Hope out of Darkness: A Guide to First Responder Mental Wellness

By: Dena Ali

Hope Out of Darkness: A Guide to First Responder Mental Wellness offers a thorough examination of the mental health challenges faced by first responders, but more importantly, it provides practical methods for transforming adversity into wellness. Drawing from her personal experiences, research, and insights from mental health professionals, Dena Ali presents a roadmap for addressing issues such as trauma, organizational stress, and suicide prevention. The book debunks common mental health myths and highlights various resources for support and treatment, offering strategies to build resilience through social support, effective leadership, mindfulness, proper sleep, and holistic approaches such as play and gratitude.

This book is for anyone interested in gaining a deeper understanding of mental wellness—whether you're someone facing challenges or someone looking to maintain well-being. It's a valuable resource for those seeking to support others through difficult times. Additionally, part three serves as a consultation guide for organizations, offering effective strategies to support members coping with personal and professional stressors and includes guidance for dealing with potentially traumatic events, safe communication about suicide, dealing with a suicide, and developing a facility dog program. 

 
 Key lessons include the following: 

• Trauma is ubiquitous, but suffering is optional 
• A strong support network is the most profound protector from traumatization and mental health ill effects. 
• Hope is a function of struggle
• Sleep is a powerful tool that can help us become not only more mentally resilient but also physically resilient.
• Through incorporating practices such as gratitude, journaling, mindfulness, laughter, and play, we can increase our ability to respond to stressors. 
• Increasing emotional literacy is a pathway to increasing resilience and understanding of our experiences.
• There is no quick fix for optimal mental health; it is a lifetime pursuit requiring constant vigilance over our minds, thoughts, and behaviors. This pursuit starts with education and understanding- this book’s primary goal.
• Historically, efforts to reduce suicide and improve mental health have focused on individuals rather than on communities and environments. It is time to recognize that something must change to reduce suicide, prevent post-traumatic stress disorder, and help those who have mental illness. We must go upstream and figure out why people are falling into the river and help give them the tools to stay safe on dry ground. This book provides the reader with a combination of tools for understanding how to avoid falling into the river and, hopefully, for sharing in their circles to keep their communities healthy and safe.
• For first responders, the three most critical areas to understand in terms of sleep are its relationship to the function of the amygdala, its relation to depression, and its ability to process events and thereby prevent the development of PTSD. Although anecdotally it is common for people to express a low emotional tolerance after sleep deprivation, science finally explains the research behind this phenomenon.
  Increased emotional resilience decreases the incidence of negative emotions, feelings, and thoughts. It is well known, especially among athletes, that increasing HRV will improve recovery and increase performance. What may not be as well known, however, is the unintentional finding that each recovery activity that increases HRV also promotes emotional resiliency by shutting down defense responses and moving from sympathetic to parasympathetic states.
• This book will provide guidance for improving sleep quality, quantity, regularity, and timing. 
• "Our ability to predict suicide is no better than it was 60 years ago, which is a little better than chance. Focusing on risk factors and warning signs is exhausting and of little effect because most people with the displayed warning signs will never attempt suicide. What can we do? We should stop focusing so much on identifying and intervening and more on creating a culture that encourages and supports help-seeking behavior. Further, we can be kinder and work to ensure those around us feel connected, supported, and valued."
• "Although most of us try to live life free from trauma and stress, trauma does not discriminate; it is ubiquitous, and nobody gets through life free of its impacts. Although our experiences are different, the emotions we feel are not, especially when these emotions coexist with shame and powerlessness. Unfortunately, we build our lives on a weakened foundation when we move past our trauma without addressing it. More often, this unresolved trauma comes back later in life to haunt us and impact our ability to take on more responsibilities."
• "Post-traumatic stress symptoms are normal responses to trauma that will resolve and even lead to post-traumatic growth for most people. The lack of support after an event is more predictive of PTSD than the trauma itself; when recovery is inhibited, post-traumatic stress can lead to PTSD. For this reason, we must train our leaders to create supportive environments that facilitate growth through adversity and trauma."
• "When leaders model a willingness to continue to learn and to acknowledge that they do not always know, their employees know it is okay to not know and will be open to improving skills. Working in a performance culture for a leader that demands always knowing and perfectionism creates a toxic environment. One of the most destructive outcomes is the level of stress placed on an employee
  who fears making mistakes or saying the wrong thing. This fear causes that person to spend more time in the sympathetic nervous system, negatively impacting vagal tone, ergo lowering the capacity for emotional resilience."
• "Protection from PTSD requires a holistic approach encompassing social support, learned coping skills, adequate sleep, and organizational support. PTSD does not occur in a vacuum, and it is not simply a result of a trauma or an event but rather an inability to process and recover from that event. When any of these protective factors are missing, the ability to process trauma becomes inhibited"
• "Just as trees need stress to grow strong, so too do humans. The thing is, no matter how prepared for stressors we are and how content we are with our lives, challenges and adversity are inevitable. Fortunately, these stressors can make us stronger, but we can grow stronger only if we appropriately manage our stress and ensure that we have a strategy for preventing our buckets from
  overflowing. This is best done by using coping skills such as engaging in play, getting rest and quality sleep, maintaining healthy relationships, practicing gratitude and mindfulness, using humor, and prioritizing a psychologically safe work environment. Implementing these skills is the key to increasing our capacity to respond to the inevitable stress inherent in our life and our profession."
• "Supporting others, especially within the context of first responders, can be incredibly challenging. First responders are often conditioned to be problem solvers and fixers. However, in exploring first responder mental wellness and working with peer support teams, I’ve come to understand that we can’t fix people. Even psychologists and therapists don’t fix their clients; they provide a safe space for growth, self-discovery, and even productive suffering. It’s disheartening to witness agency leadership and peer support teams hindered by a fear of making mistakes. This fear sometimes leads to a reluctance to offer support, favoring a hands-off or referral approach. The reality is that no single individual can fix another or even take their pain away. Often, the most powerful form of support we can offer is being present without judgment. We don’t always need to have all the answers; just showing up can make a world of difference.
  
