062. Addressing Duty Bound Grief: Building Mental Resilience for First Responders [Part 2]

In this episode of the Keep the Promise podcast, part two of our series with Rachael Belcher, we cover the critical topic of mental health among first responders. With nearly three decades of experience in the fire service and 21 years as a paramedic, Rachael shares her personal journey of overcoming the emotional and physical toll of the profession. The discussion centers around her article, 'Grief on the Front Line: Managing Our Hidden Wounds,' which introduces the concept of 'duty bound grief,' a unique type of grief experienced by first responders. Rachael discusses the importance of building resilience, seeking help, and breaking the stigma around mental health. Key points include recognizing early warning signs of mental health issues, the inefficacy of forced interventions like CISM, and the need for supportive leadership. 

You will learn:

• strategies for self-care
• the significance of peer support
• and the steps both individuals and leadership can take to create a healthier work environment for first responders.

00:37 Rachael's Journey to Mental Health Advocacy

00:57 Understanding Duty Bound Grief

01:50 Therapy and Healing Process

05:29 Recognizing and Addressing Warning Signs

12:05 Duty Bound Grief Article Discussion

23:37 Leadership and Mental Health Support

32:27 Advice for Young Firefighters

36:51 Conclusion and Article Information

Transcript

TJ: Hey there, everybody. Welcome to part two of our series with Rachel Belcher. Today we're talking about one of the most important aspects of our profession, and that is mental health. If you haven't listened to part one, our guest is someone who has walked the walk, faced the challenges head on, and come out stronger on the other side.

With nearly three decades in the fire service and 21 years as a paramedic, Rachel Belcher knows firsthand the weight we carry as first responders. From the aftermath of Hurricane Katrina, to countless shifts on the streets, she's seen the physical and emotional toll of this work. But it wasn't until she took a step back and prioritized her own wellness, that she found her true calling.

Advocating for the mental health of first responders. Rachel's groundbreaking article, Grief on the Frontline, Managing Our Hidden Wounds, shines a light on what she calls duty bound grief. A form of grief unique to our profession. Today, we'll talk about what that means, why it matters, and how we can build resilience while breaking the stigma of asking for help.

Let's get into the episode.

Rachael: There's always going to be those sticky calls. That, you know, no matter, no matter how much healing journeys you go on are going to get, get to us. Um, but yeah, I, I felt more prepared and I was, I, I did not have a miraculous healing after 30 days.

I mean, it probably took me another year and a half after that to feel like, okay, all right, I got this. I, I feel good.

TJ: Interesting. So 30 days to get the tools. And then a lot of months after the fact for you to employ those tools,

Rachael: Yes.

TJ: it like an epiphany? You woke up one day, you're like, hallelujah, I'm healed. Or did you just notice that as the time went on, you're like, Oh, this would have fucked with me in the past.

Rachael: Yes. Yeah. I noticed that it was not an epiphany. It was not like a light bulb moment. And, and I mean, I was going to there at the beginning there, I was going to therapy once a week. Um, I found an incredible MDR therapist and that follow up portion, I got the tools at Harbor Grace, but that follow up portion is really what changed my life because I don't think no matter what 30 days is going to heal.

anything completely, but it at least equips you with what you need to know going forward. So that, that therapy after and all the tools that I got from that, that I could start to kind of put in place for myself in the following, you know, days, weeks, months, years, you know, a lot of those things I'm still using today.

And, and yeah, you know, something will happen and I'll say like, Okay, yeah, that, that, that, I would not be okay with this two years ago. I, I literally felt like I had brain damage.

TJ: Oh,

Rachael: I felt like I was broken, and I did not think that there was any way for me to be any different. I just thought that, that this is just what happens to us eventually.

TJ: Like a cracked piece of fine china that you can't put back together.

Rachael: Right, right. That it's just like, well, this is, this is how I am now. And no one wants to be around me. Yeah.

TJ: Is this around the time that he came up with your duty bound grief concept or was that percolating 

Rachael: yeah, this, that whole journey kind of led to this realization and, but we hear so much about PTSD, Post Traumatic Stress Disorder, and, you know, I talked a lot about it at therapy and I'm like, I, I, I have it and, you know, and she was like, okay, you know, maybe you do, but it's not like you have this and now you have it forever.

