Suicide is a widespread problem that is severely underreported within the fire service. There is a growing body of evidence that suggests firefighters are at increased risk of committing suicide compared with their civilian counterparts due to disturbingly higher rates of posttraumatic stress disorder and substance use disorders, which serve as markers for suicide completion. The main problem for mental health professionals in addressing suicide in this population is the substantial lack of empirical research on mental health of firefighters as well as the compounding cultural stigma that exists in addressing mental and behavioral health issues. Additionally, there remains a discrepancy in reported rates of suicide and a lack of information on attempted suicides-related to low reporting rates by family members, fellow firefighters, and departments, as well as no official national tracking database for suicide in firefightersthat further complicates research in this area. This article (a) discusses current research on suicide within the fire service, (b) explores issues and challenges for psychological assessment and intervention for practitioners working with this population, (c) describes specific approaches toward decreasing suicide in firefighters, and (d) suggests policy considerations for fire departments and mental health professionals.

Research has documented a number of acute and chronic stressors unique to the fire service. Due to the rise in mental health concerns in firefighters, there has been increased awareness of the negative effects of unmanaged stress. The present study employed a behavioral-analytic model to construct a brief screening measure of stress for this population: the Firefighter Assessment of Stress Test (FAST). Psychometric properties of the FAST were evaluated using data from active-duty firefighters throughout the United States. Results indicated the FAST has good internal reliability ( α = 0.89), as well as good convergent and discriminant validity. Also, the factor structure of the FAST revealed three significant subscales reflective of stress associated with responding to calls, administrative difficulties, and being overworked. Scoring and interpretation guidelines were established to suggest when further assessment is warranted. The FAST offers a brief and valid method of self-assessment of current stress levels in firefighters. Information obtained from the FAST (i.e., overall stress level and domains) has the potential to facilitate more immediate identification and recognition of stress in firefighters than what has been possible to date. Moreover, heightened awareness of stress and its effects will hopefully culminate in expanded efforts directed toward stress reduction and intervention for firefighters and their families.

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Some research suggests that firefighters are possibly at greater risk than other at-risk first responder/public service populations for suicidality (e.g., police, Veterans, active duty military non-deployed males; Martin et al., 2017 ; Stanley et al., 2015; Stanley et al., 2016 ). Behavioral autopsies have been utilized to elucidate the clinical picture of other at-risk populations; however, to date there is no proposed or applied model for a suicide behavior autopsy in fire personnel. Developing a standardized suicide behavior autopsy will allow for a comprehensive understanding of firefighters who die by suicide and highlight potential areas for intervention. The aim of this paper is to integrate best practices for autopsy procedures from other high-risk populations into a comprehensive theoretical model for a proposed behavioral health autopsy for firefighters. Our recommended protocol is presented along with relevant limitations, clinical implications, and recommendations for future research.

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