  

Dena Ali, Battalion Chief with the Raleigh, NC, Fire Department and sought-after speaker, explores three main themes:

1. Mental Health and Suicide: An Overview
   This section explores the complexities of mental health and suicide in the emergency services, challenging common myths and misconceptions. It emphasizes the importance of education, altering environments to reduce risk, and recognizing factors like trauma, internal conflicts, and perfectionism. Key themes include the impact of adverse childhood experiences, bullying, and organizational stress.
   
   
2. Building Resilience: Becoming Antifragile
   This section highlights building resilience through meaningful social connections, mindfulness, and emotional intelligence. It emphasizes the benefits of psychological safety, gratitude, humor, and healthy habits like sleep and fitness. Strategies include fostering supportive relationships, understanding the mind-body connection, and using tools like journaling and therapy to improve well-being. These approaches help first responders navigate stress and build a balanced, resilient mindset
   
   
3. Supporting Those Who Are Struggling
   This section provides essential strategies for supporting mental health among first responders, highlighting active listening, peer support, and effective communication. It covers therapy options, substance use management, and suicide prevention while promoting resilience and leadership's role in fostering a supportive culture.

 

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Table of Contents

Foreword

 

Acknowledgments

 

I. Mental Health and Suicide: An Overview

1. Knowing What We Don’t Know

• The Basis for Suicide Prevention Education
• Altering the Environment

2. Myths About Mental Health and Suicide

• Myth 1: The Association between Firefighting and Suicide Is Causal,
• So Firefighters Are at Increased Risk for Suicide
• Myth 2: Post-Traumatic Stress Disorder Is the Primary Contributor
• to Firefighter Suicide
• Myth 3: Suicide Is Always Impulsive
• Myth 4: You Must Be Out of Your Mind to Die by Suicide
• Myth 5: People Who Die by Suicide Don’t Make Future Plans
• Myth 6: Suicide Is Selfish
• Myth 7: Suicide Is the Easy Way Out
• Myth 8: Resolving Grief Is a Linear Five-Step Process
• Myth 9: Responsible Adults Must Learn to Control Their Feelings
• and Emotions
• Myth 10: You Can Sleep When You’re Dead
• Final Thoughts about Myths

3. Suicide, Perfectionism, and Emergency Services

• How Do We Do This?
• Inside the Mind of One Who Attempted Suicide
• Talking About Suicide: The First Step to Healing
• Suicide and Internal Conflict
• Suicide by the Numbers
• Challenges
• Models of Suicide
• Connectedness: A Protective Factor Against Suicide
• Be the One

4. Trauma

• Defining Trauma
• The Roots of Trauma
• It Is Time to Change Our Focus
• PTSD
• Risk Factors
• Early Life Adversity: Often Overlooked
• Positive Coping Skills Can Prevent PTSD
• Medications
• It Is in Our Power to Control How Trauma Shapes Us

5. Adverse Childhood Experiences

• The Impact of ACEs
• Kaiser Permanente Study
• ACE Scores and Findings
• ACE Impact on the Military
• ACEs Affect Social Functioning
• ACE Score Is a Guide

6. Bullying and Harassment

• Diversification and a Seat at the Table
• Bystander Intervention Is Critical
• Psychological Isolation
• Relationships Have a Significant Impact on Mental Health
• Dare to Be an Ally: Intervene
• Organizational Leadership

7. Organizational Stress

• Human Connection
• Social Resilience
• To Lead Is to Care
• Psychological Safety
• Leaders Are Key to Change
• Culture Is Built on Safety
• What Some Leaders Are Doing

II. Building Resilience: Becoming Antifragile 

8.Social Support and Belonging

• Pain from Life Is Inevitable; Suffering Is Our Choice
• PTG Goes Beyond Resilience
• Meaningful Social Connection
• Talking: A Tool to Reverse Damage Caused by Trauma
• Society Influences Recovery from Trauma
• Protective Factors Inherent in Our Profession

9. Mindfulness-Based Resilience Training

• Mindfulness and Its Effects
• Access to Mindfulness
• Mindfulness-Based Stress Reduction
• The AFD Resilient Mind Program

