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Miriam Heyman, Ph.D. is a Senior Program Officer at the Ruderman Family Foundation where she is responsible for the oversight of programs related to disability inclusion. She has published research findings related to employment and the well-being of people with disabilities in several journals, including the Journal of Intellectual Disability Research, Early Child Development and Care, and The Journal of Vocational Rehabilitation. Dr. Heyman is also an adjunct faculty member at Boston College where she teaches undergraduate and graduate psychology courses.

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Jay Ruderman: Suicide claims the lives of more than 120 Americans each day.

Announcer: All Inclusive. A podcast on inclusion, innovation and social justice, with Jay Ruderman.

Jay Ruderman: Welcome to All Inclusive. I’m your host, Jay Ruderman and today we’re going to address the serious issue of suicide and mental health, specifically first responders, meaning police, firefighters, EMTs, people that help us in times of need. This is coming on the heels of many celebrities who are coming out about issues of mental health, anxiety, depression and so forth and we commend their leadership. People like Kevin Love from the NBA, Michael Phelps, Arianna Grande, Dove Cameron, Selena Gomez, Kristen Bell, Ryan Reynolds, Mariah Carey and even Prince Harry, to name a few. And also, over the summer, we’ve unfortunately had some very high-profile suicides, Kate Spade, Anthony Bourdain, who was a favorite of mine and most recently, a young woman, Ellie Soutter, 18 years old who was a member of Britain’s Olympic Snowboard Team.

Jay Ruderman: Just some facts before we get into the discussion, some relevant statistics about suicide. Suicide claims the lives of more than 120 Americans each day according to the Center for Disease Control. And over the past two decades, suicide rates have increased nearly in every state in the United States. Half of the states have seen suicide rates increase by more than 30% and today’s topic on mental health and suicide are first responders, which is including again, police and firefighters and EMTs. The Ruderman Family Foundation recent White Paper has found that more first responders die by suicide than in the line of duty.

Jay Ruderman: My guest today is a Program Officer at the Ruderman Family Foundation, Miriam Heyman. She received her PhD in Applied Developmental and Educational Psychology from Boston College. She’s the authors of the latest Ruderman White Paper on mental health and suicide of first responders. Dr. Heyman, thank you for joining me today.

Miriam Heyman: Thank you for having me.

Jay Ruderman: So let’s talk a little bit about this very heavy issue, but an issue that impacts millions of Americans, millions of people around the world and seems to be a growing phenomenon in our society. Why this White Paper? What led you to write a White Paper focusing on first responder mental health?

Miriam Heyman: So, we noticed that the bravery of first responders is brought to the public’s attention in the aftermath of the most huge and horrific tragic events. Things like the recent incidents of terror in Parkland, Las Vegas, Sandy Hook, and more. But the public discourse very rarely acknowledges that first responders witness death and destruction regularly, if not daily.

Miriam Heyman: A conversation that I had with Commissioner Evans of the Boston Police Department, he was telling me about a murder victim that he encountered and early in the conversation I assumed that he was telling me about an important turning point in his life or his career. And then a few moments later, I realized he was describing just the day before, maybe 12 hours before the conversation that he and I were having. And that was a turning point for me and us at the foundation, because we realized that, given the regular exposure to death and destruction and horror, we should expect this to exert a toll on our first responders and it’s important to pay attention to that.

Jay Ruderman: I think all of us have an appreciation for first responders. In our time of need, and in medical emergency, something happens in our home, fire, we depend on the police, fire-fighters, EMTs, to save our lives, save our property, to keep order in our society. I think that most people hold first responders in very high esteem, but maybe you could talk about what the most pressing issues are, facing first responders’ mental health.

Miriam Heyman: Yes, absolutely. So, we know that first responders have elevated risk of post-traumatic stress disorder, depression and substance use. One study found that almost 50% of Fire-fighters surveyed had thought about suicide at some point in their lives, and another study found that the depression rate among Police officers is five time higher than the rate among the general population. And what’s important to point out, is that before you can enter the Police force, you have to pass a qualifying mental health exam. So when you enter the Police force, you do meet a baseline level of mental health, so these rates of depression, of PTSD, of anxiety that we’re seeing really represent deterioration of mental health after joining the Police force. And that’s because first responders … yes, their bravery is unparalleled, but they’re also human. So when they witness this death and destruction, this exerts a toll on them. We should expect it to.