Fuck you, goodbye, like you're screwed. It's more like. You have an injury. You break your leg. Okay, have an injury and it hurts and it's going to affect your life, but you, you absolutely will heal from this and hopefully, you know, have hope. So, in thinking about the PTSD and how it's more of an injury, I was thinking about all of the things that are recognized. as things that are traumatizing to us. Like I've had a gun pointed at my head on the job. Um, we've all seen, you know, horrible visuals on calls and things. If you were to say, Hey, I saw this thing. They'd be like, Oh yeah, that's, that's probably traumatizing.

But even though I like unpacked all those things in therapy, I still felt that I had this lead blanket over me. Like, why have I done all this work? I have unpacked all of these traumatic calls that I, you know, I thought were these sticky ones, the nightmare calls, things that would come back to you, the things that would give, you know, give you anxiety. And I'm still feeling this lead blanket over me of just this heavy feeling, and I came to the realization that it is grief. It is the grief of, you know, years and years of many different things that we experience. for having me. And it doesn't have to be our own personal grief. You know, the only death training we get is, uh, look, break it to me gently.

TJ: Yeah.

Rachael: Don't say they passed. Say they're dead. And it's like, oh God, come on. But this has more to do with how we experience other people's. We suck it in like a sponge. And it's not acknowledged. It's not talked about. It's not discussed. And once I made that realization, And for myself, I started to do some research and like, is this something that's talked about?

Is this something that's taught? And you know, in a few pieces of literature, I saw the word grief or the mention of grief, but no real further exploration of how or why it affects us and how it can, you know, I say that, you know, without the acknowledgement, it could be like a pretty large branch on the PTSD tree, but it does not have to be.

Right. Right.

TJ: And I think we're all guilty of, like you said, sucking it up like a sponge. We see those bad things that I go back to those suicide calls. The vibes are just always the energy. It's cold and desperate, you just feel it in the air that somebody was so desperate and hopeless that the only way out was to end it all right then and there.

And I think unless we're absolute sociopaths, we are going to empathize and we are going to take a little bit of that and you mentioned in your article, the suitcase. We're just stuffing this into that suitcase and it gets heavier with every call that's traumatic with everything that we do unless we start unpacking it.

Rachael: Right.

TJ: Is there some sort of early warning that like, Hey, my suitcase is getting heavy. Is there something that we can share to, for people to pay attention to? Or is that going to be that individual journey that we all have to just sort of When the wheels fall off the suitcase, that's when each one of us goes, Oh fuck, I gotta do something now.

Rachael: So, retrospectively, there, I, I had warning signs, and I knew I had warning signs, but I didn't understand that it was my suitcase getting full. I just thought that this was the normal progression of the career. And I think highlighting the fact that our suitcase, like, there are some people who just aren't affected by this. And cheers to them, like, they're, you know, there are just some people lucky enough to have that resiliency to let things roll off their back. Um, and then, and then there are other people who, you know, I like to say, and I think we've talked about this before, and I'll continue with the suitcase analogy where we all come into this job with a suitcase. Some of them are big giant trunks and just some of them are little tiny carry ons. And some of our suitcases are already pretty full from all the shit we've already experienced in our life up until that point. And some of us, you know, some of them are empty. And that speaks to the what, where, when, and how, what is going to affect us has to do with, you know, the suitcase that we came in with. You know, you could have a rookie who has one traumatizing call and that could, that could be their suitcase full. Um, if they're not aware of the process of looking at their childhood trauma and looking at how they feel about their emotions and how they express themselves and yada, yada, all that other stuff, my, my warning signs, I think it's highlighting that this is not feeling like shit is not the normal progression of the job. Feeling like shit is a symptom of a full suitcase. That's the analogy. We'll continue with that. And the sooner you recognize it. The sooner you can begin to address it and the sooner you can begin to unpack it and start to learn the tools to, to keep it from getting to that overflowing point. So I would say withdrawing, drinking too much, um, substance use in this profession is quite high.

