Now the Ghost Ship fire has become a catalyst for change in the Oakland Fire Department, where Robertson, a 54-year-old lieutenant and the president of the Oakland firefighters union, and other firefighters are pushing to create a peer counseling program. Firefighters in general are at high risk of developing post-traumatic stress disorder, which can lead to anxiety, substance abuse and even suicide, and that has spurred firefighters in numerous cities to demand that their mental health be treated as urgently as any other injury sustained on the job.

Oakland fire officials insist that existing mental health services are sufficient but underused. Deputy Chief Mark Hoffmann pointed to the city’s “incredibly robust workers comp system,” and noted that firefighters who were at the Ghost Ship fire have been offered extra employee assistance program sessions, though few have claimed them.

Robertson disagrees. The fact that few firefighters use the current services, he said, is proof that they aren’t working. “Is it underutilized because it’s not needed, or is it underutilized because people have no faith in it?” Robertson asked.

‘That Was Going to Sit With Me’

After the fire came the search for bodies. Eight men and women who participated in the recovery efforts said it was the most difficult aspect of the whole week. One fire captain, who has been with the department for more than 20 years, said thinking about it still makes him feel like he is teetering on the edge of a breakdown. He could see 10 bodies in the ash and rubble when he arrived, and he knew from the way the building collapsed that there would be more.

The victims died of smoke inhalation, not fire, so all their features were recognizable. The firefighters could see every detail: The cellphones in their pockets flooded with missed calls. Their tattoos. Their eyelashes. “There was no question,” said another firefighter, “that was going to sit with me for a while.”

All of them spoke about that day on condition of anonymity because they weren’t authorized to speak to the news media.

The firefighters were quick to emphasize that the Ghost Ship fire was just one in a long series of traumatic events over the course of their careers. In a big city like Oakland, they respond to everything from stubbed toes to heart attacks, from shootings to wildfires to structure fires. When asked to think back on a call that stuck with them, all the firefighters were able to conjure up several memories in perfect detail.

There was the firefighter-paramedic who still remembers the faces of two teenage girls shot in the head execution-style on a street. Another firefighter, in the department for less than five years, described a day when they drove an alcoholic to the hospital to get detoxed; as the man left the hospital that evening to go home, he was shot in a botched robbery, and the same team was called back to the scene to pronounce him dead.

Firefighters have a metaphor for their emotional baggage: the backpack. After every traumatic event, more junk is thrown into their symbolic backpacks for them to carry around each day. Eventually it will get too heavy; it will drag them down. “My backpack’s full,” said a firefighter still in his 18-month probation period. “It’s super full.”

PTSD and other post-trauma mental health issues can be tricky to identify in first responders, said psychologist Mark Kemena, a lead clinician for the West Coast Post-trauma Retreat, because it often builds up over time. It is like having a car alarm that is triggered when even the slightest wind passes by, said Michael Palmertree, a psychologist who has worked extensively with the Oakland Police Department.

There have been many studies about rates of PTSD in veterans and police, but reliable statistics for mental trauma in firefighters are hard to find. Suzy Gulliver, director of the Warriors Research Institute, is one of the few clinicians who has done studies on firefighter mental health. Over the course of a lifetime, she said, 20 to 22 percent of firefighters in the United States will experience PTSD — the same rate as returning combat veterans.

The consequences can be tragic. According to estimates from the National Fallen Firefighters Foundation, firefighters are three times more likely to die of suicide than in the line of duty. And many PTSD sufferers self-medicate with drugs or alcohol. Robertson said excessive drinking and substance use, including marijuana, have always been common in the fire department, particularly in young members. He himself had to go to drug rehab early in his career.

'When you do this for a little while, you’re scarred mentally for sure' Chris Foley, Veteran fire captain

“When you do this for a little while,” said Chris Foley, a veteran fire captain helping Robertson start the peer counseling program, “you’re scarred mentally for sure.”

Firefighters Wary of Treatment

Firefighters like to say that the fire service is 150 years of tradition, unimpeded by progress. When Robertson was a new recruit in the early 1990s, mental health wasn’t talked about in the firehouse. Back then, veterans from World War II, Korea, and Vietnam were on the crew, men who had already experienced their fair share of trauma.