Miriam Heyman: One survey from Police officers from around the country found that, on average, Police officers encounter 188 critical incidents throughout their career. And these critical incidents include things like death, child abuse, domestic violence, things like that. And so without access to mental health services, this exerts a toll on their mental health. And the results of our White Paper show that, in 2017, there were 103 Fire-fighters that died by suicide, and 93 Fire-fighters died in the line of duty, so more Fire-fighters died by suicide than the line of duty, and this 103 is likely a vast underestimation of the actual number. This is the number of reported and validated suicides. Experts estimate that the actual number of Fire-fighters who die by suicide every year is closer to 200, which would be twice the number of line of duty deaths. Also in 2017, there were 140 Police Officer suicides and 129 line of duty deaths.

Jay Ruderman: So, there was recent coverage of the White Paper in the Boston Globe a few days ago, which focused on a retired Fire-fighter, and some of the things he experienced were things that I think any human being would have a hard time adjusting to. Holding a baby as the baby is dying in front of his parents, or showing up to a fatal auto accident where the person is still alive and holding your hand, and their life slips away right in front of you.

Jay Ruderman: So, let me ask you, we’ve seen this abundance of celebrities talking about mental health and how that’s affecting them. Some of them have talked about suicide, some of them haven’t. Have spoken more about the mental health that they deal with, and they’ve really become leaders on this issue. In the first responders community, with police and Fire-fighters, EMTs, there are some great leaders who are speaking out and many of them you’ve met, and you’ve interviewed. And Commissioner Evans of the Boston Police Department has been a leader and speaking out about the importance of the mental health of his officers, but historically, why do you think there’s been a dearth of raising this issue publicly within the departments or the press in general?

Miriam Heyman: So, that’s a great question. I think, first of all, there’s a lot of stigma around mental health and mental wellness in our society at large. We know that children and adolescents who experience symptoms of mental illness, it takes them about 10 years to access services after they start experiencing symptoms, and it’s because our society at large doesn’t talk about mental health and mental illness, so these kids are ashamed to speak up, or they don’t know what they’re experiencing and they don’t know how to ask for help. And the Police and Fire departments around the country are a microcosm of this larger phenomenon. These are professional who explicitly prioritize bravery and toughness, and putting others before themselves, so there’s this perception within these departments that to speak out about your own struggles is selfish and is contrary to your job description.

Miriam Heyman: And there’s also the perception that speaking openly about your own struggles will injure career advancement or development. Mental health is a pre-requisite for becoming a Police officer, and folks fear that if they speak openly about anxiety or depression, they might lose their weapon, they might be told that they have to retire, and that’s not entirely fictitious. That has happened. People have been discriminated against after speaking out about mental health and mental illness.

Jay Ruderman: And yet, we hear so many stories of police and Fire-fighters who, because of stresses and mental health issues, have not only turned on themselves, but an increase of domestic violence against their partners, an increase in alcoholism or drug use: these are all factors that will affect their performance and affect the performance of public safety in the departments, so where are departments in addressing this issue in order to keep a healthy-

Jay Ruderman: departments in addressing this issue in order to keep a healthy department who is available to respond to the public needs?

Miriam Heyman: Before I answer that I want to elaborate on your point because I think it’s an important one. We depend on our first responders to be as physically and mentally fit as they can possibly be. We know that mental health or mental illness when untreated can interfere in decision making in a crisis situation. The symptoms of PTSD include flashbacks. When you’re experiencing a flashback, your cognitive capacities are not as strong as they could be. Studies have shown in emergency situations that have been recreated in a laboratory setting that emergency workers who experience flashbacks, that diminishes their ability to assess risk or to plan a multi-step response or to divide attention between a victim and perpetrator. There are also links between physical and mental health. Mental illness is associated with higher levels or cortisol which leads to higher levels of cholesterol and obesity. You’re absolutely right that when we ignore the mental health, our entire society is at risk because our first responders are not as capable as they would otherwise be if we were acknowledging this issue.

Jay Ruderman: We talked a little bit about domestic violence. What is the toll not just on the first responders themselves but also on those who depend on them, their families?

