Episode 8 - Dr. Ryan Sharma
In this epsiode of the Firehouse Roundtable podcast, Dr. Ryan Sharma, contract psychologist with Oxnard Fire Department and Associate Professor/Director of Clinical Training at Cal Lutheran University, joins the show to talk about his work helping firefighters, discuss firefighter sleep deprivation, and provide practical advice on how firefighters can spot a colleague in need.
Transcript
Peter
Welcome to the Firehouse Roundtable podcast, brought to you by the Ventura Fire Foundation. My name is Peter Mackenzie. I'm one of the hosts. I'm retired fire captain with the city of Ventura Fire Department.
Jason
And I'm Jason Kay. I'm an active fire captain also with the Ventura Fire Department.
Peter
And we are excited that you are going to spend some time with us at the kitchen table learning about Firehouse issues that we're trying to bring awareness to.
Jason
Thanks for joining us as we discuss the issues of being a firefighter both on and off duty and how it affects us.
Peter
Let's get right to it.
Ryan
All right, welcome.
Peter
To another episode of the Firehouse Round Table, one of your hosts, Peter McKenzie. And I'm. Here with Jason Kay. Jason, how are you doing?
Jason
I'm good, Peter. I've been looking forward to this episode a while. Doctor Sharma is coming on today and he was introduced to our fire department a few years ago and I know that he's volunteered to do a bunch of stuff for us. He came to the last. Award ceremony at the Foundation ball and. The more we ask him to. Do the more he just steps up. So I've been. I've been excited.
Peter
For this one to come to come, yeah, we're we're lucky to have him as a resource. I'm gonna hit. Him up. I know that I'm gonna hit him. Up about sleep. Because I I remember sitting in one of his trainings and he he talked. Not the whole. Time but a a significant portion of. Time was on sleep and. I know for me personally it's an issue, so I'm going to try to see what what, what tips and tricks I can extract from him and I know that a lot of the guys have like serious sleep trouble as well. So yeah, I'm excited about our conversation. Glad that he is volunteering his time to come chat with us.
Jason
Let's have therapy for free on Doctor Sharma. Let's do it.
Peter
You know, firefighters love. Free things. Alright, let's get into the show. Doctor Sharma, welcome to the podcast.
Ryan
Hi, thank you for having me.
Peter
Yeah, we're excited about having you come on. I think Jason and I are are both pretty familiar with who you are, but for the sake of our listeners. Why don't you take a? 2nd and just give us. A quick bio for you know. A little bit about yourself and what your expertise is in and all. That good stuff.
Ryan
Yeah, and. Be happy to. So my name is Ryan Charm. I'm a psychologist. Here in Ventura County, my full time work is as a Director of clinical training and associate professor at California Lutheran University. I've been teaching here for almost 12 years. Now teach a. Number of different courses and behavioral therapy and treatments for anxiety disorders. Those are my my clinical specialties for the past. About six or seven years and. Contract with the Oxnard Fire Department to provide direct services for that, so I also. Have a private practice here in in town. It's very small because my full time work here takes up quite a. Bit of time, but I've been working with firefighters and other first responders for quite a while now and have really kind of gotten to know the Oxnard. Well, I've done some informal work as well with Ventura City Fire Department helping them out with a couple of projects and doing some informal. And so I'm just kind of happy to be around and and sort of like, you know help, you know, provide the best of what psychology can for, you know, the betterment. Of firefighters.
Peter
Why don't you go into how how did you bridge the gap from being in your professional world to your your interactions with the fire service? What did that? Look like.
Ryan
Yeah, that's a great question. You know, it's interesting, I think probably back around 2013 or 2014, we actually got a visit from several firefighters here in the community. It was at that time Chief Hamilton was a Battalion Chief. And he came along with several other firefighters and basically came and said, you know what, we're having a problem in fire service. We have more line of duty deaths than we. Have excuse me, we have more suicides. We have line. Of duty deaths. And he was really looking to kind of build out some networking with other psychologists and help professionals to see what they could do as far as getting more services. For firefighters, so to be completely honest, fire service kind of found me. I never really set out to work with first responders. It kind of found me and. As I was learning. Kind of like going to some of their meetings. I went as a community resource and they do their safe talk trainings for suicide awareness and and intervention. I started going to some of the peer support summit, so just kind of listening to the stories that firefighters were telling. And as I was doing that, I realized that there was just a whole nother world that. That I didn't know about and to be completely honest, I also heard a. Lot of other stories. About how firefighters were going to clinicians and they left the first appointment feeling more hopeless than when they had started. And I realized that psychology as a field was really not meeting these needs well. And we were falling short. And so kind of like, as I've been learning more and more about like how we as a profession needed to do better, I kind of have taken it as a as my mission to help improve the training that we do for students and other clinicians so that we can better serve firefighters and their families.
Peter
Yeah, that's awesome. This is a relatively new thing in the fire service anyway. As far as having clinicians who have are culturally competent, I believe is the word they use in looking at your bio, it looks like you have some expertise in OCD, panic disorder, PTSD. So I'm wondering if that's probably along the lines, why Chief Hamilton? Sought you out, but what was different about your therapy or your treatment for, for people who need your services, a regular person versus a firefighter? Like obviously, if you have expertise in PTSD, I think that's a lot of you know there's big component in the fire service related. To that other than like figuring. Out how to navigate the fire service. Is the therapy pretty much the same? Or similar for the trauma that a fireman suffers versus, say, trauma that a, you know, a civilian suffers.
