For years, Tucson-area fire departments have been working with a local health-care program to create a comprehensive medical plan that addresses stress and mental health in first responders.
April was a difficult month for the Tucson Fire Department, with a murder-suicide perpetrated by one of its own taking place days before the sentencing of a former captain for three murders.
On April 15, Frederick Bair, a captain, shot and injured his ex-wife and fatally shot her friend at Firebirds restaurant at La Encantada. Bair killed himself in the incident. Days later, former Capt. David Watson was sentenced to life in prison for the murders of his ex-wife, her mother and her mother’s friend.
Bair’s shocking act of violence hit department members hard. Firefighters and paramedics across the department were shaken by the incident. But it also affected Dr. Wayne Peate, who’d known Bair for decades.
“One of the things that firefighters do well is work as a team. I could see them grieving, but I could start to see the team forming to support those who needed help,” said Peate, who has worked as a doctor with the Tucson Fire Department since the 1990s and started a company that subcontracts with the Fire Department to provide health and wellness programs.
Fire departments across the country have seen an increase in mental-health challenges over the years, which the Tucson Fire Department and the Tucson Firefighter’s Association have been working hard with providers to address.
In response, the Tucson Fire Department has been taking steps to ensure the best mental and physical health of its employees, said Assistant Chief Joe Gulotta.
“Firefighters are normal people, too, and people have stress in their lives,” he said. “Those things are what we’re trying to deal with.”
Recruits are educated about mental health from day one and the department is always increasing its resource list for employees, in addition to emphasizing early identification by co-workers, friends and family members, Gulotta said, adding that the peer support program involves employees helping colleagues.
“We’re exposed to human conditions that are really difficult for most people to think about, “Gulotta said. “The violence that’s out there, the conditions where we arrive at a scene and a child is dead or there’s been a traumatic event. Things that most people just don’t see.”
The department has also developed a list of call types that will trigger the peer assisted response system, including cardiac arrest of a child, traumatic injury or death of a firefighter, mass casualty incidents and a fire in which an employee was lost or trapped for a period of time.
Patricia Haynes, a clinical psychologist who works with the Tucson Fire Department providing treatment and program development, helped TFD and Gulotta develop the Peer Operational Support Team, referred to as POST.
“We’ve created a system where trained peer supports go in after a critical incident and provide resources,” Haynes said. “The assumption is that people are going to be a little rattled after a tough call.”
The peer support won’t provide a mental-health assessment, but rather just check in and see how the employees are doing.
If it’s determined that an employee is experiencing symptoms, that person will have the option to get the rest of his or her shift covered, Gulotta said.
Seven days after an incident, a peer support member sends an email to the involved employees.
“The gist of the information is that it’s really normal to experience symptoms in the aftermath of a potentially traumatic event, so don’t worry, but here are some things you can do,” she said.
A month later, Haynes completes a post-traumatic stress disorder screening with the involved employees.
“That’s really considered the key element of POST. It’s not the going out in the aftermath of providing the information, it’s really 30 days later,” she said, adding that the peer support team was designed as a bridge to get people professional help in a confidential and safe way.
Haynes, who specializes in sleep issues, stress and depression, previously headed up a research program examining the effects of sleep on veterans with PTSD.
The Department of Defense-sponsored studies investigated how stressful life events can affect sleep and daily routine and can lead to an increased risk for depression and other stress-related disorders. She is also the primary investigator into a national study of the effects of sleep on veterans with PTSD, which Haynes said is helpful in her work with first responders.
Haynes provides eight hours a week of treatment or program development for the Tucson Fire Department, a big part of which is spent trying to reverse the negativity associated with mental health issues and treatment.
“With firefighters, there is some stigma against mental-health care. I think there’s a presumption or assumption that everyone’s immune,” she said.
Haynes also provides brief therapy to employees in need and is available to consult with department employees about getting help.
While the Tucson Police Department has a full-time psychologist and two full-time sergeants devoted to behavioral health issues in the department, Haynes is the only clinical psychologist devoted strictly to the Fire Department, which does not have anyone on staff specifically devoted to employees’ behavioral health.
Haynes’ work for the TFD is possible through a subcontract with Well America, which Peate opened in 2001 to address a department need for more elaborate physicals than could be obtained at typical occupational medicine practices.
Well America offers health and wellness solutions for roughly two dozen agencies across the state, the largest of which is the Tucson Fire Department.
“We try to take a very personal approach to treatment,” Peate said, adding that Well America has resources available that include dietitians, physical therapists, cardiology consultants, orthopedic specialists and a clinical psychologist.
During new physicals and annual exams, Well America uses a mental-health evaluation and screening program that Haynes helped designed for the program.
“Firefighters, like the rest of us, of course struggle with emotional or other issues related to relationships, finances, work, etc.,” Peate said. “The fire departments have worked over the years to develop some programs and in many cases, firefighters have taken advantage of those programs.”
But “in many cases” wasn’t good enough, so Peate said he decided he needed to do a better job in getting firefighters help with mental-health issues. In conjunction with the TFD and the union, Peate began collaborating with a variety of local groups to be able to refer patients for counseling services.
“We encountered that co-pays could be expensive ... and didn’t want the financial barrier to prevent people from getting valuable help,” Peate said.
After trying a few different approaches to making counseling affordable and available, the Fire Department expanded its contract with Well America several years ago to include mental-health services and enlisted Haynes’ services.
While Peate is thrilled with the work Haynes does, it’s still vital that first responders talk to and look out for one another.
“Nothing really replaces that kitchen table at the station,” Peate said, referring to the casual conversations that employees have at the firehouse. “We try to tell people, if you see something, say something. If you see someone weeping, reach out and help them just as you would someone who was wheezing.”
Well America is working with other local agencies to develop similar mental health programs for employees.
Lisa Ritter-Baker has worked at Well America as a physician’s assistant since November but was previously employed as a firefighter and paramedic before joining the medical field.
“The stress that first responders face is an unavoidable part of their career,” she said. “We are well aware of the psychological risk of this job and we’re actively working on a compendium of resources to be able to give to all the departments and all the patients we see here.”
Although the culture is changing, firefighters and paramedics are trained to help people and tend to want to fill that superhero role.
“They kind of think that they’re not the ones that should be seeking help, and there’s also that stigma of weakness when you’re vulnerable,” Ritter-Baker said. “We know as health-care providers that vulnerability actually shows strength, but that’s hard to get across to the population.”
