Men’s mental health in the fire service

An approximate 15 minute read

As I discussed in part one, the fire service has the highest rate of “good” mental health reported in our Blue Light services but there’s always room for improvement. It’s vital we acknowledge specific risk factors for men or much of our support and initiatives will continue to be dismissed by many as nothing more than “posters on toilet doors.”

In today’s part, we’re going to discuss risk factors and barriers to help-seeking for men, as well as cultural issues.

Please note: I will have to make generalisations and speak to stereotypes to keep this piece as succinct as possible but I do recognise there is great individuality with our men.

Barriers to help-seeking and risk factors

Many of us working with men will say that masculinity is “hard won but easily lost” because much of masculinity is performative, from the way men treat themselves to their peers, partners and colleagues and that there are many ways that men can “lose” points in the perceived eyes of others, especially other men. Masculinity is not inherently “toxic” nor negative but, like a lot of things in life, there are aspects that, when taken to extremes, can be harmful to men themselves however, masculinity can also be protective against mental ill health and we’ll discuss this in the final instalment.

In the workplace, Harvard Business Review research attributes this to “masculinity contest culture” which encourages hyper-masculine and dysfunctional cultures to “win at all costs.” Essentially, the more male-dominant a workforce, the more potentially harmful it becomes, creating hostile and damaging environments for everyone in them. This is something we have sadly recently seen demonstrated within several services and the damning HMICFRS report into Values and culture of the fire and rescue services, highlighting harassment, discrimination and misconduct amongst other severe issues, which the Fire Brigades Union (FBU) have rightly agreed with.

Every year, we take our employers to court on behalf of FBU members who have been the victims of discrimination and harassment.

The latest HMICFRS report details how racism, homophobia and misogyny are routinely ignored by people at the very top.

 @MattWrack on @SkyNews today pic.twitter.com/jsZ42idvng

— Fire Brigades Union (@fbunational) March 31, 2023

The London Fire Brigade was found to be “institutionally misogynistic and racist” by an independent review (requested by their commissioner), firefighters in Dorset and Wiltshire shared photos of dead women whilst commenting on their underwear (with their chief apparently none the wiser about his second in command’s sexual misconduct), and a Tyne & Wear leader was promoted despite being under an active police investigation for rape. Whilst I will always support and advocate for our men, it would be morally and ethically remiss of me not to emphatically state that more needs to be done to support our women and minority groups in and out of service against the abhorrent attitudes and actions they evidently face from some within our services.

It is, however, extremely important to highlight that recognising an institution is “X” does not mean every individual within that institution is “X” or even affected by the issues, but that the institution as a whole can encourage and maintain “X” behaviours through its systems, structures and cultures. 

Harvard business review found there were four masculine norms within such cultures:

• Show no weakness
• Strength and stamina
• Put work first
• Dog eat dog 

Glick, Berdahl & Alonso (2018) further found that the masculinity contest culture had damaging effects for those within the workplace demonstrating (arguably backed by the HMICFRS report findings):

• toxic leadership who abuse others to protect egos
• low psychological safety
• poor work/life balance
• bullying and harassment including sexism
• higher rates of burnout and turnover; and 
• poor personal wellbeing for both men and women, with higher rates of illness and depression

And the above isn’t to attack our men (far from it) but to acknowledge how many men, through no fault of their own or even awareness of it at times, uphold the unspoken rules of masculinity that prevent them and their colleagues from seeking help, certainly in the company of other men. No one governs or denies men’s thoughts and emotions more than other men.

Whether people are prepared to acknowledge it or not, masculinity is both a protective and risk factor for mental ill health and suicide in men. As I said in part one, men don’t need to be mentally ill to die by suicide. For many, it’s a combination of severe life stressors (in and outside of work) together with barriers of masculinity, including shame, and it’s these such stressors which we need to be proactively looking for in our men to offer support, and I’ll discuss proactivity in the final part.

Below is a non-exhaustive list of some of the specific risk factors for our men in the fire service. First we have a small list of risk factors that people around the man can proactively identify and the second list are risk factors that only the man himself will likely know he is experiencing. 

External risk factors:

• Age
• Barriers of masculinity (more on this below)
• Relationship status – single/separating/divorced
• Relationship breakdown
• Family breakdown/parental alienation
• Becoming a father
• Undergoing investigation or disciplinary procedures
• Due to retire/resign from the organisation or have recently left
• Unexpected change in job role or team
• Adverse childhood experience (if known)
• Going through therapy – talking/EMDR
• Financial difficulties (if known)
• Anniversary or difficult dates
• Recent suicide of colleague/friend or attended run of intentional harm calls
• Organisational injustice (moral injury)

What’s vital to note about the below interpersonal risk factors is that some of them will also be ways in which mental ill health/illness can manifest and present in a man, thereby leading them to become external risk factors requiring proactive support, as above. 