Ryan
I would say overall is the same, but the flavor may be a little different. So for example there may be some specific factors that are relevant to firefighters that may not necessarily be relevant for for other people who experience trauma and it just has to do with the work environment and the nature of the work itself, I'll give you an example like, you know, several times I'll hear firefighters tell stories. About, you know, really nearly calls that they go on and that it may include, you know, like a, a quite a bit of dismemberment. Just sort of like a lot going on and it may not necessarily even be the blood and guts, you know, that is traumatic to them, like it may be a wailing mother, or it may be a hysterical father, or it may be sort of like, you know, other aspects of the situation that they feel they're equipped to handle. It could be it could be the case that some of their equipment doesn't work the way that they want it to, and they feel like they. May have let the the family or the victims down. So like there's some of these unique factors that. Are you know? Very specific to the work of being a firefighter, but you wouldn't necessarily see in other aspects of treating trauma in. The general population.
Jason
That hits home with me a little bit. I know that the ones that are left alive affects me personally more than the actual gruesomeness of the call. One of the things that you said a second ago that I want to hit on again is firefighters would go to their first session and they'd leave more hopeless than when they got there. Can you tell? What regular therapy does for, say, the general population? And then why that same therapy would leave a firefighter feeling more hopeless?
Ryan
Yeah, there's a number of things. I think that that come up and some things that clinicians really need to. Be aware of. For any client who comes to counseling, like, it's really important that they feel understood. It's really important that the clinician really take the time to sit down and really understand their world from their perspective, because if they're not doing that, they're not going to be able to empathize effectively. It's not about assigning assigning any blame or or trying to find fault in the client right? You really want to understand their world so that you can kind of see it from their eyes and kind of help them. Helped them through it and so as an example of some things that clinicians may sort of miss when working with firefighters, for example, like let's say, perhaps like subtly. Or implicitly judging the use of humor, I know like firefighters often use gallows humor to kind of cope with the difficulties of the job, and that's pretty natural and normal thing. To do. Clinicians may not necessarily understand that if they don't understand that and they judge the client, they're not going to feel safe in opening up to the clinician. Clinicians need to understand the. Nature of the the work schedule itself, I mean the schedule itself can provide a considerable amount of stress. On a family. Considering that you know you could be on a 72 or a 120, or you could get, you know, assigned to a strike team and be out for a long period of time and like that poses a lot of challenges. And #1 like. Being able to call parents, it poses a lot of challenges and sort of like missing important milestones or, you know, family events or holidays. The transitioning between work and home is also a challenge. Like if clinicians don't understand like you know that you you're going from like a very high pace intense environment to 1 where you back with your family and you're going to want to, you know plan. The next birthday party that takes some. And so I think clinicians are kind of missing some of these unique challenges here and if they're missing them and they're not sort of communicating with the client that, hey, I I recognize these as parts of the stressors that you having to deal with and clients are going to feel understood and that's why they may end up leaving some of these clinicians feel like they're not. They're not being understood and no one. No one is there to, really.
Jason
Help them. Yeah, that makes a ton of sense. And that also makes sense. It seems like a little bit like this is a passion project for you that you came to the fire service and now? I think it. That the gist I get from you is that you really enjoy this side of the job and it I think it kind of makes your brain turn on a little bit from what I've seen and I know you've come and offered to have dinner with the guys at the fire stations and we've all taken you up on that. That's been cool, and I know you've also actually read some of the ifsta manuals and the books to kind. Of get the. Terminology down and and what we're. You know when somebody comes into your office and we say vernacular from the fire service, we look at you and you go, oh, yeah, I got that one. We're good. So I think that's really cool and. And I I could see that you really. Enjoy this part of.
Ryan
Yeah, that's absolutely true. I mean, there's some aspects of right that's kind of goes back to the culture piece it's like. How important meals are? I know how important the kitchen table is. I know that I'm not going to sit at the. Kitchen table until I'm invited to. One last thing is I hear a lot too, like in all of my readings and like I really tried to do a lot to really understand fire service from a number. Of different perspectives. And one thing that comes up over and over again is that firefighters invariably say that, you know, being a firefighter is the best job in the world. As difficult as it is. And as challenging as it can be. They all say that it's it's the best occupation and I always rebut that. And I say, well, actually, to be honest with you, caring for firefighters. Is the best job in the world.
Peter
What was something about the culture when you were on your journey to learn? You know, how this world works that you didn't expect, or that the average listener would never assume? Or, yeah, give us some things about it. When you did your research and we're trying to. Figure out how this fire service works, that you kind of threw your curveball.
Ryan
Probably 2 that come to mind, if that's alright one. That the job changes. The way you see the world that's come up over and over again like it's I hear lots of stories about how like. You don't look. At the beach the same way when you're a firefighter and you've you've had to do like ocean rescue or you don't look at a house the same way like a historic house looks like it's a pilot tender, you know, versus just being a. An interesting looking out. So there's there's aspects of sort of like how it because being a firefighter is so unlike other professions that it necessarily shapes how you see the world. I think that's also true for law enforcement. The second thing is that I don't think you can underestimate the role of trust in fire service. I think that, you know, one of the probably my most humbling lesson. Was knowing that I can't really kind of come in to this culture and talk like I know. What's best for? Everyone, I don't think that works well and I. I think a. Lot of clinicians fall into that trap. They fall into the trap of thinking that they've got all of the the book knowledge about mental health and and behavioral treatments for, you know, certain disorders. They just assume that thing go and start applying it to everyone and we have to remember that fire service has been around longer than psychology has. And so a lot of what I had to do or that I was sort of very sensitive. With that, I cannot assume that I'm going to have anyone's trust if they come into my office, even as a even if a firefighter was referred to me by another firefighter, I cannot just assume. That I'm going. To have that. I'm going to have their trust. I know that that means something very specific in fire service, likely solidified by the fact that you're all inheriting. Situations routinely where you're counting on each other. To keep each other safe and and there's a there's a bond that that creates that can't be replicated. So I also know that, you know, if I if I screw up like I also. Risk kind of like, you know, sacrificing the trust that I've built over time. It's like there's a responsibility and a loyalty that I've learned to develop over time, that is. Sort of very sacred.
