Episode 29: First Responder Mental Health with Dr. I. David Daniels, Part Two

00;00;09;01 – 00;00;48;26
Rick Hoaglund
The relationship between our work culture and our safety at work is intertwined. According to Dr. I, David Daniels, our work culture, along with the stress of the job, influence how we perform, especially for first responders. It can lead to injuries or worse. You’re listening to OnTopic with Empathia – in our first episode with Dr. Daniels, he explained that his own experience showed that first responder work culture can be at war with the mission designed to protect the workforce and help people. Today, Dr. Daniels will talk about what we can do to change our ways. Welcome back, Dr. Daniels!

00;00;49;03 – 00;00;51;11
Dr. I. David Daniels
Good to be here! Thanks for having me.

00;00;51;13 – 00;01;04;28
Rick Hoaglund
We had talked in the first episode a little bit about or- or quite at length about culture and things like that. Are there any other factors that go into mental health and safety for first responders?

00;01;05;01 – 00;06;16;24
Dr. I. David Daniels
So- so again, I approach all of these topics from a safety lens. All of them. All of them. So if you place a person in an environment where they are exposed to a hazard, they are vulnerable to that hazard as well, because I’m not vulnerable to every hazard I’m exposed to, but particularly from a psychosocial perspective of the hazard may be there, but it’s not a hazard to me because of whatever. It’s not an issue for me. But if I am vulnerable to that hazard, there’s also the potential for risk. And the more risk that’s potentially there, the greater likelihood of harm and ultimately that’s what we’re trying to avoid is harm. We again, we get exposed to things all the time, and sometimes we just make the adjustment and we keep on going. What we’re trying to avoid is the harm. And so in the public safety space, again, or in any other space, we should be looking at that space as a hazard free environment as much as possible. So there’s a thing called the hierarchy of controls. For physical hazards, that means you gotta identify the hazard first. And then once you identify the hazard, can you eliminate it? Can you substitute something that is less hazardous? Can you engineer the hazard away? Can you institute administrative controls or do you provide the person with PPE? Standard hierarchy of controls! But when we talk about psychosocial hazards, we’re talking about a different- a slightly different hierarchy. In that hierarchy, again, it’s very similar, but it’s slightly different again, based on the work done at Naoshima from a worker health kind of perspective from a mental health perspective or from a psychosocial has a perspective. When we talk about hazard mitigation or the- when we talk about the hierarchy of controls, we do want to eliminate the hazard first. So can you eliminate that psychosocial hazard? Can you eliminate the- the bullying that goes on in, or can you eliminate that? Of course you can! Can you substitute that psychosocial hazard for something that’s slightly less hazard? What you cannot do in in public safety is eliminate the responsibility to care for others. That’s the job. You can’t eliminate that! That is the job! If you don’t care about other human beings, you probably won’t do very well in the industry because that hazard will be way too much for you. That constant having to care about, you know, other people’s physical state and what’s going on with them, that’s- that’s a part of the job. So substitution is a second. The next, though, is to redesign the work, because I may be you know, I can’t eliminate it. I can’t substitute with something else, but I could certainly redesign it so the person has less exposure or less severe exposure to that psychosocial hazard. So, for example, instead of keeping a person at a really, really busy precinct, really busy ambulance location or really busy fire station, how about rotating people so their exposure is reduced when they are exposed is going to be severe because that’s what goes on there. But to leave people there day after week after month after year and then wonder why they start to suffer from PTSD? It’s because you didn’t redesign the work! The next control is education. Giving me more information about this. Maybe I may be able to adjust the way I deal with these kinds of things, and so it becomes less of a hazard to me. And then ultimately, it may just be about encouraging me to do things different because you can’t eliminate it, you can’t substitute it. I can’t redesign the work. I can’t give you more training about this. This just is what it is. Now, what are you going to do? But often we skip the other floor and we go directly to that one. It’s about the person. So you need to work harder. You need to do this. But I was a great person when you hired me. Otherwise you wouldn’t have hired me. Who puts up an ad in Ilndeed, or one of these websites and says, Hey, we’re just we’re looking for the worst people we can possibly find? The least skilled people, come on and work for us! Of course not! We all have the flowery kind of, you know, rhetoric about we’re looking for the best people with the highest skills. So why is it six months down the road, they’re all of a sudden not that person? I’m going to suggest it’s the environment you put the person in. It’s not the person. It is that environment. That’s also what we call fundamental attribution error. When we look at the person and we blame what’s going on with them, all on them. And we don’t take any account to the environment that the person is in.

