The following is an interview with Dr. Robert Smith written by Kathleen McCarthy for The Advocate journal for the American Mental Health Counselors Association.
Long before September 11th, psychotherapist Robert L. Smith, Ph.D., was interested in the mental health of firefighters. The son of a firefighter and a firefighter himself, Smith observed firsthand the stress the job produces and the generally poor way most firefighters coped with the stress.
So while still a firefighter, he enrolled in graduate school to conduct research on firefighters' attitudes toward mental health. His research culminated in two major findings: 1) the day-to-day stress of the firefighting job is as significant as the effects from a critical incident such as the terrorist attacks on 9/11, and 2) the skills firefighters learn on the job for coping with stress differ from those used by people, not in public safety professions.
Smith's discoveries prompted him to stay at the fire station but to use his mental health expertise to create a Stress Management Unit (SMU), a unique organizational unit to address, "global stress."
His number one goal now is to recruit mental health professionals interested in working with firefighters.
Reducing Global Stress
Smith created the SMU at Washington Township Fire Department in Indianapolis in 1999 to better manage global firefighter stress - stress from both critical and non-critical incidents. The first of its kind, SMU components include stress education, new-recruit education, firefighter mentoring, spiritual/pastoral care, public relations, and assessment.
The philosophy underlying the unit is that the average firefighter encounters more stress from daily, non-critical incident sources than from critical incidents. Lowering global stress is crucial because it gives firefighters "a greater chance of sustaining psychological wellness and avoiding burnout and other stress-related diseases," Smith says.
The types of day-to-day stress that firefighters might experience include:
Being a single parent: Because firefighters are away from their families for long periods, the spouse left at home often has to function like a single parent. For example, recently the spouse of a female firefighter had a broken water pipe. "That's stress," Smith says, "because the spouse who isn't a firefighter has to handle it."
Missing family events: Babies take their first steps, and the high schoolers win championships while the firefighter parent is away.
Taking a job- and getting a dozen roommates: Firefighters have to be able to get along with 10-15 other people and all their quirks. "If you have a personality conflict with someone, it doesn't end at 5 o'clock," he says.
The 16 members of the SMU make themselves available to help reduce whatever stress firefighters experience, such as in the days immediately after September 11. Eight firefighters from Smith's department went to Ground Zero in New York City as part of an Indiana task force. Back home, the SMU worked with the families of those eight, doing everything from mental health referrals to fixing the mailbox at the home of one of the absent firefighters.
When they came back to town, the SMU gave each of the eight a packet full of information about emotions, stress, and mental health. The unit also made follow-up calls and assigned members to each spouse. "The feedback we got from that was just outstanding," Smith recalls. By focusing on reducing all stress - the stress from the lifestyle of the job as well as critical-incident stress - he hopes to enable firefighters "to respond to all incidents in a lower state of stress."
How Do You Know It Works?
"I tell mental health folks that if you ask any firefighter if they're okay, they're going to say, 'I'm okay.'" So Smith has trained his firefighters to ask themselves, "How do I know I'm okay?"
Smith recalled an incident where an engine company and a medical unit responded to a call from a restaurant about an injured person. When the firefighters arrived and were directed to the kitchen area, a woman from the kitchen handed them a dead baby. "The number one stressor I heard from those folks who went on that call was, 'We didn't know what we were walking in on.'"
When Smith later on talked to one of the men who had been on that run but said he was okay, Smith asked him how he knew for sure. "He repeated back to me what he heard in training: 'I'm sleeping okay, I'm not irritable, I don't keep thinking about it.' That was very rewarding and we've had that happen a number of times."
Coping Skills: Out With the Bad, In With the Good
"One of the things we don't want to mess around with is firefighters' ability to cope while operating at the incident," Smith says. He tells new recruits "I want my generals to be pushy; I want my waiters to be compulsive; and I want my firefighters to be people who can shove that [emotional] stuff aside - for a little while."
When Smith became a firefighter in 1978, he observed dysfunctional coping mechanisms that firefighters routinely absorbed on the job such as drinking, drugs, and inappropriate displays of anger. His research showed that "firefighters feel that emotional expressions are a sign of weakness," and are conditioned to "sit on it," he says. They typically rely on support from their peers when they have emotional problems rather than seeking professional counseling.
Each one of the new recruits at the Washington Township Fire Department has a mentor who is both a peer firefighter and a member of the SMU. The mentor drills the recruits in good coping mechanisms that counter the negative organizational socialization that used to occur.
In addition, certain types of runs - for example, pediatric cardiac arrests - automatically trigger an intervention from someone in the SMU. "We emphasize that coping skills are like tools in a toolbox. It's not a question of whether one is good or bad, but which one to deploy." Some positive coping mechanisms the SMU recommends include:
Getting Exercise
Taking advantage of the built-in support system of the fire station and the fire service
Nurturing a support system at work and at home
Knowing how and when to ask for help
Opening Minds
Firefighters are an eclectic group of people, experts not only in putting out fires but in handling hazardous materials. Their ranks include not only emergency medical technicians and clergy but also attorneys, architects, and others with college degrees.
Because the face of the fire services is changing, Smith says, firefighters are more open than ever before to learning about stress as well as how they can manage it better. The image some people have of the typical fire station is a group of burly, mustachioed men playing cards, being interrupted only occasionally to put out a fire or rescue a cat from a tree.
That stereotype is no more true before September 11 than after, but since 9/11 most Americans have a heightened respect for the jobs firefighters do. Certainly, that's been gratifying, but what makes Smith happy is that firefighters now "are not just thinking about their critical incidents, they're thinking about their global stress."
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