In June, in the aftermath of the Grenfell Tower disaster, images of exhausted, traumatised firefighters filled our TV screens; firefighters with smoke-blackened, tear-stained faces, staring ahead vacantly, haunted by what they had witnessed. Something of the reality of what firefighters go through to save lives and property became visible. We could suddenly see what should have been obvious, that firefighters are human beings as well as heroes.

When Gloucestershire Fire and Rescue Service (GFRS) signed the Mind Blue Light Pledge earlier this year and a team of workplace counsellors at Gloucestershire County Council was asked to get involved in improving mental health in the service, I jumped at the chance.

In 2014/15, Mind had conducted a survey with blue light personnel and published startling figures regarding the mental health of emergency service staff.1 In Blue Light Programme Research Summary, they state that; ‘blue light personnel are disproportionately affected by mental health problems,’ and are ‘around twice as likely to identify problems at work as the main cause of those mental health problems as the general workforce.’ Significantly, they also found that ‘mental health problems are stigmatised within the blue light community’ and that in the Fire Service, ‘37 per cent think that colleagues would treat them differently – in a negative way – if they spoke about mental health problems at work.’3

With an initial £4 million pounds of Libor funding, the Mind Blue Light Programme was launched in March 2015 to tackle these issues and to improve the mental health of emergency service personnel in England. In January 2017, GFRS signed its Blue Light Pledge, committing to a culture where, ‘being mentally healthy is as important as being physically healthy,’ promising to ‘tackle mental health stigma through education and support’ and to ‘create an environment where no one needs to suffer alone or in silence’.

Beginning

Three weeks later, we ran the first mental health awareness workshop at a fire station in the Cotswolds. Over the next six weeks, we visited 20 stations, with the ambitious aim of talking to every single full-time and retained firefighter within Gloucestershire about mental health. Our goal at this stage was simply to tackle the stigma and start a conversation, to get people to open up about their experiences and opinions and to think about their own mental wellbeing.

Given Mind’s findings about stigma within the blue light community, we didn’t expect it to be easy, and the defensive body language as we walked into that first station confirmed our expectations. Ninety minutes later, those same firefighters openly admitted that they hadn’t wanted to come, but that it had been ‘an eye opener’. Subsequent feedback included: ‘I’ve learnt I’m not alone,’ ‘I’ve learnt it’s good to talk,’ ‘I’ve learnt it’s OK to not be OK,’ and ‘I feel less afraid to be open now’.

In the quest to challenge stigma, it’s fair to say that these comments indicate that we made a good start. However, that could not have been achieved without one man, a firefighter called Dean Evans, who is challenging mental health stigma within GFRS in a very personal way. I’ll come back to Dean.

Each workshop began with a quiz about the mental health statistics. ‘How many people in the general population experience a mental health problem at any one time?’ They knew this – it’s been on the news a lot. We divided off a sixth of the delegates to make the numbers real. ‘How many over the course of their lifetime?’ We divided off a third of the group. ‘How many blue light personnel have experienced a mental health problem?’ We divided off 61 per cent of the group.2 ‘So, that’s how much more at risk you all are,’ we said, and together we looked at how many more people there were in the blue light group. The body language shifted, a few crossed arms unfolded and several who had been leaning right back in their chairs sat up just fractionally. This was news to them. ‘How many people have considered taking their own life while working for the emergency services?’ Mind’s poll suggests it’s as high as 30 per cent.2 ‘How many have made an actual suicide attempt?’ Five per cent.2 That’s one in 20. Some of the group looked surprised, while others started to recount stories of someone they knew who’d tried to kill themselves – or had succeeded.

Opening up

We asked them why they thought it was that firefighters are so much more at risk. Perhaps stating the obvious, some said, ‘because of what we see’. Then, as they started to warm up, they began to talk about what it’s really like to be a firefighter. Surprisingly, Mind found that the frequent exposure to trauma and significant physical risks were not the largest triggers of poor mental health within the fire service. Organisational upheaval was cited as the biggest trigger, with pressure from management rated a close second, especially for managers. Retained and full-time firefighters each cited very different stressors, but organisational culture and change featured highly for both. Several talked about not feeling valued as being a significant stressor.

Exposure to trauma seemed to be more likely to cause problems for retained firefighters who, since they live and work in their own communities, have a greater possibility of being called to an incident involving someone they know. Some retained crews also felt they had less time to process a traumatic incident with their colleagues immediately afterwards as they might not then see each other for several days. One retained firefighter likened the images in his head to a stack of gruesome photographs that needed processing and filing before it got too big.

Several talked about not being able to discuss what they’d witnessed at home, not wanting to burden family and friends. Others described the surreal nature of attending a gruesome scene and then returning to their day job in a customer-facing role and having to smile as though nothing significant had happened that day.