00;06;16;26 – 00;06;55;25
Rick Hoaglund
So what do you do if you are a boss of someone? This person is, let’s just- let’s just keep with the same first responder piece. So you’re a boss or you’re a coworker of someone and you notice something’s going on. You know, you’re looking at this both from a safety aspect – excuse me, occupational safety as well as from a mental health perspective. You notice – yes! – what do you do? And how does that work – and there’s a lot of stereotypes in your stigma out there about why telling someone else or seeking help and what do you- what is your advice?

00;06;55;28 – 00;09;25;28
Dr. I. David Daniels
So I’m give you a lawyerly answer. It kind of depends. First of all, it depends on how much I know about what it is I’m seeing, because again, I’m not a mental health practitioner! Now I am a certified mental health first aid, but- so my training in mental health first aid gives me a slightly higher awareness than another person. My training as a violence prevention specialist gives me another perspective that some folks might have- might not have. My studying of, well, my my understanding of bullying and harassment, what that means in my study of psycho- I might be, I’m a little bit more attentive to that. But if it just seems like the person is acting differently than normal, the first question is to simply ask. You don’t need a a study or a dissertation or a algorithm to help people to help understand what’s going on with people. Why don’t you start with just asking, Hey, how are you doing? Starts right there! And again, sometimes I think we make this really super complicated or sometimes people will self-disclose. I’m not feeling good about this. That ought to be the indication that, okay, they’re not feeling good about this. And the the first assumption should not be there’s something wrong with them. The first assumption should be there’s something wrong with the environment that the person is in. So what’s going on around them? What- what what’s going on that causes them to feel that way? And again, depending on if I am in a position to be able to do something about that environment, I should get right about trying to change that environment because again, often we go to the person, well you need to get counseling. But no, perhaps we should address the environment. Perhaps we should start there! Now we might – we may also need to provide counseling or support for the person, but maybe we just need to stop doing that. So maybe when the person says that I am working with a coworker or a supervisor who is being abusive to me, maybe we should just stop that. Maybe we should- perhaps we should provide training when people come into the organization to help them understand what hazing is and what harassment is and what bullying is. And to be clear with them that we don’t engage. That is not our culture toengage in that here. And if you do, here are the consequences of doing that so we’d rather you not do that.

00;09;25;28 – 00;09;45;01
Rick Hoaglund
How do you go about encouraging people to come forward? Because there is a stigma in any small organization has to work together for a long time. And you guys, let’s face it, when it comes time to step up, I would imagine – and just because this is in any small group – there’s a stigma against reporting. There’s a-

00;09;45;01 – 00;12;38;28
Dr. I. David Daniels
It depends! It depends. There was never a stigma about reporting to people that you trust, which is a reason why people will talk to their coworkers. I trust my coworker. I’m going to talk to my coworker about how the boss is treating both of us. We’re going to have these conversations around the dinner table or out on the you know, out on the ramp at the fire station about how Captain So-and-so is yelling at everybody. We may not say it to Captain So-and-so, but we’re going to say it to the person that we trust because we feel it is safe to do so. It’s safe to do so. So the question is, how do we extend that feeling of safety so we can go to the captain and say, Captain, you made this statement, and here’s how I interpreted it. And I just- I just want to talk to you because that caused me to feel a certain way. Why should- why should that be that I can’t go to the person who is in a leadership – so here’s the gig. I don’t- I will never work for anybody ever again. I’ll work with you. And your role may be as in a leadership role. But I won’t for anybody. You don’t own me! Last I heard back in 1865, we kind of solved that thing. So you know, I’m not yours. I work with you. Work with you. And just because you are a director, CEO, whatever you are, I’m another human being just like you are. And I should receive the same modicum of respect for who I am as a human being, as you should. Now, again, your role might be different, the expectations might be different that make you better than me, though. So some of it is even breaking down some of those stereotypes around the hierarchy, and lot of that exists in quasi military organizations where this rank, structure- and rank structure has a value in some cases, But it doesn’t mean that the person at the higher rank is better as a human being. And- and even when we’re at an emergency, if you aren’t swift enough to understand that you need other people, then you’re creating an unsafe environment for everybody there. Just because I’m the battalion chief or the fire chief or whatever, I need to be open to people who see things and perceive things that I do not and I may never perceive because I’m not where they are. My job – and I’ve always felt this way – My job is, as a leader, is to create a safe environment so people can get things done, not to do them myself. Because if I could do it all myself, I don’t need them! But – But so you hire people, you recruit people, you bring people onto your team because they bring some skill or some talent that you don’t have. And that talent might be the fact that they have the time and you don’t. They may have the technical skill and you don’t. It doesn’t make you better or worse than them. It just makes you different. And those differences help us to accomplish what we said we wanted to accomplish.