10. Face the Storm and Feel Your Feelings!

• Emotions Inform and Prepare Us
• Our Response Is the Problem
• Emotional Literacy
• How Emotions Are Expressed in the Body: Emotional Intelligence
• Shame versus Empathy
• Components of Empathy

11. Increasing Bandwidth (Polyvagal Theory)

• The Polyvagal Theory
• Heart Rate Variability
• Evolution of the Autonomic Nervous System
• How the Vagus Nerve Works
• Emotional Resilience and HRV
• Yoga Impacts HRV

12. Psychological Safety

• The Benefits of Psychological Safety
• “Not Knowing” as a Positive Trait
• Transparency and Gossip
• Belonging Cues

13. Gratitude

• Gratitude versus Negativity
• How Gratitude Works
• Practicing Gratitude

14. Journaling, Humor, and Play

• Journaling
• Humor
• Play

15. Sleep

• The Link Between Sleep and Physical Health and Safety
• Pros and Cons of Various Sleep Schedules
• Physical Effects of Inadequate Sleep
• Sleep and Emotional Responses
• Critical Pointers on Sleep for First Responders
• Lack of Sleep and Psychiatric Conditions
• Improving Sleep

16. Healthy Body, Healthy Mind: Fitness Is Important to Mental Health

• Physiological Response to Exercise
• Physical Response to Exercise
• Community Aspect of Group Exercise
• Where to Start

 17. Therapy Is Awesome

• Helpful Definitions
• Treatment Is an Individual Choice
• Connection with Your Clinician Is a Priority
• How to Find Help
• Don’t Rule Out Going Out of Network
• Recommendations When Looking for a Counselor or Therapist
• Tips When Looking for a Clinician

 III. Supporting Those Who Are Struggling

  18. Active Listening: A Simple but Critical Skill for Human Connection

• Why Not Give Advice?
• Establishing Trust
• Hurtful, Unhelpful Statements
• Active Listening Skills
• Motivational Interviewing

 19. Peer Support

• Peer Support Teams
• Pointers for Peers
• Departmental Responsibilities and Company Officers
• Departments Need Relationships with Resources
• Evolution of Peer Support Initiatives
• Resources for Implementing a Peer Support Program
• Garner Fire Department Implements Peer Support
• Healthful Boundaries: A Must for Peer Supporters
• An Expert’s Method for Setting Boundaries

 20. Action Planning

• The Trilogy

 21. Substance Use Disorder

• Brandon Dreiman on Substance Use Disorder
• Substance Use Disorder

  22. Therapy and Treatment

• Treatments
• Experiential Therapies
• Psychedelic-Assisted Psychotherapy
• Treatment Centers

 23. Asking About Suicide

•  Interventions for Suicide
• Sally Spencer-Thomas on Asking Directly About Suicide

 24. Means Safety: Building Time and Distance Between a Suicidal Person and a Firearm

• Gun Owners and Suicide
• Firearms: Leading Cause of Suicide Among Responders
• Means Safety: Critical in Moments of Suicide Intensity
• Preplanning for a Crisis
• The Crisis Card
• Protect a Gun Owner You Care About
• If You Own a Gun

 25. Building Resilience in Our Organizations and Establishing a Chaplaincy

• Some Best Practice Models Found to Be Harmful
• Stress Continuum Detection Tool
• Prevention Is Crucial for Mental Health
• Preparing First Responders to Handle Stress
• Impact of Positive Leadership Behavior on Responder Mental Health
• Resilience Boosters
• Starting Pointers for Building Resilience

 26. The Company Officer’s Role in Building Safety

• My Experience with Leadership
• A Catch-22
• Leaders Have A Responsibility To Do More
• Building Psychological Safety
• Leaders Must Model Vulnerability
• Hope, the Antidote for Shame and Suicide
• A Little Intervention Goes a Long Way
• Best-Case Scenario

 27. Responding to Potentially Traumatic Events

• Events Are Potentially Traumatic
• From Responding to the Station Nightclub to Improving the
• Fire Service
• Fire Service Members—Mental Health Services Relationship
• North Carolina Peer Support Flow Chart Components
• Formal Debriefing
• When Members Feel They Cannot Continue at Work
• One-on-One Peer Support
• One-on-One Intervention
• Provide Optional Clinical Resources
• Priority Response Categories for PTEs

 28. Facility Dogs, Behavioral Activation, and Treatment

• Types of Assistance Dogs
• Behavioral Activation
• Canines Are Social Facilitators
• Behavioral Activation and Assistance Dogs
• Chief Snyder’s Email

 29. Postvention

• Postvention Can Become Suicide Prevention
• Critical Components of Postvention
• Dos and Don’ts When One Dies by Suicide

 30. Words Matter: Safely Communicating About Suicide

• The Goal Today Should Be to Promote Hope and Resilience
• Change in Language Is Needed
• A More Effective Approach to Suicide Prevention
• There Are Multiple Factors Implicated in Suicide
• Best-Case Scenario
• Steps to Positive Communication

 

Closing Thoughts

 Review Questions

 Index

About the Author