FireRescue1 Stigmatizing Mental Illness?

[wanderingmedic]

I ran across this article a couple days ago. Because I'm interested in mental health, and because I'm interested in the mental healthcare of first responders, I figured it could be an interesting read. What I found was sorely disappointing, and I'm afraid that attitudes implicit in the article stigmatize Fire, Law Enforcement, and EMS personnel who struggle with mental health concerns.

The tagline to the article is: "The recent European airline tragedy shows how hard it is to filter out those with mental health problems" (emphasis mine).

I do not think that there is any problem with performing psychological evaluations to try to filter out problem personal before they hit the streets, however the article never defined "mental health problems." In failing to define "mental health problems" my fear is that personal who have sought help with mental health concerns and are now psychologically stable, will be clumped together with people who (like the airline pilot) are symptomatically mentally ill and a threat to the public. Furthermore, it concerns me that if there are personal reading this article who are considering reaching out for help, they won't ever access the help they need because they are afraid they could loose their jobs, or be clumped with the same crazies that fly jet liners into mountains intentionally. I was left wondering whether the author was suggesting that personal with managed PTSD, depression, anxiety, should never be hired, or removed from departments completely. We have to distinguish between the personal who are psychotically unstable and a threat to our departments and communities, and the personal who are struggling with mental health concerns and are receiving help to heal. It's simply not fair to put both of those kinds of people in the same category.

I'm all for discussing ways to make sure departments put the best people on the streets. But, I think that we need to be careful not to stigmatize people who have mental health concerns and get better with therapy. As corny as it sounds, Public Safety should be a brotherhood where it's okay to not be okay, and where personal can feel comfortable knowing that their departments stand behind them when they struggle with mental health issues and ask for help.

 

[AmbalampsDriver1987]

Medic1 is stupid. That guy was a bum and selfish prick more than a depressed pilot.

To compare an ambulance driver with Ptsd to a murderous pilot who kamikazes a mountain side is ludicrous.

 

[RocketMedic]

I would never admit to mental weakness or PTSD in the field of public safety. Too many opportunities would be lost- and like a dam, admitting weakness begets weakness.

 

[COmedic17]

I agree they need to be more accepting of mental illness- to a degree.

If someone needs help, they should get it. Some sort of debrief should be provided after difficult calls. But on another note, if your easily upset- this probably isn't the field for you.

Way back when I first started, I had a partner who needed counseling over a psychiatric patient. The patient "looked at them with crazy eyes" and was threatening her (pt was restrained). She had to be medicated for PTSD over the event, and they got traumatized over every single call that wasn't a basic BLS call.

I get people getting upset after a pediatric cardiac arrest and things like that, but I have seen several people be disturbed by some very mundane calls. Which if fine, but if it's a problem for you - find a different career.

Also, if someone has a long history of mental illness, a high stress career is detrimental to their mental well being. If you have a track record of getting severely depressed/suicidal, you probably should not work in a field where seeing death is a regular Occurance. It's not helpful to anyone - patient or provider- if the provider routinely gets manic due to an underlying mental condition.



And before everyone attacks me- let me repeat- I don't think people should be dinged for being upset over a hard call. PTSD should be treated as a work related injury.
I just don't feel that if someone has a CHRONIC mental history/condition that would be hindered/hurt by being in a high stress environment- that they should not work in EMS. It would be like hiring a schizophrenic with routine visual hallucinations to work in a haunted house. It's great they want to work in a haunted house, but at the end of the day it's detrimental to their well being.

 

[epipusher]

Mundane to you is not mundane to all.

 

[COmedic17]

If you pass out at the sight of any blood, freeze and can't function during critical calls, can't handle a psychiatric patient, and get so worked up over the way "they looked at you" that you can't function and preform your job- then you have no business making life and death decisions regarding the life of another person.

Not everyone is cut out for this type of work. I understand EVERYONE will get upset over some things, but there has to be a limit.