00;12;39;01 – 00;13;04;20
Rick Hoaglund
What is your opinion when there is a shared experience? And I would imagine, especially in the fire- firefighting arena, you have a lot of shared experience, bad things, bad things that are shared, bringing in a counselor, bringing in someone to help with debriefings, does it work? And then what is the reaction from those that are participating? Because I imagine you’ve been through a few of those.

00;13;04;22 – 00;16;26;22
Dr. I. David Daniels
I’ve been though a few of those! Actually, before I- in my time in Seattle, I actually coordinated our critical incident stress debriefing program and we had a mental health practitioner who was in our clinical lead and, you know, I started off as a debriefer and eventually ended up coordinating the program. And as a matter of fact, I participated in a really- we had an incident on January 5th, 1995, where we lost four firefighters at the same incident. And in the aftermath of that event or that incident, we did a debriefing of 140 people at the same time. A nd it didn’t meet – there’s a guy by the name of there was the Mitchell model, I think it was Jeff Michell. I think that was his name – that came up with the classic critical incident stress debriefing model. And like, like most things, everything has its course and takes, it’s , you know, it things evolve. But we felt for that particular incident that having small groups wasn’t the most effective way to do it. So we did a big one with 140 people on the same room. And again, ultimately it is about what is it that we’re trying to achieve? How do people perceive it? It depends. Some people don’t want to do it at all. Some people think it’s great and there are a bunch of people in between. There is no singular solution, particularly to psychosocial hazard exposure. There’s not a single solution. It’s what’s going to work for that person. And I guess I didn’t know this at the time, but the mandatory nature of some of those programs actually is not good for some people. For some people, you know, doing that mandatory is probably the only way I’m going to do it. And I feel better when it’s over. But for some it doesn’t. So it’s a very complicated question. It’s a very complicated situation when we’re dealing with psychosocial hazards in general, everybody feels differently. And I might feel differently tomorrow about the very same thing. So to me, it’s most important to set the stage when we start, when people first come to, when they first meet me, that I’m really clear about, safety is not everything. Safety is the only thing. Because if you can’t keep people safe, you think about Maslow’s hierarchy just above eating, breathing, sleeping is safety and all these other conversations about, you know, self-actualization and, you know, self esteem and all that. They’re cute, but if the person isn’t safe, they never get there. So I can’t think of anything else. And so when I- when I joined a team, when I get involved in a you know, in particular, I want an ongoing kind of relationship with people. I want to find out how safe is this, first of all, for me? And then how safe can I help, you know, can I contribute to making it safe for other people? How do we make it safe for each other? And then we can contribute to our ideas and then we can pat each other on the back or, you know, or push back against each other. It has to be a safe environment. I’m not going to criticize something that’s going on if I feel like, you know, what I- my criticism is, is brought up and I’m going to get beat up for doing it, so then I won’t tell you, then ultimately, that makes it less safe.

00;16;26;25 – 00;16;42;09
Rick Hoaglund
So do you think safety is kind of a piece of the DNA that people that go into being first responders, Do you think it’s just a part of their nature like because I, I- while I’ve never been one, it just seems like it would have to be.

