Firefighters play an essential role in the Department of Homeland Security’s mission to respond to and recover from emergencies and disasters. In order to bear the responsibilities of this role, firefighters must meet high standards of preparedness both physically and mentally. As time in this mission wears on, the diagnosis of Post-Traumatic Stress Disorder (PTSD) has become more prominent in the fire service and seems to be associated with a rising trend in firefighter suicide over the last 10 years; 2014 and 2015 were record years for the number of firefighter deaths by suicide in the United States.
PTSD in firefighters occurs about three to five times more than in the general population—one factor that explains the higher rates of suicide. Firefighters are routinely exposed to physical and mental trauma while completing their duties, but the fire service culture is to “suck it up” and not acknowledge these traumatic events’ psychological and physical toll. Any discussion of mental health is taboo to the firefighter, so the subject of suicide remains neglected. Lack of accurate data makes determining the problem’s severity even more difficult; since suicide tends to be a private issue, commonly associated with shame, it remains under reported.
This thesis was written in order to determine how fire chiefs can address PTSD and firefighter suicide to break the cycle of increasing suicidal events. The main research is published studies by mental health experts and information from agencies such as the U.S. Department of Veterans Affairs, National Institute of Mental Health, International Association of Fire Chiefs, National Volunteer Fire Council, and the Firefighter Behavioral Health Alliance.
The causes of PTSD vary and are often associated with exposure to acute trauma events such as 9/11, military combat, and Hurricane Katrina, as well as recurrent trauma such as that routinely experienced by firefighters. PTSD diagnosis of firefighters is on the rise, but PTSD by itself does not cause a person to commit suicide. The process leading to suicide often includes PTSD, but is also commonly combined with other comorbid issues such as depression, substance abuse, anxiety, and mental illness. In order to understand this process better, the Interpersonal Theory of Suicide is used to identify the elements that cause a firefighter to commit suicide. Using this theory, firefighters who are suffering from PTSD and are susceptible to suicide can be more easily identified.
It is incumbent upon fire chiefs to institute policy and programs designed to decrease the number of firefighters who suffer from PTSD, and in turn the number who commit suicide. Programs such as Psychological First Aid, Stress First Aid, and Critical Incident Stress Debriefing have been developed to help individuals develop better coping skills when faced with traumatic situations. The DVA has been very successful through treatments based upon psychotherapy, medication, and eye movement desensitization and reprocessing. 
The research strongly suggests that the number of firefighter suicides related to PTSD, as well as the number of PTSD diagnoses, can be decreased through a program based upon policy and process. Peer support needs to be provided through the establishment of a Stress First Aid program, and supported by access to mental health professionals. In order to achieve this goal, reporting firefighter suicides to a central collection point must become mandatory throughout the United States. Mental health training in the fire service must receive as much emphasis and commitment as physical training in every fire department. As demonstrated by several academic research studies, as well as by the Joint Military Services and DVA, successful treatment of PTSD, and therefore potential suicide, is possible and should be applied to suffering firefighters.
Firefighters have dedicated their lives to saving others and ensuring public safety. There are enormous benefits to establishing a mental-health training program designed to prevent PTSD and suicide in the fire service. Inaction in this area is too costly. This will require a cultural change within the fire service and must be endorsed by fire chiefs at the federal, state, and local levels to be successful.
Dill, Jeff. “Firefighter Behavioral Health Alliance.” Accessed January 31, 2016 2015. http://www.ffbha.org/.
Del Ben, Kevin S., Joseph R. Sotti, Yi-Chuen Chen, and Beverly Fortson. “Prevalence of Posttraumatic Stress Disorder Symptoms in Firefighters.” Work & Stress 20, no. 1 (March 2006): 37–48.
National Center for PTSD. “Understanding PTSD Treatment.” August 2013. http://www.ptsd.va.gov/public/understanding_TX/booklet.pdf.
 Jeff Dill, “Firefighter Behavioral Health Alliance,” accessed January 31, 2016, http://www.ffbha.org/.
 Kevin S. Del Ben et al., “Prevalence of Posttraumatic Stress Disorder Symptoms in Firefighters,” Work & Stress 20, no. 1 (March 2006): 37–48.
 National Center for PTSD, “Understanding PTSD Treatment,” August 2013, http://www.ptsd.va.gov/ public/understanding_TX/booklet.pdf.