Miriam Heyman: We know that divorce rates are higher when first responders experience mental illness, domestic violence. Then, in terms of how departments are beginning to address this issue, they are. We’re seeing progress in this area but we need to see a lot more. There are about 18,000 law enforcement agencies in the United States and less than 10% of them have suicide prevention training programs. But we know that when leadership of these departments do speak openly about these issues and encourage their professional members to seek and access treatment, that’s when we see real change.

Jay Ruderman: Why is that? Why are many departments not sort of getting with the program and realizing that this is a real crisis facing them and not addressing it? Why are they ignoring it?

Miriam Heyman: I think what we really need to see is cultural change and we’re there yet. We’re starting to. The president of the International Association of the Chiefs of Police has said officer mental health is an issue of officer safety. But we’re see waiting to see that, that message from leadership trickle down into individual departments. I think why we’re not there yet is there is a tremendous amount of stigma in our society at large and also within smaller departments and also within families. Family members often hide the suicide of a loved one so in some cases the department leaders might not know of suicide within their own departments. I think there’s a real fear of a vulnerability and to some extent for leadership to speak openly about this issue they have to show their own vulnerability and within these professions that prioritize bravery and courage. That’s something that many people aren’t yet comfortable doing.

Jay Ruderman: I think this may be an issue for another show but maybe there could be an analogy to how soldiers who are returning from combat and the way society treats them and the real issues that they might be facing with mental health issues and post-traumatic stress and how the stigma may be exasperating the issues that they’re facing and there is corollary between that and first responders.

Miriam Heyman: Absolutely. That’s also important to point out that many first responders do have military experience and that impact of trauma is cumulative. Many of horrors that first responders witness are piled onto a personal history that’s already pretty ripe with drama.

Jay Ruderman: Within the first responders community there’s a lot of diversity. Race, sexual orientation, sex of the officer. How is this relevant? How does this play a role, the diversity in the population?

Miriam Heyman: Across cultures there are differences in terms of openness around mental health and mental illness so some cultures are more likely to access services than others. Those differences exist within first responder departments as well. I think it’s also to point out that some of the barriers to receiving treatment and help are pragmatic and not necessarily related to culture or stigma. In some areas of the country it’s easier to access mental health service. There are more available qualified people who can offer that support. We see differences across urban various rural areas. We also see differences across paid volunteer firefighters. Paid firefights have access to the resources that their department provides whereas volunteer firefighters often do not. I think it’s an important distinction between these pragmatic barriers and these more cultural barriers. I think many departments do a very good job of providing qualified professionals who can deliver mental health services and yet the firefighter and police officers don’t access those services. While I think there’s variation in cultural barriers, there’s variation in pragmatic barriers as well, the extent to which the services are available.

Jay Ruderman: The Ruderman White Paper on Mental Health and Suicide of First Responders has gotten a lot of media attention, especially the statistic that jumps out that more first responders die by suicide than in the line of the duty. That’s been a key pull-out statistic. Why is this not getting more attention? It seems like as an American society we’re more responsive to the latest attack in issued tragedy and then society tends to take action. Why don’t you see more action occurring now?

Miriam Heyman: I think the field has been very reactive in this area as well as opposed to proactive. Boston has made great strides in the area of first responder mental health. All of the leaders that I have spoken to here has said it was a really an aftermath of the Boston Marathon bombing of 2013 which was a time when many first witnessed horrific tragedy and it was a very public event. After that, the city of Boston saw the need to do something. They’ve made great strides. There’s now a program at McQueen’s hospital which specializes in mental health for first responders and people with military experience. Many police officers and firefighters are able to access those services through the insurance provided by the city of Boston. I think to answer your question of why aren’t people doing more and paying attention to this, I think, unfortunately, we’ve seen us taking these big, horrible tragedies to spur action in this area.

Jay Ruderman: In writing the paper I’m sure you’ve had many conversations and met people and there’s so many different stories but what are some of the stories that sort of jump out at you that you’re just like this is something that really had a personal impact on me?

Miriam Heyman: The stories about children I think are the most difficult to hear and absorb. I spoke with a detective from the New York City Police Department who was telling me about a four year old who had just been horrifically abused. When he arrived at the scene, she had died. Stories about fires in which entire families pass away. It’s starting to change but the norm has been for decades that after these really life changing, horrendous events you go get a beer with your colleague and then you go back to work the next day. Even when there is access to a mental professional or a mental health check up so to speak, the culture has not been to take that step. The culture has been to have a beer, suck it up, go to work.

