Levelling Up Safety by Embracing Total Wellness at Denver Fire Department with Manuel Almaguer
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“At that time, we had focused so much on line of duty deaths, but what we did not know is that suicides were starting to outpace line of duty deaths in the fire service.” Manuel Almaguer remembers back to 2013 when the Denver Fire Department began to roll out training with an intentional focus on discussing stressors, risk factors, and ways to take care of themselves and each other in public safety. Tune in as Manuel discusses steps the Denver Fire Department has implemented through the years to beat the stigma, build trust through vulnerability, and prioritize peer support to embrace total wellness throughout the fire department.
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Hi, and welcome to the Safety Guru. Today I’m very excited to have with me Manuel Almaguer. He’s the assistant Chief with the Denver Fire, 20-year veteran champion of mental health and we’re here to talk about some incredibly powerful actions that he’s taken. He’s driven within Denver Fire to bring the topic of mental health to the forefront. So many really excited to have you with me today.
Hey. Good morning, Eric. It’s my pleasure and looking forward to this conversation for quite some time. Thank you.
Excellent. So many your story has been shared in many different forms that I’ve heard. In terms of the work you’ve done in Denver Fire, maybe let’s start a little bit about what got you inspired to do some very powerful things which we’ll get to very soon around mental health within Denver Fire.
That’s great. It’s a great intro. And my background before I came into Denver Fire Department was in psychiatric settings. So, I was a psychiatric registered nurse and I worked in institutional settings with the developmentally disabled as well as those with some severe mental illness concerns that would require the institutional setting. So, I’d worked in that setting for eleven years and then I went into the career change with Denver Fire and really thought, okay, I pretty much have seen what I’m going to see in life and there’s really nothing that’s going to be shocking to me or something that’s going to as I thought would be traumatic. So, this was in the year 2000 and then I started to see trends and people that I had worked with and people who had retired from the fire service and taking their own lives. But where it really impacted me, and a few others was in 2013 when there was a suicide of one of our respected captains in the Democratic Department and just a man that many of us kind of looked up to as a mentor. And you have to keep this perspective when you come into public safety and specifically the fire service and you always think of somebody who’s stoic, somebody who doesn’t have any issues personally, somebody who’s just kind of that man’s, man, firefighter, firefighter.
He just never really looked deep into the layer of anything that could be preoccupying them in any way. So, this individual took their life in 2013 and it crippled a handful of us. And at the time it was with an employee group called Firefighters Incorporated for Racial Equality and maybe on the executive board worked with this individual in the firehouse. So, what was so interesting about this is that at that time, we had just started to get at the forefront of suicide in the fire service. And at that time, Denver fire collaborated with the National Pawn Firefighters Foundation. We were focusing on the Life Safety Initiative, which is mental health. So, we started to roll out some training. It was very basic training. It was called stress first aid. So, at that time was the very first introduction that I could recall in the fire service, where we started talking about stressors risk factors and ways to take care of yourself and each other. But we were influenced in all of this. We were just trying to get the message out. Well, while we were doing this, right under our nose is when the suicide of the captain occurred.
So, at that time, we knew we had to do something that had a little bit more teeth to it, that was more sustainable, and actually would capture the attention of the importance of this pattern that was starting to go on in the fire service. Because at that time, we had focused so much online of duty deaths, but what we did not know is that suicides were starting to outpace line of duty deaths in the fire service, but we never even so at the time, a task force was formed with FRE. There’s about three to five of us that says, okay, let’s go out and see what we can do. We’ve had enough and we were broken. Eric we really did not know what we were going to get into, but we knew we needed to do something. And so, what we did is the firefighter mentality. We picked up our bootstraps, we marched forward and said you were not going to take no for an answer. But we really didn’t have an idea. We started to look at resources in the state of Colorado, city of Denver, and at that time, we were knocked on many doors.
We’re here, we’re men. We lost somebody very close to us. We have a lot of the same DNA running through our bodies. We’re high-risk factors. We’re at a high stress job. And people are like, yeah, that’s great. That’s a tough culture, tough stigma. Let us know if you have somebody that’d be willing to work with you. It was to us as like, boy, we were just kind of like, whoa, I guess we are kind of in our own little category of high-risk occupations. Well, then what happened at the time is I just happened to be looking on YouTube and I saw there was a local department of the region down to the south of Denver that had put together this video called Dealing with the Aftermath of Suicide. So, I watched it very captivated, like, wow, this is what we’re trying to get into.
