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Treatment Experts on the Latest Research, Best Practices and Treatment Options – October 2015
It’s important to note, too, that there are various aspects of the job that can contribute positively to mental health. These include:
Finding balance when the negative issues begin to outweigh the positive is essential to maintaining optimum mental health.
Sometimes it takes conscientious effort to maintain positive relationships with friends and family members.
In the United States, treatment of all mental health disorders is essentially based on scientific research and evidence that is objective and repeatable. The self-correcting process that comes with new and diversified research methods, the peer review of findings, and the transparency of research provided through publication in journals not only help to spread awareness of new and updated treatments but also demonstrate the differences among patients when exposed to different treatments and/or combinations of treatments in different contexts.
Because the United States is a melting pot of cultures, it becomes important then to discuss the significant impact that an individual’s culture and personal experience not only has on the development of mental health symptoms but on one’s willingness and ability to seek treatment, follow through with treatment, and benefit from the treatment services commonly applied to the care of different diagnoses.
“Culture” includes the views, beliefs, and values that an individuals holds as “normal” and can impact the experiences and choices of the client, the client’s family and community, the clinician, as well as the body of work informing treatment. Additionally, other cultural issues – such as gender, race, economic status, professional culture, religious views, and more – may contribute to an increased or decreased ability to access and benefit from different mental health treatment models or to work effectively with different clinicians. It’s important to take all these issues into consideration when determining the best course of action for treatment.
The 2007 Behavioral Risk Factor Surveillance System (BRFSS) by the Centers for Disease Control (CDC), suggest that the stigma against those who are living with mental illness is a significant issue in the United States. For example, only 24.6 percent of participants who were living with mental health symptoms thought that people would care about their struggle. Fortunately, this same study found that 57.3 percent of respondents who were not struggling with mental health symptoms believed that people were sympathetic to the issue. These survey results could be interpreted as those with mental health issue mistakenly underestimate the overall sympathetic nature of the general population when it comes to those suffering from mental health issues. Furthermore, the study also found that almost 77.6 percent of people living with mental health symptoms and almost 88.6 percent of those not living with mental health issues believed that treatment could assist in helping the person to live a balanced and “normal” life. These survey results could be viewed as showing an overwhelming consensus that treatment is a good thing.
What do these findings suggest? Possibilities include:
The Substance Abuse and Mental Health Services Administration (SAMHSA) among other mental wellness agencies is working to decrease stigma in the United States by dispelling myths and increasing awareness of the personal experience of those living with different mental health symptoms. One way in which SAMHSA is working to increase compassion and support for those living with mental health symptoms is by advocating for the development of peer support and social inclusion services for individuals and their families. These services seek to:
For firefighters, first responders, and their families, the stigma against mental health issues can be an obstacle to treatment. Not wanting to call attention to their struggle and preferring instead to focus on the job, many in the profession do not want to acknowledge that they might be in need of treatment or that their symptoms may be complicating their ability to function physically and/or mentally.
The organization that writes standards for firefighter safety – NFPA – gave behavioral health a distinct chapter in 2013. And the organization generally leads the charge in taking proactive measures to ensure firefighter safety.NFPA.Org
This indicates that while preventative behavioral health has taken a while to gain broad scale traction, things are changing for the better.
Law enforcement officers, firefighters, paramedics, and other first responders must continually see the worst of human experience. The ravaging effects of fire, the emotional and physical damage caused by accident and abuse, the threat of personal attack, constant stress, and an inability to save everyone they attempt to help take a toll.
Additionally, long shifts, working with others who are similarly struggling with mental health disorders, difficulties at home, and other personal issues can all contribute to the high rates of the mental health disorders commonly diagnosed among first responders.
Furthermore, retirement can uncover or exacerbate alcohol, drug, and mental health disorders that may have been masked or submerged during active duty.
First responders who have trouble making the transition are even more vulnerable to the host of mental health disorders that target first responders, such as:
There are different manifestations of post-traumatic stress disorder, and not all people who may be living with the disorder will exhibit the same symptoms. Exposure to significant trauma – like the experiences that could happen on any given shift for a first responder – are known to trigger the different types of PTSD. According to the National Institute of Mental Health (NIMH), the three types of PTSD include:
Though everyone may occasionally get the blues, or feel sad or down about a specific event or problem in their lives, first responders often suffer from ongoing and deep feelings of hopelessness, loss, suicidal thoughts and behaviors, guilt, insomnia, and other issues related to the disorder. Depression can be diagnosed as mild (dysthymia), moderate, or severe, or it can be a symptom of another mental health disorder like post-traumatic stress disorder (PTSD). It can also be worsened or driven by substance abuse and addiction.