Jay Ruderman: More toughing it up and this is part of the job and whether you’re a solider of a first responder, this is what you deal with and just deal with it on your own and go on with your life which some people may able to do but a lot may not and may be repressed and it comes out in other ways. What do you think needs to happen in order to see real change?

Miriam Heyman: When I spoke to a psychiatrist here in Boston, she suggested referring to mental illness amongst first responders as an occupational hazard. It is absolutely normal and given what these men and women go through on a daily basis it really isn’t an illness it’s normal and normative and we should expect to see this happening. The question is then how we do we address it?

Miriam Heyman: I think first and foremost we have to acknowledge that this issue is very complicated. The majority of police officers who die by suicide use a gun and of course there’s no way to limit access to weapons. There are also pragmatic barriers. As I mentioned before, in rural areas you might have to drive an hour and a half to see a qualified mental health professional. This is complicated. At the same time, first responders work very long and perhaps very odd hours. Putting all of that aside for now, the answer really is conversation. When people aren’t talking about this, first responders who are struggling with depression or anxiety feel ashamed and therefore they feel alone and it seems as though getting help is not an option. The conversation can start at the top and the national news outlets or the department chiefs in fire and police departments to encourage regularly their subordinates to access care, to have posters within offices that have phone numbers of who people can turn if they need help. I think that conversation has to start at the very beginning and has to extend throughout the career of firefighters and police officers. In some academies, they’re learn-

Miriam Heyman: fighters and police officers. In some academies, they’re learning about the importance of maintaining mental health along with physical health, and that’s great. It should start as early as the academy, but we have to make sure that these … that our police officers and firefighters continue to receive these messages throughout the entire course of their career. First responders who die by suicide, their lives should be celebrated, and they should be remembered as heroes just as we celebrate and remember the lives of first responders who die in the line of duty.

Miriam Heyman: I think it’s also important to point out that the National Law Enforcement Memorial in Washington, D.C., currently first responders who die by suicide are not allowed to be included in that memorial, so we need to change that. We need to celebrate those lives, and that, in turn, will bring this issue to light so that people don’t feel ashamed, they don’t feel alone. And then, I think we should do more to encourage first responders to access those services that are available within their departments. Others have suggested instituting mandatory mental health checkups, perhaps annually, or perhaps after a critical incident. And I think we need to prioritize mental health, as a society, the way that we prioritize physical health.

Jay Ruderman: So, in the age of social media, and where news is happening 24/7, this issue of mental health is getting a lot of attention, but it can also reinforce stigma. I think that stigma of society, that people with issues of mental health are weaker, is something that we need to combat. It can happen from the ground level. It can happen from leadership like Commissioner Evans, other leaders in the first responder community across the United States, and across the world, political figures.

Jay Ruderman: I do think that there is a growing trend in entertainment. I don’t know if you have any … It’s a little bit off-topic, but it’s on-topic of being why is that happening, in your opinion, that entertainers are coming out and talking very publicly about their mental health, and it’s not really happening in the first responder community.

Miriam Heyman: I hope, I mean, I think the optimistic view to that is that entertainers see their power and their potential to have a tremendous impact, because you’re right, mental illness is seen as weakness, and yet, when the idols of our society speak openly about their own experiences and struggles, that shatters the view that mental illness is a sign of weakness. So, when we hear people like Dwayne Johnson, The Rock, speaking about his experience with depression, I think that forces us to rethink how we view mental illness, in a very good way.

Jay Ruderman: But, I think you also brought up an important point where for celebrities to bring up issues of mental health doesn’t necessarily adversely impact their career. In fact, sometimes it might help their career, whereas a first responder addressing it, in a very bureaucratic structure, may actually harm their career.

Jay Ruderman: So, I think that’s an issue that needs to be addressed by the overall first responder community head-on.

Miriam Heyman: Yes. And I think it’s important to acknowledge that for some people with serious struggles, it might be the right answer for them to take some time off or to retire. People are afraid that that will be the answer they receive, and that’s a real fear, however, the more that we institute regular mental health checkups, and regular access to mental health services, we can prevent people from getting to that point, so that people will receive treatment for more minor or subtle mental health struggles before it gets to the point where they are told, “Yes, please go home. Take a week, take a month, whatever.”