Peter
In this work. That's interesting. That last answer wasn't what I expected you to say, but very true. I mean, it's true. Like it, it's definitely like a I don't wanna say like a club, but I mean non firefighters don't understand what some of these things are that we do and it's hard to explain those things as well because there's so much wrapped up. Into it, it's. A feeling it's a situation it's it's, it's not really describable sometimes. But yeah, interesting question for you and it kind of leads right into. What you were saying? What are the things that you are seeing in the firefighters that you work with and interactions that you have that kind of are blind spots? Like what can firefighters? Due to. You know, combat some of the things that cause PTSD. I mean, what are you seeing that if you, you could wave your magic wand and you know and. All of a. Sudden all firefighters did XYZ that you know you know 50% of these issues would go away. Like what? What are the things you see in your professional world? Obviously not specifics with names and dates and things. But just in general terms.
Ryan
Gosh, the first thing that comes to mind. When I think about any type of anxiety disorder and PTSD was historically classified as an anxiety disorder, and recently it's kind of been set, you know, set aside because it's got some unique teachers, but it. Does follow the same kind of pattern? And what we know about anxiety disorders is that they're perpetuated and maintained by avoidance. And so I mean typically like if you think about. You know how you we typically understand PTSD, is that the there's a memory that may be very anxiety provoking, could be a memory of a past call. It could be a memory of the situation, or it could be a collection of memories, and sometimes what happens is that our brains begin to interact. Those memories is dangerous. Even though memories send in them themselves are not are not dangerous, they they can be unpleasant, or they may be accompanied by unpleasant sensations. But the memories are not dangerous. And So what happens is that people who develop sort of like longer term problems with PTSD will be into, like, avoid anything that's associated with the memory. Because it's interpreted as something that they don't want to get close to. So as an example. Not wanting to talk about it, avoiding places that remind them of the memory, avoiding reading materials or or anything else that reminds them of the memory or wanting to sort of like, you know, avoid through alcohol or or other substances and. Usually what happens. Is that it? Sort of perpetuates the belief that the memory. Itself is dangerous, and so one of the things that I really want firefighters to understand is that, you know, you don't have to avoid and as unpleasant as it can be, like we have methods and strategies kind of help. With those memories and the basic strategy, the basic strategy is that, you know, we're not going to be able to erase the memory. You can't. You can't make the memory itself go away, but you can take the wind out of the sails. You can make it so the memory. Exists without necessarily. Having the strong emotional reaction or the strong physiological reaction. To the memory and it just happens to be through approach versus avoidance. So we kind of impose the memory and a safe place where you can kind of see it. For what it is. And like over time, like the memory. Something either. Yeah, but it's not going to have the same kind of punch. That it did before. And so I think you know, overall I think you. Know kind of. Like having a an approach attitude can be helpful in, you know kind of. Dealing with some. Of these issues.
Peter
What do you do to take the the wind out of the sales of some of those memories? Like what are?
Ryan
The strategies like how does that work? What does that look like? Broadly speaking, it really looks like kind of moving towards instead of moving away. And what that could mean is doing things like writing or journaling about the memories or about events. Talking about it with the clinician, closing your eyes to kind of reimagining being there so you can kind of see it for what it is and what you're doing as your approach is that you realize that it's not. It's no longer dangerous because, like, maybe you're going to get an emotional reaction there in the session, or they're in the activity, whatever you're doing, but the reaction itself is just the reaction. It's not necessarily indicating any type of oncoming danger, and I I do have to say this is one thing that I really like. About working with firefighters, I mean, aside from the fact that they have great sense of. That's always kind of fun. To do like I always like to use humor in my sessions and I you know, just because I'm a doctor. Doesn't mean I'm not a a. Pretty normal person, I think. But the other thing is, is that firefighters already have skills in being able to activate behavior even while they're feeling intense sensations. It's invariable. Like I I can ask any firefighter who's had to, you know, go up onto a roof and cut a hole above a a structure fire. You know, what do you do? Do you sit at the bottom of the ladder and you wait until you're feeling calm before you go up? No they don't. I mean, it's going to be terrifying, probably first couple of times, but they're going to go up even while they're feeling terrified. So like, they're they already have this inherent. Skill in doing things very directly and very solution focused and that actually can work really well in therapy because there may be opportunities to challenge. Firefighters in some of these assumptions and and usually when I do, they're kind of they're all ready to go at it head on which which is kind of fun.
Peter
That, that's funny. You bring that up because that place back into trust, right? So like, if firefighters are great at getting things done. Like you give a group of firefighters an objective. Like, hey, that you need to take that wall down. It needs to be gone. They're going to. Do it like no questions asked. It's going to happen. But it's the same applies and I've experienced this in my personal life is. If I am in either employing someone or paying, you know someone a professional or something and and I trust that person that they know something more than I know and I'm trying to, you know, learn from whatever they have, if I trust them and they and they show. Me the way like. I'll put my head down. I'll do it. Whether it's like the gym, fitness, nutrition, the the doctor telling you. To get your blood pressure, whatever it is like, we take action, which I think is. An attribute that. Is pretty universal in the fire service. Like once we're we know the program and we know the plan like that's it. We're headed that direction. And so I want to go back to one thing you said before and then I'm going to get, I'm going to stop talking and let Jason talk. But the last couple of years of my career, I worked at Station 4, which is out on the East End of Ventura and I live in the same sector. And I thought that was great because that was close to home. If I needed to swing by the House, not a big deal. If the family wanted to come over. That's great. Now that I've been gone for a year and a half going on 2 years, I don't think that was such a good thing for me because literally when I drive to work now, I literally take the same Rd. every time. And it's there's two calls that I drive by every single day, twice a day, and they don't. I mean it. It is what it is. But and I don't think about it, every time I drive by, but they're definitely there and they're clear as day. And I got to thinking like. Maybe there is something to be living, not living in the area where you work because you know Jason lives out in the. Santa Clarita area. He doesn't have those, I don't think. Anyway, those those connections to all the street corners and the houses and and driving by all these terrible things. But the guys who live in town, they absolutely do. And sometimes I think. It's a it's a privilege to have that. Separation cause it definitely comes up and I think from the. This stuff gets worse over time, especially after guys retire and and whatnot, but definitely resonated with me when you were talking about locations and. Associations with memories.
