I recently reactivated my social media accounts. I’m still fairly limited in engagement on them all still. I have, though, posted a few times in LinkedIn - it tends to have more individuals in both the research and the frontline versus the other more traditional social media platforms. I recently posted about “Resilience” programs. Programs like R2MR (Road 2 Mental Readiness), Resilient Minds, or BOS (Beyond Occupational Stress) fall into this category. I’m not sure they would consider their programs “Resilience” programs, though Resilient makes its way into at least on the names!
What I posted about was the fact that Jennifer Wild, a researcher from Oxford University, had studied Preventative Programs and found that none had lasting impacts on the participants (Wild et al, 2020). Even on Canadian soil, a Blue Paper lead by Shadi Beshai and Nick Carelton reviewed the exisiting programs for First Responders, finding significant lack of rigorous research that can help us make any kind of decision whether these were really helping or not (Beshai & Carelton. 2018). The problem: things sound and feel good in terms of these courses, they don’t actually do much. You came for fireworks and got a sparkler. And, in case it sounds a bit like I’m on my high horse, I’m happy to report that “mental health presentations” that I used to give hoping that would make and impact of a difference also don’t do much. So, now add a disclaimer when someone approaches me ensuring they are aware that the research does not suggest that an hour or two long training will make any difference in their members outcome. Drop in the ocean, as it were.
Response to this post garnered a bit of interest. I was happy that it was shared - and that there were responses. I had a great conversation with someone who offered a bit of a cautionary tale when it comes to research. Its a good point; research takes time to complete. This is the same drum that was beat back in 2015 when presumptive legislation launched. Something is better than nothing, right? Well, if what we have for research now is any indication - something is doing nothing of real impact or substance.
So, all this to say, that we need to find a parallel where those organizations that are promoting these programs and suggesting that it WILL do something ought to put their programs where their mouths are. These programs need to be connected to universities and they need to be studied. It’s one thing to suggest that research is too expensive and takes too long to complete - its another to continue to sell for thousands of dollars a program that has no demonstrable outcome differences. If you, or your organization, are looking to buy any of these programs and are unsure what one is right for you - I have some great news (at least in terms of decision making). Flip a coin - doesn’t seem to make a difference.
But, this does bother me. Speaking only about my backyard, the volunteer sector makes up 85 percent of the fire service in Canada. Its staffed by hard working, well meaning, local to their community members, who do this work off the corner of their lives. Interruptions to important family events, dates, birthdays, weekends, and perfectly good sleeps are common - and they pay is north by just a hair of what an employee at Costco might make. To be blunt, we ain’t in it for the money. And that’s a good thing, because there isn’t any money.
Which is why all of this is so frustrating to me. They tell us that everything that we do is traumatic (its not, but that’s a different post), they tell us that we compartmentalize (we do and have to) and things can build to a breaking point (its the de-compartmentalizing we have a problem with after all). They tell us to get support, to get help, to seek therapy, to seek treatment. And, after all that, they also tell us to do their program - for our mental health. Now, if I had no idea about any of this, I would think “what well meaning folks!” Happy to support! Sign me up… But, I do have an idea. And I am aware of their cost. Both fiscally and psychologically.
Truthfully - from what I can see, you would be better off saving your money and investing in private therapy with the focus on building your modifiable skills. This means, seeking out a therapist that you trust, and make your work analyzing and managing beliefs and thoughts about yourself, others, and the world. We can all do a little to improve a bit (and there is some research to suggest that this might be one of the only evidence based ways to improve “resilience” Wild et al, 2020). Not only will this have a much greater likelihood of impact over time on the person who engages in it - the added effect of developing this relationship long before any mental health issue ever knocks on the door is such a massive bonus for that person. Without digressing too far, the simple fact that therapists and therapy programs have such a long line to get in, qualified and effective therapists are hard to find, and there is always an awkward period while you are getting to know the therapists and develop that trust, you really don’t want to be waiting until crisis is at your door to start that conversation.
We have a long way to go with what research can say “causes” one thing or another, but I do think we ought to hold the mental health organizations that are promoting these programs, and at no small fee, accountable to what can be demonstrated in the actual practice. It is only fair to also say that we have a long way to go on the research end as well. One of the most difficult to answer questions right now is: what is “resilience”. Its such a varied topic that getting some type of operationalized definition (meaningful to both the front end user as well as the researcher) has proven to be exceptionally difficult. Not to mention the cofounding factors that “resilience” itself is used outside of mental health considerations. This only muddies the waters a bit (though, I’d hope, dunking yourself in freezing cold water to develop resilience is clearly seen as “physical” resilience and even “motivational resilience” but it sure isn’t Mental Health promoting resilience.
In the end, the person in the ambulance (or firetruck, or cop car, or dispatch pit etc) needs to connect with the eggheads at the university! Only when we team up for a mutually blunt and forward conversation are we going to get anywhere. I get it, organizations that want to help us with our mental health also need to find sources for funding to keep that work going. I have no problem with that - what I have a problem with is that many (maybe all) of the big programs on offer have very capable and effective researchers inside those organizations already. Let’s utilize that expertise to do rigorous evaluations of the programs on offer.
Your mental health, my mental health, and the mental health of our brothers and sisters in all First Responder fields are depending on it.