Monday, July 24, 2023

Mental Wellness Programs for Fire Departments

When it comes to mental health, first responders face unique challenges. The nature of their work exposes them to traumatic events, high stress levels, and prolonged exposure to intense situations. Yet, there's often a stigma surrounding seeking help, and many first responders hesitate to reach out due to concerns about appearing weak or the fear of career consequences, which may lead to a significant impact on their overall well-being. 

Fortunately, dedicated individuals like Jason Corthell (Director of Ironclad Wellness and Division Chief, Fire Training in Harris, TX) are breaking down this stigma. Through his emotional wellness program created with Dr. Liz Fletcher, Jason aims to provide a safe space for first responders, providing in-house resources for mental health. By promoting self-care, education, and support, he's working to ensure that no one in the firefighting community suffers in silence.

Jason and his team have created documentation to facilitate a groundbreaking program for optimal mental wellness through chaplaincy, peer support and therapy. In this article, Jason details how his innovative emotional wellness program is transforming lives for those on the front lines. 

Chief Corthell explains further:

First, I'd like to say that it costs a lot more to lose a firefighter than it does to provide these services for a firefighter. Think about the benefits that this can have for a department. I’d say an astronomical percentage of firefighter mental health struggles are at-home issues. If we can get these firefighters the help they need to solve the at-home issues, so they're not bringing work issues to home, and home issues to work in a negative way, then this is one hundred percent worth the investment. I think my fire chief would agree that when this program launched, he was skeptical at best, now he’s turned around 180 degrees, bought into it and is super excited about it.

What I found in my own mental health struggles is that the complication behind seeking help and finding resources was overwhelming, and it kept me from seeking help. Not only did we want to make the process uncomplicated for the firefighter, we also wanted to make it easy to duplicate and then share that with other departments. We don't want to just change the department, we want to change the fire service. So we came up with a common three pillar approach of chaplaincy, peer support and counseling.

Our chaplaincy program has two chaplains, and we have an 11-person peer support group. On the clinical side with professional counseling, we hit a home run right off the bat by going with a counseling group in our district. It seems easier for people to transition (if necessary) to a different counselor within a counseling center if one clinician isn't their type. They don't have to redo their insurance or registration or re-explain their issues. They can just say, “Hey, I'm not feeling this therapist, can I switch over to this other one I've heard good things about?” 

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Probably the most unique approach that we've done is embedding counselors in the fire stations, where they conduct onsite appointments. This took away the need to make an appointment and miss work, and the insurance was already established.

The firefighters are already getting paid to be at the fire station. And so our men and women would walk in and say, “Hey, Tiffany, you got a second to talk out in the bay?” And they go out in the bay, and it might be 15 minutes, it might be an hour.  My fire chief always jokes with me, “I don't know if this is a good thing or a bad thing that we have so many damn counseling appointments. Are we doing something right, or are we doing something wrong?” And I respond, “Just let it go, Chief!”. 

When we found this counseling organization, we hit a home run. They're a 501c3 nonprofit, and work on a sliding scale. If a member did have to pay for an actual appointment, they decide the amount they can pay. We go through insurance because there is a bit of cost savings, as our insurance coverage pays for a portion of the appointment. Then we cover whatever the insurance doesn't. So if an appointment costs $70 and the insurance pays $40, we'll pay $30 to make up the difference. 

Jason and Dr. Fletcher also created program documents, including procedures and guidelines. He explains the reason that they were necessary:

When I started this process, documentation was not out there, so we didn't have Standard Operating Procedures (SOPs) or Standard Operating Guidelines (SOGs) to help us guide this process. We now have SOPs and SOGs for every element of behavioral health, peer support, chaplaincy, and our licensed professional counseling, and they outline expectations, and financial needs and wants.

Another document Jason’s team created is the Memorandum of Understanding with the licensed clinicians. This covers counseling appointments for the firefighter, counseling appointments for the firefighter's family, and play therapy for their kids. It also defines a mandatory quarterly training program for all members. Then it covers the financials and the embedment phase of the counselors.

We have an SOP for everything. If anyone out there needs those documents to help get you started, we would be more than happy to share them. I prefer to explain the documents first, so they don't get lost in translation.  There are a lot of documents and if I put them on a website, and you print them, they'll probably sit on your desk for a bit. I can be reached via a phone, Zoom or in person and my email address is 

I won’t say that I have a hundred percent buy-in from all my folks on this program, but I've had some of the crustiest, crabby, hard-to-crack captains come to me and say, “We appreciate what you're doing, and this program is good!”

Chief Jason Corthell is a 4th generation firefighter who started his career in 2004. Jason is also a proud Marine Corps Veteran. Chief Corthell serves as the Division Chief of Training and the Wellness/Fitness Director for his department, and has a great passion for progressing mental wellness in first responder organizations based on his personal and professional battles and experiences. Jason is also in the beginning stages of writing his book, Disentanglement Division. For more info on Chief Corthell, visit:  

Public Service Announcement

Step into the world of real-life heroes with RESPONDER RESILIENCE, an insightful podcast that sheds light on the challenges and triumphs of firefighters, EMTs, dispatchers, and law enforcement professionals. Hear firsthand accounts from our community's finest as they discuss critical issues on the job and share their experiences. Explore topics of mental and physical wellness with emergency services thought leaders, and get ready to be inspired and gain a deeper appreciation for the sacrifices and resilience of our responders. Tune in to RESPONDER RESILIENCE now! 