Jason
Yeah, I agree with you, Pete. It's funny. I was in Ventura with my family when we drive through. To go either to a function for the city, or if we're going. To dinner or something out there and. I'll talk about how we get places by calls that have come up and the longer I've been in Ventura, it's like I could talk about almost any St. in Ventura and a call we've been on that's horrible or even not a big call, but. That's how we. Know where we are and where we're headed, and we'll get somewhere and. I'll look at my wife and they'll be. Like she's been quiet for a while now because she's just hearing. Me talk about. Terrible things for the last 10 minutes. She's like, I think we're good. We don't need to keep going over all. This stuff. Yeah, I agree with you, it's.
Ryan
Yeah, there's a topography of the city that is sort of just inherent in your work, especially when you've been in a sector for so long that you just kind of. Get to know every nook and cranny of it, and it's true. Like I I hear it from firefighters at at Oxnard, it's like many of them will say, you know, when I retire, I'm probably not gonna spend a lot of time in. I'm going to try not to go. To upstart as, as as. Much, right? It's just going to be riddled there. There's going to be some associations there. I've heard it the other way, though too. I've heard other firefighters who've left Oxnard and gone to the fire departments in their home communities and sometimes for the the sense of wanting to be A to help in your own community. Kind of being there for your neighbors, and I think there's sort of like. That again like. That spirit of of helping. And like of being of service. That's so strong with firefighters. You know that can also pull people that want to be live closer to where they work.
Jason
One of the things. We talked about in one of the previous shows was when your family needs you when you're at work and there's a big there's a big, big call going on that you have to be at and you can't help your own family and your wife's calling you for some assistance, you know, big or small, and you just can't be there for that. So there's definitely some value for working in in close to your house and. Knowing what's. Going on there too. I want to ask you about some as a somebody who's in the station with with other firefighters and as a captain especially, I would love. To have some. Some things that you could recommend that? We look out for for each other. So when it comes to high stress levels, when it comes to problems at home, when. It comes to. Suicide awareness, all that stuff. I'd love to hear. Maybe some some symptoms that we can lookout for and then recommend our peer support team and then I know they usually are just going to recommend going to professional like yourself.
Ryan
I'd be happy to share some things. And I don't want this to sound like it's that's authoritative or like I've got the answers some, but there are a couple of things that sometimes stand. Out to me. Let me back up for a second and just say that when I first meet with the firefighter, we're kind of going through like a history. I'm trying to get an idea of of, you know, where their stress is. I usually think of the stress that a firefighter has kind of like falling into 3 broad categories, and this is mostly work related, work related stress. I'm not talking about any family or external issues, but for work I'm usually thinking in three category. One is administrative difficulties like these are like the rules and regulations you have to follow. Like you know the the battalion chiefs way of doing things and just like policies and procedures and just like the natural stress that sometimes comes along with having to follow rules that don't. Make a lot of sense. The second one is the the aspects of the job itself. It could be like the. Calls that you. Go on the frequency of the calls the the lack of resources, the lack of functioning equipment, those kinds of things. The third category. Is the sort of intra departmental dynamics that happen between firefighters and like in the work environment? So like, I know that it can be very, you know, depending on the size of your department, it could feel very clicking. There could be sort of coalitions or maybe certain in groups and out groups there. Sort of. You know, between shift fighting, that happens. It kind of like adds another level of stress. And sometimes I think about that, that type of stress is an avoidable stress. The job itself is already hard enough, like there's probably some aspects of like kind of like working together as sort of like part of the same department. That could probably be. Just make life easier for a lot. People now I say that of course not having the work because I also know that you have to live with each other. And so like you, you. Can't raise that back. You know, there's, there's just gonna be things that get on your nerves, just like you know, with within your own families like that just happens to. It doesn't mean that you. Love each other any less, but it's. It's it's going to. It's going to bubble up to the surface, so I I see that recognizing that. But I'm also like wondering like you know what, maybe some ways to just kind of increase morale, broadly speaking, by simply addressing some of the relationship issues and and and basic relationship skills to maybe resolve some of those difficulties and that's a big ask because it it it comes with a lot of different layers and I I know that there's a lot of other factors that are. Involved in that so. But that's something that I've always just. Kind of found interesting.
Jason
Yeah, that's that's cool. That's one of the reasons that we try to have. Events and get people. There, and whether it's just we have one coming. Up to go to to. Made W just come hang out with. The guys for a night. That's always a a good team building type thing.
Peter
You know, inevitably, a lot of firefighters are type A personalities in and and then you put them in a living environment with confined walls of the fire station, and then then, then make them work hard and don't let them sleep and don't let them eat like it's inevitable like. There's going to be. The issues for sure, but definitely I mean obviously if we. Could all get. Along better and address address the things that are easily addressed easily solvable right like. Getting along with each other or. Understanding somebody else's perspective that that seems like a a no brainer for sure.