If you routinely can't preform your job due to stressors - and your completely unable to manage it- then it's irresponsible (and dangerous for both you and patients) to attempt to do something that you are not capable of.

 

[epipusher]

The same could be said for any type of call. Pediatrics upset you? Maybe EMS is not the job for you.

 

[COmedic17]

I don't get upset after pediatric patients, nor can I find where I said I did. So if you could point that out, it would be helpful. Because I'm most definitely confused.

But I'm also understanding that maybe that's not the "norm". I recognize that the types of calls that typically upset people involve pediatrics. Which I have found is pretty standard. But something can upset you without debilitating you.

As I stated -several times actually- if you can't control the way you react to something to the point it's debilitating- why does it sound like even a remotely good idea to continue down the same path? If you can get it under control -great. Then find a way to cope with what bothers you and continue on. But if it's so caustic to you that you can't function is that good for your mental health? No. If it good for the patients you are trying to administer care to? No.

If a soldier was such severe PTSD that they don't sleep for weeks at a time, and are routinely having suicidal thoughts- is it a good idea to send them to war? Absolutely not. If they work through their issues and are no longer struggling with it- great. Then allow them to do what they feel comfortable with. Why should it be any different in EMS? If it's out of control- you shouldn't be working in the field. It's dangerous for everyone involved.

 

[RocketMedic]

COmedic17 is on point woth that- absolutely correct. Some people are too weak, fragile or sensitive for EMS.

 

[epipusher]

"You" was used as a general term. Sensitive?

 

[triemal04]

EMS, and medicine, like most jobs, is not for everyone. Not only should people be excluded from it for intellectual reasons (do you have the requisite intelligence?) but for emotional and mental reasons as well. What that means is, a career in medicine will expose you to some very disturbing things that can have a very negative, and sometimes permanent impact on your life. Not everyone will deal with those things in a safe and appropriate manner, more importantly, not everyone is CAPABLE of dealing with those things in a safe and appropriate manner. While anyone and everyone should be encouraged and helped to seek out whatever help they need to recover from depression or mental trauma related to the job, and supported while recovering...not everyone should be encouraged to return to their previous role. There will be many who can, and should continue. But not everyone will fit into that catagory, and people like that need to be aware of it. If early in a career it becomes clear that a person falls into the catagory of not being capable of dealing with the stress, they should be encouraged to find another career. Because, almost without a doubt, if that type of person persists, they will end up doing harm TO THEMSELVES.

And there is not, and never should be, any shame or stigma attached to that. Ever. For any reason. Personally, I would much rather work with, know, and be someone who knows and understands what their limits are, and is capable of saying, "no, for my own good, I'm done here."

Unfortunately EMS, as a culture, is moving in the direction of telling everyone, "it's ok, you can do this, you'll be fine, this jobs for you!" even when it clearly IS NOT the job for many, many people. All this does is leave more people open to harming themselves by being in a setting that they can't cope with, and should never have been in. When even the people who are best equipped and mentally prepared for this begin to have problems, this should be a bright, shining indicator that not everyone should do this, and that people need to be told up front when it is clear they are not a fit.

Without any ******** or smoke being blown.

Think I'm wrong? Look around.

Everyone needs to ask themselves which is worse: telling people that they aren't, or have become, incapable of performing and to continue to do so will be to likely cause serious and maybe permanent problems, or bringing everyone into the fold and then trying to pick up the pieces when the damage has been done?

 

[RocketMedic]

The flipside is that people can and do adapt to the conditions in EMS.

 

[Angel]

I take an issue with someone making a blanket statement about who is and isn't cut out for xyz.
What qualifications do you have to make that determination? And like epipusher said, what is mundane to you can be the opposite for someone else.
You provided the example about a pedi code (call) which is why it was referenced.

 

[OnceAnEMT]

I would never admit to mental weakness or PTSD in the field of public safety. Too many opportunities would be lost- and like a dam, admitting weakness begets weakness.

