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How a Network of 200 BCACC Members are Changing Mental Healthcare for First Responders

By Matthew Johnston, RCC

 

On October 5th, 2017 an idea swiftly became a nervous reality as I entered a classroom filled with 25 mentaI health professionals. They were eager to learn about the nuances of first responder subculture and were looking to me for insight.  As I entered the room, I remember thinking to myself “Why would these people want to listen to me?” and “Do I really have enough content to fill 2 days?”. These thoughts rushed through my mind, aggravated by sleep fatigue as I had tossed and turned the night before. I had placed too much pressure on myself and all the lingering self-doubt culminated in that moment. My trusted stress relief – running up to 15 kilometres per day – was the only tool I had to quelling my anxiety. I hadn’t run in weeks. A combination of organizing this course and working full-time as a firefighter left me frazzled.  All I could do is mask it with a half-hearted smile.

A few moments later, class was set to begin, and my co-facilitator Steve Farina broke an awkward silence with a now infamous icebreaker. “Okay class, time to get started” he says. “We have 10-pounds of shit to put in a 5-pound bag”. Peering around the room, I nervously await the class reaction. It didn’t take long for nearly all to burst out with laughter which drowned out any other noticeable reactions. My anxiety instantly melted away as I was just happy that opening line didn’t come from me.

Steve is a unique individual.  He is the epitome of ‘wearing his heart on his sleeve’ and often says that he can easily eat his size 12 boot because he puts his foot in his mouth so often. A former grocery store clerk and now 22-year veteran of the Coquitlam Fire Service, Steve rose through the ranks to emerge as a leader in the province and now Canada in the field of occupational health and safety. Steve steadfastly protects his brothers and sisters – even if it comes at offending others, which surprisingly – he seemingly rarely does. Steve’s approach certainly lightens the heaviness of two days for me and the classroom participants. A seemingly odd combination of teachers – me a former play therapist and Steve a grocery store clerk, are leading a group of more than 300 distinguished clinicians across Western Canada on how to work with public safety personnel.

A recent Occupational Awareness Training class held at Coquitlam Firehall #1. It has become tradition for classes to tour the active firehall and interact with the on-duty crew.

 

Lunch & Learns

Our classes have been a success in part because members across all host fire departments are more than happy to share their lived experience with an audience eager to listen. Our “Lunch & Learn” chats with members of the host fire department resemble an ad-hoc group therapy session, as clinicians are given a firsthand look into the organic nature of personal struggle. They bare witness to common firehall coffee table talk filled with dark humor and sometimes graphic stories of personal tragedy – all intermixed with common daily stressors that we can all relate to. These conversations serve to showcase human resiliency and entice a cathartic sense of clinician voyeurism – so that fascination with these stories do not guide the therapeutic alliance later in individual counselling sessions. Although tragic, these conversations are normal for seasoned firefighters and they want our group of mental health clinicians to get it. Most do.

A Panel of off-duty firefighters in Surrey. In the middle is Isabel Rudiger, a 27-year member of the Surrey Fire Service. Isabel was one of the first of two females hired in the Surrey Fire Service. She is currently completing her master’s in counselling psychology as she prepares for the next stage of her career.

 

The lunch and learns have proven powerful for both clinicians and participants. This segment of our course is often moderated by our third instructor – Fire Chaplain Scott Young, who plays an integral role in creating a safe space for local firefighters to share their personal experience with a novel audience. Many firefighters enter our classroom nervous, only to leave feeling lighter and inspired. They are warmed by the simple power of feeling heard, even when 25 clinicians simply sit in their presence – with their body language indicating that they share their personal pain. Clinicians have proven that they are allies and sharing can foster precious insight, which in turn, facilitates a process of meaning and purpose for many of these emotionally brave firefighters. It was the best way we knew how to mend this traditional disconnect.

Spirituality and Healing

I first met Scott the same way I have met many other firefighters over the years – at a memorial service. My department struggled with two suicides just 7 weeks apart in 2015 and Scott played an instrumental role in aerating my department’s pain while also containing our collective suffering. It was no small feat and a responsibility that few would be willing to take on. I sat in an auditorium with 1500 other firefighters listening to Scott’s words and was taken back by a Chaplain that showed a sense of vulnerability we could all relate to, but rarely expressed in the context of firefighting. Scott’s poetic words showed firefighters that you can still be masculine while listening to your soul. This was the permission we all needed to be granted in order to unbuckle our tightly wound grief across 400 members.

