Can The Low-country Firefighter Peer Support Team Help Prevent Suicides?

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Table of contents

  1. Abstract
  2. Introduction
  3. How do peer support teams work?
  4. What is the LowCountry Firefighter Support Team?
  5. Conclusion
  6. References


According to a 2015 article published in the Journal of Emergency Medical Services, first responders attempted suicide rate is 10 times greater than that of the general population within the United States. More than 4,000 first responders or 6.6 percent had attempted suicide in 2015, and first responders attempted suicide rate has been gradually increasing over the past 10 years. Stress is an inevitable part of a first responders life. They deal with many different types of stressors on a daily bases and work under conditions which present a constant danger in unsecured environments. These professionals are constantly exposed to diseases, unsafe environments, and traumatic events that present a threat to their health and well-being. The exposure to these stressors put first responders at risk for psychological challenges, which include but not limited to: depression, anxiety, anger and post-traumatic stress (PTS). Any psychological challenges can lead to other problems, such as relationship difficulties, substance abuse, absenteeism, and suicide ideations.

This paper will research and discuss the effectiveness of peer support intervention programs that are design to help first responders to cope with stress, tragic or traumatic events. Through research this paper will identify the difference between “crisis-focused psychological intervention programs” and “peer support programs”. Identifying, “How the LowCountry Firefighter Support Team can help prevent suicides within the first responder community?”

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Some hard cold facts about first responders and suicide. “Between 2015 and 2018, more first responders died by suicide than in the line of duty.” (Heyman, PhD, Dill, MA, NBCC, & Douglas, DCC, 2018b) In 2015, Abbot et al. found that suicide among first responders are often driven by emotional strain in a work culture that as long to discouraged individuals from showing any signs of weakness. In a recent study (Substance Abuse and Mental Health Service Administration, 2018, p. 3), “It is estimated that 30 percent of first responders develop behavioral health conditions including, but not limited to, depression and post-traumatic stress disorder (PTSD), as compared with 20 percent in the general population.” According to the Code Green Campaign, a Washington based non-profit organization that tracks first responders suicide rates, “First responders deaths involving suicide received less attention than other types of first responder incidents.” A study completed by the Firefighter Behavioral Health Alliance (FBHA), reveals that there had been 374 suicides committed by active duty firefighters, compared to 268 Line of Duty Deaths (LODDs) between 2014-2016. The study also revealed that suicidal ideation rate among first responders is 10x greater than that of the general public, 12x greater for firefighters, and that first responders’ suicide attempts were 13x higher, while Firefighter suicide attempts were 30x higher than the general public. First responders risk of successful suicide was more than 2.5x that of the general public.

In 2018, academic journal Canadian Psychology, revealed the results from a self-reported sampling of more that was 5,000 Canadian first responders that suggested, “all public-safety professionals are above the national averages in terms of suicidal behaviors.” According to this report “these results even surprised many seasoned researchers who have spent years mapping out mental-health disorders among first responders.” According to the 2017 survey, 10 percent of the public-safety professional admitted to having suicidal ideations and had seriously thought about killing themselves. Four percent admitted that they actually had planned a suicide attempt, while only 1 percent actually admitted to acting out a suicide attempt.

A study conducted by the Ruderman Family Foundation, a philanthropic organization looked at depression, post-traumatic stress disorder and other issues affecting first responders as well as national suicide rates. This study revealed that first responders are five times greater to be affected by Post Traumatic Stress (PTS) and Post Traumatic Stress Disorder (PSTD) than an average person and less than 5% of Emergency Services Departments have suicide prevention programs. One core risk factor affecting first responders is the fast pace of their work. First responders are always on the front line facing stressful, highly risky and dangerous situations. The fast tempo and stressful workload of the EMS professional can lead to an inability for EMS professionals to recover between traumatic events (Bentley et al., 2013). As a result, depression, stress and PTS symptoms, suicidal ideation, and a host of other functional conditions have been reported. Research studies and empirical data on the problem remains scarce, but the behavioral health problems among emergency responders seems to be widespread. Studies done by the Code Green Campaign and the Blue Study have shown that as many as “37 percent of firefighters may exhibit symptoms of PTSD. Compounding the problem is a lingering stigma that can make it difficult for emergency responders to acknowledge behavioral issues like depression, whether it’s their own or that of a colleague” (Wilmont, J., 2014, May 2).

Emotional strain among the first responders community are often driven by a culture that discourages an individual to show weakness. Firefighter, police officers and EMS training does not prepare trainees for the mental impact of what they visualize, feel or experience during their careers. Visual, auditory, and sensory details from bad a experiences become embedded into the brains of a first responders. As these experiences and memories become embedded and emotional triggers begin to build up. Different triggers, such as a smell or sound can render an emotional response or memory of a horrific event that occurred during the first responders career. Unfortunately, social and cultural settings may not permit first responders to take time to process their emotions. First responders tend to ignore, tamper down, and suppress their emotions. These emotions’ overtime start to slowly build up and begins to destroy a person's ability to communicate or relate with others. Some other factors that contribute to stress and suicide among first responders include: high call volumes, long shifts, low pay, sleep deprivation, and a lack of administrative support.

