Fire services lose 48 years to mental health every year

An approximate 12 minute read

Fire services are losing up to 48 years of working days and shifts to mental ill health and illness every year. In this three part series, I examine the national picture and how to help our firefighters.

The state of things

With 66% of the fire service said to have personal experience of mental health problems and men currently making up 92% of firefighters (though women account for 77% of control staff) and 75% of suicides in general population, it’s extremely important we talk about men’s mental health in the fire service, despite them being the default majority operationally. 

Mental ill health costs the UK economy approximately £56 billion annually, with it broken down to presenteeism (being in work despite illness) (£28b), turnover (£22b) & absenteeism (£6b). In other words, despite the narrative that people with mental ill health/illness are a “drain” on workplaces due to time off, the evidence demonstrates that many should be off but are continuing to work. I don’t doubt presenteeism is the leading financial issue because of a mix of stigma (both individual and cultural) and the rising cost of living and lack of sick pay available. The good news is that if we invest in our people, we will get the return. The seminal Farmer-Stevenson review found that return on investment (ROI) for mental health initiatives in the workplace was around £5 for every £1 invested. However, a Lancet study into Australian firefighters went one step further and found that mental health training for managers increased this to £9 for every £1 invested.

Unfortunately, outside of Mind surveys, we don’t know the current state of mental ill health in the UK fire service nationally because we don’t have the figures. This surprised me as I expected the National Fire Chief’s Council (NFCC) or even The Firefighters Charity to hold figures (in much the same way as the National Police Chiefs Council (NPCC) or Oscar Kilo do). Instead they all had generic information, pointing back in the direction of Mind, suggesting a heavy reliance on the organisation for both data and solutions to mental ill health in their services, and the organisation as a whole. I therefore set about submitting Freedom of Information (FOI) requests to every fire and rescue service in the UK to get the data; months later and I have it (note: if these figures are already available somewhere and I simply haven’t found them, I apologise for duplication).

I asked each service “How many working days (both firefighters and staff) were lost to psychological disorders between January 2020 and January 2022?” You can see a full PDF breakdown of all the data and responses I received from every service in the UK below. Annoyingly, it wasn’t until I started receiving the results that I had wished I’d asked them how many they lost to suicide but thankfully that’s a matter of public record and we’ll discuss this a little later.  

Correction: I had included the wrong “total” figure for West Midlands in the original PDF and have since corrected the document below as of 18 April 2023 to reflect this. This means that the figure included in the headline of this article is incorrect and should read “42” years. I have kept the “48” in the title for those who may have already shared the link.

What’s evident from this data capture is that it’s a mess. Or, to put it another way; a total shit show. There is no standardisation to reporting or even categorisation of mental ill health in the services and whilst some services offered a clear and detailed breakdown, others gave me a single figure with no context (though that could be down to my question not being more specific). Therefore, the data I refer to throughout these pieces is raw and the comparisons I make are from the perspective of an expert opinion as opposed to truly quantitatively analytical. 

London Fire Brigade lost 30,378 days or 83 years, which isn’t surprising given it’s one of the geographically largest and most densely populated services but even still, the numbers are shocking when laid bare. Warwickshire had the least shifts lost with 567 and I’d be curious to see what factors could be keeping this number so low. 

Not only were there huge discrepancies in how services recorded lost working hours (days/shifts/breakdown of personnel) but how they recorded the absences. The majority of services used “Stress, Anxiety, Depression and Other” which captures the most common mental ill health disorders but I’m surprised there isn’t a separate category for “trauma” given it’s prevalence and the fact that you could potentially record trauma symptoms under both “stress” or “other” therefore rendering analysis and reporting on the subject inaccurate. 

Others, such as North Yorkshire, simply had “Sickness – Mental Health” to record such an absence which is far too broad in terms of the services’ ability to accurately record, analyse and tailor support toward. Similarly Gloucestershire recorded it as “stress and depression” which is, again, far too broad and prevents us from making meaningful comparisons in the service and with others for a broader picture. Greater Manchester went even further with their lack of understanding, recording absences under “mental health illnesses” which is a complete oxymoron. Everyone has “mental health” but not everyone has a “mental illness” and this distinction is important, for reasons I discuss below. 

I was pleasantly surprised to see that Kent had included “exhaustion” in their absence recording though I’m curious to know what is defined as “exhaustion”. To me it would be akin to emotional and mental burn out but this is unclear, though I do commend Kent for their acknowledgement of this aspect of mental ill health, especially given what their people do. 

Mental health or illness

What concerns me overall is that there is no clear distinction between mental health and mental illness i.e. the latter was often incorporated in the former when they are not the same. You can be mentally unwell but still not meet the criteria for a diagnosis of mental illness. “Stress” for example, isn’t considered a mental illness but can greatly impact your mental health. This distinction is necessary to make because whilst we’re becoming more “mental health aware” as a society, we can’t appropriately support those affected by either (or both) if we don’t clarify the differences to begin with. 