00;16;42;11 – 00;18;09;07
Dr. I. David Daniels
No, I don’t actually. No, no. I think at least the people that I’ve come across? Generally safety is the thing. It’s helping other people, that’s the thing. I mean that’s what people I do because I want to help. I want to help people. Now, ultimately, if you peel that back, I can’t you know, I’m helping me! I do this because I enjoy it. And and again, I, I do have this belief that sometimes the most selfish thing I could do is for someone else, because. But I do it because I enjoy it. I give to other people because I like it. I like how it feels when I see people smile. I like how it feels when I, you know, when I show up and somebody is not breathing and I do CPR, work with the paramedics. I like that feeling. I like that adrenaline rush from that person. So really, I’m doing it because I like it. And that sounds again, taboo for some. So people aren’t doing this often because of, you know, safety. They’re doing it because they want to do something that they think is for other people actually going for themselves. But however, however, I think, you know, it’s important for folks to realize the only way to even do that for this for yourself is you have to have a safe environment to be able to do it. Otherwise, it won’t be fun. It won’t be, it won’t be enjoyable if the environment is not safe and you ultimately won’t be able to do it very long.

00;18;09;10 – 00;18;46;05
Rick Hoaglund
And you were saying earlier you were talking about PPE, personal protective equipment, and the fact that there are people that will jump in and do things without using it. It’s not a good idea. But I’m wondering what do you do when you come across someone that is doing things? I’m not going to call it carelessly because it may be for all the right reasons. It’s just not done in the right way, like not using PPE, not following whatever protocol you have for safety. What do you do if you’re the boss or what do you change culturally? If it’s a whole group of people, how do you address that?

00;18;46;08 – 00;21;02;23
Dr. I. David Daniels
So- so the first thing is, as a safety professional, it’s not my job to make other people be safe. As a safety professional, it’s not. It is to provide information. It’s a consulting role to provide information that people need so they can make a decision about whether or not they’re going to be safe. I’m going to! If you ride in the vehicle that I’m in, seatbelts are not optional because it’s my car. Now, if we talk about if I’m in a leadership role and these folks are in my circle of influence, then there are some things that are not optional. It is not optional. So being safe and treating each other with dignity and respect are not optional. How you go about it is optional, but the fact that it’s a priority is not optional because that’s what I require inside my circle of influence. Because that’s what- again, that’s what works for me. I also believe that that will help us accomplish the goals that we’re trying to accomplish. So if you don’t want that type of perspective in leadership, then you probably shouldn’t hire- and I actually told some folks that! I was going up for a promotion and I told them, I said, if you want things to stay the same, you probably shouldn’t promote me. And they didn’t! They didn’t. Eventually they kind of came around and things changed a little bit and they decided that they wanted to, but I think we’re not honest about that type stuff upfront and that’s how you address it! So if- if I’m clear upfront that this is a safety environment, this is what we do, safety is a priority. You might not want to be on my team if you’re not because you know what’s what- you, you probably start to get the fact that I’m one of those people who’s was going to remind you about that over and over until you do it. And who might, you know, there may be some consequences and they may not be consequences you want. So if you want to be kind of lackadaisical in that area, you might want to find another team to be on. Again, I’m not saying you’re a bad person. I’m saying that in this environment, this is how we do it, because I am in the role of leadership. I am in the role that I have to be accountable. And again, my job as a leader is to create a safe environment. And the way that I do it is this way. If that doesn’t work, let’s see if we can come up with some other ways. But if it doesn’t result in things being safe, well then you’re going to have to change.

00;21;02;25 – 00;21;18;11
Rick Hoaglund
So as a leader, you’re concerned with things that are on the job, things that are working there. But you’re also, you have to admit, you’re thinking about if this person gets hurt, injured, whatever, at work, that’s going to affect the family as well. Like people at home!

00;21;18;14 – 00;23;12;14
Dr. I. David Daniels
Yes! Yes. But- but again, that’s a choice that they can make. Really. I’m really very open about that. You do have in a free society, you have the right to get injured or killed if you want to. You do! You don’t have the right to take me along with you. So that again – so it kind of depends on the relationship. And so I you know, the question is, when you ask people from a safety perspective, why do you do things safe? And so tell me the when I ask people this question before, tell me them- that, that the people, the two, two people who are most important as it relates to safety and they’ll say, you know, my you know, my spouse and my children, I says, Well, what about you? You can’t take care of your spouse, your children, your family, all these people, if you get killed, then somebody else will be taken care of because it won’t be you! To try it, you know, try to appeal to their enlightened, their own self-interest. So, again, you don’t have to worry. I’m not going to follow you home to see if you’re going to be wearing a pair of safety glasses when you’re cutting your grass. I’m not going to do that. But if you lose your eye, you won’t be able to come back to work here because this job- we don’t have a job that can give you that accommodation if you can’t see, we just don’t have those. There may be something else but it probably won’t be this. So again, that’s a choice that you get to make. Are you willing to risk this job? The benefits, the pay, the environment, how nice it is here. Are you willing to risk that by going home and getting hurt at work? Are you? Because if you aren’t, that’s a risk management exercise on your part. And if that happens, I’ll certainly care about you as a person. But I can’t fix that! You have to do that on your own. It has to be important enough to you to take these safety conversations to your home. Because again, if you get hurt at work, you’re still- your work, you’re hurt. If you get hurt at home, you’re still hurt!