Scott often jokes with our classes that the mental health field stole many common concepts including mindfulness and narrative modalities from the field of Chaplaincy. To a certain extent, he is right. Fire Chaplains were an established part of ‘talk therapy’ in fire service well before the birth of Carl Rogers. I sense that many clinicians have been struck by the thought of Scott jumping on a fire truck as a Captain in the City of Coquitlam the same day he leads a celebration of life. Scott will often tell the group that his poetry is what keeps him grounded as he balances multiple, even competing, life roles.

Captain & Chaplain Scott Young provides a poetic narrative on his lived experiences on the job and life. His approach on articulating spirituality for firefighters has made him well known in the province.

 

A Provincial Initiative Emerges

Within 4 months, the Occupational Awareness Training Program emerged as a provincial-wide initiative, with support and assistance from the BC Professional Firefighters’ Association.  Steve, a Vice President with the BCPFFA, has also brought Scott and I on to their Mental Health Taskforce.  A true honour to be part of for sure. The three of us travelled around the province, sometimes shortly after a local first responder took their life, or a high-profile tragedy unfolded in the host community. We began to feel that tragedy was following us – or that this was just the unfortunate norm when you see things from a provincial-wide lens. Oddly, each tragedy served to reinforce the need for clinicians to receive our training. It was hard and stressful at times for the three of us, but the effort was justified by the depth and meaning of the work.

In 2015, the BC Professional Firefighters’ Association put out a survey to their 4000 members and found that over 90% of the province’s firefighters preferred to share their struggles with a colleague rather than an outside mental health professional. This statistic would have been easier to digest for me if first responders were doing well with managing their life and job-related stressors. However, I knew from Nick Carleton’s research in 2017, that nearly half of all Canadian public safety personnel struggle with symptoms consistent with one or more psychological disorder.

I asked myself ‘How did the mental health field get so disconnected and unattractive to firefighters?’ ‘What could be done to change this?’ These were the obsessive questions that drove me to find answers and influence change in a vastly political arena. For the next year and a half, I would spend nearly every day seeking answers to these questions and sharing my thoughts with as many mental health professionals as would listen. Many did listen and I felt little pushback, which added to the confidence of my spoken words. I thought to myself “I must be on the right path” and for the first time in this process, I was gaining confidence in my outlook.

My forming perspective changed the way I read or heard stories about another community shaken by the death of a local first responder. At times, I felt like an eccentric character such as those in the movie “A Big Short”. The answers were complex, hard to articulate in words but somehow drove me to pursue a greater meaning on this troubling social trend. At times I wasn’t sure if it was the mental health field to blame for this human tragedy, the political motives of others or the first responder culture itself. I have since come to realize that all arenas are to look inwards and through collaboration, we can collectively curb this mental health crisis. No wonder I struggled so hard at times to explain my ever evolving, often on-the-fly formulated outlook.

A class hosted at the BC Professional Firefighters’ Association provincial headquarters in Vancouver. Union leaders from around the province will often see our smiling group of clinicians learning about fire culture here. This is how we bring two distant worlds closer together.

 

Exploring the Disconnect between Therapist and First Responder

For every clinician who enrolled in our course, I carefully examined their website – over 300 of them. Many mentioned they treated depression, anxiety and trauma utilizing evidence-based modalities such as EMDR, CBT and some less popular, more process-oriented modalities that really spoke to me – as I peered through the lens of a clinician.  I pondered their company name and even examined the chosen colour templates for their websites. Most were talented therapists who could be incredible assets to local first responders and families. However, my lens shifted towards how their services spoke to an audience of people who generally embraced hyper-masculine qualities, were skeptical of outsiders and perhaps indoctrinated in subcultural messages that still convey a sense that ‘reaching out for support is a sign of weakness’.

