If our stigma about discussing and seeking treatment for behavioral health is dead, where do we focus next?

By Rick Markley

This article originally appeared in the Fall 2024 issue. View the full issue here.

In the 1800s, Friedrich Nietzsche and many other German philosophers proclaimed that God was dead. Of course, they didn’t mean that God was splattered in a crosswalk by some metaphysical bus that blew a red light. They considered whether Christian-based morality still mattered in the “modern” era. 

Today, we could apply science to answer that question. We could conduct randomized surveys and focus groups to measure religious and moral beliefs among various segments of our population. We could conduct observational research to see how many attended religious services. We could look for other markers like parochial school enrollment, donations to religious institutions, and other measures and then compare that to historical data. 

We might not answer the philosophical question, but we would likely find — to paraphrase beloved author and humorist Mark Twain — that the reports of God’s death are greatly exaggerated. 

The Persistence of Stigma

When it comes to firefighter health and wellness, even the most irreligious of us are aware of the existence of mental health issues in the fire service. Most are probably also supporters (hopefully not practicing believers) of the long-standing stigma surrounding firefighter mental health. You know that stigma: Don’t talk about it and don’t treat it because it shows that you are too weak for the job.

Yet today, firefighter mental wellness is talked about and written about to more or less the same extent as firefighter cancer and firefighter heart health. In fact, a search of scholarly research on firefighters turns up more work on mental health than either cancer or cardiovascular health.

So to recast Nietzsche’s theory: Is the mental health stigma dead in the fire service?

Based on all the talk and writing, you’d have to say “no”, the stigma is living loud and proud in our midst. But talk and writing aren’t research and maybe don’t tell the full story.

Key Findings from Questionnaire

In 2023, the International Association of Fire Chiefs pulled together a working group from different walks of fire service life to look at the state of mental health. The group created a questionnaire to get at what it felt were the most pertinent issues regarding firefighter mental wellness. 

Spoiler alert: Stigmas surrounding behavioral health in the fire service scored really, really low. 

“This was not a survey; we didn’t get scientific data,” says leading fire service researcher Sara Jahnke. “It didn’t answer all our questions, but it did tell us where to start asking more questions. And the stigma response was a really exciting find, because we probably wouldn’t have looked at it further without these results.”

Jahnke has launched Science to the Station: A Health & Wellness Alliance, a platform to bring important firefighter health and wellness science to firefighters. She also headed up the working group that developed the questionnaire and analyzed the results. 

Here’s a peek under the questionnaire’s hood. Just shy of 1,500 firefighters completed the questionnaire. Those who did were what researchers call self-selected — meaning they were not pulled randomly to represent the entire population, but simply those who decided to do it. The largest number of respondents came from Arizona, a tick more than 18%. Career firefighters made up 64% of the respondents. Nearly 26% held the rank of firefighter. 

In close step with the general firefighter population, 84% were men and 89% were white. (According to the U.S. Bureau of Labor Statistics as of 2020, 96% of firefighters were male and 85% were white.) 

Respondents were asked to rank the barriers to accessing mental health through their department. Only 1% listed stigma within the organization as a barrier. Stigma within their family was even lower at just one third of one percent. 

See, we told you it was really, really low. 

Conversely, when asked how fire and EMS agencies have improved their approach to behavioral health, only a quarter of one percent listed reducing stigma as an improvement. Responding to another question, about a third of respondents said that reporting a mental health issue could impact their ability to make a living. 

One way to look at those numbers is that departments are not putting effort into reducing the stigma because the stigma doesn’t really exist. And the concern about not earning a living can be seen through pragmatic eyes. For example, they may feel that a behavioral health issue would disqualify them from working versus having them ostracized by their peers, which would be more reflective of stigma. 

And while that looks all fine and good on paper, what are those on the street seeing?

The Need for More Comprehensive Support

Jada Hudson owns Hudson Clinical Counseling and is a behavioral health therapist who specializes in working with first responders. She works almost as an embed with several fire departmewe can focus less on ‘it’s ok to seek help’ and more on ‘here’s where to go to get help’ that’s a huge win for all of us.

“We often say that we need more research. Here, that research can lead to nts near Chicago. And she says we are heading toward a post-stigma world.

She admits the departments she works with are more progressive on mental health issues — evidenced by them hiring her to improve their mental well-being. She attributes part of that shift to a strong union presence and their making mental health a priority. She also says it is generational, with younger department members not bringing the same fear-of-mental-health baggage into their careers. 

Jeff Dill, who founded the Firefighter Behavioral Health Alliance and is a certified therapist, says he too is seeing more openness among firefighters about seeking behavioral health help. He says that in a post-stigma world, we need to do more than provide lip service to mental wellness.

“An organization needs to build consistently upon their behavioral health program,” Dill says. “Creating peer-support teams, qualified counselors/chaplains, educating family members, creating behavioral health policies, offering both physical and behavioral health annual check-ups, creating a program for those members who retire, resign, are fired or have an on-duty injury all need to be part of the ongoing effort.” 

Nobody, Jahnke says, is ready to declare stigma dead. 

“But this is exciting,” she says. “If stigma is on life support, it means we can start planning for how to better allocate our behavioral health resources. If real changes in how we approach firefighter behavioral health.”

This article originally appeared within the Fall 2024 issue. View the full issue here, or browse all back issues in the CRACKYL Library.