I looked at the credits, and in the credits was Dr. Sally Spencer Thomas. And I looked at, wait a minute here. She’s down the street from us. So, we made contact with her. About three of us went in there to talk to her, and immediately we knew we were in the right hand. She almost was, like, waiting for us. And at that time, she was recognizing this pattern and trend that was going on amongst working agents, specifically in the public safety industry as well as the construction industry. So, what we did at that time was we collaborated with Sally, and we started at a very, very we had a strategy to go and get some focus groups. And so, what we did is we got members from all ranks, probably about ten to 15 members of the Denver fire department of all ranks. We just went into a room, and we just started talking about what we were all going through and what was so glaring and all that. And I knew everybody in this room, and I thought I had a pretty good idea of who they were as men and as women and as firefighters.
The out is I really had no idea what they were going through. And they were raw. They were tough conversations and very real and eye-opening dialogue. And we had felt that the common thread we had all had been we were all stressed. We take home our work, and we knew we had a system that needed more resources. Keep in mind, at the time when I came on the Denver fire department in the year 2000, we had a city policy that had kind of made its way into our department policies. And it basically was, if you’re experiencing a crisis or if you need mental health resources, call this number.
And it was office of employee assistance as a paragraph, probably that big, and every city employee, this was the avenue for resources. So, at the time I thought, well, I don’t want to minimize what anybody in a city employee is going through, but I felt pretty confident that somebody in the library or somebody in parks and rec wasn’t dealing with the same stressors. And that’s me.
I think that’s probably a fair assumption.
And so those are the types of things we knew we had to start having in place in order to have options for our members. Because, you know, the more options you have, the better choices you’re going to make, and there are resources that are better suited for you and your own individual needs. But at that time, our most used resource was our care support team, and that is members of the Democratic department through specialized training. And that is what we had. It was most widely used. We had a department of psychologist. But if you did not feel comfortable with those two resources, then all you had was just the city OOE EAP employee assistance program. So, what we did with that focus group is we looked at a strength and needs assessment. What are the strengths of the fire service? What are the strengths of the Denver fire department? We knew the strengths are we’re a family, we take care of each other. We all have the risk factors that we all can pretty much unspoken language know that, okay, this person, he or she is going through probably the same challenges that I’m going through.
We knew that the strengths are with the firefighter mentality. Give us a task, we’ll take care of it. And the weaknesses we have were lack of resources, lack of trust. Lack of trust meaning that we didn’t feel confident that we could come forward with vulnerability. It was a weakness at the time, and we felt that we didn’t have trust and there would be no labeling the stigma attached. And I want to promote in the fire service well if I come forward and I start talking about the course I’ve taken in my career with dealing with my mental health challenges or concerns, does this impact me where I go on my future? He felt very, very leery about crossing the boundaries of being leaders in the fire service and conveying vulnerability to our peers. And then our peers felt I don’t trust leadership because they’re going to go and use this against me in my career. All these obstacles, we just kind of hashed them all out. And so, we also had done a survey and got to keep in mind a survey in public safety. We probably have 2% to 5% Ops participation. We put this survey and we asked what do I think about mental illness?
What do I think my peer thinks about mental illness? What do I think leadership thinks about mental illness? Can I name five risk factors, somebody who may be experiencing a crisis? Can I list five resources that are available to me and to my peers? We had about a 20% participation rate in the fire service and to many in a company organization, I might not see my calaba. To us it was huge. And we knew at the time that people want to be heard and people are struggling. So, we found out some very alarming data from that. People couldn’t even name resources other than the EAP. And so, with that, we put together a training and said, okay, we’re going to go through this model called the working minds model. We’re going to train the trainer because we knew in the fire service public safety, you bring in an outside speaker to tell you, you know, this is what you’re going through. You automatically get suspicion. You’re going to get the fear of conspiracy. So, we knew in order for it to be effective, it had to be biased for us and we had to put people who’ve actually walked this path.
We’re in positions of leadership and basically say, okay, this is what we’re dealing with. That was the first challenge. The second challenge is we knew we could not go in there and just say, we’re going to talk about mental health and resiliency. Sure, you’re probably going to get callings that day. You’re probably going to get people who have some other thing they want, training they got to take care of. But we knew we couldn’t do that. So right at that time in the fire service, we always are championing physical health. Cancer is high amongst firefighters, heart attacks amongst firefighters and first responders. So, we knew we had to capitalize on that and morph it together, what we call the total wellness. So, let’s talk about what we’re going to take care of our physical health, checkups physicals body composition analysis, propensity for injury, and then let’s start talking about our minds, what’s going on here? As below, as above, so below, that’s kind of our approach. So, we coupled it all together. We called it total wellness and we got great buying. And it was something that we felt that became a model that continued to be used in corporate America.
