Breaking the Stigma – Part 6

We are going to wrap up this series of articles on breaking the stigma by talking about the ABCs that will undoubtedly make a difference and help change the landscape in emergency services for the good of those who serve in those vital roles.

First, the A: Address the Issues.  The causes of the stigma associated with seeking help must be addressed.  We’ve talked in this video serious about what at least some of those causes are: personnel don’t trust their department or agency to support them, they don’t believe clinicians understand them, and they don’t want to appear weak by asking for help.

Still, the fact that stress-related injuries exist needs to be addressed.  Stress-related injuries are just as real as the physical injuries that uniformed services personnel may suffer.  It’s time that they were treated with the same sense of urgency and understanding.  And of course, the fact that we lose more first responders to suicide each year than in the line of duty needs to be addressed.  This has been true every year for at least the last five years, and the unfortunate truth is that the trend is rising despite the efforts of a number of good organizations that are trying to make a difference.  We need to acknowledge that this is the inevitable result of having a culture of stigma regarding mental wellness in these services.

Next, the B: Build Trust.  Trust is critical to the success of relationships.  The point of building trust is for others to believe what you say. Keep in mind, however, that building trust requires not only keeping the promises you make but also not making promises you’re unable to keep.  Keeping your word shows others what you expect from them, and in turn, they’ll be more likely to treat you with respect, developing further trust in the process.

Developing trust in a relationship can take a significant amount of time.  Building trust is a daily commitment. Don’t make the mistake of expecting too much too soon. In order to build trust, first take small steps and take on small commitments and then, as trust grows, you will be more at ease with making and accepting bigger commitments. Put trust in, and you will generally get trust in return.

In important point to remember here is that peers have a natural advantage for accelerating the time it takes to establish trust.  In fact, first responders tell us – by a 4 to 1 margin – that they would rather have voluntary participation in an effective peer-to-peer support program than to be forced to have mandatory annual meetings with a mental health professional hired by their department.

Finally, the C: Change the Culture.  We need to stop shaming and/or punishing individuals who are seeking help.  Some elements of the culture in uniformed services are deeply ingrained and are likely to never change.  That’s okay.  But there are some aspects of that culture that we’ve described earlier that simply must change if we are to break down the walls of stigma that prevent people from getting help when they need it.

The International Association of Chiefs of Police and the National Fallen Firefighters Foundations have been consistently publishing information and guidelines for the past 5 years, at least, on how departments need to proceed to take better care of the mental wellness needs of their personnel.  Agency leaders need to do a better job of identifying and implementing solutions that will work for their people.

Silence isn’t strength and asking for help is not a sign of weakness.  That’s why Call for Backup exists – to remind us that it’s okay to not be okay, but it’s not okay to stay that way.  There is help, there is hope, and we are here for you.  If you’re struggling and need some help, it’s time to call for backup.  You can reach us by sending a message to m.me/callforbackup.org/.

Coronavirus Anxiety: Coping with Stress, Fear, and Uncertainty – Part 1

It’s a frightening time. We’re in the midst of a worldwide pandemic, with cities and even entire countries shutting down. Some of us are in areas that have already been affected by coronavirus. Others are bracing for what may come. And all of us are watching the headlines and wondering, “What is going to happen next?”

For many people, the uncertainty surrounding coronavirus is the hardest thing to handle. We don’t know how exactly we’ll be impacted or how bad things might get. And that makes it all too easy to catastrophize and spiral out into overwhelming dread and panic. But there are many things you can do—even in the face of this unique crisis—to manage your anxiety and fears.

Fears about COVID-19 can take an emotional toll, especially if you’re working on the front lines as a first responder or medical professional, or already living with an anxiety disorder. But you’re not powerless. Each day this coming week we will be sharing tips that can help you get through this stressful time.

Here is today’s tip:

Stay informed—but don’t obsessively check the news

It’s vital to stay informed, particularly about what’s happening in your community, so you can follow advised safety precautions and do your part to slow the spread of coronavirus. But there’s a lot of misinformation going around, as well as sensationalistic coverage that only feeds into fear. It’s important to be discerning about what you read and watch.

