I’d rather listen to your troubles than your eulogy

How to talk to EMS providers about their mental health and identify suicidal tendencies


By Jay Fitch, PhD

The medic’s eulogy was moving. Patrick was a great guy. A rock-solid clinician. A loving father. A faithful husband. And, as the funeral service progressed, my mind could not be quieted as I kept thinking why? Why did Patrick commit suicide when he had so much to live for?

The pressures of modern life and the unique stresses our profession are taking a terrible toll on caregivers. According to data published by the U.S. Fire Administration, there are more public safety suicides than line of duty deaths each year. Suicide among first responders is a national tragedy, and it’s getting worse. As leaders, it’s essential that we learn to recognize symptoms and how to provide help.

It’s been said that listening is the most important act of EMS leadership. Listening to a colleague’s troubles is a whole lot better than listening to their eulogy. (Photo/Getty Images)
It’s been said that listening is the most important act of EMS leadership. Listening to a colleague’s troubles is a whole lot better than listening to their eulogy. (Photo/Getty Images)

Many first responders are reluctant to share their feelings or seek help because they believe that doing so will harm their career. They frequently express fear about how they will be perceived by others for seeking care or being seen as “weak” by peers.

Providing mental health first aid

How sad that we teach CPR throughout our communities in order to save civilians’ lives, but we fail to teach front line supervisors the psychological first aid skills needed to support our own caregivers. The most important first aid supervisors can provide is to pay attention and listen closely when interacting with troubled colleagues. There are many risk factors and warning signs for suicide, but the most important rule of thumb is to listen and follow your instincts. Essentially, as you talk with someone you are concerned about, if it doesn’t feel right, it isn’t right. Don’t try to rationalize or justify what you see or hear. If you are concerned, reach out and do something. Don’t wait. Act now or find someone who can.

If you are concerned about a colleague, try reaching out in a private setting, with words that express your concern. You need to know that asking direct questions can open a conversation and send a clear message that they can talk to you about the very difficult and painful thoughts and feelings they may be having. You might try something such as, “You seem really down lately. That has me concerned. I care about you, and this isn’t like you. Are you coping OK? Are you feeling depressed? Sometimes when people feel depressed, they may have suicidal thoughts or feelings. Are you having these?” The exact words you choose are less important than the implicit message you send. Reaching out and expressing care and concern is the key. People who are suicidal often feel alone and believe no one cares if they live or die. Your words can send a strong message of hope.

EMS leaders’ responsibility to caregivers

If the caregiver you engage signifies they have been having suicidal thoughts, then your responsibility is to help get them to a competent mental health professional who can complete a comprehensive suicide risk assessment and obtain the mental health care they need. It is not your role to play therapist or provide solutions. Instead, ask them about suicide, listen to what they say, and refer them to professional help. Never agree to keep suicidal thoughts or attempts a secret.

Getting the person to professional help is the key to saving a life. Most of the time, caregivers with suicidal thoughts are relieved that their supervisor has noticed and cares about them. Sometimes, all they need is permission and encouragement to go for help.

It’s been said that listening is the most important act of EMS leadership. Listening to a colleague’s troubles is a whole lot better than listening to their eulogy.

Read next: What’s your department’s suicide prevention plan?

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