Supporting our men in the fire service
An approximate 16 minute read.
In part one of this series, we discussed the current state of mental ill health in the fire service (bit of a shit show on the data collection side), and in part two, some of the (many) risk factors for men and barriers to help-seeking. In today’s final part, we’re going to be discussing how best we can help our men, both for ourselves and our colleagues, as well as acknowledging some of the issues around support.
Whilst 77% of the fire service personnel agreed that their organisations have encouraged staff to talk openly about mental health and wellbeing only “30.4% of fire service personnel said they would seek support from their managers for a mental health problem,” (Mind) “60.4% of fire service staff and volunteers agreed that people feel more able to talk with managers” and 85.1% of managers agreed they felt more confident to support their personnel.
Mind’s 2015 and 2021 (pandemic) surveys were also predominantly responded to by managers/leaders and in the 2021 survey, “interviewees identified that for real change to happen, things need to change at a senior leadership level, and wellbeing support should be about the people and not the process.”
“You know, we get kind words, from the management and all that sort of stuff, but it’s pretty empty…there’s that feeling of…you’re just a number to them, you’re a replaceable bum on a seat…You know, and when you go and start talking about mental health and all that, you become a statistic, and they can sit and wave the flag and say ‘Yay, we supported this many people this year.’ But, it’s like, how many of them actually feel better? – Interview participant, Fire service personnel”
Mind Survey
“An environment that is not safe to disagree in is not an environment focused on growth – it’s an environment focused on control.” (Wendi Jade).
So, how do we help?
Firstly, we stop telling our men to be more resilient. Over the last five years being connected with uniformed services, I’ve become deeply concerned (and extremely frustrated) about the rhetoric of enforced personal resilience within much of the mental health training I’ve seen delivered. I’ve written about this, specifically in policing, many times and several Twitter threads about it; that resilience training is merely victim blaming for structural and systemic issues.
What you do when you dismissively tell people to “be more resilient” is place the responsibility and blame on an individual if they can’t be. This can lead to further feelings of failure by the man because he can’t “get his shit together” compared to others and we want to lessen his emotional and mental burden, not increase it. Not only that but many people fail to appreciate that resilience is often borne from adversity so, when you “congratulate” men (or anyone) for their resilience, remember that it often came at a price and we should be mindful of that.
There is some evidence to suggest that resilience training can work in Blue Light services but we have to recognise that, given austerity and the pandemic, in order for resilience training to be beneficial, you have to be in a resilient and psychologically safe organisation, which Blue Light services aren’t. There is, after all, significant reasons the FBU and its many members, recently went on (successful) strike.
Though it appears in direct contrast, we need our men to be vulnerable because when you validate his vulnerability correctly, you build his resilience; something known as the “vulnerability loop.” The key is learning how to actively listen and respond to vulnerability in a way that doesn’t infantilise, ridicule or dismiss our men. Do that and you create a trusting (psychologically safe) relationship/environment where sharing and validating vulnerability becomes passive and continuous with minimal effort, which I’ll discuss below.
Support & its pitfalls
When it came to support available, 96% of fire service respondents to Mind were aware of support on offer which included: TRiM (Trauma Risk Management), EAP (Employee Assistance Programmes), Occupational health, emails and signposting and mental health first aiders (MHFA).
EAPs often offer confidential counselling through phone or video support as well as other benefits such as general advice and discounts, details of which are usually found on your services Intranet. Whilst services don’t get informed of your engagement with them, many EAPs are contracted to private sector companies who many not be trauma-informed or understand specific issues relating to the fire service.
TRiM is formalised peer support i.e. its a process which gets triggered after you attend an incident that management/policy dictate is potentially “traumatic” and that you might need support for. This is great as it proactively acknowledges trauma but the limitations being that its focus is on operational trauma, not general life, despite “life stressors” and common mental illness disorders being more prevalent.
The top three sources of mental health and wellbeing advice were friends and family (52%), information provided through your employer (39%) and charities (26%), with personnel accessing Mind (75%) and The Firefighters Charity (57%) the most. If friends and family are the people our men turn to first, improving peer support is vital.
