Back to the Nov-Dec 2021 issue

South Metro Fire Department Makes Mental Health a Priority

By Deborah Lynn Blumberg

In the summer of 2019, two firefighters with the South Metro Fire Department walked into Chief Mark Juelfs’ office and told their boss they had been suicidal. One had even come up with a specific plan on how and where to end his own life.

City of excellence awardThey wanted resources to get help, and Juelfs did everything he could. One firefighter ended up at an inpatient center in Maryland, where he got treatment for post-traumatic stress disorder (PTSD). The incident stayed with Juelfs. It bothered him that in his 25 years of training, never once had he been specifically taught how to help firefighters in distress.

“It got me thinking about what we do for our firefighters in the mental health realm,” he says. One suicidal firefighter told Juelfs one reason he hesitated to come forward was that he was worried he’d be overlooked for promotion if he admitted he was struggling with his mental health. That concerned Juelfs. Something had to change.

Several months passed and work and life got busy. Then, in November 2019 a police officer the fire department worked closely with died by suicide. Firefighters were devastated, and Juelfs wanted a professional to speak to his team about the death.

He called Dr. Margaret Gavian, medical director for the Minnesota Fire Initiative. Gavian led a three-day workshop for the South Metro Fire Department, which serves the cities of both West St. Paul and South St. Paul, providing fire and emergency medical services to over 40,000 citizens and 11 square miles of coverage area. Gavian spoke about signs of suicide and where to turn to for help.

A South Metro fire truck.
Photo by Eric Haugen

“During that time, I told her, we really need something in place that’s preventative instead of always reacting when something happens,” Juelfs says.

Gavian had developed a program that would do just that, and she and Juelfs worked together to bring the program to South Metro. West St. Paul and South St. Paul won a League of Minnesota Cities 2021 City of Excellence Award for making the mental health of firefighters a priority and implementing this program.

Suffering in silence

When Juelfs contacted Gavian, she was putting the finishing touches on the PAR360 Mental Health Initiative — a program to help firefighters manage their mental health issues and keep them and their families healthy and resilient. She developed it after years of working as a therapist with firefighters and recognizing the critical need for more support.

First responders attempt suicide at a rate six to 10 times higher than the general population, according to research, while more firefighters die by suicide than in the line of duty. Half of firefighters think about killing themselves.

Meanwhile, firefighters have twice the rate of alcohol problems than the general population, four times the rate of PTSD, and eight times the rate of depression. Adding to the issue is that the majority of firefighters are unlikely to seek help — 92% think that seeking help for mental health issues is a problem.

“Firefighters are suffering in silence,” Gavian says. “They don’t like to talk about what’s going on. We have a staggering problem and no comprehensive solution.”

South Metro Fire Chief Mark Juelf says the department’s new mental health program is starting to remove the stigma of firefighters getting help. (Photo by Eric Haugen)

Taking a major toll are the high number of medical calls firefighters respond to. “They’re in there cleaning up body parts after a car wreck,” Gavian says. “These are gory, extremely stressful roles. Their job is to save people and often they can’t. It’s one of the most stressful jobs on the planet.”

Historically, firefighters have not been trained to handle the emotional aspects of their job, the tragedies they’re exposed to every day. “And they are paying the ultimate price,” Gavian says. “They are dying as a result.”

Retired South Metro firefighter Tom Brooks is one of the two firefighters who found themselves in Juelfs’ office in 2019. Brooks’ breaking point came after a 15-year-old who attempted suicide died in his ambulance on the way to the hospital.

Brooks struggled with nightmares and anxiety while at the department. He’s been in treatment since and has improved. But he understands well the challenges firefighters continue to face.

“There have been generations of ‘deal with it and go on to the next call,’” says Brooks, who was a firefighter for 20 years. “When stuff piles up over the years, some of us don’t do so well with it. You think you’re doing good, and then all of a sudden, one day all hell breaks loose. Any program to help with mental health is huge.”

Leaders give full support

Over the last 10 years, the South Metro Fire Department has seen its call volume rise by 28%. Last year it responded to 6,760 calls, 5,021 for emergency medical services.