00;23;12;16 – 00;23;23;20
Rick Hoaglund
Are things changing. I mean, we’re having this conversation and, I don’t know, maybe you can answer this, but, you know, 25 years ago, would we have had this kind of conversation?

00;23;23;22 – 00;26;11;26
Dr. I. David Daniels
I don’t- I don’t think so. I do believe that particularly, and some will say that the pandemic changed everything. I am- again, I tend to be a little counterculture on a lot of things. I don’t think the pandemic changed anything, but it exposed virtually everything. Most of the things that- that- that it highlighted were already going on. We were- businesses were already struggling and the pandemic took them over the edge. Most of the people who died when they were exposed to the COVID 19, there were people who are already sick and it just took them over the edge. You see them. And so it just exposed things that are already there. As a matter of fact, I would argue that most disasters make us more of what we already are. So if we’re prepared, are we? It gives us an opportunity to practice our preparedness plans. If we’re not, we get a chance to suffer because we’re not. So yes, I do believe that things have changed a bit, that in particularly there’s a generational shift that’s gone on. Is that the- particularly my Gen Z’ers, I love Gen Z’ers, I really do. As a matter of fact, I think I was probably a Gen Z or just born too early because I’m with them. This idea that, look, I’m not going, how can you expect me to come and work for you for 30 years, for 25, forever, whatever. When you don’t guarantee me anything, you’re liable to send my job to another country tomorrow. But I’m supposed to be loyal to you. You expect me to come to work and and be yelled at, mistreated and disrespected? But I’m still supposed to do a good job. No, no. This is an exchange. And you will get as much out of me as you put into me. I’ll get as much out of you as I put into the organization. We both have a part to play. And if. If that’s not working, I will find some other environment. And that’s what they’re doing. People are looking at the workplace and not just the physical part of it. They also look at the psychological piece. There are fire departments, police departments, EMS organizations, health care organizations who are struggling to find people. You know why? Because you still have the same organization that you designed 110 years ago and you continue to do it the same way. People have changed. They don’t want to be yelled at and screamed at and put in situations where they know they’re going to get injured and killed and they’re smart enough to be able to figure it out. They can look you up. There are websites now that I can find out what’s going on in your organization. It’s very difficult to hide. Somebody’s got a videotape and recorded it, so it’s more difficult. So if you want me there, you’re going to have to create an environment that’s safe for me. And if not, I have other options because there are particularly those of us who have high skills. I have options.

00;26;11;29 – 00;26;20;25
Rick Hoaglund
So if you feel like you’re in an organization that’s behind the times and you want to change it, what’s your advice? What’s your advice to that person?