Jay Ruderman: Right. And I know that this is a heavy issue, and it’s not comfortable. I mean, none of us like to think of suicide, as I said in the beginning, the suicide of Anthony Bourdain really hit me and millions of people around the world very heavily, because we were attached to him. He was on our TV every week, and he was full of life and experiencing wonderful things around the globe, and we often don’t see the signs but we really have to shine a light and put this out in the open so that we can have a more fulfilling life and a more secure life, and watch out over those that we love, and our kids, and our people that we depend on.

Miriam Heyman: Yeah, I absolutely agree. I mean, I think Anthony Bourdain seemed to have the perfect life. I think it’s a great example of how this issue can impact anyone and loved ones might not necessarily see the signs. The best we can do today is talk about it and hopefully reach someone who is having a hard time, and encouraging all of you out there to access services if that would be helpful.

Jay Ruderman: So, I think we have to be very cognizant of the fact that popular media has a huge impact, especially among younger people, of how they look at issues of mental health and suicide. So many people who are celebrities, younger celebrities, have come out very courageously and talked about mental health, which I think will impact a lot of younger people to look at their mental health and to take it seriously. You know, we, as a foundation, have commended them for this. But, we also have to be careful that we don’t glorify suicide, especially when it’s on the rise. Recent show, 13 Reasons Why, I know from my own kids who are young, who watched the show because it was popular in their school and a lot of people were watching it, it’s a very disturbing show in terms of dealing directly with suicide and some very disturbing scenes, and what you don’t want to happen … I mean, the entertainment industry is hugely influential, and you don’t want to see these copycat issues where people take action based on messages that they’re receiving.

Jay Ruderman: So, I think that’s important. I think on the one hand, we’re dealing with stigma. On the other hand, we’re dealing with a really serious issue, and we want to save our kids. Life has a lot of pressures now. It has a lot more pressures with kids being on social media, and bullying, and so many things that they’re facing that the entertainment industry, public in general, public figures, have to be very careful about how they talk about this, and that we don’t do things that might encourage people to take actions that are irreversible.

Miriam Heyman: I agree. I think that conversation such as the one that you and I are having today is a very key piece to the puzzle of ending this epidemic. There are really effective mental health services and treatments out there, but without conversation, people don’t know about those services, or they don’t feel comfortable accessing them. So, ending the silence around this issue I think is key to seeing change, and as you said, ending unnecessary tragedy.

Jay Ruderman: So, first of all, I want to say to anyone who’s listening to this, if you need help, if you want to talk to someone, there is the National Suicide Prevention Lifeline, and their number is 1-800-273-8255. There’s someone there to speak to you 24 hours a day, seven days a week. If you’re having any feelings of suicide, acute depression, I suggest that you reach out to this number. I mean, we really need to, as a society, make this a national priority. We don’t want people that are coming to our aid to be in a situation where they are unhealthy and unable to help the general public. I think we need to turn to our public leaders to really address this issue. I want to commend you, Miriam, for taking the lead in writing a white paper, A Mental Health and Suicide of First Responders, that I think is having a tremendous impact on our national culture, and it’s getting a lot of media attention and hopefully will get more media attention.

Jay Ruderman: One thing that I’ve noticed is that this white paper is getting picked up all over the country, and whether it’s in North Dakota, Louisiana, any other state around the country, every police department has a story where they’re dealing with the mental health of an officer or an EMT or firefighter. It’s so important to continue to get this story out there. You know, we, at the Ruderman Family Foundation, support first responders in every possible way. We realize the importance that they have on society, and we want to make sure they feel welcome and able to access lifesaving mental healthcare.

Jay Ruderman: I think that’s a wrap, and I appreciate everyone for joining us today to listen to this podcast. I want to especially thank Dr. Miriam Heyman for joining me and discussing this important issue.

Miriam Heyman: Thank you, Jay. It was great being here.

Jay Ruderman: Thank you.

Announcer: All Inclusive is a production of the Ruderman Family Foundation. Our key mission is the full inclusion of people with disabilities in all aspects of society. You can find All Inclusive on Apple podcast, Google Play, Spotify and Stitcher. To view the show notes, transcripts, or to learn more, go to Have an idea for a podcast? Be sure to tweet @JayRuderman