After the police officer’s suicide and with calls increasing, Juelfs committed to instituting the PAR360 Program at the department. He easily got the support of the South Metro Fire Board.

“Our firefighters witness things that most people only hear stories about or see on TV. If we can find a way to help them normalize talking about how those things affect them, they’re not going to feel alone.” —Wendy Berry, West St. Paul Council Member, South Metro Fire Board President. (Photo courtesy City of West St. Paul)

“Approving it was a no-brainer. It’s the right thing to do,” says Fire Board President Wendy Berry, a West St. Paul City Council member. “Our firefighters witness things that most people only hear stories about or see on TV. If we can find a way to help them normalize talking about how those things affect them, they’re not going to feel alone. We can help them validate their feelings and understand other people feel the same way.”

South St. Paul Mayor Jimmy Francis agrees. “I think the best decision that we made was saying yes to our chief, saying yes to the idea that he saw a need, and we could solve it by just saying yes,” says Francis, who is also a Fire Board member. “And what I’m really excited about is that we have it in place and so now every new firefighter … is going to experience this program.”

A comprehensive program

The program kicked off in June 2020, and South Metro became the first fire department to implement it. The yearly subscription provides consultation, training, and emergency response for fire department leaders and firefighters and their families.

For chiefs, the PAR360 initiative includes an action plan on how to deal with mental health issues, monthly conference calls with Gavian, as well as specialized support for flagging “at-risk” team members before it’s too late.

Firefighters benefit from an anonymous, confidential eight-week online resilience training (with modules including handling stress and relationships), access to a confidential Facebook page to answer questions, a listing of vetted mental health providers familiar with the challenges facing first responders, and a yearly mental health check-in, also called a “resilience pre-plan meeting.”

“The resiliency meeting gives you the opportunity to talk to a professional and get feedback on what’s going on with your life, taking a more global look at your life, not just concentrating solely on the fire service,” Juelfs says. Family members also get to participate in periodic, all-day workshops on how to support healthy families and relationships.

Gavian said she felt compelled to create the program after getting frustrated with the lack of mental health resources for firefighters. “It struck me that someone has got to do something more to help firefighters, and in a larger, more systemic way,” she says. “Firefighters need culturally competent providers who understand their lifestyles and who are also trained in trauma.”

The PAR360 program costs $170 per firefighter, with additional services chiefs can add on as needed. South Metro pays about $12,000 per year for the program with the cost split equally between the two cities.

That’s compared to the financial costs of not having a mental health strategy in place, which can add up to thousands or even millions of dollars in lost productivity, treatment for substance abuse, and other expenses.

Removing stigma of getting help

This past July, a little over a year after the program started, Gavian updated the Fire Board on the program’s progress. Due to the program’s confidential nature, little concrete data is available, but 100% of firefighters had an initial meeting with Gavian.

“The meetings were very productive,” Juelfs says. “People opened up and they relayed their issues. I think we’re doing a great job of starting to remove the stigma of getting help, though as a community we still have a long way to go.”

“What I’m really excited about is that we have [a mental health program] in place and so now every new firefighter … is going to experience this program.” —Jimmy Francis, South St. Paul Mayor, South Metro Fire Board Member. (Photo by Eric Haugen)
Fire Board President Berry says she thinks the mental health program has “shown our community how important mental health services are to our first responders. I hope more fire departments see this and acknowledge the importance of taking just as much care of mental health as we do physical health.”
Brooks benefited from the initiative for several months before he retired, and he found the program’s training modules to be especially helpful. “The program was very good. For years, there’s just been too much of the ‘tough guy firefighter can take anything’ mentality,” he says.
The South Metro Fire Department’s program is normalizing speaking up, and it’s helping to get more firefighters the critical mental health services they need.
“I’m very proud of our fire chief for initiating this and continuing to advocate for its importance,” Berry says. “It could have easily been swept under the rug or shrugged off as ‘just part of the job’ when he had firefighters approach him about the toll the job had been taking on their mental health. Instead, he acknowledged the problem and spent time looking for ways to help.”
Deborah Lynn Blumberg is a freelance writer.