And that, the stigma of mental health, is the problem. This is not a culture or profession specific problem. Though it is certainly improving with increased education regarding mental health, it is often considered "different" and stigmatized for all the burdens that it may carry, despite the fact that it is just as biological and thus just as physical as any other disorder or injury. Dr. Hainline, the medical director for the NCAA, spoke on our campus recently and held a Q&A during our capstone AT class regarding the state of sports medicine in the NCAA, with an emphasis on mental health. My favorite line of his and one that I abide by is that healthcare access for mental health should be just as accepted and just as available as healthcare for an ankle sprain. Though the concept applies in other ways to all careers, but for civil service, just as an example, a history of back injuries or disorders and chronic low back pain should be just as scrutinized as a mental health disorder of any sort.

That said, one may argue (and some of you are getting there) that someone may not know their insensitivity to specific things. But that is what clinical experiences and rideouts and probationary periods are for, to make sure the job is for you, and you are right for the job.

I agree they need to be more accepting of mental illness- to a degree.

If someone needs help, they should get it. Some sort of debrief should be provided after difficult calls. But on another note, if your easily upset- this probably isn't the field for you.

Way back when I first started, I had a partner who needed counseling over a psychiatric patient. The patient "looked at them with crazy eyes" and was threatening her (pt was restrained). She had to be medicated for PTSD over the event, and they got traumatized over every single call that wasn't a basic BLS call.

I get people getting upset after a pediatric cardiac arrest and things like that, but I have seen several people be disturbed by some very mundane calls. Which if fine, but if it's a problem for you - find a different career.

Also, if someone has a long history of mental illness, a high stress career is detrimental to their mental well being. If you have a track record of getting severely depressed/suicidal, you probably should not work in a field where seeing death is a regular Occurance. It's not helpful to anyone - patient or provider- if the provider routinely gets manic due to an underlying mental condition.

And before everyone attacks me- let me repeat- I don't think people should be dinged for being upset over a hard call. PTSD should be treated as a work related injury.
I just don't feel that if someone has a CHRONIC mental history/condition that would be hindered/hurt by being in a high stress environment- that they should not work in EMS. It would be like hiring a schizophrenic with routine visual hallucinations to work in a haunted house. It's great they want to work in a haunted house, but at the end of the day it's detrimental to their well being.

We are seeing pretty close on this, and I'll reiterate again that mental health should be analyzed just like the rest of the physical exam, and should be a repeated evaluation, just like the rest of the physical exam.

I'll relate mental health-related issues to an ankle sprain again. For that sprain you will need treatment, rehabilitation, and a prevention program to hopefully heal and grow to be as strong if not stronger than before. Just the same, the concept exists for mental health-related issues. Critical Incident Stress Management, debriefings, team discussions, all of that type of group and personal talk is your acute treatment, while periodic counseling may be the rehabilitation, and the prevention may be classes regarding CISM and the like. My point being is that there are resources available to manage these types of issues (I really generalized that analogy to a cookie-cutter approach). Now, what if it isn't helping? Then I think part of the process is then shifting away from helping them as a first responder, and towards helping them as a person, which may involve discussion of a career change. These systems exist already, we as teammates to those who suffer are responsible for helping our team by ensuring these resources exist, are available, and have evaluations of effectiveness.

 

[RocketMedic]

I think CISM is a loa dof hippy talk.

 

[chaz90]

I think CISM is a loa dof hippy talk.

It works for some people. It's not my thing, and I don't think it should be mandated as such, but I'm all for people using whatever works for them. Everyone has their favored coping mechanisms, and I don't think I'm in a position to deal them what's right or wrong about it as long as it's not utterly self destructive.

 

[Summit]

Grimes I like your post a lot except:
CISM = discredited and causes more harm than good

 

[OnceAnEMT]

Grimes I like your post a lot except:
CISM = discredited and causes more harm than good

It's only an example, was more so referring to the concept of CISM. Besides, how come it is causing more harm than good?

 

[NomadicMedic]

http://www.bryanbledsoe.com/data/pdf/mags/CISM (BP).pdf