GFRS now works in partnership with the South West Ambulance Service to provide emergency medical cover to areas of Gloucestershire where ambulance cover is stretched. The aim of a co-responder team is to preserve life until an ambulance arrives. For firefighters, this means new challenges such as dealing with relatives at the scene, and an increase in the number of fatalities they witness.

Being on call

Retained firefighters particularly cited the challenges of managing their work-life balance. On top of their main jobs, they are on call for at least 60 hours a week, sometimes more. Being on call means that they can’t be more than five minutes from the station, must wear their pager at all times, can’t drink alcohol, and can’t be left alone with their children in case a call comes in. The impact on relationships is significant and many talked about this being a major stressor. Many said that they don’t sleep properly waiting for their pager to go off, and another said his heart rate monitor jumped from 45 to 150 when his pager went off one night.

What makes firefighters choose their profession is, I believe, another contributory factor to their mental health. My personal observation, based on my experience with clients, is that firefighters are carers by nature. They are passionate about their role and their communities.The firefighters I have worked with individually (in common with counsellors and social workers) all have what Babette Rothschild calls ‘exteroceptive bias’.4 In order to do the job, they have to be able to filter out their own physical and emotional needs and focus entirely on the needs of others. Firefighters are very good at looking after others. And not so good at looking after themselves.

I asked the firefighters if they agreed with this generalisation. Unsurprisingly, they did; they identified with it and they were proud of it. But by the end of the workshops they had also started to recognise that this characteristic increased their risk of mental health problems.

At this point in the workshop, it was time to introduce Dean, a manager from GFRS headquarters, who had attended the pledge-signing ceremony. On each chair at that event there had been a card, asking the question: ‘What will I do to be part of the change I want to see?’ Dean had written on his card, ‘share experience’, and the next day he produced a short film to do just that.

Before we showed Dean’s film, we discussed the finding by Mind that 37 per cent of firefighters believe that someone would be treated differently if they disclosed a mental health problem at work. What did they think about this? The response was mixed; some said that it was getting better, others that they thought it would still affect you negatively if you disclosed something like that. Some said they thought that people would tiptoe around them, others admitted that they themselves wouldn’t know what to say.

At the time of these workshops, mental health was in the news a lot. The Rugby Players’ Union had just launched its ‘lifting the weight’ campaign and a few weeks into our own workshops, the Duke and Duchess of Cambridge, together with Prince Harry, launched their ‘Heads Together’ campaign. We talked about Duncan Bell, the Bath rugby prop and his experience of disclosing depression to his team mates. The fact that team mate Ollie Berkley had teased him about crying if they didn’t set him up for a try, might have shocked other communities, but the firefighters understood why Bell was relieved – the teasing signified that he wouldn’t be treated any differently; the banter would still come his way. It’s what most of the firefighters would want too.

In Dean’s film, he is wearing his uniform but sits in his favourite chair at home. It sends a strong subliminal message: ‘I am a firefighter and I have a life outside of that too.’ He has three pips on his shoulder – he is equivalent to a station manager – and this means something at the stations.

Dean tells his story. It’s very personal. His daughter contracted a critical illness over Christmas. There are photos of Dean with her in intensive care in Southampton – the closest place that could take her – on Christmas Day. They thought they were going to lose her, he tells the camera. It was his job, as the dad, he says, to look after everyone else and make sure they were OK, and he did that well he thinks.

Once his daughter had recovered, someone casually asked him how his Christmas had been and Dean describes that as the moment when it suddenly hit him. He says it was like being hit by a steam train. He describes his immediate emotional collapse and the aftermath in raw detail: the tears, the anger, the drinking, losing his temper over the simplest thing and gradually alienating himself from his family.

Dean describes his occupational health experience, a triage appointment the day after he made the call to HR, and then his first counselling session just nine days later. ‘I didn’t want to go to counselling. I thought I’d have to lie on bean bags and listen to whales and stuff.’ There’s a murmur of laughter, ‘But it’s not like that at all… If you break your arm, you’re not going to fix that without going to your doctor, and if your noggin starts to play up, you’re going to struggle to fix that on your own too.’ The firefighters needed to hear this from one of their own.

Dean’s film was played at every single workshop, at 20 fire stations across Gloucestershire, and each time we turned the lights back on afterwards, the atmosphere in the room had changed. Dean had done the unthinkable: a manager – someone many of them knew or had worked with in the past – had gone public in graphic detail about his own battle with mental ill health.

‘Is Dean brave or stupid for making that so public?’ we asked. It was unanimous: he was brave. ‘Do you think Dean will be treated differently?’ They thought, yes, but in a good way. When we meet a few weeks later, Dean confirms that this is true; many people have wanted to shake his hand and thank him personally for speaking out.

We continued with other exercises and discussions but now people were fully engaged. There were more personal disclosures, with several people choosing to share that they too had had counselling and what it was like. We invited people to talk about possible symptoms; what might Dean have noticed – or his colleagues noticed – before he was hit by the stream train? What kind of thoughts, feelings, sensations and behaviours might be expected. They filled several flip charts and lots of discussions ensued. ‘Was that easy?’ Yes. ‘Why was it so easy?’ Because we all know what mental health problems feel like; they’re not something abnormal, they’re common, a normal part of life.’