I see a lot of Blue Light services overly relying on Mental Health First Aid (MHFA) training and whilst, on paper, it looks beneficial, there is no evidence to suggest that MHFA training works. Not only is it more suited for stable working environments (corporate and non-trauma based) but the content of such courses discuss generic mental health and support/coping mechanisms which aren’t always applicable to trauma-based, under-funded and resourced uniformed services. Awareness is, of course, beneficial but I see little action borne from it.
The issue with our services passively relying on processes such as TRiM or organisations such as Mind, an EAP or even GPs to do the heavy lifting around support is that wellbeing becomes “someone else’s” job and some of those within these processes and organisations don’t know enough about how the fire service specifically works to offer wholly beneficial support. The last thing a man needs, especially in crisis, is to have to first educate a person on the specific processes, or even acronyms, of the fire service before he can receive the help he needs.
Mind survey findings revealed a preference (51%) for support that is tailored, not just to the emergency services as a whole, but also takes into account the individual differences between the services. Fire service personnel highlighted the importance of having facilitators of support/training around mental health that understand the culture within the fire service.
Tailored support is key because, as I’ve already stated, there is diversity in mental health and therefore a need for diversity in support offered. If we’re tailoring support toward the fire service, we must also acknowledge the need to tailor support for our men, and other groups, within it and this is something research is beginning to acknowledge. You can’t just start a generic mental health campaign, slap the word “men” at the front and think it’ll be beneficial.
Similarly, putting posters up on the toilet doors and reactively expecting men to engage is naïve when there is a wealth of evidence that demonstrates men are extremely reluctant to seek support for either their physical or mental health. Having the courage and skill to enter a burning building is not the same as having the courage and skill to seek help for emotional or psychological support. They are two entirely separate threats, except we only train our men to face one of them.
A long-standing issue I have around mental health support, in general, is that it is geared toward the “feminine” i.e. to easily discuss feelings, especially to others, and for many men, this doesn’t come naturally to them. Most men also don’t have the size and depth of social support networks that women do so, expecting them to seek help in the same way women do is naive to the reality of men’s specific risk factors and barriers to help-seeking. This is one of the many reasons why I always encourage people to “reach in” instead of expecting men to “reach out.”
Criticisms of informal peer support (my field of expertise) are nearly always around risk-mitigation and fears of legal liability should a man’s mental ill health worsen or he kills himself whilst receiving such support, which I understand (to a point) but let’s turn it around. Where are your fears of legal liability or risk-mitigating actions whilst one of our men is stuck on a waiting list or between therapy appointments? Because, as leaders and services, you’re just as potentially culpable, morally and legally in doing the bare minimum.
Peer support is often recommended when you’re going through therapy as having an outlet between sessions, especially EMDR where suicidal ideation is a known side effect, can bring up lots of past trauma and emotions etc. Also, if you have a good therapist, they will highlight that it isn’t ethical to discuss deeper or more longstanding trauma within a limited amount of sessions. And what are you going to do once he finishes his course of therapy? Just leave him to fend for himself under the misguided belief he’s been “cured” by a few sessions? I have been supporting some of my men for years. Case in point? It once took me over 17 hours of video calls spanning almost 25 weeks of working with a police officer to gain his trust enough for him to give me his personal mobile number.
How to help our men
There are many aspects but it starts with education. If we educate our people on the specific risk factors and barriers to help-seeking in our men, we can improve men’s self-awareness. This, in turn, gives them the ability to proactively identify when other men who may be struggling and the confidence to have those difficult conversations and all of the above, done well, improves both personal and team resilience. PWC recognised that to increase the potential for return on investment for wellbeing support in large organisations, this was dependent on good management and leadership at more local/team levels, which is why tailored education is key. Although my work with men is time and labour intensive on an individual level, my knowledge and skills can be replicated and I know it works because my men show me. Those who have worked with me who have gone on to better support their colleagues and men in distress in their community they’ve been called to.
