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"The strongest people are not those who show strength in front of us, but those who win battles we know nothing about."
What if the greatest risk to our firefighters comes not from burning buildings and toxic smoke, but from the invisible battles they fight once the flames have been extinguished? While firefighters bravely protect our communities from external harm, they are also facing an internal crisis that requires our immediate attention and action.
The statistics paint a sobering picture of firefighter behavioral health. Up to 20 percent of paramedics and firefighters meet the criteria for post-traumatic stress at some point in their careers compared to a 6.8 percent lifetime rate in the general population. Worse still, an estimated minimum of 100 suicides per year are caused by firefighters, with 18 per 100,000 for firefighters and 13 per 100,000 for the public.
These aren't numbers, these are dads, moms, brothers, and sisters who invest their whole lives caring for others. According to the Firefighter Behavioral Health Alliance, more firefighters take their own lives each year than those who die in the line of duty, and some unknown number of many more suicides aren't reported.
Firefighter behavioral health encompasses the particular psychological stressors of the occupation. In contrast to other occupations, firefighters repeatedly witness traumatic
events, have life-threatening encounters, and shoulder the responsibility for the safety of communities. Wildland firefighters reported symptomatology of mental health disorders at a 2.5 to 4-fold greater rate than the general population, including depression, generalized anxiety disorder, and post-traumatic stress.
Together, these exposures equal a recipe for mental health. Depression, anxiety, PTSD, and addiction are not badges of shame, these are occupational hazards that merit the same sobering scrutiny that we apply to physical trauma.
At the forefront of dealing with these serious issues is the Firefighter Behavioral Health Alliance (FBHA), the beacon of light in the darkness. Firefighter Behavioral Health Alliance will seek to collaborate, create, and implement behavioral health awareness, prevention, intervention, and post crisis strategies to allow firefighters to have an easily accessible, confidential source of information at their fingertips.
Established by Battalion Chief and licensed professional counselor Jeff Dill, the FBHA has become a cornerstone asset for firefighter behavioral health programs nationwide. The FBHA is to come together and create and use behavioral health awareness, prevention, intervention, and post crisis techniques to provide firefighters immediate access to and a confidential source of information.
The comprehensive approach by the alliance includes:
● Educational workshops in behavioral health awareness and suicide prevention
● Resource development for families, fire departments, and firefighters
● Mental health professional training to identify fire service culture
● Suicide data collection to track and improve prevention efforts
The Firefighter Behavioral Health Alliance provides workshops to fire and EMS agencies, as well as dispatch centers, which focus on behavioral health awareness. The workshops focus on suicide prevention and promoting available resources.
While professional mental health services are needed, fire department peer support programs add a unique and precious component to the behavioral health continuum. These programs recognize a fundamental reality: frequently, one's best healing is obtained from someone who has walked similar terrain.
Peer support has been shown to reduce the number and severity of mental health issues for firefighters. The secret is attributed to several factors:
Shared Experience: Peer supporters understand the quirky challenges of being a firefighter because they've lived through them. They don't need to be informed why a certain call was traumatic, they understand.
Reduced Stigma: Stigma is a significant barrier to evidence-based treatment in fire service due to the "tough guy" culture. Stigma can be minimized by utilization of peer support from a well-respected firefighter to offer access to professional services and
bridge the gap between firefighters' need for treatment for behavioral health and professional help.
Cultural Competence: Peer supporters are native speakers of the fire service's language and are familiar with the unwritten and written rules of firehouse culture.
Existing research promotes the effectiveness of the programs. Results show that peer support among firefighters is positive but availability is not clearly known. A pilot study conducted in Texas showed firefighters were very satisfied with the IAFF Peer Support Training, and most firefighters used at least one supervision session.
However, challenges still remain for implementation. Only 35% indicated they were confident in EAP as a source of support, and only 37% thought that their peer support team was properly trained. This indicates that there is a definite need for proper training and ongoing support for the peer team members.
The future of fire mental health training is evolving rapidly, shedding traditional approaches and embracing evidence-informed, culturally relevant solutions. New training recognizes that mental health is not an amenity, it's a business imperative.
The best programs now include multiple elements:
Stress Management: Teaching firefighters practical skills to manage job-related acute and chronic stress.
Trauma Identification: Helping fire fighters identify signs of trauma in themselves and others so early intervention can occur.
Suicide Prevention: The stresses that fire fighters and emergency medical responders face in the course of duty – incidents involving children, violence, risks associated with firefighting and other possible traumatic exposures – can cumulatively impact mental well-being and health.
Resilience Building: Building psychological resilience skills that enable firefighters to recover from traumatic exposures stronger than they were before.
Comprehensive training is led by the International Association of Fire Fighters (IAFF). Upon graduation from the training, members have the necessary knowledge and skills to assist peers, a general understanding of common behavioral health issues in the fire service, and can serve as a bridge to community resources or behavioral health treatment when necessary.
Current research substantiates the effectiveness of new interventions. A 12-week intervention that combined occupationally-specific high-intensity functional training (HIFT) and psychological resilience training (RES) seemed to reduce depressive and post-traumatic stress symptoms and improve psychological resilience and mental health among career firefighters.
Though there were improvements, issues still persist. Though not only self-efficacy in identifying mental health issues and therapeutic empathic skills improved significantly following the training but also participants did not exhibit any significant gain in knowledge regarding mental health, it reveals that more comprehensive, multiple repetitions of education are needed over one-shot training.