Ryan
Hey, this is Joe Booth from the Ventura Fire Foundation. To learn more about the foundation and our programs, visit our website, www.venturafirefoundation.org, 100% of our funding comes from generous donors. If you like what we're doing. I encourage you to become a donor. It's very easy. Just go to our. Website Again, that's Ventura firefoundation.org and click the red donate button at the top. Whether it's $5 or 5000. Hours every donation helps ensure local firefighters thrive.
Peter
I I kind of want to switch gears on you a little bit. I remember sitting in a in a class you put on at the at at the Ventura. Fire department and we talked. About sleep quite a bit. And that is something that I. Know a lot of firefighters struggle with. Myself included. I mean, I still have. Sleep issues. How does sleep factor into mental health and like what are some things that, that, that the guys can? Do to to solve some of those issues. Or or make them.
Ryan
Better, and that that's a that's a great question. I absolutely agree. I think poop is pretty cornerstone to a lot of just what we do. I mean it's you're not going to be able to function effectively in your life whether you're at work or at home. If you're not firing and also. And sleep is just so essential to like our restoration during the night and kind of like, you know, cleaning out some of the chemicals in our brains so we can kind of feel refreshed. This is real issue to date. I think there is 2 broad approaches to how we understand sleep and how we would help people with sleeping problems one of the. Approaches works. You know very well, but is not well suited to firefighter schedules for the simple fact. Part of the treatment is kind of training good sleep behaviors and you can't do that if you're required to wake up every. Hour and a half to. Put out a fire at the river bottom. One area of research that has a lot of really good support for doing better with sleep is called cognitive behavioral therapy for insomnia, and it's includes several different parts. And there's some of those components that actually could be used. People for firefighters and some of them don't fit very well just by the like I mentioned because. Of the. Nature of the. Work the parts that would be useful are. Called sleep hygiene and sleep hygiene. Just have to do with like really good habits around preparing for good restful sleep. These include things like not drinking coffee past a certain time of day, maybe cutting down on naps, especially if you're having a hard time falling asleep. Then you probably shouldn't be taking naps during the day. Keeping a consistent wake time. Like if there's one thing that you could do if there's only one strategy that you could do, the one that's actually most effective is keeping a regular waking time. Regardless of whether or not you're working, and regardless of how much sleep you actually got the night before, so if you have 6:00 AM as the time that you wake up, then you always get up. At 6:00 AM and that's more important. Believe it or not, then like the the going to bed time is the waking time and part of the reason is because you build. Sleep capacity throughout. The day. And if you're keeping these. Consistent waking time then. You're also making consistent your your sleep capacity build up throughout the day. Apart from that, the other approach that actually could work pretty well for firefighters, and I'll have to you have to excuse me for being a little geeky here for a minute, but part of one of the well established evidence based treatments that we have in psychology is built on an acceptance model and what that means is that sometimes we think about our. Emotions or our thoughts as the problem. Like sometimes you say oh, I'm feeling this way, like I shouldn't be feeling this way. I need to be feeling better. I need and so sometimes there's like this this conflict that we have with ourselves based on how. Feel, and we usually see that as sort of like a secondary secondary level of suffering. It's like when we're not accepting like how we're feeling, then we have like this another layer of suffering and this relates back to the sleep approach because sometimes people with insomnia get really frustrated with having insomnia. So they're going to be awake at the night, and then they're laying in bed and they're just angry. About the fact that they're awake and what that usually does is it just prolongs how you know, how awake they are and and how little sleep they're gonna get cause. It's very difficult. To to to sleep when you're that and. And so So what I mean by the acceptance based approach with insomnia is imagine what it might be like if you just accepted insomnia as a factor of your life and if you accepted it and you actually relax and just said, OK, this is this is how it is and this is what I'm going to deal with. It actually makes it easier to fall asleep or to. Kind of find restful moments. To rejuvenate, even if it's not. On a regular sleep schedule. At least you don't have that added burden of feeling like you have to. You have to be sleeping, because that's often counterproductive. And so I don't know if I answered your question well and I know I got a little nerdy there for a second, but it it kind of like our approach. To like how we feel about the actual symptom.
Peter
That's the first time I've heard that the latter about accepting. It and just. Kind of being OK with it and. Then that might in itself help that I could see it. Yeah, it's interesting. Yeah, I know. For me, it's been a long road. Just after I left the fire department to kind of normalize my sleep again. And the problem with working at the fire department. Is exactly what you said. Try a morning routine try in evening routine. Try any of the tricks that traditionally are out there to improve sleep. It's impossible, and nowhere in any of the literature do they say shine a bright red light in your. Face and jump out of bed. Immediately like that doesn't work right, and that's what was so incredibly difficult when I was at the fire department is getting. Into those routines. The second I left, I was like. All right, I'm I'm doing. All the routines I can ever imagine, and I went too far the other way. And then then kind of? Killed and trying to bite off too much, but it's slowly getting better.
Jason
You just slept all day.
Peter
Yeah, yeah. I wish. It's slowly getting better, but it's definitely a work in progress. I had a just a regular check up. With my doctor and I. Hey, I said the same, you know, trouble sleeping all this and they go well. How long did you have sleep? Trouble and I go uh. You know over 25 of the whole time I was in EMS and she's like, how long have you been gone? And I go, oh, about a year and she's like. Good luck with that. They say. I don't know if she was speaking with authority, but she's like it takes probably about half the time that you had the problem for it to resolve itself. And I was like, oh, great. So I'll be. Dead by the time I figured fix this, but anyway.
Ryan
That sounds about.
Jason
Right. Yeah, you know talking. About getting back in some kind of regular habit too, I notice that the days off are so important in between shifts because you can build up some kind of regularity of sleep. And it's funny to hear. Guys who say in order to get rested and feel good again, sometimes it takes a full seven days off. After you know a 72 that's really tough or even a 96, they say you're regular four day. You never really even get back into the routine of feeling good again and like you're rested and they. Need a week? Do you have any idea statistic wise at how how many days it takes or how many hours it takes to get back to normal or or is? It never back to normal.