Um, you know, it comes along with having a lot of really big hard feelings and that is a way that some of us choose to not even deal with, I would say cope with, coping mechanisms. Um, anger, being, uh, being, having a hair trigger when it comes to getting upset or getting angry. I mean, those are just some things that come to the top of my mind about, uh, maybe some early warning signs that you can look at in yourself.

TJ: I also like, and I'm looking at your article, we're talking about compassion fatigue. But before we get to the compassion fatigue, tell us a little bit more about the article. Because by the time this goes live, the article is going to be published by like a week or so.

Rachael: The article that I wrote is called, Grief on the Frontline. Managing Our Unseen Wounds, and it discusses specifically the, uh, the concept of duty bound grief and kind of how it affects us. It introduces the topic, tells us a little about what it is, and what it is is a, a very unique form of grief that we experience. And, and it's unique to us because of the repeated exposures. To trauma, not being able to kind of like feel our emotions in the moment because we need to carry out our duty and also that this type of grief just isn't acknowledged.

TJ: So it's sort of that wake up call. That call to action for us to acknowledge it, to say, Hey. This is just one more of those things that we stuff down, that we pretend it's not there. You know, that we, I guess we kind of acknowledge it 'cause people come to you and they say, Hey man, you good? And that's the extent of it.

And I'm like, no man. I just like this dude canoed his head open and I got to witness it all along with the note that he left for his mom. That shit was wild. Yeah, sure. 

I'm good. , right? Let's go get a pizza on the way home. And then joke about it and inside we're like, what the hell was that? That just happened?

Rachael: Yeah, and I think what's interesting is, um, after I came home from my stay there, the one thing that was absolutely different for me was going on calls like that and, and feeling guilty that like the younger members had to see that stuff. Like I'm already, you know, I'm already broken. Let me do this, um, to try to. You know, keep them from, uh, which, you know, you just can't do. There's only a couple of us. And sometimes we need, we need all of us, obviously. Hopefully sometimes there are times where we can kind of shield people that don't need to witness that. But, um, I have like guilt of, uh, And looking at the faces of the young people and just seeing myself is like a 24 year old who was like, this job is awesome and just, uh, I don't know, there's something about just seeing the look on the face of, uh, a new, you know, a new person witnessing something like that for the first, you know, first time and it's just like, uh, heartbreaking.

TJ: For those young people, what can they do when they experience this? What sort of skills or what sort of actions can they take to mitigate? Because we're going to be exposed to that anyway. Like it's, it's, that's the job. But what sort of things can they do to minimize that impact?

Rachael: So one of my favorite quotes is what is predictable is preventable. And in that same breath, I will say that accumulation is the first step toward any disease process. So if you look at all the statistics, it is incredibly predictable that the People in this line of work are going to suffer mental health injuries way more often than the general public. Our suicide rates are much higher than the general public. Our, um, substance abuse is much higher than the general public. Our, I mean, lots of different symptoms of this, uh, traumatization, um, combined with lack of tools on what to do. The best and first thing that I would recommend is talking about it.

And as you know, sitting around the kitchen table. Is like, sometimes the very best therapy that anybody can ask for. of course it depends on your shift and if, if they actually are being honest about how they're feeling and if it's an environment where you can say like, Man, that was fucked up. Like, I did not like that.

Instead of like, yeah, it's all good, whatever. And you know, everybody has their own way of dealing with it. I'm not putting down the, yeah, it's all good, whatever, if, if that's true. But typically in my experience, if someone says, yeah, it's all good, whatever, They actually mean like either A, I don't feel comfortable talking about it with you or I don't feel comfortable expressing my emotions to begin with, so let's just move on to the next thing and we're going to pretend like it never happened. So I think talking about it is the first thing, acknowledging it, talking about it, allowing yourself to feel how you feel and kind of just seeing how it goes. If it's, if it's sticking with you after some time or if it's, you know, changing or affecting your life or your work or you're doing things that are unhealthy to cope with the things that are coming up about it, then it might be time to do something a little bit more in depth, but talking about it is the most important aspect of this, in my opinion.

TJ: So it's looking at those peers, looking at the people who have been there. Is that what I'm getting out of this?