But it was something, like I said, if I look back on it and it was probably the best thing that we could have done, but there’s was something missing. We had just started to capture data and at that time the data was alarming because like I mentioned before, you think of firefighters, you think of the worst possible thing that could happen is a line of duty death. But when we start talking about working age, men, fire service, the risk factors we all bring in, we’re risktakers by nature. We’re around death all the time. We know if we are in a crisis. We know the mechanisms to take our own life. And we had captured the attention of the data of the people we were presenting to on the organization. But we knew in order to get that knockout punch to really deliver the message. At the time, Dr. Sally says, let’s get about five people in leadership positions. Let’s put together a video. And I want you to talk about moments in your career when you are vulnerable, maybe going through a difficult time, have soft treatment, and you are now triumphant, if you mind.
The ten of us that are going through this, we’re like, we’re very passionate. We know what needs to be done. But all ten of us are like, I don’t know anybody like that, do you? We’re kind of looking around the room. In reality, we were part of our own story. This is part of our own healing. And those of us who were deeply impacted by the suicide of the captain, I look back on it and going through this was part of the best thing we could have done for ourselves because we were able to lay our hearts on the table, be open be vulnerable. So, once we got together, a group of us that basically talked about seeking help, advocating for mental health and resilience building, which is what captured the attention of the members of the department of everything we did. And it was all great. People said, you know what, I never knew that you were going through this, and I admire you so much for your courage and vulnerability and coming forward and that we were able to build on. And I firmly believed, unfortunately, we had a line of duty death about a year and a half later, and this was a firefighter who had fallen through a roof and had lost his life two weeks later.
Well, because we had already started to build those skills of resiliency, crisis intervention, suicide prevention, we were able to teach the entire department on grief and loss. And I firmly would never have been able to broach that topic if we hadn’t already built that trust. And so that is kind of the story in a nutshell on how Denver Fire Department began to morph into championing mental health, coming up with more programs, recognize the value of resource building internally through peer support. Department psychologists were able to come up with a chaplain service for people who are more inclined to have spiritual intervention for mental health. And we were able to collaborate with many, many agencies and suicide prevention organizations and champions. But that’s how it all began.
I think the story is incredibly powerful. A couple of things that really hit home for me was the importance of peer support. And I think the message you shared around without trying to minimize the challenges that other groups may go through. EAP and many organizations that actually remember having the conversation earlier this week is the EP group that you’ve got prepared to address themes. Do they understand what you’re going through saying in the fire department or whether it’s law enforcement without its construction, whatever industry that you’re in because it seems maybe different construction, sometimes you could be away for six weeks or you might be flying to see your family for a day, which could create new stressors and differences. So, I think the peer support piece is something I’m hugely in favor of. I think it’s incredibly important. I love how you adapted things; you made it for the fire department, you adjusted terminology, the total wellness. I think these things are powerful because if it feels like it’s something that’s corporate that’s being pushed, people won’t use. And I think that’s incredibly powerful. And your message around vulnerability, I’ve seen it time and time again when people are comfortable, and leaders are comfortable being vulnerable.
It’s so powerful in terms of getting people to understand.
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That’s a great point, Eric. And this is a story I want to share with you recently. About two weeks ago, I was at a call downtown on an actual suicide of an individual who had taken their life by jumping off of a structure. And so, if that would have happened 1520 years ago, those who were part of that incident had witnessed what had happened, we would lose them because we would never address what they’re feeling now or what they may be feeling next day down the road. So, after everything was mitigated and during that time when I’m getting the company back in service, the first call I made was our purpose support director. And I said, this is what happened. These are the individuals that were on the scene. Please give them a call by the end of the day or tomorrow morning. So, to see that transition and now it’s part of our call process. First incident, I would never have even thought of that 1520 years ago. It was just something that you went home, you took it home with. If you were able to talk with members of your family or of your own internal support network, fantastic.
But if you didn’t have those, then this is carried with you, and it be accumulated through your career.
Right. And I think one of the reasons why I think your story’s powerful and obviously we’re talking mostly about safety. You’re in the public safety space, you do incredibly dangerous workday in and day out. What’s the impact of mental health and not addressing on physical safety of a team member? That because I think the two things are intertwined. We know from a physical safety standpoint, distractions, all sorts of things that can be exacerbated by mental health can have an impact in terms of my choices, my decisions, and how I stay physically safe as well.
Yeah, that’s a great question. So, as I mentioned earlier, we started to recognize the trend and pattern in line of duty death being surpassed by suicides, not just in the fire service, but in public safety. And this has continued to be the trend for almost ten years. I think the only time we had line of duty deaths that were outpacing suicide was during COVID, but we don’t see a drop off in these trends. So, the cumulative effect, if these stressors and risk factors aren’t addressed, obviously the worst-case scenario is the suicide of a member. But you can also attach it to the things that maybe we don’t consider taking it home to your loved ones. Anger, substance use. And that data we had done back in 2014, we started to see the prevalence of substance use. We started to see the prevalence of domestic issues that were going on in the home. We started to see a trend in the number of divorces in the fire service. We started to see the number of disciplines in the fire service. We started to see a number in injuries. So, all the things you can easily attribute to not taking care of yourself.