As I said in part two, masculinity can be both a barrier to help-seeking but also protective to mental ill health. And what I mean by “protective” is that we typically encourage men to be independent, solution-focused, emotionally stoic etc. which can, for a lot of men, minimise the impact of trauma and/or mental ill health or enable them to seek help i.e. compartmentalise trauma or upsetting events.
A lot of men are solution-focused, meaning when they do “ABC”, wonder why they’re still struggling and greatly criticise themselves for a sense of perceived failure if the outcome isn’t what they expected. We need to get better at reminding our men that following advice and guidance isn’t a panacea to all our ills. We can do all the “self-care” and use all the coping mechanisms we have to “fix” our perceived issues but sometimes, we just need to allow ourselves to feel angry, sad, lost etc. and feeling such emotions isn’t a failure, however uncomfortable they may be to sit with.
I wrote in part two that I specialise in men’s mental and emotional health because a lot of what I support men with are based in how they feel, such as lack of confidence, even if their emotional health then impacts their psychological health. If, for example, a man doesn’t feel confident in his professional role, he’s highly unlikely to seek support from colleagues for fear of judgement or repercussions, and unlikely to tell his partner because he “doesn’t want to be a burden” so, where’s he going to go? Because it won’t be to Occ Health for counselling, I can tell you that. This is where and why peer support can be so beneficial – offering support in areas that are needed which might not the criteria to receive formal support.
Be proactive. I cannot overstate enough how important it is to “reach in” to men instead of reactively expecting them to self-present because we refuse to acknowledge how powerful shame (perceived or realised) is for them. Yes, of course, we can’t know a man is struggling until he tells us or confirms that he is but we have to consistently demonstrate that we can be trusted with his vulnerability and do some of the work with him. I will nearly always message my men first to “check in” and what that does is two fold: firstly, it clearly demonstrates that they’re never far from my mind and that I care, and that I’m not going anywhere, and secondly, when you consistently “reach in” you’ll often find that, at some point, the man will begin to trust you and your relationship (be it colleague/friend etc.) enough to contact you first, and tell you when he’s having a bad day. Like most things in life, if you invest and get the foundations right, everything else is just decoration.
Don’t just signpost support but do the referral or go with them to the GP. Something I come across a lot in uniformed and armed services is something I refer to as “defensive signposting,” the idea of hearing a man’s experience of mental ill health and immediately telling them to go somewhere else i.e. to Occ Health or an organisation outside of the service. Sadly all this often does, however unintentionally, is demonstrate to the man that you “don’t want to hear” what they have to say, thereby allowing him to feel rejected but also gives them something else “to do” and someone else to disclose to, at a time when we should be lessening his burden, not increasing it. If you want to signpost (and I encourage you to), research the details for him or ask him if he wants you to make the referral (if you’re able) or if he would like you to go to his GP appointment with him (for example). I have lost count the amount of referrals I’ve made and GPs I’ve called to get one of my men support, either because they didn’t know how to navigate processes and systems or they simply felt too overwhelmed (or ashamed) to do it themselves.
Supportive disclosure. This is more than just active listening but how to respond in a way that doesn’t make the man feel dismissed or judged. An example would be, if a man discloses he’s suicidal, don’t reply with “don’t do anything stupid” because, believe me, the last thing he wants or needs is to feel judged and ridiculed when he’s at his most vulnerable. It’s also about not using clichés to reply with such as “everything happens for a reason” or “you’re so strong” which mostly minimise, dismiss and shut down his emotional and psychological experience.
Lived experience leadership is very important to a lot of our men, by which I mean that someone publicly discloses their experience of mental ill health/illness, which allows other men to relate and potentially gives them the courage to disclose and seek help. One of the many reasons I’m able to connect with my men so well is because, whilst our trauma may be different, I know what it’s like to hit rock bottom after a life-changing traumatic event and come back from surviving suicide. I’m not saying that those without lived experience can’t be impactful or that those with lived experience will always have the ability to support others, but I am saying that lived experience is valuable and we should view it at the asset it has the potential to be.