We ended each workshop by signposting to our own occupational health unit, to the EAP, and to the Mind Blue Light Helpline. Many didn’t know these services were available to them; all took flyers and leaflets. Some asked what they should do if they were worried about a colleague or even about their manager.

Supervision

Some weeks after the workshops, I met with Dean to discuss this article and to find out if he had any regrets about going public with his film. Dean is modest and appears to be slightly embarrassed about all the attention. He tells me he doesn’t regret it at all, but there have been consequences for him. At the end of his film, Dean says: ‘Don’t wait until you get hit by a steam train – talk to someone, talk to occupational health, talk to me!’ It was a throwaway line but he has since been inundated with calls from firefighters, to such an extent that he is now working with one of our counselling supervisors to support him in dealing with them.

Some of the accounts he’s heard are the kind of stories that even trained counsellors struggle to hear; stories that conjure up images you’d rather not have in your head and that keep you awake at night. Although it’s tough for him to support others on top of his other duties, the calls he receives mean that Dean’s film has had the impact he intended. Dean thought that if he could just make a difference to one person, it would be worth it. He now knows it’s done much more than that.

Future plans

Looking ahead, Mark Astle, the Head of Personal and Organisational Development at GFRS, told me about future culture change plans. An ambitious ‘People First’ strategy will be launched in November this year, including unconscious bias training, coaching and mentoring, and a personal development plan, for everyone in the organisation so that career progression is proactively managed.

Already there has been a change to uniform protocols, to erode demarcations and facilitate a shift away from the old command and control-style of leadership that can so easily lead to bullying in the wrong hands. It is both radical and progressive; this is an organisation in which relatively recently managers were called ‘commanders’. Signing the Blue Light Pledge was part of this much larger cultural review.

Improving the mental health of blue light personnel nationally is a huge task, requiring a multifaceted approach, and that is also true in Gloucestershire. The mental health awareness workshops we ran were only ever intended to be a start. The real solution will take time and will be through meaningful cultural change. Challenging mental health stigma and providing psychoeducation are just a small part of that.

As a result of feedback from the workshops, we have since provided mental health training to 20 new recruits as part of their induction process, and training sessions have been booked to address the concerns raised about co-responding. Critical incident debrief procedures will be re-written jointly by GFRS and occupational health to reflect current best practice regarding post-trauma treatment. Critical incident response training will follow this autumn for supervisory managers.

Interestingly, there has been a recent spike in referrals to occupational health – a fact that is open to different interpretations. Some cite it as evidence that the problems are getting worse, while others say it shows that we are succeeding in raising awareness and making it safe enough for people to come forward. Many are still doing so indirectly, and rather than contacting HR or their line managers, they’re telling a colleague, who then makes that call on their behalf. It shows we still have a long way to go.

Closing thoughts

Being involved in this project has reminded me just how vulnerable people can feel if they put their hand up and ask for help in many organisational cultures. Dean told me that he’d gone to his first counselling appointment intending to, ‘tell her nothing’. By the end of the session, he thought: ‘maybe’. This isn’t just true in GFRS; I’m hearing the same stories in some schools. Sometimes, as workplace counsellors, we can’t expect people to come to us; we will have to go to them first.

GFRS has moved from a strategy of responding, to one of prevention, and there is a real opportunity for us as counsellors to now do the same. There are 63 per cent fewer fires than 10 years ago and 53 per cent fewer road traffic collisions. Imagine if we could achieve the same statistics in the mental health arena.

An article about firefighters was bound to include tales of individual heroism. Bravery comes in many forms and in the fire service there are many ways to save lives. The firefighters we’ve talked to have told us about the impact of Dean’s film and how it made them realise they weren’t alone. Given the statistics on suicidal ideation and actual attempts for blue light workers, I have no doubt that Dean has saved lives as surely as his operational colleagues do every day.

Lisa Jenner works as a staff counsellor for Gloucestershire County Council and as a coach, supervisor and consultant. She is a BACP accredited counsellor and a director of Rubicon Change Ltd, which delivers organisational change initiatives. She has a keen interest in the application of neuroscience to counselling and organisational culture change. www.rubiconcounselling.com

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References

1 Mind. [Online.] https://www.mind.org.uk/media/4614222/ blue-light-programme-research-summary.pdf (accessed 9 September 2017).
2 College of Paramedics. [Online.] https://www. collegeofparamedics.co.uk/downloads/160420_Firefighters_ data.pdf (accessed 15 September 2017).
3 https://www.mind.org.uk/media/4849782/blue-light-scoping- survey-fire-rescue.pdf
4 Rothschild B. Help for the helper: the psychophysiology of compassion fatigue and vicarious trauma. New York: WW Norton and Company; 2006.

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