1st Responder Conferences is committed to the emotional, physical, and spiritual well-being of public safety professionals and we work with leaders in the public safety professions to make this possible. We recognize that first responders are our greatest asset, and we feel it is our responsibility to create a climate that supports wellness and resiliency.

We are dedicated to promoting awareness surrounding the difficulties of the profession and inspiring conversations that minimize the stigma associated with the stress our first responders' experience. We provide education, mental health tools and resources for agencies, individuals, and family members. Our mission is to improve the quality of life for all who dedicate themselves to protecting and serving others.

Our two-day multifaceted training and networking events are for all 1st Responders, Police, Fire, EMS, Dispatchers, Military/Veterans, Corrections, Coroners, Chaplains, Retired First Responders, Spouses, Professional staff, Clinicians, and all those who work in or around the Public Safety field.

Our training brings top-notch national resources to areas that wouldn't receive them otherwise. We also capitalize on a mix of local speakers / organizations that each area has to offer. By discussing the real 21st Century issues that are consistently faced by our first responders and their families, our conferences will provide awareness, resources, and tools to combat PTS, depression, suicide, addiction, stress, and overall wellness. Please visit our website at for more information.

The Major Occupational Hazard of Post Traumatic Recall (PTSD)

By: Dr. Robert L. Bard 

High risk professions like law enforcement, military service, healthcare and emergency response are known to have exposure to some of the most extreme levels of trauma - both physically and psychologically.  They range in effects from manageable symptoms to crippling disorders.  Over time, most people overcome disturbing or traumatic experiences and continue to work and live their lives. But others who get affected by traumatic experiences may trigger a reaction that can last for months or even years. This is called Post-traumatic Stress Disorder, or PTSD. Proportionately, studies have shown a lower percentage of retirees from such challenging careers acquire PTSD (from 15-20%) while an estimated 30-40% who suffer from PTSD associated symptoms go undetected or do not register as full cases. A larger percentage ‘on the job’ might be able to maintain the expected work standards throughout their career and even make it to retirement without visible signs. But “POST traumatic recall” leading to fully blown PTSD occurs when repeated exposure to trauma compounds on the tolerance capacity that eventually, one’s coping ability collapses.  The individual may feel stages of grief, depression, anxiety, guilt or anger from uncontrollable issues like recurring flashbacks and nightmares. [1]

Field report by: Dr. Leslie Valle-Montoya

PTSD can occur in all different extremes with at-risk professionals (like cops, responders and veterans). The trauma that they experience are above the ordinary that they could cause extreme flashbacks, anxiety and depression—heavily affecting their quality of life. The average civilian is also prone to this disorder starting with MICRO-TRAUMAS that can happen to everybody throughout any point in their lifetime.  Usually stemmed from childhood issues, micro-traumas actually shape the way an individual reacts to other people. As an example, child bullying may lead to developing a protective or defensive personality disorder.  Anytime they feel disrespected or embarrassed by others, feelings of extreme uncontrollable anger may arise without knowing the source of the hurt or why they're acting in that way.  This dilemma often causes problems in relationships.

Similarly, a first responder who experiences extreme traumas like horrendous disasters may stick with them in a much harsher way that could lead to flashbacks that are hallucinatory.  If gone unchecked or untreated, these symptoms (including auditory hallucinations) can get increasingly more intense and expand to other symptoms that can affect their daily functions.  A common way that anxiety can debilitate a sufferer is from recurrent lack of sleep disrupted by bad dreams triggered by the traumatic event.

Enduring trauma is different and unique for everyone. Some cases are event-specific (having intense auditory impact or visual intensity of a terrifying event) while other cases are contingent upon the tolerance of an individual. There are people who are more emotionally expressive than others- and that might help with if they talk about the trauma that they've been through. A latent emotional disorder like PTSD symptoms can come out over time just like anything that is suppressed or repressed. It could take some time for somebody who came back from combat or a first responder who has been in a traumatic event to show signs of disturbance. They could be holding it in and repeatedly thinking about it privately (or ruminating over it) allowing the disturbing memories to get more intense by the day.  This can often be a coping mechanism- protecting themselves from dark or negative feelings for a while, but eventually it builds up and can become symptomatic like flashbacks and anxiety, then leading to an eventual explosion.  Meanwhile, some people just have flashbacks right after the experience because of the way that everybody's brain processes differently. Others obsess over thoughts that keep popping up over and over again. It really just depends on the person.

