Heartwork-Healing Our First Responders with Trauma and PTSD
This is a reprint of an article posted on LinkedIn December 19, 2018 and came from the results of a survey of First Responders' preferences for treatment
Growing up and watching re-runs of Superman or Lone Ranger in black-and-white on television the characters seemed larger than life. They were heroes, who often solved problems quickly that were drawn, like the screens they were on, along lines of black and white. Good and bad were easily discernible. Today Marvel has made a colorful franchise of heroes: Captain America, Black Panther, Jessica Jones, Luke Cage, the Avengers. We root for them; we become invested in their struggles, seeing them almost fail just before they overcome. They show us gritty, even damaged heroes, hurt during battles they fight, sometimes blurring the lines between heroic and fallen. They experience trauma and pain. Through them, we see that helping and rescuing others comes at a personal sacrifice. Carl Jung, the psychologist and philosopher would say that this archetype of the Wounded Warrior is one we all carry somewhere within us, one that we all can relate to. What we don’t see is the internal battle. When we look at superheroes, we see those who always get back up again. Many first responders hold themselves to this expectation of thinking they are superhuman, that they can never fail, or let down those who depend upon them. They will feel tremendous amounts of guilt and feelings of inadequacy if they have human moments, moments where feelings seep in, or let someone down. We don’t see how they carry thoughts for a long time afterwards of people in their minds’ eye both whom they helped and those they feel they failed.
In the Fall of 2016 I became involved with a group in Albuquerque, New Mexico called Behind the Badge New Mexico (BTBNM). Behind the Badge NM was started by the owner of another company the provides services to first responders and their families. Allies provides trainings, direct mental health services, peer support, and more. Allies for First Responders is run by Mary Baca, a certified trauma specialist and licensed counselor, who began Odyssey Counseling Services in 1990 and launched Resilience Integrative Services, a holistic practice, in 2011. In addition to her work with both companies, Mary throughout her 35+ year career has conducted child abuse investigations, taught psychology and criminology classes at local colleges, served as the full-time employee assistance counselor for the United States Postal Service and more. Additionally, Mary has developed and provided professional trainings for the past 20 years. These trainings include topics specifically related to first responders as well as other business and mental health topics. Mary is passionate about helping first responders and their families on a departmental and individual level. I met Mary while working on a Federal project in was pleased when she asked me to help with statistical services. I have had military and first responders in my family, and her insight and compassion inspire me. When I think of Mary, what comes to mind is the phrase, “Every hero needs a hero.”
This essay will share the survey I ran for Behind the Badge New Mexico (BTBNM), as reported to the Bernalillo County Board of Commissioners in March, 2017. However, national research and statistics will first be shown, demonstrating a broader understanding of the issues related to first responder trauma, PTSD (Post Traumatic Stress Disorder), and suicide. A recent USA Today article shared the toll of officers shot last year, 2017 as 46 in the United States. However, the toll of officers committing suicide was more than triple that, at 140 (Hayes, 2018). It can be the cost of many calls, encounters, stresses, and lack of resources that accumulate over time. By nature, a first responder is a protector and helper in society. When we talk about “first responders” – often people think of police, firefighters, emergency medical services, the military, or even the intelligence community (IC). There are many more who can be listed. In fact, USFRA (US First Responders Association) defines a first responder as someone who runs towards an event, rather than away. The very strict, closed nature of the system – or “Us/Them” nature, and stigma associated with mental health issues can make it difficult for many first responders to ask for help. Stepping out of that role from “strong” to “weak,” is counter-intuitive to say the least (Crank, 2015, McCammom & Allison, 1995). During 9/11 the terms “high-risk rescuer” and “rescuer victim” were coined within mental health and first responder professions. During 9/11 in New Jersey, cop-to-cop mental health support programs were instituted and the need outweighed the demand (Castellano & Pilonis, 2006). A study released in 2017 by the University of Phoenix, reports that 80% of Firefighters report being exposed to a traumatic event, and 33% report having been diagnosed with a mental health condition while serving (Aubert, 2017).
