Ann Marie Farina, A.A.S, B.A.c The Code Green Campaign

1. Calling a Code Alert on our Mental Health:Dealing with Suicide, Depression, and Stress in First Responders Ann Marie Farina, A.A.S, B.A.c The Code Green Campaign

2. The Code Green Campaign • Storytelling project • Suicide tracking • Resource database • Education/Outreach • And more! Introduction

3. Today’s Class • Stress & Trauma • Recognizing someone in crisis • Talking to someone in crisis • Resiliency

4. Stress & Trauma

5. Stress in First Responders • Sources • Critical incident stress • Chronic workplace stress • Home life stress • Family • Finances Courtesy Postsecret

6. Critical Incident Stress • Critical Stress • 86% experienced what they defined as “critical stress” 1 • PTSD • Full PTSD 15%-25% 2 • Partial PTSD 25%-35% 2 • Acute Stress Disorder • No data

7. Chronic Workplace Stress • Feeling unrecognized • Feeling undervalued/unappreciated • Interpersonal conflicts

8. Personal Life Stress • Interpersonal stress • Relationships • Friendships • Parenting • Financial stress • Legal issues

9. Risks for PTSD • First responder specific criteria • Routine work environment stress • Self-blame coping/guilt • Lack of support network • Wishful thinking • Peritrauma distress • Peritrauma disassociation

10. Risks for PTSD • General criteria • Multiple traumatic events over time. • Proximity to the traumatic event. • Feeling helpless or ineffective. • Not processing memories and emotions caused by a traumatic event. • Use of drugs or alcohol as a coping mechanism. • Personal stress, or stress at home (marriage, kids, money).

11. How many of those stressors can you control?

12. Normal vs Acute vs Chronic • Some symptoms are normal after a stressful event no matter who you are. Most people recover without issue. • Severe, immediate, symptoms that resolve after a few weeks are called Acute Stress Disorder (ASD). • Symptoms that develop after weeks, months, or even years later are PTSD.

13. Resiliency

14. What is resilience? “Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors. It means "bouncing back" from difficult experiences.” Too long, didn’t read: Resilience is being rubber instead of glue.

15. Resilience Factors • Having caring and supportive relationships. • The ability to make realistic plans and carry them out. • A positive view of yourself. • Confidence in your strengths and abilities. • Skills in communicating and problem solving. • The ability to manage strong feelings and impulses.

16. Building Resilience • Make connections. • Avoid seeing crises as insurmountable problems. • Accept that change is part of living. • Develop goals and move towards them. • Take decisive actions to solve problems.

17. Building Resilience • Look for opportunities for self-discovery. • Nurture a positive self-view. • Keep things in perspective. • Maintain a hopeful outlook. • Take care of yourself.

18. Mindfulness • Actively engage vs autopilot • How are you really feeling? • Are you paying attention to all your feelings and sensations? • Recognizing why A causes B and vice versa. • Recognizing the why

19. Are Stress/Trauma Always Bad? NO

20. Post-Traumatic Growth • People who experience trauma can often experience positive growth after. • Increased empathy • Expanded worldview • Change in values • Change in spirituality • Change in relationships

21. Yes, we know exactly how cheesy that all sounds.

22. Suicide

23. Joiner’s Interpersonal Theory

24. Identifying Someone in Crisis • The following are known risk factors for suicide in firefighters: • Expressing feelings of hopelessness and helplessness* • Feeling as if they are a burden • Previous suicide attempts • Increases in alcohol or drug use* • Changes in sleeping pattern • Social withdrawal or isolation* • Anxious or agitated behavior • PTSD and/or depression

25. Identifying Someone in Crisis • Sudden changes in mood, especially anger or being withdrawn.* • Increased stress due to things like finances or family. • Being late or missing work. • Increased use of alcohol or drugs.* Citations: American Psychological Association

26. Identifying Someone in Crisis • Sudden interest or disinterest in religion. • Making end of life plans. • Giving away belongings. • Disinterest in planning for the future. Citations: American Psychological Association

28. Helping Others

29. What you can do • Don’t assume someone else sees what you see. You may be the only person who realizes something is wrong. • Talk to them, ask questions, and find out what is going on. • Listen to what they are going through. • Help ensure their safety. • Assist them in getting help.

30. Talk • Start simple. • “What’s wrong?” • Be direct; asking about suicide won’t put the idea in their head. • “Are you thinking about killing yourself?” • Use open-ended questions. • “How are you feeling?” vs “Are you feeling angry?”.

31. Talk • It is normal to feel anxious or uncomfortable. • Have a plan and look up resources ahead of time. • Do it in a private, non-confrontational manner. • Avoid “some of us” or “the guys” are worried. • Less personal • May make them feel ganged up on. • Do not make no the “right” answer.

32. Listen • Paraphrase & repeat their statements to show understanding. • “You’re angry Linda left you, how else are you feeling?” • In order to help, you have to understand the problem(s). • Active listening is your best tool. • Let them tell their story without judgement or interruption. • Communicate that suicide is a bad idea without platitudes. • If you don’t know what to say, say that, but let them know you are still listening.

33. Platitudes • “There is light at the end of the tunnel.” • “It is always darkest before the dawn.” • “Have faith, and God will sort it out.” • “You’ll get over it.” • “It could be worse.” • “Don’t dwell on it, and you’ll be fine.”

34. Safety • Persuade them to get safe. • If they are driving, have them pull over and meet them. • This may mean removing alcohol or firearms from their presence. • They have to allow it. An “intervention” can make them feel out of control. • Have someone stay with them

35. Help • Persuade them to get help. • “Will you go with me to get help?” • “Will you let me get you some help?” • “Will you promise me you won’t kill yourself until we’ve found help?” • Get permission to get others involved. • “Who else can help?” • Friends, family, co-workers, clergy, medical professionals.

36. Conclusions • Don’t contribute to the stigma! • Accept what you can’t change. • Build resiliency and develop mindfulness. • If you see something, say something.

37. Resources www.codegreencampaign.org/resources SafeCallNow – 1-206-459-3020 National Suicide Prevention Lifeline – 1-800-273-TALK Lifeline Crisis Chat – www.crisischat.org / 741741