  • Stick to trustworthy sources such as the CDC, the World Health Organization, and your local public health authorities.
  • Limit how often you check for updates. Constant monitoring of news and social media feeds can quickly turn compulsive and counterproductive—fueling anxiety rather than easing it. The limit is different for everyone, so pay attention to how you’re feeling and adjust accordingly.
  • Step away from media if you start feeling overwhelmed. If anxiety is an ongoing issue, consider limiting your media consumption to a specific time frame and time of day (e.g. thirty minutes each evening at 6 pm).
  • Ask someone reliable to share important updates. If you’d feel better avoiding media entirely, ask someone you trust to pass along any major updates you need to know about.
  • Be careful what you share. Do your best to verify information before passing it on. We all need to do our part to avoid spreading rumors and creating unnecessary panic.

We hope these daily tips this week offer you some help and hope.  Meanwhile, if you’d like to chat with one of our peer support specialists, feel free to message us a m.me/callforbackup.org/ and we will connect with you as quickly as possible.

Source: helpguide.org

Breaking the Stigma – Part 5

When we left off last time, we said that we were going to be addressing the three things that first responders need to manage stress, especially in the immediate aftermath of a critical incident.  Those three things are ventilation, validation, and education.

Ventilation is the process through which we encourage and allow individuals to express themselves freely – to “tell their story.”  Quite simply, research tells us that traumatic memories often get trapped in the mind, and the longer we avoid talking about the trauma the more likely we are to develop PTSD.  Talking about the event will often lead us to sources of support, help us make sense of what happened, and to realize that our identity is not limited to that traumatic event, even if it was a defining moment in our lives.  It can help us view ourselves as victors, not victims.

Clinicians, family members, and peers must be able to listen without seeming shocked and without passing judgment.  They need to be able to listen without expectations or judgments. As a helper, you can make it clear that you’re interested and that you care, but don’t worry about giving advice. It’s the act of listening attentively that is helpful, not what you have to say in response.

As you give that person the opportunity for ventilation, some of the things he or she tells you might be very hard to listen to, but it’s important to respect their feelings and reactions. If you come across as disapproving or judgmental, they are unlikely to open up to you again.

The next thing is validation.  Validation is the process through which we acknowledge the event(s) and the individual’s reaction(s), and then “normalize.”  One of the most refreshing things a person who is struggling with symptoms of stress can hear is that they are not “crazy.”  As we say in teaching critical incident stress management, people who have experienced a traumatic event are having a normal reaction to a very abnormal event or unusual set of circumstances.

Individuals will also benefit from hearing that others have experienced similar reactions or have had similar thoughts.  One of the benefits of group-based crisis interventions is that the idea that there is a set of reactions that is common to people who have experienced the same or similar types of situations.  This helps legitimize rather than stigmatize the symptoms that people are experiencing.  Research done for Call for Backup shows that over 90% of first responders agree that the things they see affect them emotionally.  People need to know that they are not alone.

Finally, there is a need for education.  Education is the process through which we help identify existing coping skills and suggest additional coping skills to manage stress reactions.  Individuals suffering from the effects of a critical incident and/or chronic stress need instruction on the right kinds of coping skills that will help improve their chances of feeling better sooner rather than later.

The idea is to promote healing from past events and to build resilience against potential future events.  Research done through Johns Hopkins University on early psychological intervention demonstrates that a person who receives good stress management education and learns effective coping skills will often show a higher level of adaptive function than was shown prior to the traumatic event.  Not only have we promoted recovery, but we have also helped that individual develop resistance against the impact of stress and resilience that will help them “bounce back” more quickly in the future.

In our next article, we will put this all together as we talk about the ABCs of dealing with the problem of the stigma for first responders associated with reaching out for help.  If you have issues that you are struggling with and know you need to seek some help, you can contact us confidentially at m.me/callforbackup.org/.

Breaking the Stigma – Part 4

Some of the best clinicians to deal with the needs of police officers, firefighters, paramedics, and others in similar careers, are those who have a background in emergency services themselves.  It is not unusual at all to see clinicians who advertise that they treat first responders to have such a background.  For example, one of the members of the board of directors for the Call for Backup organization is a retired trooper from the Michigan State Police who obtained is counseling degree and now has a practice serving exclusively first responders.

Clinicians who do not have a background in emergency services can still have members of those populations as clients, assuming they have taken steps to become integrated in some way with the culture, and who conduct themselves in a way that shows acceptance of the culture of emergency services.  I’ve conducted many training classes in critical incident stress management with first responders seated along with clinicians who were being trained to understand and work within those cultures.