Interpersonal risk factors:

• Decrease in risk aversion & apathetic (personal/team level)
• Increase in risk-taking behaviour
• Little to no social support
• Identity crisis
• Late to shift/making simple mistakes
• Emotional numbness
• Substance abuse issues/gambling
• Self-sabotaging behaviour 
• Nightmares/difficulty sleeping
• Increase in anger/irritability
• Change in sexual libido (less or more, including use of porn)
• Physiological symptoms (aches & pains, digestive problems etc)
• Low self-esteem and self-loathing/imposter syndrome
• Problems with appetite/exercising
• Lethargy/brain fog
• Adverse childhood experience
• Financial difficulties

Barriers to help-seeking

So, what do we mean when we talk about the “barriers of masculinity?” These are the unspoken aspects and “rules” of masculinity that men often feel pressured to abide by, or do so without realisation. These can include things such as emotional stoicism (not discussing thoughts & feelings), hyper-independence (not seeking support even when needed) and rejecting empathy (as it’s viewed as “feminine”). Even the Samaritans recognise that “masculinity” is a risk factor in rates of male suicide.

Many men typically use risk-taking and self-sabotaging behaviour in response to life stressors also. This could be drinking to excess, impulse buying or sex (typically affairs), for example. I don’t judge any of my men for their coping mechanisms, even if they’re deemed “unhealthy” (something we’ll discuss in detail in the final part) because we do what we can and must to survive life and some men genuinely don’t know why they take risks or self-sabotage in the first place. As I’ll always say, I would rather one of my men use alcohol to cope than not use it and die because I can work with a chronic drinker; I can’t work with a dead man.

Another key barrier within masculinity is emotional illiteracy (again, highlighted by the Samaritans), by which we mean that we don’t teach men (as boys) the value of introspection and give them the necessary language to vocalise their thoughts and emotions. We tell them they’re “easy/simple” or “not complicated” thereby minimising their emotional needs and preventing their ability to accurately identity and articulate their emotional and psychological needs. For me, this is why I have such a huge issue with reductively telling men “to talk” because how are they supposed to know how to do that when we’ve spent their whole lives, as a society, telling them not to and demonstrating it often comes with judgement and ridicule? And we’ll come back to this point in part three.

I often say that if you ask a woman why she’s angry, you’ll get everything from “resentment” to “disappointment,” “rejection” etc but ask a man why he’s angry and you’ll get 50 variations of “I’m angry” and that isn’t to imply that men aren’t intelligent but that we simply don’t teach them the value of self-awareness and the language to articulate their experiences.

Stigma, I find, is the biggest barrier for men, not just in terms of potential stigma from other men and even the professionals they engage with but self-stigma i.e. “as a man I should be able to cope.” We have come a long way in the fire service in positively changing cultures to openly discuss mental health and illness but there is always room for improvement. Within Mind’s recommendations, they noted “insights suggest that stigma is a still a barrier to accessing support that is particularly pertinent for fire service personnel”.

Within stigma is also another barrier known as “status anxiety” where we feel that professional and/or our social statuses will be detrimentally affected by us disclosing mental ill health/illness. This is huge for a lot of my men in that they fear what others will think of them if they confide they’re mentally unwell, or it’s discovered, especially when they’re watch managers and leaders in general or, going through promotion. Many in uniformed services will only publicly disclose their experience of mental ill health/illness when they’re in a position of career safety i.e. they’re not looking to move roles or be promoted.

An uncomfortable and consistent barrier to discuss is leadership, on two fronts. The first being that there is so much pressure on many of our mid-level managers and leaders, from those above as well as outside influences such as HMICFRS, that they don’t feel able to speak up when they’re breaking under the pressure, or receive help and support even once they’ve asked for it. The fire service has taken a real terms pay cut within Tory austerity, with a 20% loss of fire personnel since 2010, and many are now facing the inevitable task of “doing more, with less” both in terms of people and resources available. This leads to the potential of compassion fatigue – emotional and mental exhaustion from empathetically supporting others – as there are fewer people with less time to dedicate to supporting colleagues.

The second is that cultures and attitudes are set from the top down and I have been growing increasingly concerned about some of the attitudes and actions yielded against our men in service. There’s a reason why the FBU state “every year we take our employers to court on behalf of our members.” Indeed, the issue I support men in the fire service, and wider uniformed services, with the most is moral injury and organisational injustice, from slow processes when seeking support through to being on the receiving end of abhorrent attitudes and actions from colleagues and leaders. Within fire, and all uniformed services, I also repeatedly come across the attitude of “I’m fine so, don’t see the problem” especially from those in positions of leadership; the passive workplace equivalent of “man up.” Not only are these attitudes life-threatening but I’d argue that many of the leaders who share this sense of entitled ignorance are often in denial at the compartmentalisation and emotional numbing of their own issues.

We also have to acknowledge that many senior leaders will not have been operationally frontline since austerity began which I’d argue, as I do in policing, means that the stressors these leaders face will not be the same as those remaining on the frontline. That is not to dismiss the work-based trauma that they have been subjected to within their careers but to highlight that their stress and trauma stressors will likely differ from those who are currently operational, as they won’t experience the level of relentlessness their colleagues currently are. Therefore our leaders, including senior leaders, have their own risk factors and barriers to help-seeking, which we must also address.

