More firefighters die by suicide than in the line of duty according to a study from the Ruderman Family Foundation. And at the latest U.S. Fire Administration Summit, behavioral health was listed as one of six critical issues facing the fire service.

A national push towards improving firefighter behavioral health is a welcome improvement, but firefighters in the region can also turn towards the MUSC Center for Firefighter Behavioral Health (CFFBH) for resources and treatment options. Founded in response to the 2007 Sofa Superstore Fire, the center provides training for mental health professionals as well as courses and information around topics like suicide prevention, substance abuse and employee assistance programs.

Angela Moreland-Johnson, Ph.D., a clinical psychologist at MUSC and Tatiana Davidson, Ph.D., an associate professor with the MUSC College of Nursing, are co-directors for the CFFBH. They point to a few reasons firefighters avoid seeking out the mental health care they need. “A lot of providers are not trauma focused in general and so are not equipped to handle the traumas firefighters need to talk about,” Moreland-Johnson said. “But even more critically, many providers aren’t aware of firefighter culture and would prescribe lifestyle changes that firefighters aren’t able to commit to with their work schedule.”

One example is sleep hygiene. As an important aspect of overall health and wellness, sleep can help with stress and anxiety, but firefighters aren’t able to change their sleep schedules due to the nature of being on call and shift work. But many mental health providers suggest improving sleep hygiene which only discourages firefighters from returning for future sessions. 

This gap in knowledge led Moreland-Johnson and Davidson to develop an online course known as Helping Heroes where mental health providers can learn about firefighter culture as well as working with patients who have experienced trauma. By working with local fire departments and the National Fallen Firefighters Foundation, they have developed a total of 10 online resources – which include apps and additional training courses – for both firefighters and mental health providers.

“Our main mission is to provide free and accessible behavioral- and mental health-related resources,” Moreland-Johnson said. “And we want to get them into the hands of both firefighters and therapists.”

Davidson says the key to their program is working with both local and national groups to recognize which gaps to address. Hearing from firefighters directly and following the foci set from national strategic planning meetings, the team can direct their attention to what resources are most needed by the firefighter community. “It’s important that everything we develop is informed by national firefighter leaders and local firefighters,” Davidson said. “Everything is created for and by firefighters.”

Another popular program is designed to support family members and significant others of firefighters which provides them with the tools they need to handle some of the challenges that come with shift work and to navigate and cope with the stress their loved ones might experience from work.

Another focus is on rural communities. With over 65% of firefighters in the U.S. volunteer according to the National Volunteer Fire Council (PDF), many reside in rural communities where they might not have access to a mental health provider. Davidson says they might not even need one-on-one therapy but rather peer support. “They could be having symptoms of PTSD or depression or struggling with substance abuse,” Davidson said. “The firefighting community has a broad spectrum of needs that will be different for each firefighter. But recognizing behavioral health as a concern that needs to be addressed is such great progress.”

The cultural emphasis on mental health as a whole has helped reduce stigma for everyone but also firefighters. And with a national push towards behavioral health, Moreland-Johnson is excited about the mental shift. “10 years ago, if we said the words mental or behavioral health, people would close their ears and leave the room,” she said. “Now they’re all ears. They acknowledge it and want to be a part of it.”

“We have the demand. Now we just need the access to meet it.”