And when you look at the number of calls that the peer support receives on an annual basis, of course they’re all confidential. But we do look at the types of calls and they all are on family, substance use, anger management, feeling loss of value and a sense of purpose because of injuries. And you have to keep in mind we’re all kind of have our bread to be on the frontline, to be out there riding on the rig, to be a part of a crew. And when you have issues where you’re taking time off of work, whether for recovery, whether it’s mentally or physically, you lose that sense of value being a part of something bigger than yourself, part of a team. So those are all the things that you can attribute to not taking care of yourself. And then we were also seeing trends, and this is something that may be surprising to a few, is our retirees were taking their lives in the past two years. I probably have a handful of retirees who once they were off the department, had taken their lives. It’s a sense of possibly not having a support network of the brothers and sisters of the fire department to bounce things off and maybe not having the support network that they once had.
And I’ve seen this in other industries as well, where there’s a very strong bond connection to the mission, even in the aviation space, pilots as well, risk factors after they retire. All of that also changes the context that you’re operating within. So, is this something you’ve also extended to people that have left the fire department in terms of the peer support or not yet?
No. Well, we’ve brought it to the attention of administration. We brought it to the attention of the union. Of the union. And yes, I believe it’s part of the message that this is what we’ve seen, these are the resources available to you. But we don’t really have to touch points like we would have members who are currently in the department. But I will tell you what we did that I really felt that was a game changer for us is that I really didn’t start talking about mental health until my 15th year on the department. When I came on in the year 2000, if there was anything going on with me internally, I’d dare not say anything. And even if I was to say, hey, I’m having a bad day, I’ll be quiet kid, just move on, get on the rig. So, part of the academy process, when the new recruits come in, they are automatically just within that first 17 weeks of their training are instructed on the importance of self care, are instructed on being able to have the courage to intervene if a member or a colleague. And I use this story, and I’ve used it with the recruits.
So, in the fire service, we’re safety oriented. Everything’s about safety, of course. And when you’re on a call, all of us are responsible and have an obligation to safety. It doesn’t matter if you’re the chief. It doesn’t matter if you are the brand-new firefighter in the city. You come up on a house fire and you see a roof sagging, I ask the most junior person, the least seniority on the department, what would you do? You roll up on this. What would you do? Oh, Chief, you know what? I immediately talked to the incident commander, but there’s a safety issue right there. The roof is saying, we need to pull people off the roof without hesitation, with confidence. I said, okay, you go back to the firehouse, and you happen to walk past your officer’s room, and you see your officer with his head in his hands and he saw me. What are you going to do? They look around, I don’t know. I said, the mindset is we’re safety officers on the fire ground and in the firehouse, if somebody is in danger or there’s a concern or somebody is not themselves, just like reading smoke, we can tell when there’s turbulence.
We should be able to read each other when there’s inner turbulence, have the courage to intervene and have that dialogue. So that’s the mindset that we’re trying to have. Our entry level recruits have those skills and at least the awareness of themselves and their peers that they can start having that conversation and start moving things in that direction early in their career.
Thank you, Manny. That’s very powerful. So, Manny, thank you for sharing all these great ideas and your experience through this. If somebody wants to get in touch with you to explore your journey within Denver Fire, to explore how to leverage some of the insights you’ve had there in the organization, how can they get in touch with you?
Eric, they can contact me through my personal email. And that is [email protected].
Perfect. And I also want to thank you for coming, sharing your story, for the work that you’ve done within Denver Fire and how you brought all the teams together behind this. I think it’s a very encouraging story and a story I wish a lot of others started thinking about. How do I embark on a similar journey and ultimately as well, thank you for your service within Denver Fire and keeping people safe day in and day out. Really appreciate everything you’ve done. Thank you.
Yeah, thanks, sir.
It’s been a pleasure.
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ABOUT THE GUEST
Assistant Chief, Manuel Almaguer, has been a Denver Firefighter for 22 years. Chief Almaguer has served in many roles in the Denver Fire Department. This includes Division Chief of Fire Prevention, Assistant Chief in both Training and Operations. Hazardous Materials Captain, and Lieutenant in Administration. He is a national champion of mental health and resiliency. He has spoken at The White House and Pentagon on Suicide Prevention and Men’s Health.
For more information: [email protected]
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