When people are living with both drug or alcohol dependence disorder and a diagnosed mental health condition, they are diagnosed with co-occurring disorders. The two issues often significantly impact one another, making it difficult to impossible to treat one disorder without also comprehensively treating the other. For example, those who struggle with anxiety and who use drugs and alcohol to calm their fears may not benefit from stopping the use of drugs of alcohol for long if they are not given the coping mechanisms they need to manage their anxiety issues without feeling the urge to drink or get high.
Firefighters, First Responders, and Law Enforcement Have High Rates of Mental Health Disorders
The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that about one in five adults – or 43.8 million Americans – in the United States was living with a diagnosable mental health disorder in 2013. Additionally, they found that about 9.3 million Americans considered taking their own lives that year. These are numbers that resemble reports from 2012. First responders, including law enforcement and firefighters, are certainly part of this statistic, but unfortunately, as compared to the general public, there are often higher rates of mental illness, including substance abuse, addiction, and suicide.
There should be nothing stopping people who struggle with a mental health disorder or substance abuse issue from connecting with treatment that will help them to change their lives. Unfortunately, there are often perceived barriers cited by people living with these disorders that may postpone them getting the help they need. Firefighters and other first responders are often deeply impacted by these issues.
When people recognize that there are changes – negative changes – that have occurred in their lives and relationships due to their substance abuse or mental health issues, it is hard to deny that treatment is needed. The simplest way to avoid having to contemplate change and what that would look like – and often the biggest barrier to treatment – is to simply deny there is a problem.Denial is not just personal. People in denial will often work hard to cover up their use of drugs/alcohol and do the same thing with their mental health symptoms to avoid addressing issues. This makes it more difficult for others to recognize the problem in its early stages or to see how serious the issue is so they can turn the focus toward getting necessary treatment.
Firefighter and law enforcement cultures and first responder work environments are not particularly conducive to the exploration of “feelings.” These are tough jobs, and there is the perception that people need to be tough to do them. Though it is recognized that people on the job may struggle with the dangers they have to deal with every day and things they have seen in the line of duty, it is not always readily acceptable to discuss it openly or to admit the need to talk to someone about it on the therapeutic level. Rather than deal with the stigma against working through, for example, post-traumatic stress disorder related to the job, first responders may instead drown the experience at the bar or use other drugs in an attempt to escape – not only avoiding treatment that can help them but also inadvertently developing a second disorder that is equally debilitating.
Many first responders believe that if they discuss their issues with post-traumatic stress, depression, anxiety, and substance abuse that they will put their jobs at risk. In most cases, this fear is unfounded. In fact, the earlier people get help, the more likely they will be stabilize more quickly and return to work more functional than before. Unfortunately, avoiding treatment for a serious mental health condition including addiction will almost certainly result in job loss when the issues related to that disorder cause the person to make deadly mistakes on the job. These mistakes often reveal the problem as well as its depth and severity at the worst possible time and in the most public way. In addition, the mistakes put coworkers and the people being served at risk.
In addition to the above concerns about how people at work may respond to the admission that a mental health symptom, experience of trauma, or substance abuse disorder has become an unmanageable issue that requires treatment, many first responders fear the response of the community at large. They may not want to admit to their family at home or to extended family members that they are struggling, and they have concerns that they may be treated differently as a result. They may also be concerned that others in the community – people they serve – may find out or know about their health issues and that will affect their ability to take charge of situations when necessary. Again, however, the stigma against choices made under the influence, or choices that put others in emotional or physical harm’s way caused by untreated mental health issues and addiction, is far worse and more difficult to overcome.
Many continue to live with disruptive mental health and substance abuse issues because they mistakenly believe that there will be no benefit to getting treatment. Rather than risk issues of stigma or job loss, they characterize what they are living with as unavoidable and continue to try to deal with it on their own.
Some treatment programs can be expensive, but everyone has access to affordable health insurance coverage that will help to bear the brunt of the cost of treatment services for mental health issues as well as substance abuse and addiction. Additionally, many first responders are afforded increased care and coverage for the treatment of issues that occur on the job.
