Mental Health Crisis: Have You Preplanned?

( By Jeff Dill, Fire Engineering )

As firefighters, we recognize that preplanning a building is a necessity. We learn how it is laid out, what the pitfalls are, how to best attack the fire based on the building, and how to have a successful outcome. I know from experience that it’s not the premiere training like live-fire training, saving our own, technical rescue, and it probably ranks below throwing ladders. Yet when responding to a possible fire, that little book of preplans is a wealth of knowledge and a possible lifesaver. My question to all of you in the fire and EMS organizations: have you preplanned your life in the event of a mental health crisis?

I am not referring to what steps are taken within your organization. Rather, what do you do if your world changed in a heartbeat? As a retired fire captain, licensed counselor, and founder of Firefighter Behavior Health Alliance (FBHA), this planning is crucial and can be the difference between a positive outcome or a deadly consequence. This article is not written to scare or threaten you. For four years I have heard hundreds and hundreds of stories on the losses of my brothers and sisters to suicide. Many of these tragedies are the result of an acute event, usually in their personal life, where their first inclination is to take their own life. These acute events range from an announcement of divorce, loss of a family member, disappointing a spouse with an affair, financial ruin, or medical results that will affect their health. For so many of these firefighters and EMTs, the initial response is an action that I term in my workshops “cognitive disconnect.”

I define cognitive disconnect as a condition where reality and one’s understanding or perception of reality are different. In the cases of suicides, the reality is that we are human beings who make mistakes or feel pain, anger, guilt, and shame. These are real emotions under the situation they are dealing with, yet in their minds there are no exceptions, no other choices, or no one to turn to who would understand them. Suicide becomes their only option.

Preplanning

If you have attended one of FBHA’s workshops, you have heard me speak of Post-Traumatic Stress (PTS). I believe if you are in this job you will suffer from some form of PTS. This might just be smallest aspects of PTS–such as trigger points of names, places, or smells that take us back to calls years ago in which we can recall the scene in its entirety. It might not be Post Traumatic Stress Disorder (PTSD), which can debilitate a person on a daily basis, but PTS can affect each one of us in a different way. Factoring in the cumulative effect of the job and then adding the stressor of an acute situation can potentially lead to cognitive disconnect. Those who suffer from cognitive disconnect may see suicide as the only way to solve our problems.

It is for these situations you need to have a preplan on hand.  When an acute issue occurs, the first thought should be to confer with your preplan to get you through those first initial challenging hours where decisions are made in haste. It is similar to driving to the structure fire when your mind is racing through all the steps that need to be done. We rely on preplans, box cards, hydrant placement, response vehicles, radio frequencies, and so much more. When faced with an acute situation, don’t let the anger, guilt, shame, depression or other emotions take over–consult your preplan.

What does a preplan look like? Simply, whom are you going to call? Have an envelope titled “Mental Health Crisis Preplan.” Inside include a list of phone numbers like your peer support team, chaplain, Employee Assistance Program, close friends, or a trusted family member. In addition, write yourself some words of encouragement. When life is going well, we never reflect on how it could change with one phone call, conversation, or however random curveball. Words of encouragement can be as simple as “Life has become tough; call the people on this list to help me get through this moment.” Because that is what it is, just a moment in the span of your lifetime. It can hurt with unbearable pain, bringing thoughts of never finding happiness or seeing a loved one again. At the bottom of the list write in bold letters: SUICIDE IS NOT THE OPTION, FRIENDS AND LOVED ONES ARE. MAKE THE CALL NOW!!

Yes, it might sound simple and ridiculous, but when you are in a mental health crisis, the goal for assistance is to keep it short and simple. The key is to refer to this emergency envelope during an event. Preparation of a mental health crisis envelope needs updating and reviewing, just like our building preplan books. If this simple step can save just one soul, then preplanning a mental health crisis has accomplished its goal!