Family members also need to embrace the culture and understand that family routines change for those in the military or emergency services.  Guess what – there will be missed anniversaries and birthdays.  Someone else is going to have to take the kids to soccer practice or to the dance recital.  Dinner plans will have to be changed, and family vacations may be interrupted.  Rather than fight it, families must embrace it together.

And let’s face it – “crap” rolls down-hill.  Spouses and life partners have to understand that when their loved one has “had it up to here” they may behave in ways that seem uncaring, unloving, or perhaps even downright mean.  Be present and be supportive.  Walk through those challenges together.

Family members of first responders are also at risk for vicarious traumatization and secondary traumatic stress as a result of the trauma that may be directly experienced by the person serving in one of those uniformed services.  Any family member who begins to experience stress-related symptoms should also seek help in adjusting to those difficult circumstances.

Finally, peers can take advantage of their shared understanding and empathy to help one another.  What would you expect coworkers to ask each other after some kind of stressful incident or event?  They would likely ask each other, “Are you okay?”  They naturally care for each other, and they naturally understand each other because they wear the same uniform and do the same work.  They simply need to be accustomed to asking that question of each other when they simply recognize that a peer may have been going through some “stuff” and just needs to know that he or she is important and supported.

Many peers have been trained in peer support programs that may be unique to their own service, or in critical incident stress management programs offered by organizations such as the International Critical Incident Stress Foundation.  Peer support definitely belongs on the continuum of care that individuals may need in dealing with the cumulative effects of chronic stress, or the sudden impact of a traumatic event.

I have seen department or agency leaders resist the idea of implementing programs to help their personnel deal with issues related to their mental and emotional well-being.  I have also seen members of departments band together and continue to lobby their administration until they were given the funding and access to training so they could begin the process of creating a culture of support within the department.

In our next article, we’ll be talking about the three things every first responder needs to effectively deal with stress, especially the aftermath of critical incident stress.  If you have any questions or concerns about your own well-being and you’d like to chat with one of our peer support specialists, simply go to m.me/callforbackup.org/.

Breaking the Stigma – Part 3

I am always quick to point out that our response to stress and trauma in emergency services has to include a mental health component.  Please don’t assume that I have anything against licensed clinicians; they occupy an important space in the overall approach to addressing the needs our first responders have in the area of mental and emotional wellness.  But that doesn’t mean that there may not be some problems associated with that.

For example, clinicians often don’t understand the first responder culture.  I’ve heard horror stories from police officers who have seen a therapist that wouldn’t allow them to have a firearm in the office, or from medics whose therapists have broken down crying because they couldn’t stand to hear the accounts of the traumatic scenes that we have all responded to, or from firefighters who were told by a therapist that they should probably go into a different line of work.  And if therapists can’t understand the culture, they’ll never be able to earn the trust of those they would like to try to help.

Clinicians often don’t have sufficient training in the field of psychotraumatology.  Many clinicians have limited training in dealing with issues relating to post-traumatic stress and being able to effectively work with individuals suffering from a variety of stress-related disorders.  The worst outcome of that is that everything gets labeled as PTSD when the vast majority of first responders and military personnel, even those who are dealing with stress-related symptoms, do not meet the diagnostic criteria for PTSD.

I’ve used this statement many times in training mental health professionals to work with first responders: “If the only tool you have is a hammer, every problem looks like a nail.”  The hammer that clinicians have is the DSM-5, and every person they see needs a diagnosis.  I have seen personnel misdiagnosed as having narcissistic personality disorder, borderline personality disorder, passive-aggressive personality disorder, obsessive-compulsive personality disorder.  We have to be careful about not confusing exaggerated behaviors caused by stress with symptoms of genuine disorders with similar characteristics.  It would be important to keep in mind that every military member of first responder you might see as a clinician has already had to pass some pretty rigorous screening for mental disorders prior to being hired or allowed to enlist.

In future articles in this series on breaking the stigma, we are going to talk more specifically about what family members can do to understand and help their loved one who may be suffering, what peers can do for one another, and what clinicians can do to be more effectively prepared to help first responders manage their stress and to better adjust to the trauma they experience on the job.  The more we know, the better able we are to work together to break the stigma that is keeping so many of our first responders from getting the help they need.

Feel free to reach out to us any time for information or just to chat about any personal struggles you may be having – m.me/callforbackup.org/.