The Modern Age of Non-Invasive Mental Health Innovations:
Transcranial Magnetic Stimulation

By: IPHA Editorial Team 

In the continued expansion of the medical society to “go non-invasive” (or non-surgical) and the trending reassessment of interventional medications, the mental health community has acquired major tools in its toolbox to support clinical diagnostic and treatment efforts.  In 2008, the FDA approved the first TMS Depression Device for Depression Treatment. In 2018, the FDA approved the marketing of Repeated Transcranial Magnetic Stimulation (rTMS) as adjunct therapy for of obsessive compulsive disorder (OCD). Current reports have presented an est. 30% of depression cases have a resistance to antidepressant drugs, where Transcranial Magnetic Stimulation (TMS) and the application of Transcranially applied non-invasive neuro-magnetic intervention has shown positive results in combination with antidepressants in patients with treatment-resistant depression.
(See complete feature on TMS)

Written by: Dr. Roberta Kline

Traumatic brain injuries can contribute to both short-term and long-term issues with cognitive function, but they can also impact emotional and physical health beyond the brain itself. While much of the research to date has focused on more severe forms of traumatic brain injury, it is now expanding to evaluate concussions. 

Writing this article reminded me that I, too, am part of this story. I had two episodes of concussion in my teens and early twenties, neither related to sports: one from a fall where I hit my head, another from a car accident that resulted in whiplash. In both of those cases, I was just told to rest until my head stopped hurting and then resume normal activity. Fortunately, I recovered without any long-term issues. In the decades since then, our understanding of head injuries has greatly expanded, prompting innovations in both diagnosis and treatment.

Concussions are viewed as a mild form of traumatic brain injuries and most frequently occur following an event that involves an acceleration–deceleration mechanism without actual injury to the head, such as whiplash, or the head striking an object. As we study these, researchers and clinicians are learning that these are fairly common, but often underdiagnosed. 

According to the CDC, an estimated 1.6 – 3.8 million people suffer from concussions related to sports or recreational activities every year. A National Health Interview Survey in 2020 found that 6.8% of children aged 17 years and under had ever had symptoms of concussion, while only 3.9% had ever been diagnosed. [1] There is also good evidence to suggest that an athlete who has had one concussion is also more likely to suffer from multiple concussions and suffer long-term consequences. [2] Not all head injuries occur in athletes, but these are the most studied.

While the vast majority of people with concussions recover without obvious disability, people can end up with long-term cognitive, emotional and functional issues affecting quality of life – including memory issues and Alzheimer’s disease. [3] Efforts to better predict outcome from head injuries by focusing on the age, sex, type of injury and acute assessments have led to some improvement, but still fail to predict or explain the variation in healing and outcomes. 
Studies in professional athletes have shown that about 80–90% are sufficiently recovered to return to playing within 7–10 days. But that means that 10-20% are not, and their recovery can take up to 3 times longer. Even taking into account variations in initial injury, this variation is difficult to explain or predict. [4]

Brain injury is broken down into two phases: a primary phase and a secondary phase. The primary phase is the result of the physical or mechanical forces on the brain causing direct injury. The secondary phase involves the brain’s response to the injury – a complex interplay of multiple biological systems including immune, vascular, neuroendocrine, neurotransmitters, neuroplasticity and even mitochondria and epigenetics. [3] In concussions, it is typically this secondary phase that plays a major role in how well an individual responds and recovers – both in time and function.

DNA is the genetic code that is the blueprint for everything that goes on in our bodies. Genomics is the study of how small changes in our DNA affect how our bodies function. [See feat. on Genomics testing] Research, primarily focused on combat veterans and athletes so far, has shown that these small variations in our DNA may account for at least some of why some people respond to and recover from traumatic brain injury better than others. 

The APOE gene plays many roles, including immune response and neuroplasticity. Carriers of the APOE4 gene can be predisposed to worse outcomes after traumatic brain injuries, especially if they are moderate or severe, or there are multiple concussions. While the APOE gene is the most widely studied, there are now over a dozen others that have been identified. Variants in other genes involved in the inflammatory response, blood flow, DNA repair, neuroplasticity, learning and memory are also implicated, including TNF alpha, IL1, IL6, NOS3, ACE, COMT, NMDA receptors, BDNF, KIBRA, MAPT, PARP, MME, SLC17A7, GRIN2A.  Because there are hundreds of genes impacting all of these biological systems, it is likely that there are many to be still evaluated, and outcomes are the result of the interaction of multiple genes.

As genomics contributes to our understanding of how and why individuals can vary greatly in their ability to recover from traumatic brain injuries, it is paving the way for more personalized prevention and treatment strategies for concussions. Having accessible and noninvasive technologies to provide evaluation of brain injury and ongoing recovery will be a key part of this progress.

References: (1) (2) McCrory et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;0:1–10.  (3) Bennett et al. Chapter 9: Genetic Influences in Traumatic Brain Injury, in Laskowitz D, Grant G editors. Translational Research in Traumatic Brain Injury. CRC Press/Taylor and Francis Group 2016. (4) Jane McDevitt & Evgeny Krynetskiy. Genetic findings in sport-related concussions: potential for individualized medicine? Concussion 2017; 2(1)

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