Rachael: Yes, so yes, there's, you have your peer support team, like your official peer support team, and you also have your, your peers, your buddies, your co workers, your, you know,

TJ: Right.

Rachael: and, and each are equally important. And even if you don't have somebody on your shift to talk to, you know, Ideally, you have a, you have a close shift where at least someone on your shift, you feel comfortable talking. Um, and if not, then your support team, and if not, hopefully you have someone in your close, you know, non fire department friend group or your family that you can talk to, talking to someone that you trust about what happened or how you feel, even if you don't want to give them details. Because I know sometimes divulging details, the non fire department.

Fire department people feels like you're just traumatizing

TJ: Oh my God. It's so bad for them.

Rachael: Yeah. Yeah. So, I mean, You'll know the right place in the right time. I mean, gosh, I've heard so many horror stories of people who've gone to a therapist for the first time. And you know, they're like, this is what I'm here to talk about.

And the therapist is like, Oh, I can't, I can't do this. And it's like, okay, well that went well.

TJ: Oh, that's awful. I shouldn't be laughing about that.

Rachael: It happens though. And it, you know, that, that is why it's so important that we have the resources and the information information. And like a, a list of vetted therapists who know us, you know, maybe not, don't know us personally, but who know about our community, who know, like, We're gonna crack a fuckin dark, dank joke about something completely inappropriate.

We're going to laugh when we should be probably crying. And we're gonna tell you some shit that you probably wish that you've never heard. And like, that, that list of people need, that, they need to be vetted. We, we can't just go to, you know, Joe Schmo, who knows nothing about us, and think we're gonna get any useful information.

TJ: Anything out of them.

Rachael: Right.

TJ: What's your take on SISM versus peer support models?

Rachael: In my opinion, system is trash. Um, I despise the act of essentially attacking a crew of people right after a call and forcing them to sit down and talk about something that, um, they, they really, um, shouldn't be forced to talk about if you want to go back to your station and talk with your people that were on that call with you by all means.

Thank you. But this is not like forced family fun. Okay, this is not how this works. It is, it is not effective. It puts a horrible taste in everyone's mouth. And it is, it's just not, um, it's not an effective way to, you know, the point of it is to help people. And it's not, it's, I think it's more damaging than it is. The schism at this, the schism pathway.

TJ: Yeah. Yeah. And I, I don't want to, maybe I've been lucky that I've experienced both pathways. If that's the word to use.

Rachael: Right.

TJ: And SISM felt Like checking a box, don't get me wrong. We did drop the ball also when we went through her light of duty death, because even as peers, like when other departments, peer support teams showed up and they were following us around.

We found out later is that we basically had bodyguards in case we wanted to like, I don't know, go into the bathroom and off ourselves. Like, yo, what? That's kind of weird. And I think it, it comes from a good place of people who always want to be the helpers, not knowing how to help. And they just start throwing things at the wall and saying what sticks, unfortunately, a lot of times what sticks is some bizarro world shit like I've heard stories of chaplains suggesting that they would talk to, you know, the family who just lost their loved ones and their kids and they were going to use.

God, I can't believe this really happened. Like, they were gonna use like puppets and marionettes to explain what happened to their loved one. We're all, like, you hear that and you're like, excuse me, like, what? Like, we're gonna bring the Muppets to say that their loved one's gone? Like, I feel that we can pick a more normalized approach to this.

And I get it. It's leadership trying to help. And I think that takes us to the point of leadership has to be in tune with what's happening to their people. What sort of steps can leadership take? Can those chief officers, like if in a utopian ideal world where you can have your thoughts be embedded in a department chief's mind on how to handle.

This duty bound grief on grief, how to handle these people who are going through these hard times. What would you tell them?