Ryan
Oh, great question. I wish I knew. Like what the standard was and that and whether or not that actually differs with firefighters. I'm not familiar with that research, but I think it would be really fascinating. But what you say is actually pretty consistent with what I also hear from other firefighters. A lot of firefighters will say, well, it takes me at least one day, two days, sometimes three days, to feel like I'm. I'm back in this group and usually by that time they have to go back to shift the schedule itself just adds this layer of stress that requires an adaptation that's not. Required for people in other professions.
Jason
They have one of the things I've said on the show in the past is I don't. I've decided to not make any important decisions on my first day off because it never it never is a good decision that I end up making on the 1st. They often my family knows also, you know the 1st. Day off. Sometimes have tiptoes around. Dad, that's just the way it goes and. I need to keep myself in check at the same time. One of the things I deal with personally, and it seems exacerbated at work too, is I'll feel like I'm doing OK. And then when I go to bed and this is not a firefighter. Specific thing, all my thoughts turn on right? I hear that. All the time. Specifically with firefighting, I will have a list of. Things that are undone. And then as soon as I lay down, those just are a recording in my head of you should probably just do this. You should probably get up and do that and you know, I kind of have to train myself to turn all those thoughts off. Do you have anything specific when it comes to that, I'm sure. You've heard that stuff in the past.
Ryan
Well, I mean, kind of consistent with the acceptance based model that I was talking. About a little. Bit ago, you know on the one hand like our our minds are like that our minds. Are like these noise machines. It's like constant noise machine that's always on and it's always feeding us material and sometimes you know people get frustrated with their minds for doing what minds do. Same kind of thing with insomnia. They get frustrated with, you know, the fact that they're having these thoughts and and I get that they're uncomfortable and and it's irritating. You're trying to get to sleep, but. You know one strategy, there's a a term that we have which is called cognitive diffusion and cognitive diffusion is kind of like looking at thoughts for what they. Are instead of what they represent. And we can kind of just see thoughts as thoughts and kind of detach from them and just allow them to be there right again accepting which means kind of like you know not feeling compelled to have to push against them. And if you don't have to push against them, then now you're, you know, you're freer to kind of, you know, direct your attention to where you wanted to go. And so like in some of those and I know that's kind of like when I see that it's sounds like you know. Easier said than done and and it's absolutely true. It's easier said than done because it requires practice, but that is the essential skill. Is like, you know, the the fact that you're not, the fact that you're having those thoughts in and of themselves may not necessarily be the problem. Problem may be that we're spending a lot of time trying not to have. If you've ever tried. To you know. Control your mind by like not thinking about chocolate cake for example. And you know how that's going to go.
Jason
Yeah, I feel like most things in therapy are easier said than done. They take a. Lot of practice. If you had a if you. Had a matrix. Be able to just plug it into our heads, that'd. Be perfect.
Peter
Yeah, in in our world, at the Ventura Fire Foundation, we constantly have to. Evaluate. You know what? Do our resources allow us to do in the terms of charitable work for the the Community that we serve, which obviously is firefighters and their families? It would be awesome if we had you know, multi $1,000,000 budgets and could do whatever the heck we wanted to help, but that's clearly not the case. So sometimes we struggle with directing our funds to like the highest and best use for what we're trying to do, and that is easier said than done. Similar to what we. Were talking about before. But in your experience, in in your interaction with firefighters and their families and your knowledge of the mental health issues and, you know, treatments and all the things that you do in our world. What are like? Some areas that are maybe underserved, that need some awareness and or you know resources thrown at them to make to make a difference like I know that's a that's a hard question I assume, but what are you seeing? Out there that. Could help organizations like ours get clarity on you know how to be better? At what we do, yeah.
Ryan
That's a really great question and I think it's an important question to ask and and to think. About and consider. Now of course. Like I'm not as familiar or knowledgeable. About like all. Of the different, you know, factors and and domains within fire service that need funding, but like within mental health, like if you're asking about kind of like if I were to. If I could sort of, you know, plan kind of like a targeted intervention that's related to firefighter behavioral health, that may have strong dividends. I think it does, and hopefully I'm not just answering this way because I'm biased, but I think it does have to do with kind of access to to early intervention because I think a lot of the issues that I end up. Dealing with, they're not serious. Issues but they. Are often issues that develop into serious issues if if sort of left. Intended and I think you know, we kind of have a problem with our healthcare system right now. Mental health care is not easy to access. Using insurance is not easy, and if you do, you're not likely going to get to a clinician who may understand fire service for the whole purpose. While I'm doing this this work, you know there's very easy things that therapy can help with. And sometimes people ask me, like, do you feel like everyone needs therapy? And I say no, I don't think. Everyone needs therapy, but. I do believe everyone can benefit from there. And it doesn't have to be anything major. It doesn't have to be anything sort of life shaking, even if there's, like, aspects of relationships that you want to work with. Like if you can. Get those even. Out, you know, relationships are a protective factor against a lot of mental health issues, including suicide. And so, like, if you have strong relationships around you, like that's a protective factor that can help. Three, you through? A lot of very stressful times and so sometimes it's just a matter of, you know, kind of like doing a size up right, like using a metaphor or doing the size of your life every once in a while and sit with a clinician and just kind of take a look like, how am I doing with my, my spirituality or my religion? How am I doing with my relationships? How am I doing with? My my health routine. And my physical health. How am I doing with, you know, my job and my occupation? And and you know, how am I doing in my in my romantic relationships? And so sometimes I think, you know, having another person to kind of talk through and just help do that assessment can really go a long way. And it doesn't have to be long or extended. Is something that you can kind of make sort of. A maintenance issue.
