Firefighter PTSD, Depression and Suicide -- Helping the Helpers

Sept. 9, 2011— -- When Jack Slivinski Jr., a member of Philadelphia's elite fire rescue squad, killed himself last June, friends and family partly blamed the humiliating suspension he endured after he posed barechested for a firefighters' fund-raising calendar without department permission.

However, few people were aware that the caring, 32-year-old former Marine had been quietly drowning in survivor's guilt in the seven years since his supervisor suffered fatal burns racing into a collapsing building to rescue Slivinski and another firefighter, unaware they'd both gotten out.

"It was very apparent when you got to know Jack that it was something that was wearing on him," said Lt. Dan Cliggett, his close friend inside and outside the firehouse. Cliggett, along with Slivinski's wife, Carla, from whom he'd separated but hoped to reconcile, believe Slivinski had developed post-traumatic stress disorder because he felt responsible for the death of Lt. Derrick Harvey, 45.

The terrorist attacks of Sept. 11, 2001, made heroes of the 343 New York City firefighters who lost their lives rushing to save others at the World Trade Center. But that tragic, life-changing day has also had a more subtle impact on the nation's first responders: It created more awareness, if not empathy, for the sacrifices they make in putting others' lives ahead of their own physical and psychological health. It also generated changes in firehouse culture and attitudes.

As Slivinski's housemate until a week before the suicide, Cliggett noticed "myriad signs" of a preoccupation with Harvey's death. Slivinski named his dog Harvey. He transformed part of the bar in his house into a Derrick Harvey memorial, with a mounted printout of the call to the fatal fire, a section of charred hose line and pictures taken with Harvey in better times.

"I would say 'Jack, some of this stuff needs to go. It's been a long time,'" Cliggett said. "He used to say, 'I know. I'm trying. I can't."

When Philadelphia Fire Commissioner Lloyd Ayers initially suspended Slivinski last April over the calendar incident, he was unaware of Slivinski's inner turmoil or the shrine to Harvey, he told ABCNews.com. "Of course, we would be concerned with something like that if you knew about it," he said. "I'm sure that any supervisor that saw anything related to stress, which they're trained to do, would have taken care of that." Ayers enumerated the "critical incident debriefings," employee assistance plan services and literature available to Philly firefighters in crisis.

But Slivinski, who got his job back but never bounced back, was part of the traditionally stoic culture in the nation's 35,000 fire departments. "It's considered a weakness to ... ask for help," explained Francine Roberts, a clinical psychologist in Marlton, N.J., who treats firefighters and police. She accommodates her patients' desire for absolute confidentialty by seeing them in an office with a private parking lot and rear entrance. To allay worries that having word get out about their therapy could jeopardize their careers, she offers sessions "under the radar. I tell them I don't report to anybody. I don't take insurance. Whatever you can pay me, pay me."

Once firefighters and police enter her office, she spends time breaking through "a lot of denial. They believe that resilience means stuffing it, so 'If I don't react, I'm fine,' as opposed to the actual definition of resilience as being able to tolerate strong emotions such as sadness, grief or loss, and then move on."

In the immediate aftermath of 9/11, the Federal Emergency Management Agency sought to help the stressed helpers who survived the assault on lower Manhattan, many who helplessly witnessed desperate men and women jumping from the burning twin towers. FEMA Director Joseph Allbaugh asked the National Fallen Firefighters Foundation to provide peer support to firefighters and their families. That, in turn, led the foundation to devote new attention to their psychological well-being.