Rachael: Before I talk about the chiefs, I want to start at the station level for our station officers, and I think we do a decently good job at this, but it's knowing your people having an open door policy where they need to talk to you. They know that they can come and talk to you. And, you know, You are a, for a lack of a better term, I hate to use it, but a safe person to come in and talk to and to know your people well enough to be able to, to identify when something is not okay. I, I will tell you that when I was not okay, I thought I was okay and my shift knew something was off and something was wrong and they were like, are you good? And I'm like, yeah, I'm good. Like, and. You know, they just didn't know how to help me and I can't blame them because I didn't know how to help me. I, I, I didn't know how deeply affected I was. Um, so I think putting, putting tools in place for officers to be able to discreetly approach someone where they're recognizing. You know, the red flags, the, are you isolating yourself from your shift? Are you calling out way more than normal? Are you coming to work smelling like a liquor store? Are you, uh, you know, is your marriage okay?

Is your relationship okay? Is, you know, is there something going on in your personal life? Like, I just think knowing. Your people on a, on a pretty personal level, you know, as much as everybody wants to divulge, obviously, and being able to identify when something is off or when something is different to kind of be able to address it discreetly.

You know, not like we're going to, we're going to send you somewhere like with kindness and, you know, like you would a family member as far as the chiefs go. I don't know why. The concept of mental health and wellness is so, I guess, difficult to grasp in the sense of, it is more than just providing the EAP number. It is more than, um, having a peer support or CISM protocol. It is more than a protocol, like these are human

beings, 

TJ: are people. Yeah.

Rachael: and we're all very different. And we're all going to handle and digest and process and, um, whatever we do very, very, very differently. So I guess if I could say anything to the chiefs, it would just be, treat us like human beings, not just cogs in a machine. And when we say that we're having a problem, um, we, we had a, a prior chief in our department who is no longer with us. Well, he's alive, but he's no longer with us. You said the Center of Excellence was a place for people to go have a vacation. Oh, great, now everybody's going to be going on vacation there. I have never heard a more disgusting thing uttered. I mean, you may as well just say, I do not give a fuck about you or how you're feeling. Please go run the calls.

TJ: You little cog in my machine. Go, go, go get me those emails reports. Go make sure the stats look good,

Rachael: Right. And like I get, I get it. We have a job to do. I, I absolutely understand that we have a job to do and it's a very, very important job. Um,

TJ: but it can't be done without the people.

Rachael: it can't be done without the people and the people need to be healthy and that's physically and mentally. And, you know, there, there needs to be more. We, we, um, we need regular, um, wellness trainings. And events and seminars, you know, we have, we have RIT training, we have, uh, all kinds of different, you know, trainings pertaining to our jobs specifically, all very important, but the wellness aspect is equally as important to those other trainings.

TJ: And it shouldn't be a career advancer for people, meaning mental health within the fire service. Has come to the forefront in the last few years. We've seen, like you said, a rash of suicides. We've all had people like we know people who have been impacted by the way that like that's those systemic issues that we deal with within the fire service.

And there's always that one opportunistic person or group of people who will say, ha ha, this is how I will make my career. And I think that devalues the whole point of yeah. caring about your people. If you are that person promoting yourself on the backs of the broad term mental health for firefighter, it's crystal clear.

It is crystal clear that you're just going for the buzzwords and you're doing these things in a way that's going to bring the attention to yourself. Because, oh, suddenly I am the savior, and everyone's gonna look at me so great because I am dealing with mental health. In the meantime, the people who need it are still suffering, because they don't trust you.

Rachael: And, and, you know, unfortunately, that, that's kind of what we're dealing with now in that, you know, the bare minimum is being done. We have the EAP number, which I have called it, and it is a shit show to, you know, find, it's just horrible. And when someone is in crisis One of the, uh, analogies I like to say is the, uh, the farmer goes to the hospital.

I don't know if you've heard it before, but if a farmer shows up at the emergency room, you have to know that he or she has tried her second, third, fourth, and fifth line of defense probably tried to stitch his own damn leg back on anything rather than going to the emergency room because he's got shit to do. It's the same thing for us. If we are asking for help, it is typically an emergency and we don't need to be given an EAP number and say, call this number, jump through these hoops, wait, wait three months for an appointment with a clinician who doesn't know anything about you. Um, we're not given the information of what is the best kind of therapy or trauma? Um, what are the best therapists? What are some questions? Okay. I can ask my therapist when I'm interviewing them. Um, what are some things that I can do if I don't want to go to therapy? What if I need treatment, but I can't leave and go somewhere for 30 days? Like, this information should be readily available. It should be readily available, and it's not. And it is a detriment to us. It is a detriment.