There are also cultural stressors unique to the job. Being in a closed system can be very supportive and feel like a family. These closed systems – where members rely strongly upon each other, have a unique language, rely upon each other to make meaning out of events, and experience high stress and traumatic events together (Kranke, et al., 2017). They also have one-of-a-kind struggles (Crank, 2015). They can be highly functional and become like families in need of healing. Because of the cohesive nature, many prefer for the healing to come from within. Trust from outsiders is often hard to come by because, for example in policing, outsiders are often the ones that are those being monitored, “policed,” and have often inflicted the trauma being suffered (Crank, 2015). Even if trauma has occurred within the system itself, that is often of a different nature.
The current data on PTSD for first responders is varied. The CDC has a hard time parsing it from other occupations (Farina, 2016). However, it is believed that the general population experiences PTSD at a rate of 3% and first responders at a rate of at least 10% (Castellano & Pilonis, 2006). However, given that some areas are more violent than others, the numbers could be quite varied. Additionally, the spotlight has been on suicide prevention as many cases have been in the news as first responders – police, firefighters, EMS workers have taken their own lives. We can see from this that the services provided by Allies for First Responders, supported by BTBNM, are crucial to first responders and their families.
So, because of the intense stress, the closed nature of these systems, and the fact that these first responders are our protectors and helpers, BTBNM conducted a survey to demonstrate the need for funding for crisis peer-to-peer support for Allies for First Responders and Behind the Badge New Mexico. There were three questions asked of respondents to compare the likelihood of their support for and use of peer-to-peer services. One hundred thirty-one respondents answered, most firefighters, n=72, and many EMT, n=48, the rest were spread between other first responder professions. The statistical tests indicated a significance, and we can conclude that peer-to-peer services make a difference, versus crisis services without peer-to-peer support.
There were three questions asked of all first responders to directly gauge need for/support of peer-to-peer services. These questions were: 1) “I would use a crisis line if one were available to first responders,”; 2)“I would be more likely to use a crisis line if I knew it was peer-to-peer - meaning it was manned by first responders trained to help other first responders in crisis,”; and 3)“I would recommend a peer-to-peer crisis line to another first responder.” All three questions were scaled - asked on a 1 to 5 scale rated “Very unlikely, Unlikely, Maybe, Likely, Very Likely.” In all three questions, using non-parametric tests, because of snowball sampling (the population distribution was unknown, and n=131), we could reject the null of no difference between groups, thus concluding that a peer crisis line was desirable, it would be preferable to a non-peer crisis line, and it would be recommended to their peers. Thus, these echoed findings of the other research stated above.
While, the reporting of a small survey can be dry, it is important to understand that this survey ran for three days, and was shared through Facebook, Twitter, and LinkedIn, through first responders’ word-of-mouth. The support at the board meeting was well attended, and the desire and need for these services were huge. One of the things I have observed, having worked in public sector, State and Local Government, as well as having had family member first responders, is how much is demanded of those on the front lines, protecting our safety. They do so much, with very little in the way of resources, equipment, and often the schedules are demanding. What Mary and her team are doing is needed in New Mexico, but it is needed in many parts of the country as well. As a result, Mary and her team will be expanding their efforts in 2019 taking things to a national level.
One day I was talking with Mary, and she shared with me about her father a military policeman who was a gentle, kind man, and there was a picture she showed me of her with him. My dad was in special corps of engineers, Army, during Korea. I realized the influence of these special men and their service upon both of us. Whenever I have worked with men or women in the military, the intelligence community, or public service, I tell them thank you for their service. I am so very thankful that Mary and her team have given me an opportunity to be part of an endeavor that is a need in monumental proportion. For Mary, myself, and her team, our work and collaborative efforts with first responders and their families are heartwork.
You can follow Behind the Badge New Mexico and Allies for First Responders here:
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References
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Crank, J.P. (2015) Understanding Police Culture (2nd ed). Routledge: New York, NY.
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Kranke, D., Weiss, E., Gin, J., Der-Martirosian, C, Saia, R., Dobalian, A. (2017). “A culture of ‘Compassionate Bad-Asses’: A Qualitative Study of Combat Veterans Engaging in Peer-Led Disaster Relief and Utilizing Cognitive Restructuring to Mitigate Mental Health Stigma” Best Practices in Mental Health, Volume 13, Number 1, January 2017, pp. 20-33(14).
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