Constructing enduring change requires more than efforts from individuals—it requires an underlying shift in fire service culture. Departments must shift from stigma to acceptance, from silence to affirmation.
Fire service leadership is the crucial element to this change. There must be an internal champion and overall support for programs and policy to advance. Chiefs and officers having mental health as an issue of open discussion, seeking assistance when necessary, and prioritizing their people sends a signal that empowers others to do the same.
There must be a consistent approach to effectively change culture: Policy Development: Having explicit guidelines in place to provide behavioral health support and crisis intervention.
Resource Allocation: Adequate funding and staffing of mental health programs.
Training Integration: Incorporating behavioral health training as a mandatory aspect of recruit training and professional development.
Confidentiality Protection: Confidentiality protections for peer supporters who are not trained in critical incident stress management do not exist. These shortcomings need to be addressed if the program is to be a success.
Examples of regional peer support collaborations between departments or jurisdictions were evident in our sample. These collaborations facilitate easy access to peer support by smaller departments that do not have peer supporters. These models hold potential for resource-deprived departments.
While traditional approaches focus on crisis intervention, forward-thinking organizations like MyOmnia are at the forefront of holistic wellness frameworks that span the full scope of firefighter behavioral health. MyOmnia's informed-wholeness model recognizes that true wellness encompasses physical, mental, social, spiritual, vocational-financial, purpose-meaning, and fun-relaxation.
This multi-dimensional model, specifically designed for high-stress professionals with trauma-informed strategies, provides a guide for firefighters and fire departments to not just survive their careers, but excel on them. Bringing evidence-based treatments together with culturally sensitive support systems, MyOmnia is the future of firefighter behavioral health.
No firefighter must struggle with mental health issues alone. An effective set of resources is in place to support:
● Firefighter Behavioral Health Alliance: In-depth educational workshops and materials
● IAFF Behavioral Health Program: Educational and peer support materials for union members
● National Fallen Firefighters Foundation: Mental health prevention and awareness programs
● International Association of Fire Chiefs: Leadership materials for the application of behavioral health programs
● 988 Suicide & Crisis Lifeline: 24/7 support for anyone in crisis
● Crisis Text Line: Text HOME to 741741 for instant support
● IAFF Center of Excellence: Special treatment center for firefighters and EMS personnel
A variety of agencies offer specialized courses of training specifically designed for fire service personnel and their families.
The battle for firefighter behavioral health requires action at all levels - individual, departmental, and systemic. This is how we can take the next steps:
● Know that seeking assistance is a sign of strength, not weakness
● Learn to identify trauma and stress indicators in self and others
● Participate in peer support programs and behavioral health training
● Build resilience through laughter, stress reduction, and healthy relationships
● Embed robust behavioral health programs
● Provide regular training in mental health awareness and suicide prevention
● Implement policies that promote help-seeking behavior
● Coordinate with agencies like FBHA and MyOmnia for expert guidance
● Lobby for funding of fire department behavioral health programs
● Advocate for legislative protections and resources
● Acknowledge that an investment in firefighter mental health stren
gthens community safety
The behavioral health crisis for firefighters is a fact, an emergency, and a solvable problem. Through coordinated action of such organizations as the Firefighter Behavioral Health Alliance, implementation of effective fire department peer support programs, and comprehensive training on firefighter mental health, we can reshape the world of firefighter wellness.
These statistics that started this column don't need to dictate our future. When we combine the strength of peer support with evidence-based training and cultural transformation, we create a world where firefighters don't just survive their careers, those who are equipped by us thrive through them.
As we look across the flames to the human beings who run towards danger to protect us all, we are obligated to defend them too. Their wars are abstract, but our help must be obviously concrete.
Departments and fire fighters can make their move today by taking on peer support and professional training for long-term health. It's time to act, and the resources are here. Our fire fighters have never hesitated to answer our calls of need, now it's our turn to answer theirs.
1. Firefighter Behavioral Health Alliance. (2024). Retrieved from https://www.ffbha.org/
2. Gulliver, S. B., et al. (2024). Peer support training for Texas firefighters. Baylor University Medical Center Proceedings, 37(6), 934-937.
3. Harvey, S. B., et al. (2016). Mental health of fire-fighters and repeated trauma exposure. Australian & New Zealand Journal of Psychiatry, 50(7), 649–658.
4. International Association of Fire Fighters. (2019). Retrieved from
https://www.iaff.org/behavioral-health/
5. National Fallen Firefighters Foundation. (2023). Retrieved from
https://www.firehero.org/firefighter-mental-health/
6. Ruderman Family Foundation. (2022). Mental Health and Suicide of First Responders. Boston, MA.
7. Stanley, I. H., et al. (2016). Suicidal thoughts and behaviors among firefighters and paramedics. Clinical Psychology Review, 44, 25-44.
8. U.S. Department of the Interior. (2024). Retrieved from
https://www.doi.gov/wildlandfire/behavioral-health
9. U.S. Fire Administration. (2024). Retrieved from
https://www.usfa.fema.gov/blog/increasing-the-focus-on-fire-and-ems-behavioral-health/ 10. For more information about comprehensive behavioral health solutions for firefighters, visit MyOmnia's firefighter solutions page.
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