Mental Health Literacy
By Nick Halmasy, Amanda Brazil, Robin Campbell
To help address mental health concerns, the fire service needs to move past awareness and reach educated fluency
By Nick Halmasy, Amanda Brazil, Robin Campbell
Imagine this: You’re just wrapping up a weekend long certification program. You stayed awake for the in-class portion and your hands are dirtied by the practical. The test, when written, was a pass with distinction. You earned your bragging rights. You’ll head back to the hall, and quickly update everyone on your newest knowledge nugget. You’ll proudly, in a power stance and with head held high, announce this achievement loudly to everyone, ushering in station-wide envy.
You are now… Hazmat Aware.
You’re right, this scene as imagined is not likely to happen. As firefighters, we roll our eyes at the Awareness Level certification, like we are likely to do at our Legislative 101 courses. We want to be Technician level, after all. That’s the true testament to our practical and academic merit. Yet, when it comes to mental health, we carry on in maintenance mode with low-level basic mental health knowledge. We are nowhere near mental health literate, or Technicians if you prefer, when it comes to firefighter mental health.
Even more importantly, we don’t know how to challenge those in our profession who may not see a need to move past the awareness stage, who continue to think, believe, act, and sometimes lead with the misunderstanding that mental health is not a true concern in the fire service and when it is, it is either too late to help or there is really nowhere to turn for help.
How do we use checks and balances to ensure we move beyond awareness and actually become educated about our own mental health and how the work of the fire service impacts it? Because it will impact it, one way or another. This is exactly why mental health literacy is important.
The media has really helped advocate for firefighter mental health by relaying true stories of PTSD and suicide in our brotherhood/sisterhood, serious issues that are devasting firehalls across the country. But when the media is our teacher and their coverage is the extent of our education on our mental health, many of us may be left to wonder if they have PTSD. Actually, your lack of sleep and irritability after the recent fatal MVA is most likely normal and is one component of how you process a bad call.
Recent research on volunteer firefighters’ mental health found that firefighters are more aware now than ever that their work can impact their mental health, but for many, the mental health knowledge seemingly stops there (Brazil, 2019). What firefighters need, once they become aware, is what is called mental health literacy. Mental health literacy is defined as the “knowledge and belief about mental disorders which aid their recognition, management, or prevention” (Jorm, Korten, Jacomb, Christensen, Rodgers, & Pollitt, 1997, p. 182). Basically, it is knowing how to recognize, manage or prevent mental health problems; problems we are vulnerable to because of the very work we do. We are trained how to recognize, manage, and prevent a lot of things in the fire service so we can work effectively and efficiently. Wouldn’t it make sense to do the same with our mental health? Until we start to become literate on this issue, we will have a heck of a time trying to address it.
Think of what we currently do or have in our fire departments relating to mental health as falling along a continuum. At one end we have available services should we find ourselves off the fire ground because of mental health challenges; we have WCB coverage and insurance. In the middle of the continuum we have our CISM defusings and debriefs where we address the bad calls right after they happen to help lessen the impact. At the beginning of the continuum we should have mental health education to improve our mental health literacy. This way, we have a chance to recognize what is going on with ourselves from very early on and through practice and reflection, help prevent any new stories for the media.
Why is awareness level information on its own so problematic? Perhaps the most harmful aspect of not moving beyond the awareness stage is misinformation. How we receive and access information is critical for understanding the harmful consequences. Many of us only gain knowledge through popular media sources such as social media, personal blogs, and online forums. But as the sole source of information on mental health, harms of self-diagnosis, confusion, and further stigmatization can emerge.
Most of us believe that sharing a meme or information on social media is a strategy to lessen stigma on mental health issues, but in reality, it can intensify stigma and increase the likelihood that individuals will not seek help early if the information is wrong. There is a problem with the accuracy of many mental health messages. The overload of PTSD awareness campaigns has contributed to a crisis of misunderstanding of mental health problems and creates confusion for the individual who may be struggling. A rising issue is seen in how firefighters and other first responders are self-diagnosing, with PTSD being the main verdict. The danger of self-diagnosis is two-sided — it can either trivialize the mental health problem or it can magnify it. This can lead to panic and/or self-medicating, which can be equally as harmful.
Knowing this, how do we move past this awareness stage? Firefighters need to demand access to the educational tools and practical opportunities that will help them recognize, manage or prevent mental health problems.
Fire departments have an obligation towards striving for the best knowledge, based on evidence, that they can provide their staff, just as they would for fire suppression or prevention. Again, if we fail to recognize the importance of becoming literate when it comes to our own mental health, then we will continue to be confused, frustrated and continuously lose battles. It would be as if we were trying to fight modern fires without the understanding of modern building construction and fire behaviour.
Awareness is about basic understanding, like understanding that where there is smoke, there is usually fire. Literacy is extensive knowledge and action — when there is fire, this is how you supress it. As with any program or intervention worth its salt, there should be some metric for which you are able to measure its effectiveness. We would never think, for instance, that just taking a pump-ops course is enough to ensure proficiency in running the pump on scene. That academic knowledge allows one to conceptualize how to run pumps; it doesn’t teach how to run your pump, on that particular scene, with the particular water demands, etc. To be frank, if your organization is simply running once a year information sessions with mental health focus, because that is what is called for by the PTSD Prevention plans, then you are offering bread and water to folks. That is awareness.
Practice and conscious reflection are what brings this all together.
Further, as researchers, we need your help. The majority of large scale studies have been completed using self-reporting strategies. This means that you receive a survey with questions and answer them based on the wording. The assessments, however, require more specific understanding regarding exactly what and why the question is asked. This requires the user to understand on a more literate level why answering “feeling tired, or having little energy” on the Patient Health Questionnaire (a commonly used assessment) means more than simply tired from the day or week. The completer needs to understand that it is feeling tired without any reasonable cause or occurrence (i.e. work isn’t impacting, exercise isn’t impacting, a rough night’s sleep isn’t impacting, etc.).
Literacy isn’t all on chief officers and administrators either. As has been written elsewhere (see “Forging new beliefs”, December edition of Fire Fighting in Canada), there is a high level of responsibility on the part of the frontline staff to ensure their own well-being. Indeed, it is a fair argument to make that literacy on non-frontline administrative staff is going to be much different than the literacy needed by active frontline firefighters. These two programs will never be mutually exclusive with wide overlaps, however the knowledge needed is going to be different.
Continuing to ignore or deny that these are now the realities of working in the fire service amounts to denying that cancer is not a risk factor, so we continue to practice removing SCBAs during overhaul.
It’s just bad practice.
Nick Halmasy is a registered psychotherapist who spent a decade in the fire service. He is the founder of After the Call, an organization that provides first-responders with mental-health information. Contact him at firstname.lastname@example.org.
Amanda Brazil is a research scientist at the Centre for Health and Community Research (University of Prince Edward Island), an associate researcher with FIREWELL, and a former volunteer firefighter and medical first responder with the Cross Roads Fire Department (P.E.I.).
Robin Campbell is a PhD candidate at Dalhousie University, and a lecturer in the Department of Community Development at Acadia University. Robin is an associate researcher with FIREWELL and was a volunteer firefighter in rural Nova Scotia for 10 years.