Q&A: ‘If you've been in fire service, you have post-traumatic stress’

In "The Final Call," "Fault Lines" explores the hidden epidemic of suicide among U.S. firefighters—and asks why more isn’t being done to address depression and PTSD. The film airs on Sunday, Feb. 21, at 9 p.m. Eastern time/6 p.m. Pacific on Al Jazeera America. | Click here to find Al Jazeera in your area.

In 2014, 87 firefighters were killed in the line of duty nationwide. That same year, Jeff Dill confirmed that at least another 105 had taken their own lives. He estimates that was only roughly 30 percent of the actual total number who had committed suicide, which by his math would put the number closer to 350.

Dill runs the Firefighter Behavioral Health Alliance, the only organization that attempts to track and validate suicides by firefighters and emergency medical technicians (EMT). He travels across North America talking to fire departments about the high incidence of suicide in the profession—as well as the reluctance of people within their ranks to talk about their emotional stress.

He traces his inspiration to take on this work to conversations with firefighters who returned to Illinois, where he was a battalion chief, from New Orleans, where they helped in the aftermath of Hurricane Katrina. They said, “Wow, man, we saw some horrific things: picking up bodies and the devastation.” When the first responders went to their employee assistance program, Dill said, counselors weren’t able to understand the terminology or the culture of the people they were trying to treat. As a result, most of the firefighters stopped seeking help and continued suffering.

“Fault Lines” spoke to Dill about the causes behind the high number of first responder suicides and what sort of change he’s hoping his efforts will spur. An edited version of the conversation follows.

Is your organization the only one that tracks firefighter suicide numbers?

The Code Green Campaign started tracking EMS (emergency medical services), but they do not validate like I do. When confidential reports come into us or someone I know calls me and says, “Hey, our department recently had one,” I'll call the chief, I'll give him the spiel, say I was 26 years on the fire service, I'm a licensed counselor and I'm the founder, and I do this because I do not want to forget any of our brothers or sisters that have taken their lives. They'll tell me exactly what the story, the situation, the issue was. When they don't know the method, I just put it in the unknown category.

Why isn't the government keeping these numbers?

That's a question you'll have to address to them. The National Fallen Firefighters Foundation, excellent organization, was started by Congress many years ago, and they do a great job of honoring the firefighters that lost their lives in the line of duty. And in fact, every October, they have a memorial weekend where they bring the families in. And they started actually back in late 2011, starting to have some discussion about firefighter suicides, but at this point, they don't recognize firefighter suicides.

If you have a fire, and two firemen go in and come out. One has physical wounds that lead to that firefighter's death. They're going to be on the wall, and their family will get death benefits, money from the government. The other one has emotional wounds that lead to his death. He's not on the wall and doesn’t get benefits. How do you reconcile that?

We've become very close with so many families. It's very difficult [for them] to understand why they can't be recognized. It comes down to what our nation is all about when it comes to mental health. When you talk about suicide, it's something that we really don't know a lot about. And what happens when we don't know something. We're afraid of it. We're afraid to discuss and really approach it. But what we're seeing now in these last four years, we're starting to see a positive swing into, “Maybe we need to bring behavioral health to the forefront in the fire and the medical services."

You said the National Fallen Firefighters Foundation (NFFF) started having discussions about addressing mental health issues in 2011. We’re nearing the end of 2015. What is the number of firefighters who killed themselves to date for this year?

I just validated another one today [October 2, 2015]. It's at 86, and we still have 11 more to validate, and I estimate probably 30 percent are reported to us.

So over the four years that they've been having discussions, hundreds of firefighters have died?

We had 105 lose their lives last year [2014]. You have to understand, the NFFF, they do a great job, but they were put together through an act of Congress to help honor those firefighters lost in the line of duty death. And now they're starting to get into the behavioral health aspect.

We talked to the NFFF, and the problem is they don't have any authority, and they don't even have a budget. They're an unfunded mandate. Congress could change that. How important is it to you that they change it?

The fire service has been taken aback by this. And when you talk 200 years of history, four years is miniscule, timewise. We are all working on it. The IAFF [International Association of Firefighters] is working hard on it, the Safety Board and [Assistant General President for Health, Safety and Medicine] Pat Morrison. We all know that it's an issue and it's a problem.

For me though, I need to be in front of people, and that's why I travel across the United States and speak to my brothers and sisters. This is something I can do right now. I'm not a big entity. We're a not-for-profit. We don't get a lot of funding. I'm trying to at least bring that awareness. If I can at least lay you the track down early so that we're saying, “Yeah, we know a little bit now about suicide prevention awareness,” then you get those big organizations that have a lot of funding and backing, if they can then roll with the ball, then I'm happy with that. It's not about me. It's about my brothers and sisters.

A firefighter is three times more likely to die by suicide than in the line of duty. Why is that?

Here's the problem, and this is where I'm trying to make the difference. When you say, “Hey, you know what? I'm going to be a firefighter,” they send you to the fire academy. What do they teach you in the fire academies? Well, they can teach you fire behavior—How does it react? Is it pushing out? Is it sucking in? Is it brown? Is it black?—search and rescue, ladders, ventilation, water flow, tools. But what are we missing in our fire academies? That's behavioral health. And I'd love to see every state fire marshal say, “Hey, you know what? We're going to talk about anxiety and stress and depression, because you get in this job, there's a high percentage that you will suffer.” I firmly believe that if you've been in the fire service, you suffer from post-traumatic stress. It might not be the disorder PTSD, but you suffer from stress.

Can you recall some call where a child died in your arms or a drowning or a vehicle accident, a burn victim, a rescue in a fire?

You'll see it time and time again when you ask a firefighter. Yes, I can recall. I've talked to firefighters [who from] 30, 35 years ago can recall in detail calls that they went on. And that's that post-traumatic stress. That is what we need to be talking about in our fire academies and our fire officer courses, as well.

We teach you how to run an incident. We teach you how to manage people in the fire stations and administration, but nothing about how do you talk to someone when they come to you and say, “Man, I'm feeling depressed,” instead of just saying, “Well, let's go to our employee assistance program.” That's not the answer. We have to learn how to talk to each other. So that's some of the training that I'm trying to bring in. And during my presentations and my workshops, if I can get one person to go back to the department and say, “We need to make changes here,” then we've succeeded

Is it the “bad runs” that are at the heart of firefighter suicides?

I think it's a combination. We have the bad calls that we go on. We have that cultural brainwashing through the fire academies because we're taught, “Act strong. Handle all of your problems on your own.” And so that becomes a key issue when maybe you've lost a child. This is what we're ingrained to do is be strong and handle these issues, and so we bury things. We absolutely bury them and bury them until maybe one day there is something that comes out.

And I'm not saying everyone, because that's the question: How you can you have two people go in and see the same call, and one's resilient and one suffers? I can tell you this: From our 695 documented firefighter and EMT suicides to this point, on October 2nd, 2015, we know that the number one known reason is marital and family relationships, followed by depression, addictions and post-traumatic stress.