Something I see a lot of in uniforms are wellbeing events or days where a person (or people) tell attendees to “eat better, drink less, exercise more and get more sleep” (wasting thousands on this common sense “advice”). All this ‘advice’ does is poorly assign coping strategies into binary “healthy” versus “unhealthy” thereby shaming men who are, for many reasons, using the above coping mechanisms to survive and apportions blame i.e. “It’s no wonder you’re struggling, you just need to get more sleep!” This is why, whilst I’ll always educate men on coping strategies, and encourage them to use them, I do so with the caveat that they work in an “under-funded and poorly resourced (and managed, at times) traumatised public sector organisation” and, as such, coping mechanisms will be minimally beneficial at times. If, for example, your marriage is breaking down and you’re in a team with bad leaders and management, there’s only so much mindfulness and a gym session will do for you. As I always tell people: “Before you diagnose yourself with depression, first make sure you are not, in fact, just surrounded by arseholes.”
One of the many reasons I’m able to change and save so many men’s lives is because I don’t bullshit them. I have relatable lived experience, use dark humour to discuss difficult topics and swear like a trucker. And whilst I can be very direct when offering advice (if they’ve asked for it) and pushing them forward, I call many of them “lovely” or “sweetheart,” if they need a hug, they get several and I repeatedly reassure them I’m here if and when they need me. As I’ve repeatedly said throughout this series; there is diversity in mental health, which requires diversity and variety in our wellbeing support.
Another thing I hear a lot of in uniformed services is “we don’t have time/resources” to support people around their wellbeing which, whilst understandable (to a point), merely highlights, even further, the need for peer support, because we can increase the numbers of people able to identify and support others. What, for example, are you going to do when he’s on the “twilight drive” (as I call it) – that exhausting drive between his end of shift and going home – where he’s trying to process his latest shift and/or life after a earlies but home life isn’t great either? I’m on call 24/7 for my men and though that option is rarely used, it does mean that my men call me when they’re having panic attacks or simply need to cry and feel heard. You won’t get that level of flexibility from formal support and that isn’t to denigrate formalised support but to highlight that peer support powerfully compliments it and can help “plug gaps.”
Conclusion
We love to talk about evidence-based practices within Blue Light services but we’re appearing to ignore the evidence that our men need specific support. Why? Because some leaders don’t want to acknowledge the problem or we worry about being labelled “sexist?” Given firefighters have recently been found to have a mortality rate 1.6 times higher than general population for some cancers, we wouldn’t consider it sexist to promote awareness and support around Prostate Cancer for men only. We can’t sign up to mental health concordats and promote parity of esteem (equal value between physical and mental health) but ignore the evidence because we don’t like the fact that it centres men.
We’re overly reliant on formulaic support completed by “other people” and processes and, in general, not only are we not doing enough to proactively support our men but, in some cases, directly causing their emotional and psychological ill health. Our support is also not tailored toward them and we must tackle this with a sense of urgency or we will continue to burn out our men and contribute to their suicides.
I haven’t written this series as an attack on the fire service (though some senior leaders and services appear to have taken it that way) but to encourage vital conversations and action. I am under no illusion that this series will create the necessary change but I didn’t write it for “pay checks and opportunities,” I wrote it because our men deserve better. I haven’t lost a man yet and though that day will eventually come, I know it won’t be because I did the bare minimum.
To end this series I’ll leave you with a line I often share with my men: I may not be able to fix the light at the end of your tunnel but I can sit in the darkness with you until it comes back on.
Below are links to some info and/or support services:
Firefighters Charity
Mind
Men’s Walk and Talk (set up by those within LFB)
Men’s Health Forum
CALM (online peer support for men)
Man v Fat (football for men with an aim to losing weight)
Sands United (football for men who have suffered child loss)
Andy’s Man Club (group peer support every Monday)
Lions Barber Collective (peer support from your barber)
ManKind Initiative (support for male victims of domestic abuse)
Gamblers Anonymous
