health issue such as depression does not mean you cannot be a world-class firefighter or a world-class anything.
Three points came up during the summit that are important to share with the fire service: First, mental health issues affect us all, and we all should take better care of ourselves and those around us. Second, the most horrific outcome of a mental health issue can be suicide; and, in many cases, we can make a difference. Third, and most important, it is not someone else's problem—it's our problem, one we can't run from, and one we must address directly, boldly, and courageously as we do every other issue that confronts our fire service community.
The presenters told us that there is an Interpersonal Theory of Suicide which has identified that suicide results from three mental states: (1) thwarted belongingness, (2) perceived burdensomeness, and (3) a capability to engage in suicidal behavior. As firefighters, we can help to identify and intervene in all three of these mental states.
When someone feels that he does not belong, one of his most fundamental human needs is not being met and that feeling is the need to be connected to and cared for by others, especially by his family and firefighter family. This can happen to us when we retire or get injured, and it can also happen to any one of us who may feel for whatever reason that we don't belong anymore. Something we can do to help people feel they belong is to make sure that we include our retirees, our injured, and anyone who might be on the fringe in our department in ceremonies, dinners, outings, and FOOLS meetings. Oftentimes, we get caught up in hanging out with the "cool guys"; some of the coolest guys I've ever hung out with were guys on the fringe. Let's make a bigger effort to make sure that all firefighters know that they're welcome at everything we do, because we really are a family.
We were told that burdensomeness is the belief that many people have that the world would be better off if they were gone, that they don't have anything to contribute, and that no one really cares whether they participate or contribute in any way. We have so many projects where our retirees, our injured, and just our folks with time on their hands could be useful volunteers; they are just waiting to be asked. Next time you're planning your medal day, make sure you call the retirees to participate. Next time you're planning the annual Irish day, Italian day, Hispanic day, or whatever day, make sure you get everyone involved. Look for those guys and gals on the fringe. Ask them to contribute; ask them to participate; ask them to be there. Woody Allen once said that 90 percent of life is just showing up. He was right.
Finally, they told us about the capability to engage that comes from being exposed to death on a regular basis. It also comes from the fact that as firefighters, we often have to face the reality of our own mortality. This is where I think our spiritual nature needs to come into play. It need not be overly religious, but I think a strong foundation in the belief in a higher power is an important part of dealing with our mortality.
We will be working on this issue for years to come. It has affected me, it has affected you, it's our problem.