Is It Okay Not to be Okay? Part One of ATFN’s Two-Part Series on First Responder Wellness

By James Careless

When it comes to first responder mental health and wellness, the statistics are sobering. “It is
estimated that 30 percent of first responders develop behavioral health conditions including, but
not limited to, depression and [PTSD], as compared with 20% in the general population,” says
the Substance Abuse and Mental Health Administration (SAMHA) report, ‘First Responders:
Behavioral HealthConcerns, Emergency Response, and Trauma’. “In a study about suicidality,
firefighters were reported to have higher attempt and ideation rates than the general population.
In law enforcement, the estimates suggest between 125 and 300 police officers commit suicide
every year.”

Given the many horrific and heart-rending incidents that first responders experience on the job,
such numbers are understandable. This being said, one reason they are so high is the ‘macho’
mentality that still cripples so many first responders — one where they are expected to ‘suck it
up’ and endure anything that happens to them without admitting their feelings, for fear of looking
‘weak’.

In reality, humans can’t suffer trauma and survive it without acknowledging and addressing their
psychological injuries, anymore than they can experience being shot at close range and then
‘shake it off’ without medical attention. This emotional healing journey begins by admitting that
‘it’s okay not to be okay,” says Jeff Lytle, retired Fire Chief with the City of North Las Vegas. For
years. Chief Lytle has been helping firefighters address traumatic work-related stress through
departmental Critical Incident Stress Management (CISM) programs, going back to the days
when he was just a Battalion Chief.

“The key to addressing job-related email trauma starts with personally accepting that it is okay
not to be okay,” Chief Lytle says. “This is a big change from how things were when I started out
30 years ago. There was an unwritten and unspoken expectation that you just dealt with things!
It was not acceptable to express your emotions or to be affected by the things you did or saw.
The cultural expectation was just to be tough, cowboy up, or just deal with it, kid; it is just the
nature of the job!”

Unfortunately, first responders’ historic reluctance to admit to on-the-job trauma due to negative
pressure from Command and peers has ruined the careers of many good officers due to
depression, PTSD and suicide, along with the havoc caused by using alcohol and drugs as self-
medicating ‘coping mechanisms’.

“I think back over the past 30 years and I often ponder how many lives were affected because of
our blinders to stress and emotions,” says Chief Lytle. “How many families, spouses, children,
and friends were negatively impacted because of our inability to acknowledge that everyone
deals with emotional trauma in different ways — and needs positive help and support to do so.
Unfortunately, we were taught to emotionally put things into a box and leave it there! ‘Don’t open that box, it’s too much to deal with!’ The problem is that the box could be opened or triggered
very easily from a sound, a smell, or a picture!”

In recent years, the introduction of CISM processes into first responder agencies has made a
start into addressing the issue of first responder mental health, but has only “scratched the
surface” of the problem, the Chief notes. “Many of us put out some CISM information to our
people, and checked a box that we provided a service,” he says. “But even with this in place, it
was still not culturally accepted to admit you had feelings, or heaven forbid, possibly need a little
help.”

So what is to be done? Well. Chief Jeff Lytle and other public safety mental health advocates
are trying to change this situation — to allow people to admit they are not okay and need help
— but it is still an uphill battle. “We have the new catchphrase that it is okay to not be okay, but
is it really?” he observes. “There is a lot of embarrassment and feeling of not being good
enough for first responders who experience these emotions. How do we get to the point where
culturally it is really okay to not be okay?”

According to the Chief, getting to this point requires many more changes to first responder
culture. The issues that need to be addressed within the first response community include, “how
do we normalize CISM issues, and how do we engage everyone in an organization to culturally
accept and to embrace a new normal?” he says. “For instance, In the fire service there is
generally a Morning Muster at each fire station, while in the police world there is a daily briefing.
In these daily briefings, do we normalize Critical Incident stress? Do we talk about it daily? Do
we have resource information and professional help numbers readily available? And can we
make talking about this as acceptable and comfortable as running down the day’s
assignments?”

How this can be done will be covered in Part Two of this series.