There is also a duty to report mental ill health and suicidal ideation (context dependent), whether you’re a formalised peer (Mental Health First Aider (MHFA) or Mind Blue Light champion) or occupational health professional etc. I call this an obstacle because, whilst it is, at times, genuine safeguarding, there are sometimes professional consequences for speaking up about your mental health, and it’s disingenuous to suggest otherwise. This is one of the reasons I suspect that mental ill health and suicide in the fire service, and wider uniforms, are under reported. That doesn’t mean that we shouldn’t encourage our men to seek support and disclose to their services but the last thing they need is to be surprised with a sudden change in professional circumstances (sometimes known as “punishment postings”) when their work lives are often protective factors to their good mental health i.e. it offers them stability when other aspects of their lives feel unstable. 

If, for example, a firefighter reports mental ill health difficulties, such disclosures of this could lead a watch manager or senior leader to change his role “in his best interests.” These decisions, often told to an individual instead of actively discussed with them, can lead to feelings of embitterment and even to a potential identity crisis (risk factor as above) i.e. “if I can’t do X role, I can’t be in the fire service and if I can’t be in the fire service, I don’t have anything or anyone” and within hours, you risk his life to suicide. The minute you threaten a man’s role and/or service in Blue Lights, you threaten his life.

Another important obstacle to help-seeking is something I call “comparative suffering” to which I mean that many men will attempt to downplay their own suffering and need to seek support because they feel their situation “isn’t that bad” in comparison to a colleague/peer. This comparison can also contribute to suicide contagion and clusters, as a man can see the first suicide as “permission” to end his own life i.e. “if he couldn’t keep going, how can I? His situation was worse than mine.”

We must also recognise that a lot of issues that impact men’s mental health are emotional. It’s struggling with professional imposter syndrome (despite being a leader) or not feeling good or “worthy” enough personally. It’s a stale partnership at home, with subsequent loss of intimacy. It’s worrying about his physical health. None of these are considered “mental health” issues but can lead to severe mental ill health if not discussed and supported. One of the reasons why peer support is so vital here is because a lot of men don’t feel that these emotional issues are severe enough to warrant formal support so don’t ask for any, even if they could benefit from it (dependent on what support is offered).

Sometimes even the thought of having to wait a considerable amount of time before they are able to receive the support they’re looking to seek, or even the uncertainty of what such support could look/feel like is enough to put men off from engaging. Add this to the fact that it’s estimated some 35% of men spend two years suffering mental ill health or never disclose to their friends and family, it’s vital that quick and beneficial support is available when they do or we risk them not engaging. We’ll discuss how peer support is necessary and complimentary to formal support in the final piece of this series. 

How can mental ill health present?

How long have you got for me to explain this? And yes, I’m writing a book on the topic of men’s mental health in uniformed services. Truthfully, it depends on the man but what we’re looking for are changes, however subtle. 

We’ve got to stop accepting (and perpetuating) this blanket narrative that mental ill health and illness can be obviously seen and therefore supported. Yes, some men find that when they’re mentally unwell they’ll “cry at anything,” for example, and sometimes in front of others (though, in my experience they’ll usually take themselves somewhere private to do so) but over the years I’ve found that a lot more men feel angry or nothing at all. They recognise that they’re mentally unwell or that “something is wrong” but “feel numb” or don’t even understand how they’re feeling, and therefore continue to smile and be sociable all the while having moments where they consider ending their lives.

Similarly, and a presentation which is rarely acknowledged, is that a man will often withdraw. He’ll start cancelling arranged plans or be more difficult to get hold of on the phone/messages, claiming he has other plans or his phone isn’t working etc. The flip side to this is that some of the most mentally unwell men will appear the happiest or be the most professionally successful because work can be a distraction with demonstrable rewards. When men use work as a distraction to other stressors affecting him, it is even more important we keep their work life stable and maintain its protective nature.

I hear a lot that “men don’t talk” (about their feelings) and whilst I absolutely agree that men, on the whole, are more reluctant or feel they don’t have a safe space to do so, I also know that men can and do talk, under the right circumstances and to the right people because I spend all my time listening to them. Men talk constantly, in their own ways, and it’s incumbent on those of us around them to get better at listening, something I refer to as “supportive disclosure” and we’ll talk about this in the final part. 

Conversely, sometimes there are no signs at all. For some men, their sense and fear of stigma and shame is so strong that one day they’re with us and the next they’re not and whilst I do believe we can (and should) all do more to look out for each other, it’s also important to gently remind us that we can’t save everyone.

I appreciate that all of the above might seem overwhelming to get to grips with, either because you’re struggling yourself or because you didn’t realise how complex men’s mental health actually is but in the final part we’ll be looking at how best we can support ourselves and our colleagues, as well as acknowledging some of the benefits and pitfalls to available support.

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