Peter
So it's it's. More preventative maintenance catch problems early and and then how would you? How would you logistically? If you could orchestrate that, what does that look like?
Ryan
There are a number of apartments that are making behavioral health checkups mandatory, or at least part of like what they offer, and it's. Like a once. A year meeting, right. And I've developed one for for Oxnard fire. We haven't launched it, but purely for logistical reasons. But essentially it would be, you know, they could take a lot of different forms, so it may be just like taking a couple of questionnaires or a couple of screening instruments having 1/2 hour meeting with clinician just kind of like talk about how things are going on, just kind of get a get a reading on like how you're doing and if there's any theories that you want to work on and it could be as simple as that. I mean you go every year and you get a physical and you get your cholesterol taken. Right. Every year it's like useful to kind of track that over time like, gosh. My cholesterol has been going up, you know. Routinely, like, maybe it's time to do something about that. You can get the same kind of data. From a from a mental health clinician.
Jason
So is the once a month, is the once. A month thing. Kind of a self evaluation or is that something that you're planning on going over after you after you get that? Back from them.
Ryan
Once a year.
Jason
Once a year, OK.
Ryan
So like if you like an annual type check up, it could be at the discretion of the firefighter if they want to continue or if they want to work on anything and then they do. We have services that are available to do so, but it's never forced on anyone. The check up is is kind of like an opportunity to kind of, you know, get a third person's perspective on things and if it's something that you really wanted to, we could have something to provide for you. But by no means. Would I ever make counseling or therapy mandatory because it doesn't have to be counseling or therapy? Like maybe, you know, increasing your participation at Church is something that would be really. Helpful for you. Maybe it's a weekend retreat with your with your partner. Like that could also be, you know, completely acceptable. Everyone's going to have their own way. It doesn't have to be. This way the I think the the function though of the meeting would be just kind of open up that conversation. And have the opportunity to kind of do that that evaluation, but it would include to answer your question, Captain K, it would include a a type of sort of self evaluation and and self-assessment.
Peter
Actually like that. So I mean that that is something that's attainable that you know we could potentially facilitate like it's not that cost prohibitive. I mean especially if you you know you come into some sort of relationship. Contractual relationship with someone like as your like yourself or something along those lines, but that's actually good. It's like, hey, just open the conversation up and and normalize it and make it OK and no different than, you know, a medical doctor appointment.
Jason
So I like that Speaking of Oxnard fire, what is it that as a contracted physician with them or psychologist, what is it that you? Provide for them.
Ryan
So there's kind of two branches of my contract. One is to support the peer support team and and really they're the front line. I really like the peer support model as it's developed within fire service. I think it's a a great model. Oxnard Fire does not prefer the critical incident debriefing model. The peer support model works really well. And I think it's really great. And so really my relationship with them is is just an extension of the peer support. So they're kind of the frontline, if there's, you know, issues going on or if they see firefighters, you know around them, if they think might be struggling, they'll check. And it's confidential, there's, you know, recent laws that kind of protected the role of peer support individuals within within these departments. So they're the. Frontline and then if for whatever reason there may be an issue with the firefighter that's kind of beyond their competence or beyond their scope or like maybe it's just like a little bit sort of like more than. What they know? What to do with? They can refer them to me. And I'm contracted to provide direct therapy services to these sworn personnel as well as the office. No. And do you have?
Jason
Financial contracts with them as well. Or does the? Individual pay or how does that work?
Ryan
So my arrangement actually with Oxnard is that the city of Oxnard pays me. So I'm directly contract with the city of Oxnard. But I'm very pleased that Chief Hamilton was very deliberate when he set up the contract. He wanted to make sure that in order for this service to be used, he wanted the firefighters to be able to trust it. And so the contract makes it very clear that neither the city nor the department have any access to my records. Everything is built anonymously and there's no sort of connection at all. To like their work performance or I don't do any type of evaluation for the city. This is all just to support them and their own well-being and to get them to be the best firefighters possible.
Jason
That's really neat, yeah.
Peter
Yeah, that's awesome because I think, yeah, most of most of the time they're worried that is this going to be a work comp. Least against me. Am I going to get fired because I'm whatever these issues are? So that's pretty insightful. Yeah, yeah, I like Chief Hamilton. He's good at what he does. We gotta get him on the podcast cause he he I think has a lot to contribute and and in our area has contributed a ton to this whole conversation.
Jason
Yeah, he's really on the leading edge of this. Stuff too, I think you. Presented up north at A at a a firefighter event is that. Can you tell me about that a little bit?
Ryan
Yeah, absolutely. So Chief Hamilton put together a panel on behavioral health and and fire departments for the. The subset of the League of Cities which I guess would it be the California Fire Chiefs Association? So like we presented Dr. Ogden who is a psychologist with the Responder Wellness Center down in Orange County. And then there was also I'm blanking on his name. I I should have. Had it in front of me. Kevin was his first name, but he was also prevented on some of the statewide initiatives that they're trying to roll out in supporting firefighters and and be. Health across the state. With that, I think through Cal Fire. But in any case it was a nice opportunity to kind of talk about. Like you know, if you. Want to kind of build in behavioral health services? There's a couple of different models to use. One model is to. Kind of have your dedicated clinician and so that's what I was speaking about. So that so my contribution was kind of talking about. You. What's it? Like to have a clinician that's kind of. Like just knows your your department. And I think there's some benefits to that. I mean, like I'm on the workforce emails that for Oxnard. So like I know. And the engineer rank is getting pinched for mandates. I know when there's major incidents. I know when there's just kind of like, you know, dynamics or changes within the department like I it gives me some situational awareness. The other benefit of just kind of being dedicated to a department is that I can show up to the station. Then I think the firefighters can kind of just get to know me. Just in a more informal manner. So like if for whatever reason like a a peer-to-peer support personnel on three first someone to come talk to me for some other issues like they don't have to think about, you know, some weirdo often in some office somewhere that like oh, if I have a problem I can go see that guy right. Like I've I've met him before. And so like there's there's some ways that I think that also. And helps break down some of the stigma and the barriers crew firefighters actually seeking treatment.