Many believe that there are few treatment resources in their area or that waiting lists are too long to make it worthwhile to apply. There are, however, numerous in-state and out-of-state treatment options available. While some have the benefit of offering nearby outpatient treatment services, others provide increased confidentiality protection and anonymity by putting some physical distance between the person’s home and the place of recovery.
Regardless, there is a range of inpatient and outpatient treatment services that are available. Each person who enters treatment should begin with a complete diagnostic evaluation in order to facilitate the creation of a unique treatment plan designed to connect with the services that will be most beneficial to the individual’s needs.
Signs that help is necessary include:
Each person should have a unique experience in treatment and recovery just as each person had a unique experience that led up to the need for treatment. There is, however, a general structure that is often utilized to make sure each client who enters treatment is connected with the services and support necessary to make efficient and steady progress in recovery.
Some people wait until they are in the midst of medical and/or mental health crisis before they begin treatment. In these cases, the first order of business is stabilization. Urgent medical care to manage acute medical issues like overdose and/or any injuries incurred due to accident or self-harm will be addressed first with stabilization as the goal.
In the case of addiction, some clients will experience physical and mental health withdrawal symptoms during the first days and weeks of recovery. If this is the case, medical care is available via pharmacological assistance, therapeutic support, and medical treatment if necessary to ensure that this process is as safe and swift as possible.
Evaluation and diagnosis
Once stabilized, the client can undergo appropriate evaluation in order to obtain a diagnosis or diagnoses that pinpoint the driving force underlying the symptoms experienced.
Based on the findings of the evaluation process, each client will have developed a unique treatment plan that incorporates a range of treatment services and resources to address symptoms. In addition, the plan will provide the client with coping mechanisms that will enable the ability to learn how to self-manage the disorder or disorders independently.
Most treatment programs are based upon traditional models of care in recovery, including the 12-Step program as well as cognitive and behavioral therapies provided on a one-on-one basis. Additionally, a range of support group options is often made available that may center on a specific need shared by the group or may simply offer participants a chance to work on different coping mechanisms.
A range of alternative treatment options exists to help clients explore issues and possible coping mechanisms for stress and trauma outside of verbalization. Active and interactive therapies like outdoor and adventure therapies, nutritional therapy, sports therapies, and others can provide first responders with more physical ways of regaining confidence and self-esteem and rebuilding connections with others.
Learning how to lower overall levels of stress can significantly contribute to a person’s ability to manage acute stressors on the job. By using holistic methods, such as meditation, exercise, massage, yoga, and others, clients can explore different options until they find a combination of resources that works for them.
Family members often struggle just as deeply as the person living with mental health issues and drug/alcohol abuse or addiction. As a result, family members require their own comprehensive care and treatment programs. Connecting with other family members who are experiencing the same issues in their families can provide a sense of support and community that breaks down the commonly experienced feelings of isolation and desperation that come with untreated mental health and addiction issues.
The cessation of formal treatment is not the end of recovery but the beginning of life defined by the new principles learned in treatment. In order to sustain these new lifestyle choices, it is important to remain actively engaged in the recovery community and connected to appropriate treatment services. Personal therapy, 12-Step meetings or other support group sessions, family counseling, and alternative or holistic treatment choices are recommended.
No matter what treatment resources are chosen, prospective clients can rest assured that their experiences in treatment – and even the fact that they underwent treatment and why – will remain completely confidential. Though in some cases it may be helpful to have a frank discussion with employers in order to manage certain issues related to the job or to ensure that the job will still be available when treatment is over, no details need ever be shared on any level unless the client makes the decision to discuss those details. Anonymity and confidentiality are huge components of treatment and part of why it can be so effective.
“Everyone in the department knows who has a drinking problem…In some departments, they may not talk about it, and unless there’s some kind of awareness program, they are even less likely to talk to the drinker directly. But you’ll know they know – you start getting shadowed on a run; conversation drops off when you walk in a room. At that point, the problem is no longer anyone’s secret.”
— Retired Fire Captain Michael Morse
An intervention is a formal discussion held between a person living with addiction and/or untreated mental health symptoms and a handful of concerned friends and family members who would like to help the individual not only recognize the need for treatment but also agree to immediately begin treatment services.
For those considering staging an intervention for a loved one, the following may be helpful in handling the details:
Law enforcement, fire fighters, paramedics, EMTs, and other first responders may commonly struggle with depression, anxiety, post-traumatic stress, and substance abuse or addiction, but they do not have to live another day without treatment that can be lifesaving.