“You can’t handle it?” Robertson recalled them saying if they saw a new crew member getting emotional after a run. “Then you need to go somewhere else.”

The culture has started changing, Robertson said, but many firefighters still won’t admit that a call affected them, fearing it would be seen as weakness and make their coworkers trust them a little less. In a recent survey conducted by the NBC Bay Area investigative news team, almost 50 percent of the 700 firefighters that responded said that concerns about colleagues not trusting their judgment contributed to the stigma of seeking mental health treatment.

Only one of the eight firefighters STAT interviewed who were at the scene that night has sought regular mental health treatment. For the few who do try to seek help, options are limited and, they say, often confusing.

Firefighters in Oakland are offered the same counseling program that every Oakland city employee gets: three free therapy sessions every six months through their employee assistance program (EAP). Tom Farris, president of Claremont EAP, which runs the city’s program, said it is designed to be a bridge to longer-term care, though firefighters have to pay for additional sessions through insurance copayments or out of pocket.

Complex mental health problems like PTSD are “absolutely not” resolved within three sessions, said Farris, who is a licensed psychologist. But “that’s not really what EAPs are scoped out to handle,” he said. Farris noted that in many cities, first responders are offered six to 10 EAP sessions, not three. More benefits for public safety employees “is a good idea,” he said.

Another resource in the fire department is a Critical Incident Stress Management team that is dispatched to fire stations after big events such as the Ghost Ship fire. The team members can vary from priests to other firefighters to experienced psychologists to brand-new therapists trying to boost their resume, and firefighters are required to sit together and debrief the incident.

Reactions to CISM are mixed. While psychologists say it can be very helpful, some firefighters say the team members often can’t relate to their experiences. Robertson said many of the CISM therapists wouldn’t be able to hold their own in a burning building. “Why the hell would I open up to you?” he said.

Hoffmann, the deputy chief who has been in the fire department 37 years, acknowledged that CISM has been “poorly applied at times” and said team members hadn’t received training “in about two years,” but he believes that it is an effective behavioral health tool.

Unsatisfied with the current treatment options, Robertson, along with Foley, has made it his mission in his last two years before retirement to launch a peer counseling program. They want to follow in the steps of other departments, including Phoenix and New York City, that have been using this model for years. Several other Bay Area cities have these programs, including neighboring Berkeley.

The International Association of Fire Fighters (IAFF) started offering peer counseling training courses last year and so far has offered 24 courses across North America. Elaine Viccora, a behavioral specialist at IAFF, said it plans to offer three to four trainings each month.

Robertson hopes to model the Oakland peer counseling program after the one in Phoenix. Brian French, a Phoenix firefighter, helped develop it in 2010 after four members of the department committed suicide within seven months.

Their model, French said, is “listen, refer, support.” Peer counselors are trained to reach out to individual station members after a critical incident and encourage them to get professional counseling if they think it is needed. French also oversees the day-to-day operations of a website called Firestrong, an online portal where fire departments around the country can list area-specific mental health resources for their members.

Robertson faces two main barriers as he tries to get the peer-counseling program off the ground: persuading the firefighters to admit when they need help, and convincing Hoffmann and other city administrators to pay for it.

It costs more than $250 for one firefighter to be trained as a peer counselor through the IAFF program, and membership to the Firestrong website is an additional $1,500 per year. So far, the union has paid for the training, and Robertson plans to push for city money in union negotiations this August.

But Hoffmann said he is worried that the peer counseling program won’t be inclusive and that the people chosen as counselors could just be winners of a popularity contest within the union. “The way they’re describing doing their program,” Hoffman said, “I can’t spend city money on that.”

‘Just Doing Our Job’

In early April, Robertson attended an IAFF conference in Phoenix and was surprised to receive a plaque commending the Oakland firefighters on their actions the night of the Ghost Ship fire. The honor made him distinctly uncomfortable. It was weird, he said, to get a plaque “for us just doing our job.” Especially, he added, on a night when 36 people lost their lives.

Robertson frowns at any mention of leaving a legacy in the department. That’s not why he’s creating the peer counseling program, he said, though it’s hard for him to come up with the words to describe why firefighter PTSD is such an important issue for him personally.

“It’s probably because I’m all fucked up myself by it,” he said.