The obvious problem with this lack of standardised reporting and clear distinctions is that it means we can’t truly acknowledge, discuss and support the extent of the issue because we don’t know it. It’s the reason I submitted the FOI requests to begin with; so that we could see a clear picture of the state of mental ill health in the fire service, albeit the data is anything but clear.

What’s most disappointing, however, is that whilst the NFCC are “confirmed signatories to Public Health England’s (PHE) Concordat for Better Mental Health” only 11 services nationally have signed up to the principles of the concordat. This disparity of intention versus action is something that can add to individual’s ill health, certainly if they are suffering a moral injury caused by their services, and can be perceived as organisational gaslighting. I (personally) fail to see the benefit in the NFCC signing up to agreed principles etc of another seemingly bureaucratic government-based policy when individual services don’t, other than some sense of demonstrable purported action under the guise of legal liability and good press. 

Mind found the most commonly reported mental health issues experienced were “depression (39.3%), anxiety (39.1%) and PTSD (18.1%). The percentage of fire service staff reporting experience of PTSD was the second highest across all of the emergency services.” These figures are really important because I see a lot of mental health support and initiatives putting an emphasis on PTSD and trauma within Blue Light services (which is, of course, understandable and beneficial) despite, as evidenced here, as well as other research across the Blue Light services, common mental illness disorders being more largely represented. 

This has long been an issue of mine supporting men in uniformed services, including military, because it can marginalise those who don’t have symptoms linked to trauma/PTSD i.e. their illnesses, such as depression, don’t appear overtly represented in support campaigns, and therefore they won’t/don’t seek formal support and help. Many believe, even passively, that if they don’t have PTSD (or severe trauma symptoms) that their issues “aren’t that bad” and therefore continue to suffer in silence, despite depression (and other mental illnesses) being strongly linked to suicide. 

Suicide

Every suicide is said to cost the UK economy approximately £1.7 million and figures from the Office of National Statistics tell us that between the years of 2020-2022 we lost 18 fire firefighters, including senior officers to suicide. All of them were men. That’s not surprising given that men account for 75% of all suicides in general population and the fire service is male-dominated but it does highlight that we need to be specifically addressing men and their needs. Men, for example, don’t need to be mentally ill to die by suicide as, very often, it’s life stressors such as a relationship breakdown or difficulties at work. As I’ll often say, the life stressors that women survive will often kill our men and I’ll discuss this comment in more detail in the second part. 

Mind’s survey showed that “the longer people serve, the more likely they are to feel the negative impact of workload pressures. Those with 11 to 20 years of service were the most likely to feel the effects of a range of pressures, including organisational upheaval…” This is particularly important to acknowledge in the context that the average age of firefighters is 42 with 32% of firefighters being between 46 and 55 years old, because men between the ages of 42-49 are those most at risk for suicide. I support a number of middle-aged firefighters (all men) and many have had suicidal ideation, with their colleagues and loved ones none the wiser because they still believe it’s a “weakness” to experience such thoughts and seek help for them, especially when they are leaders. 

The above is not to say that work-based trauma (of the jobs they attend) can’t be part of someone’s experience of mental ill health but that it can be a tipping factor for more distressing issues i.e. it might be a relationship breakdown at home or poor leadership further exacerbated by work-based trauma. This is why getting mental health support right in the fire service, or indeed any organisation, is so important because for many men in uniformed services, work and their team can be a strong protective factor in preventing mental ill health decline, and even suicide (something we’ll discuss in more detail in the second part).

In 2019, Mind found that the four most common organisational causes, in order, for mental ill health were “pressure from management, experience of distressing or traumatic events, excessive workload and organisation upheaval.” Indeed the issue I support fire fighters, and other men across uniformed services, with the most is moral injury stemming from organisational injustice. That is to say that it is their organisation, from not receiving support through to toxic management and being treated unfairly, not trauma of the jobs they attend that causes them the greater harm. 

Just 19 Mind survey respondents and 2 interviewees from the fire service were Black, Asian or Mixed Ethnicity and statistically those from these communities make up only 1% (Asian), 1.6% (Black) and 1.9% (Mixed) of all fire staff, including firefighters. Of note, “interviewees were keen to emphasise that identity operates at a number of levels and that the generalising term ‘BAME’ does not adequately capture the complexity of race and cultural background.” Importantly, “where micro-aggressions do exist, these were largely felt to be borne out of ignorance rather than malice. Nevertheless, many participants from BAME backgrounds described how the fear of experiencing racism or being treated differently because of their race is something that is always at the back of their mind.”  and sadly, this was something inferred in the tragic suicide of Jaden Francois-Espirit from the London Fire Brigade. More work is needed, both in recruiting those from diverse backgrounds and for having them represented in mental health initiatives and support. As I always say: there is diversity in mental health and every group will have specific barriers to help-seeking and receiving support. 

Although the fire service has the highest reported levels of “good” mental health throughout our Blue Light services, it’s vital that we continue to improve our attitudes and cultures to give our men the best outcomes when recognising their need for support, and subsequently seeking and receiving it. 

In part two, (now live here) we’re going to be discussing risk factors and barriers to help-seeking for men and we’ll end in part three discussing some of the limitations of available support but how we can help ourselves and our colleagues, as men. 

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