TJ: So we've kind of looked at the dark side of things. Let's try to look at some of the lighter side, taking those lessons that you've learned and taking your experience in the fire service, dealing with your own mental health struggles, talking to those younger folks. What do you tell them to survive? and thrive because a lot of times we end up in that survival mode and we can't take that step to the thriving.

So when they're in that survival state, how do they get out of it into the thriving state and remain there more than in the survival state?

Rachael: So the first thing I would tell them is it takes time. It is not something that happens overnight. Like, just like if you gain 200 pounds, you're not losing 200 pounds in a week.

TJ: Not with that attitude.

Rachael: Not with that attitude. Unless you maybe cut off a leg or something like

TJ: I was gonna say, you've heard of Ozempic and what's the other new, the trend and yeah, 

Adderall, let's go.

Rachael: But I think, you know, something that I've heard over and over and over and over again in my career is What are you complaining about? You know what you're signed up for.

TJ: Such empathy, right?

Rachael: Like, no.

TJ: Did we know what we signed up for? I don't think we did.

Rachael: I did not. I, I had no idea. I had no idea what I was signing up for. Like, I thought I was signing up to care for people who are having emergencies. And, you know, my dad, who is a retired trooper, as I mentioned before, one of the first things he said to me when I went into this profession is, This stuff catches up with you, make sure you are taking care of yourself, it catches up with you.

And as a, you know, young 24 year old, I was like, okay, thanks for that. And you, you know, you listen, you hear, and until, you know, until you know, you don't know. You don't know until you know. um, you have to understand that. Knowing yourself, knowing your body, knowing your mind, being able to recognize when there's an issue, having, um, a community and a network in place prior to this, you know, time where you might need to cry for help, having an established network of people that you can go to that you trust, um, mentors, and everybody, therapy isn't for everybody, that's completely fine, I get it, I totally get that.

But, um, maybe having other things, having a, uh, having a hobby outside of the fire service. Something that you feel passionate about. Having friends outside of the fire service. Having just something where, when you get off work, you can find a way to complete that stress and get out of that chronic, you know, chronic stress, you know.

Your cortisol and your epinephrine your hormones are all out of whack like so many men have low T And women's hormones are all over the friggin place and people are gaining weight like gangbusters because their cortisol You know is so high for so long and then and then they get adrenal fatigue and then they get chronic Inflammation it like I think what a lot of people don't understand, but we're learning it the hard way most of us is not addressing these things and Not can, but absolutely will go from mental distress to physical illness and it will come out of us one way or another. So kind of taking care of ourselves along the way is the ideal way to do it as opposed to kind of just putting out the fire once we realize the danger. Ignoring it until there's a blazing inferno and then you're like, well shit now. I have a whole lot of work to do.

TJ: As we're getting ready to close this and looking back on the career that you've had starting as young as you did and to the point that you are now, what is the one failure that you cherish the most?

Rachael: I would say thinking I, you know, thinking I was different, thinking this wouldn't affect, thinking I am emotionally intelligent. I, you know, I feel my emotions like I'm, I, this stuff sucks, but you know, it's just part of, part of what it is. Thinking that I was immune, thinking I was immune to it. That, that is it. My biggest failure, and I don't know if it's youth or lack of education, lack of tools, whatever it is, I can see now that that was not, it was not true, first of all, um, and it led to a lot of really big problems, but without those problems, I wouldn't, you know, I wouldn't be here today and I really feel like, I feel like I can now say I'm grateful for all that shit.

TJ: I love it. I love it. Rachel, let's talk about the article. Where can people find it?

Rachael: So the article will be published in GEMS, the Journal of Emergency Medical Services, on February 4th.

TJ: And we're setting up this podcast. So this goes live after the fact. So go on gems, find the article. We'll throw a link to it in the show notes. And I really appreciate your time. I really appreciate you being so candid and talk about your story with this audience. And I'm hopeful and I believe that somebody will take value out of this and will not make the same mistakes that we have made.

Rachael: Thank you so much for having me.