Firefighter Lindsey Nolan takes a break to call home on Jan. 9, 2018. Nolan says more mental health training would benefit his fellow firefighters. “If I knew how to recognize PTSD … I’d be a lot more comfortable approaching them and talking to them about what may or may not be going on in their life.” (Heidi de Marco/Kaiser Health News)
At 7:30 on a recent morning, Jeremy Forte, a firefighter in Imperial Beach, California, had just wrapped up a 48-hour shift. As the seven-member crew headed home, Forte drove right past a local bar that used to be a favorite haunt. A few years ago, he would have stopped for a drink, or two, or three -- and perhaps stayed on for hours. And he would have had plenty of company.
"There’s nurses from the hospital there getting off work at the same time," Forte recalled. "We’d be drinking with nurses, partying, having a good old time. And we didn’t think anything was wrong. That’s what people do, right? They get off work and have some drinks."
Jeremy is tall and lanky, with a thin mustache. He’s been a firefighter for 19 years. It’s grueling work, both physically and mentally. For a long time, drinking was how he coped.
"Our motto was work hard, party hard," said Forte, now 39. "We put in 16-hour days and then we’d go drink the rest of the night, and then probably get two hours of sleep. Wake up, you know, half-drunk and go back out on the fire line and fight these fires."
A few years ago, Forte's drinking got heavier. He started dabbling in cocaine. But he felt he still had it all under control, until he failed a random drug test at work.
Forte's station is part of the federal government: his crew fights fires and responds to emergencies in and around a naval base in Imperial Beach. The federal firefighting force has a zero-tolerance policy, and Forte was in danger of losing his job immediately.
"They really could have ended my whole life by turning their backs on me and firing me," Forte said. "And then at that point, I would lose my wife as well, and probably be living with my parents."
Forte grew up in West Covina. Two LAFD firefighters lived on his block. Forte admired them, and loved seeing his next-door neighbors on the local news.
"Doing that sort of thing really intrigued me," he recalled. Not only was the job itself exciting, but it also allowed the firefighters to spend plenty of time with their families when they were off-duty.
But not everyone believed he could do it. Forte was born with a birth defect: He’s missing some fingers on both hands, and others aren’t fully formed. His whole career, he’s had to prove that he can do everything a firefighter has to do: drive rigs, grip and haul hoses, rescue people.
Forte proved the doubters wrong.
After 19 years as a firefighter, it has become crucial to his identity. Losing that career would have been absolutely devastating. After the drug test, Forte hired a private lawyer and asked the department and union for a second chance. He agreed to every condition of a yearlong probation, including enrolling in a recovery program and beginning therapy.
"By the grace of God, I still have my job," Forte said. "I still have people backing me."
During his recovery, Jeremy was diagnosed with post-traumatic stress disorder and depression. He wasn’t surprised to hear it, and he's not alone.
First responders have increased rates of PTSD, depression, substance abuse and suicide due to the stresses they are exposed to on the job. In a recent survey, 85 percent of first responders reported symptoms related to mental health issues, but only about a third of them sought out professional help.
Another survey revealed 6.6 percent of first responders had attempted suicide, and more than a third had considered suicide. In both cases, those rates are 10 times the national average.
"I always thought, it’s a job, you go do it and you just deal with it, it goes away," Forte said. "But it doesn’t."
The pain lingers and haunts. Forte learned that when he was 22, at his first job with the forest service. His team fought fires but also rescued backpackers -- and he was surprised by the violence that nature can cause.
"There was a gentleman out camping in the middle of the forest in New Mexico," he recalled. "A piece of the tree broke off and hit him in the neck and broke his neck. And as he hit the ground, he broke his leg. We had to fly there in a helicopter, basically to rescue him."
But by the time they got there, the hiker had died. It was the first time Forte saw a dead body on the job, a victim of a violent, random accident. The helicopter extracted the body, but then it grew too dark to come back for the hiker's friend, who was uninjured but traumatized and covered in blood. So Forte volunteered to stay with him all night in the woods.
After that incident, Forte started having nightmares.
"The things that we see on the job aren’t what everyday people see and so they wouldn’t understand completely what we deal with, and how it can haunt us and stay with us the rest of our lives."
It’s not that firefighters never talk about what they see. They do, but they don’t talk about the pain inside.
"You don’t want to be seen as weak," he said. "So instead ... we’d go have some drinks and joke about it, or, you know, talk about the situation still, but it’s over alcohol."
After hitting bottom, Jeremy moved his family to a wood cabin in Lake Arrowhead. It’s quiet there, and he can decompress when he isn’t at work.
Jeremy is now sober and back in the firehouse full-time. He tries to set an example for younger colleagues by sharing his story, and talking about his emotions more often.
"The current fire crew that I work with now, we’re all very open together," he said. "We’re very tight-knit and we talk about the stuff we see. ... We’re almost like our own counselors."
Often the men gather in the kitchen to make breakfast before the shift formally starts at 7:30 a.m. Some of the men set the table, while others slice mushrooms, make hash browns or scramble eggs.
It ends up being a slow shift, with no emergency calls, so the seven men on duty spend the day checking gear and running drills.
Before turning in for the night, they gather again at the kitchen table. Things get serious when the talk turns to suicide among firefighters.
Everyone in the room knows a firefighter who killed him or herself, or at least has heard about a recent case.
The shift captain, Richard Hernandez, complained that mental health information wasn’t part of the firefighter training.
"There really hasn’t been any direction on how to work with that if somebody is having an issue," he said.
Hernandez said that his firefighters can get three visits with a counselor per year, but that’s not enough.
Another firefighter, Lindsey Nolan, said he wants to learn how to recognize signs or symptoms of PTSD in a co-worker.
"I’d be a lot more comfortable approaching them and talking to them about what may or may not be going on" if he had some training in it, Nolan said.
Another firefighter, Devin Boler, admitted it’s hard to know how -- or when -- to intervene.
"Because we live together, and we’re with each other through Christmas and Thanksgiving and stuff like that, we have to be professional," Boler said. But there's also "a family side to it, where you kind of have to check in with guys and see what’s going on, if they’re having a rough day."
Firefighters began talking about these issues more after the increase in mass public shootings, according to the Firefighter Behavioral Health Alliance, an Arizona-based nonprofit that provides mental health support and training for firefighters.
A Bittersweet Milestone
Forte has been making the long drive to a drug screening center, in National City, at least twice a month for the past year. It's part of his probation: submitting to a full year of random, and frequent, drug tests.
Today was his last visit, though. His probation is ending. Forte will still get random drug tests, but not as often.
"I feel great," he said as he drove. "Not like I’m going to go out and celebrate, if you know what I mean."
During the drive, Jeremy downed two large coffees. But despite the caffeine, he's too wound up to provide a urine sample. After a few hours, he succeeds, and finally walks out of that clinic for the last time.
"It was a humbling process," he reflected, looking back at his year of probation. "Ultimately, I wanted to get back on track for my family, for my job, for myself."
"The biggest reason is my kids," he added. "I wasn’t going to allow this to keep me down, and be some deadbeat dad that didn’t seek help."
Forte said the culture of silence among first responders has to end. So does the idea that emergency work is about being tough at all costs.
"Guys shouldn’t feel that way," he said. He wants firefighters to think about seeking counseling or mental health assistance as "the manly thing to do."