Collier EMS failed to take employee off shift after hospitalization for knife incident

Amid the growing epidemic of mental health issues and suicides among first responders, a Collier County EMT diagnosed with anxiety issues worked a 24-hour shift in February — one day after a sheriff's deputy detained him under the Baker Act.

In the incident report completed by the Collier County Sheriff's Office, emergency dispatch received a call the morning of Feb. 24 about the EMT threatening to take a knife to himself and having suicidal thoughts.

Time cards obtained through a public records request show the EMT was credited with working a 24-hour shift the following day.

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The Baker Act grants law enforcement, physicians and judges the power to have a person involuntarily detained and evaluated at a mental health facility if he or she is deemed a threat to himself or herself or others. 

Collier County EMS Chief Tabatha Butcher told the Naples Daily News the department was not immediately made aware of the employee's hospitalization and had it known about the incident, it would have taken action. 

"If we had known about that, we would not have had him on duty," Butcher said. "Without knowing and seeking out what's going on in peoples' personal lives, it's really hard for us to know those kind of things. But definitely if we knew, he would not have been on duty."

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Butcher said that once the department learned about the incident, supervisors gave the employee administrative tasks until the department could get a better handle on the situation.

Mental health issues of first responders have become a more pressing issue over the past several years.

Previously:Psychiatrist warned in 2016 that Naples murder suspect was in danger of harming self or others

Research from the Ruderman Family Foundation in 2017 found that the number of verified deaths of firefighters and police officers by suicide outnumbers the number of deaths in the line of service. Those numbers also likely pale in comparison to the real figure. The Firefighter Behavioral Health Alliance estimated that 40% were reported.

Blue H.E.L.P., an organization aiming to reduce mental health stigma and provide awareness to mental health and suicide issues of law enforcement, has verified 578 officer deaths by suicide between Jan. 1, 2016, and July 31, 2019. Thirty-two of those officer deaths were in Florida.

First responders also are more likely to attempt or think about suicide than the general public. Data from 2015 in the Journal of Emergency Medicine found that first responders were 10 times more likely to attempt suicide. 

How is Collier EMS addressing mental health?

The Daily News became aware of the Collier EMS misstep after an incident report completed for another situation months later made mention of the EMT's hospitalization.

When the deputy responded to the February call, the EMT admitted to suffering from anxiety but he had not filled the prescription for medication to treat it, the incident report stated.

The collective bargaining agreement requires EMS employees to inform their supervisors or human resources of arrests but makes no mention of mental health issues or in the most extreme circumstances, a Baker Act. 

More:Police officer kills himself, the 9th NYPD death by suicide this year

One way the department can gain a glimpse into the fitness of an employee is through the medication and treatment disclosure. 

“If they have been under a doctor’s care or if they are taking any medications that may affect their job, they have to provide a note from their doctors that it will or won’t before we allow them to go back to duty,” Butcher said.

However, there are no internal policies establishing self-reporting requirements for mental health issues. 

"We encourage employees if you're having a hard time or there's something bothering you, we have a lot of resources and people you can talk to," Butcher said. "First responders naturally think, 'I can do this. I go out and save lives and help all these people and I don't need help.' Unfortunately, they end up in bad situations because they don't seek that help."

Although the EMT situation represented a misstep, Collier EMS has taken several steps toward addressing the mental health needs of its employees.

Butcher said the department has about 10 employees who have been trained to serve as peer support. These employees are trained to look for signs and symptoms of distress and reach out to an employee if he or she needs it.

The department also has alerts when high-stress situations come up. Once an event occurs, the employees involved are checked out and the department will monitor calls to ensure no deviation in performance, Butcher said.

With education and training about mental health issues a vital component, Butcher said her department is also preparing to roll out a program for stress management.

More:After regular Baker Act committals, treatment program helps Naples teen

Mental and physical health have also been separated historically. Physical injuries on the job have required a report to risk management, but now mental health assistance is being added.

“In addition to normal injuries, we started tracking anytime we’ve provided peer support, sent someone home because they were upset," Butcher said. "The reason we did that is we can say this is the first contact we knew of, and we spoke to this person about this incident because PTSD can take months or years to diagnose.”

How other departments are taking mental health seriously

The state of Florida took the first steps in bringing the conversation about first responder mental health to life last year when it passed a first responder PTSD bill.

The bill expanded benefits for first responders who could not work due to PTSD as well as created educational requirements for mental health awareness, prevention, mitigation and treatment.

"The topic of mental health has been taboo for decades within the fire service especially," North Collier Fire-Rescue District public information officer Heather Mazurkiewicz said. "It is because of this there has been extensive work done to remove the stigma at the local, regional, state and national level."

Mazurkiewicz said North Collier complied with the state mandate before the bill's enactment but also extends coverage to the immediate family members of its employees.

Assistant Chief of Operations John McMahon is also an instructor and oversees the Regional Critical Incident Stress Management and Debriefing Team, which assists North Collier and other departments after a "trigger event."

"We have multiple layers of assistance in place for our members to first, voluntarily seek assistance for any issues they may be experiencing outside of the workplace, and our operating procedures allow for mandating assistance," Mazurkiewicz said.

She said the departments contract with Florida State University for members who require more in-depth treatment, and the the International Association of Firefighters recently opened the Center for Behavioral Health Treatment and Recovery.

The center focuses on providing firefighters with specialized treatment for substance abuse and/or co-occurring disorders like PTSD and depression.

"It is very important to note that stressors can vary based on the individual, their environment outside of the workplace and must be considered on a case-by-case basis," she said.

Although it is a smaller department, Marco Island Fire-Rescue also has added peer support training and has contracts to send employees to get help if they are in need.

More:New Florida law expands PTSD benefits for first responders, but is it enough?

Chief Mike Murphy said his department has four trained members, including one on each shift, who serve as the first line of defense. 

Murphy added that the department teaches its employees about recognition and symptoms of mental health issues, including a separate session for families to learn about indicators and how to get treatment.

Marco Island is also hiring a psychiatrist for its public safety employees as part of the next fiscal year's budget.

While first responders have the propensity to bottle up their stress, Butcher said she's seen more employees starting to break down their walls as the topic of mental health has become more prevalent.

"Take care of yourself," Butcher said. "Make sure you're watching out for each other, and I just want to remind them to not feel like they can't come to talk to somebody.

"We're all human beings because tomorrow, all of our worlds could turn upside down and be completely different from what we know today."

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