I don’t proclaim to have answers on how therapists should market their services to this often hard to reach demographic. However, I do know that phrasing the human condition in terms of frailty and pathology counters the self-image that many first responders pride themselves on – that is being strong and staying composed across any situation that life throws at them. We are the caretakers, not the patient. That is what most of us think. To change this perspective, the BC Professional Firefighters Association (BCPFFA) teaches its 4000 members that going to see a therapist is like practicing good oral hygiene. Most of us don’t wait for tooth decay to go to the dentist.  So routine check-ups with a mental health professional is a way to prevent emotional cavities from developing later in life. This is how we are working together to bridge these two worlds.

How to Influence Perception

The BCPFFA wanted to change the preconceived perspectives of many therapists and first responders alike. It was at this point that we worked together to develop a Directory of Occupationally Aware Clinicians on a stand-alone website where messaging and branding could be tactfully constructed. No sensationalized images of being a first responder, no disorder approach. It also meant that we could celebrate the skill set of our network of clinicians as they specifically pertain to a first responder audience. So instead of clinicians altering their business website content, they could construct their own personalized profile on a one-stop shop for BC’s first responders. Over 125 clinicians will be on this directory that we are excited to launch on October 15, 2019.

 

This directory is offered free of charge to clinicians and any first responder or family member seeking services through this centralized directory. It doesn’t even require constructing a user account to access the directory. There is no data mining or advertising as we are fundamentally opposed to monetizing from the vulnerability of our tight knit first responder community. The BC First Responder Mental Health Committee and the BCPFFA have been instrumental in supporting the development of this directory. Nearly two years to the day, my gut feelings about how to influence complex systemic change is coming to life. It has been worth the effort.

Why I see Occupational Awareness Training Program as Movement

  • We hosted 12 courses since October 2017 (2x Vancouver, 3x Coquitlam, 2x Nanaimo, 2x Kelowna, Cranbrook, Surrey and Oak Bay), nearly all were at capacity
  • We hosted 196 mental health professionals at Surrey City Hall for our level 2 event
  • We created North America’s first Directory of Occupationally Aware Clinicians
  • We brought together a variety of provincial stakeholder groups – the BCACC, BC Ministry of Labour, BC Ministry of Mental Health and Addictions, WorkSafeBC, the First Responder Mental Health Committee and the BC Professional Firefighters’ Association
  • We launched an online counselling service and became the first service provider to manage complex psychological injury claims for rural firefighters
  • We have expanded to Alberta and Saskatchewan with interest from other Canadian provinces

This initiative would not have been a success without the support of the BCACC and I would like to thank every Registered Clinical Counsellor who took time out of their busy lives to learn more about first responder culture. The staff at the BCACC has been an instrumental partner in our success and we look forward to working with this association for years to come.

It’s Not Too Late to Join our Network

We have two final opportunities to receive in-person Occupational Awareness Training in British Columbia.

Information and registration can be found here: https://firstresponderhealth.org/cliniciantraining

About the Occupational Awareness Training Program

The Occupational Awareness Training program is a first responder client-centered approach that compliments rather than competes with common counselling modalities. It is a foundation to place upon a set of ‘tools’ for which the therapeutic alliance can be housed. It allows the therapist to bare witness to accepting their own personal vulnerability and limitations which also serves to entice a meaningful relationship with first responders and their loved ones. In doing so, we are showcasing the enduring qualities of an unbreakable human spirit and if needed, we are moving a pile, a hill or mountain of personal challenges one shovelful at a time. This unflappable patience conveyed by the therapist leaves an indelible mark on a first responder by showcasing self-compassion and self-acceptance as the cornerstones to healing in the tolerance of uncertainty that life brings us all.

Crew cohesiveness can act as a significant buffer in diluting the stress of a traumatic encounter. We often use the saying “two in, two out” to imply we have each other’s back regardless of the call. This was my crew in 2017 & 2018. Their conversations and support were instrumental in the early stages our program.

 

About Matt

Matthew Johnston is a full-time professional firefighter and mental health clinician. In 2017, Matt built the Occupational Awareness Training Program for Healthcare Professionals in collaboration with the BC Professional Firefighters’ Association. Recently, Matt’s efforts garnered national attention as he was the only individual appointed from Western Canada to Tiger Team 3; a committee in charge of implementing Bill C-211 – the Legislative Framework for PTSD in Canada. Matt is proud to be part of the BCPFFA Mental Health Taskforce and realizes the value of collaboration in stemming the mental health challenges facing many public safety personnel in and beyond British Columbia.

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