A cultural stigma is tied to first responders’ willingness to seeking help during times of emotional crisis. First Responders are perceived as both physically and mentally strong and are not entitled to show any weakness, because that means there are “chinks in the armor” and is viewed as a sign of weakness. These cultural beliefs prevent many first responders from seeking help and learning how to cope with stress, depression, and PTS. “One study found that 92 percent of the firefighters surveyed were unwilling to get help because of this behavioral health stigma.” (Gleason, 2018) As a culture, First responders are concerned that an outsider or counselor/psychologist may not understand what they go through on a daily basis. Some believe that they will lose their job if they ask for help; many do not understand their rights when it comes to mental health. Many are concern about revealing their feelings and are unsure on who to trust when it comes to talking about confidential matter such as suicide ideations. Talking to an external counselor/psychologist may not be the most viable solution, as many first responder are distrustful of outsiders. Peer support teams can help first responders overcome the cultural stigma of emotional and mental health related issues by providing a safe, comforting and understanding environment.

What is the difference between “peer support programs” and “crisis-focused psychological intervention programs”? Peer support programs are designed to help first responders manage work-life stressors. Department members or members of the first responder community participant in the program and receive specialized training on how to provide support and outreach to their peers. Peer support teams strive to raise awareness and normalize the discussion of behavioral health within the first responder community. Crisis-focused psychological intervention programs are generally conducted following an exposure to a critical incident and are conducted within the workplace. This type of intervention is designed to provide opportunities for support and assistance in connection to work- related stressors. Crisis-focused psychological intervention are focused on the most recent single incident. Peer support teams focus on past and present events. Crisis-focused psychological intervention are grouped based, where peer support team inventions focus on the individual. Crisis-focused psychological are conducted by managers or leadership staff member and peer support team support is provided by a member of the first responders peer group (i.e., a Firefighter will support their co-worker or a police officer will support their co-worker).

How do peer support teams work?

Peer support teams or groups can offer several advantages, because of the peer support team member’s unique client perspective. Peer to peer support helps individuals to accept and engage in assistance and recovery plan a way that other health care professionals might not be able to do. In order for a peer support team to be successful, they first need to select the right team members. It is important to have a detailed screening process with letters of recommendations and completing an interview process. It is important that the selected individuals can be trusted and maintain the strictest level of confidentiality. Peer to peer counseling is can only succeed if the peer teams member is empathic, relatable, and trustworthy.

Next peer team members must go through specialized training. Ongoing training is equally important and team members need to feel confident in their ability to reach and and listen to their peers. Training should be engaging and encourage connections between team members and their peers. Team member’s emotional and mental health should also be monitored. Serving on a peer support team can be emotionally taxing and needs to have a check and balance system in place to ensure team members are maintaining appropriate balance. It is important to have mental health providers overseeing the program and needs to conduct regular check-ins.

Establishing standards and protocols to address a screening process, team member roles, relationship restrictions, mandatory reporting situations, referral guidelines and confidentiality limitations. Peer support team are usually a grassroots activity, leaders need to be in place in order for the program to thrive. According to Mental Health America, research has shown that peer support teams “have a transformative effect on both individuals and systems.” In fact, Peer support can help improve the quality of life for those seeking help. Improves the satisfaction and engagement with support and services.

What is the LowCountry Firefighter Support Team?

The LowCountry Firefighter Support Team (LCFFST) was founded in June of 2007 as the Charleston Firefighter Support Team, after nine Charleston firefighters perished in the Charleston Sofa Super Store Fire. The support team was developed to provide mental health counseling and peer assistance to firefighters and their families. Over the last 12 years it has grown into a full-service counseling program dedicated to supporting the behavioral health of firefighters (F.F.), Emergency Medical Service (EMS) personnel, police officers, 911 dispatchers, and their families. The LowCountry Firefighter Support Teams mission is to promote peer-based and clinical behavioral health services that are easily accessible and available, insure that services meet the needs of first responders and their families, and identify responders who are in distress and respond effectively. The LCFFST provides peer support by having trained personnel respond, provide initial support and referrals for emergency services personnel and their families during times of crisis. LCFFST also provides clinical support, physician support, crisis intervention, and group counseling uses the power of peer support to tackle issues and together seek solutions. The LCFFST also provides training, education as well Community outreach and support.

The question becomes “How the LowCountry Firefighter Support Team can help prevent suicides within the first responder community?”

In order for the LCFFST to be successful in developing a peer support for individuals contemplating suicide they must have a group leader or facilitator. They must remember that the facilitator doe not act as a therapist, but is the leader that facilitates the discussions, allowing all members to have a chance to speak. A group or peer leader must be able to listen and guide the conversation, while being empathic to each individuals needs. Peer team members must be able to make everyone feel safe and keep the concentration on the issues at hand. LCFFST must set rules, be respectful, and practice confidentiality. Team member need to be trained on how address a member who needs professional help or have ideations of self-harm, suicide, or harming others. The LCFFST can be successful in providing assistant to their peers and providing further resources to individuals in crisis. They must commit to building a strong foundation and a robust training program.


To stop this trend, many fire, police, and EMS department are creating formal peer-support programs to encourage first responders to talk about stressors before they become overwhelming.

Research conducted by the Code Green Campaign and The Blue Paper has shown that peer support teams and peer support groups for first responders are effective in providing support to their peers. Support teams or groups are effective for improving self esteem, reducing anxiety, providing cultural change, and creating an overall sense of well-being and security. Peer support work better than Critical Stress Debriefing, when it comes to suicide ideations. Individuals feel more comfortable speaking to their peers and avoiding speaking out in a large group setting. First responders feel more comfortable and trusting when it comes to talking to people, when an individual can relate to them and their story.


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