Jason
Yeah, you're building that trust up again. Right. Like you talked about earlier, absolutely. If you can answer. This what percentage would you say use your services that you? Offer of firefighters.
Ryan
Yeah, I actually can, because I calculate that somewhat routinely, but I haven't recently the last time that I calculated the percentage of the Oxnard Fire Department that has come to see me, it's roughly around 20%. So about one in five and not necessarily you know, for long periods of time sometimes. Just want to come and they want to check in. So let's say hi or just want to like. To chat about some things that are going on. So I mean just the nature of my relationship with the Oxnard Fire Department doesn't mean that I have to kind of take on clients for long periods of time like I'm just around. And they can kind of check in and check out as they need to.
Jason
Is that just any issue that? They have or do you try? To tailor it specifically towards. Work PTSD issues, issues like that, or if it's a relational issue or a home. Issue you you tackle all that stuff with them.
Ryan
Absolutely anything that may be affecting them, anything that I may have so. Some contribution for or expertise in. I don't pose that I have like the answers to everything, or that I'm necessarily helpful for everything, but I'm certainly open to hearing whatever that they need. And if there's something that they need that I can't provide, I'm always happy to. Get them connected somewhere.
Peter
Well, Doctor Sharma, it's been great having you on. If there's any firefighters listening that would like to reach out to you. The best way for them to do that.
Ryan
I mean, feel free to shoot me an e-mail or text. I'm happy to always consult. So like even something that you just wanted to talk through or just give an opinion on, I'm always happy to set up a phone conversation and talk about that. And I don't charge. For those, those are pro bono. My biggest mission is just to make sure that people get the help that they need. So if I can get them connected somewhere, if I can provide some referrals or or even just to some assurance that they're OK, or that they're going to be OK, I'm happy to do.
Peter
We'll we'll make sure we put your contact info or or the contact if you. Want to put out in the. Show notes so that make. It as easy as we can. I know some of. The struggle sometimes for our guys is. When they finally raise their hand and go OK, I need some help here. Then it starts. This whole other bureaucratic red tape nonsense that a lot of them just I've heard it over and over again. They go. Forget it. It's too hard. It's just forget it. Like I'm trying to get help, not create more problems. For myself. But. So the easier I think that the the more we reduce. When it comes to get reaching out for help, the better, and that's one of the one of the things that the foundation is trying to improve, which it's not an easy thing to just wave your wanted fix. But I love the fact that. You said. You you're happy to have a conversation pro bono and just help navigate some of that stuff because it it is intimidating. For sure for people. Well, thank you very much. Appreciate your time. It was a great conversation. I applaud the efforts you're making in in our industry. The fire service is definitely unique. We need more people like you, but we are definitely lucky to have you in our area. But so thanks for coming on up, Jason. Any last words or yeah, thanks to Doctor Sharma like like Peter said, I appreciate what you're doing.
Jason
I appreciate that you're putting yourself out there and and not only wanting to help people where they're at, but even even spending some time researching on how to help firefighters specifically, I know that's. That you came to the last foundation ball.
Speaker
That was really cool.
Jason
Hopefully you'll be to the next one in a few months. We're going to have another. One, so hopefully we'll see you soon.
Ryan
And thank you so much for having me. This was a lot of fun, and it was a great conversation. And of course, thank you for what you do. I think, you know, my job is relatively easy compared to yours.
Jason
Well, that was awesome. That was even more. In depth than I thought it would be. Some of Doctor Sharma's takeaways I I got a bunch of notes I wrote down. From his some of the stuff that he said that I've never thought about before, relationships are a protective factor for mental health. That was cool and that was one that I wrote. Down and then the fact that he respects the fire service enough to say I know I'm not in there automatically. I have to build that trust with the guys and how? How trust is important to him. And then another one, the fire service has been around longer than the practice of psychology. Yeah, it was just. It was a great session with them. It was fun.
Peter
I think when you talk about a relationship being a protective, what did he call it? A protective influence is that.
Speaker
What he.
Peter
Said factor.
Jason
In for mental health.
Peter
I could also argue that the opposite is true, right? So like a bad relationship is a contributing factor. To the poor mental. Anyway, the one thing that stood out, which I was really pleased with, when it's when we asked him the question like OK, you know. Help us out. What can our foundation do to make a difference and? I liked his answer. I mean it was simple. It was like a no brainer. Like yeah, duh. Like have an annual mental health check up with a professional and see how you're doing and if it goes, if you're doing great, great. If you you need help, let's get you some help. But I think that. A loan would make a huge difference, because if you're already sitting in front of the of the clinician and maybe you you've been wanting to but you you never did or the stigma attached or whatever. But let's just say you're there and you're like, well, I'm already here and I have this issue that I've been worried. About let's talk. About it. And then my guess is your. Access to resources is going to be a lot easier once you're already sitting in front of the expert. Who knows what the heck they're doing, right? So I thought that was actually a really good idea. Like, that's something that we could definitely look into from as far as foundation perspective providing something. Along those lines. So I thought.
Jason
It was good, very doable. It wasn't an insurmountable. Thing just a annual checkup. I thought that.
Peter
Was cool. Again, thanks for spending the time with me to have this conversation. And and hopefully our listeners got something out. Of it? Yeah, have. A good week. Alright, you too.