00;26;20;27 – 00;28;53;29
Dr. I. David Daniels
So my advice to that person is, first of all, know what you want out of that- out of that organization. What do you want to get out of it? You’re not going to get everything. There’s no perfect job. Come on, stop it. There’s no perfect job! There’s no perfect anything! So you’re not going to get everything. So what is it? What are your needs out of that exchange? You know, whether it be salary, benefits or environment or whatever it is, and generally the money can’t be the number one thing. But so- once you know what it is that you want, and then you have to find out whether or not that organization is willing to provide it for you, because they can’t- and some of that, as a matter of fact, most of that you should figure out before you do the application. There’s some things you can tell about these organizations when you apply. So I think you I think you should do as much or more background on them as they’re going to do on you, because some of these were- some of these toxic work relationships are only toxic because, well why did you go over there? Didn’t you know that they were going to do and say that and you’re not that’s not the kind of person you are that does that doesn’t make them bad people. Doesn’t make you a bad person either? But it’s just not the match. And why didn’t you check that out? Didn’t you know they’re going to have to work night shift? Didn’t you know? Didn’t you check that out? Didn’t you know what they pay? So again, once you understand what’s important to you and you understand the parts of that that you can get, then there has to be this ongoing dialog about how you receive it and what do I have to do to get it? What’s the exchange going to be? Sometimes things change! And with employers, I think what I think employers, I think it’s really sad when they said, we’re laying off 12,000 people. You hired those 12,000 people! What, did you didn’t you tell them that? So what would happen if you told them that we’re going to treat you really, really well, But in the next year, we’re not sure if you’re going to be working here. You think they would have applied? Some would have! Some would say cool. And then you get people who don’t have the expectation they’re going to be there. It’s being more upfront and candid about what this thing really is and continue to have this conversation about, these are the things that are that go on here, these are things we can control, these are things that we can’t, and these are how things are changing. And I think to the extent we can communicate that with each other to include, you know, maybe we want to make a change and that it’s not going to work for everybody here, how do we help those folks be successful doing something else to include helping them find another job or helping them find another solution? Because I don’t want you out on the street. It just might not work in this scenario.

00;28;54;01 – 00;29;12;08
Rick Hoaglund
As we wrap up, is there anything you’d like to tell our listeners? Anything that that deals with either first responder or just general safety, general mental health awareness, anything you’d- you’d like to put out there?

00;29;12;11 – 00;30;55;16
Dr. I. David Daniels
Psycho social hazards are real. They exist everywhere. Everyone is exposed to them all the time. And it is important that you be able to identify those psychosocial hazards, be able to assess how vulnerable you are, and determine what type of mitigation strategies you’re going to take based on the exposure. They get in everything, whether it be occupational safety, first responder communities, big business, small business, relationships with other people, it has to be psycho socially safe for you first. It has to work for you! You have to know that you’re in a space where you can be your best self, where you can contribute your gifts and talents. Because if that part doesn’t work, none of the other part is going to work. And you cannot, you cannot give to other people something that you don’t have yourself. You can’t- if you don’t have a skill, you can’t do CPR when you don’t know CPR, you can’t give drugs if you aren’t trained to do it, you can’t respond if you don’t know how to drive. So you have to have it first before you share it with other people. So again, make sure the environment is safe for you. Make sure you understand the goals and objectives that you’re trying to achieve and how they align with the group of people that you’re with. And then do everything you can to continue to create or- or to fortify the psychological safety environment that you’re in and the working with each other and the focusing on keeping it that way. Because to the extent we can do that, great things are possible.

00;30;55;18 – 00;31;00;09
Rick Hoaglund
I love it. Thank you very much for being here. I appreciate it. You’re always welcome back!

00;31;00;11 – 00;31;01;28
Dr. I. David Daniels
Thank you very much!

00;31;02;00 – 00;32;53;02
Rick Hoaglund
First responders, including police officers, firefighters, corrections officers, emergency medical technicians, health care workers and others face unique and significant psychological challenges in their line of work. The nature of their job exposes them to traumatic events, violence and high pressure situations on a regular basis. This can take a toll on their mental and physical health. Historically, there’s been a lack of adequate training and support for first responders in managing stress, depression and other mental health and safety issues. However, in recent years, there’s been a growing recognition of the importance of addressing mental health concerns within the first responder community. While progress has been made, there’s still much work to do to ensure that first responders receive the support and resources that they need to maintain their well-being in the face of the challenges that they encounter in their jobs. If you are a first responder who would like to speak to a therapist, please reach out. Use your employee or union benefits. And if that’s not a good choice for you, search the Internet for first responder specific clinical practices. If you are considering suicide, call or text 9-8-8 in the United States. If you’re not in the United States, there’s help available. Call your local suicide prevention hotline. If you’ve attempted to seriously hurt yourself, go to an emergency room. You’ve been listening to OnTopic with Empathia! For other episodes, please visit our website www.empathia.com. Follow us on social media @Empathia, and subscribe to OnTopic with Empathia to hear new episodes as soon as they go live. I’m Rick Hoaglund – thanks for listening to OnTopic with Empathia!