November 29, 2023

By Courtney Wise

Greetings, MindSite News Readers. In today’s Daily, we look at Texas fire departments that are challenging cultural stigma to get firefighters mental health help. In other news, U.S. soldiers continue to train with weapons known to increase the risk of brain injury, a nonprofit research group makes strides toward FDA approval of estrogen treatment in transgender patients, and a trend toward “payer ghosting” by health plans over mental health claims.

Plus, a look at a school shooter through the eyes of the sister who loves him.

Texas fire departments fight “tough guy” stigma to get firefighters help with mental health

Sam Buser knows that there’s a slow yet steady change happening in fire departments in Texas. He had a front row view of the shift for more than ten years as senior psychologist for the Houston Fire Department. His main responsibility was to help first responders understand it’s okay for them to need and receive help, too. It’s a tough job for the few fire department psychologists across the state, reports the Texas Tribune. Not only because plenty of cities still can’t afford to pay for full-time mental health support in their local fire departments, but also because firefighters still contend with cultural stigma around issues of mental health. 

There’s intense machismo and team spirit among firefighters, a community that is also overwhelmingly male. Many fear that any sign of weakness could cost them their place in the team – or their job – even if their trouble is related to mental health. “So when a firefighter says, gee, I’m depressed, or I have post-traumatic stress disorder, what happens is their fellow firefighters start to wonder, maybe I can’t count on this one,” Buser told the Tribune. “Maybe if we go into a fire, this person is going to freak out, and they’re not going to be able to help.” But longtime firefighters say they see a big change in the way mental crises are handled these days.

Fire Chief Scott Kerwood, a 45-year veteran of the Hutto, Texas, department, said he’s seen people get more serious about mental health within the past decade. A primary reason is to reduce suicides, which affect firefighters at a significantly higher rate than the national average, according to the National Institute of Mental Health. To aid firefighters’ wellbeing, groups like the First Responder Resiliency Coalition in Cedar Hill have emerged to fund mental health education and peer support groups. Peer groups are especially influential because they enable firefighters to convince one another to get the help they need. 

“It has been exciting to watch because I think the new wave is affecting the older generation and inspiring them to get help,” said Leah Belsches, a staff psychologist at the Houston Fire Department. “I love seeing people who have been with the department for 20 to 30 years come in for the first time asking for help.”

Despite evidence of harm, US troops still train with weapons that increase the risk of brain injury

For generations, the U.S. military assumed that it was safe for troops to train and fight long-term with rocket launchers and other weapons containing blast power later shown to be hazardous. Studies followed to help the military determine how to improve safety, and the Pentagon even began an initiative to set safety thresholds and track troops’ exposure. But even though the military was aware of the dangers, troops tell the New York Times they’ve seen few changes – little to nothing has been done to track or limit blast exposure.

Training is largely the same, and shoulder-fired rocket launchers are still in regular use. It all tracks with a well-worn pattern the military has followed for more than ten years: Leaders acknowledge the importance of protecting troops’ brains; then, they do not do it.

“It’s really negligent, given everything the Pentagon knows, that they haven’t taken action,” said David Borkholder, a professor of engineering at Rochester Institute of Technology. In 2010, Borkholder co-founded a company that made small, wearable gauges to measure blast exposure. In 2011, the company supported a mission in Afghanistan they hypothesized would show the risk of exposure to roadside bombs. Instead, they found the most harm came from the blast of troops’ own weapons. “It was hugely, hugely surprising,” Borkholder said. “The danger was us. We were doing it to ourselves.” (Read the whole story in the Times.)

FDA signals support of hormone replacement therapy as gender-affirming care

For decades, hormone replacement therapy has been approved by the Food and Drug Administration to treat women going through menopause. Now, the nonprofit Research Institute for Gender Therapeutics (RIGT) is preparing a study with the goal of achieving FDA approval for estrogen therapy as a gender-affirming treatment for transgender and gender-diverse patients. Earlier this month, RIGT told STAT News they were “positively surprised” when the FDA responded to its development plan for a Phase 3 clinical trial on estradiol — the most popular form of estrogen hormone therapy— with suggestions to forgo a placebo-controlled trial and include study participants as young as 13 years old. 

The FDA’s comments encourage RIGT’s research along an atypical drug development path, focusing on both adults and adolescents, rather than adults only first. The nonprofit’s original proposal suggested a double-blind placebo-controlled study for adults only, which the FDA said should not happen. Though the agency failed to include a reason for their guidance, experts who spoke with STAT believe it is because offering placebos for gender-affirming hormones can be unethical and impractical. Previous reporting from STAT shows that doing so can cause mental harm to patients, and the physical effects of treatment with estrogen, which include breast development and less hair growth, would make it easy to determine who received hormones and who did not. 

“They practically wrote the inclusion section themselves,” said Brad Sippy, RIGT’s founding director and president. The FDA’s feedback, he says, “really gives us a pretty clear path to a federal approval for gender-affirming care.” 

In other news…

Yesterday’s episode of Fresh Air on NPR featured a conversation with computer scientist and AI expert Joy Buolamwini whose book, Unmasking AI: My Mission to Protect What Is Human in a World of Machines, argues that facial recognition technology is rife with bias; the episode also includes an interview between Terry Gross and First Lady Rosalynn Carter. It’s a 51-minute listen.

Payer ghosting: It’s the term used by Behavioral Health Business to describe the stonewall tactic that health plans sometimes use against mental health providers when they submit claims for reimbursement.

Nearly two decades after Hurricane Katrina, survivors open up to Scalawag Magazine about their enduring physical and mental trauma. “I know I have PTSD. I’ve never been diagnosed because I’ve been diagnosed with so many things,” said Damaris Calliet. “I am always in survival mode and don’t know how to escape it.” 

In May 1998, in the throes of severe mental illness, Kip Kinkel murdered his parents, two of his peers, and shot dozens of others in his high school. Twenty-five years later, his sister Kristin spoke to the New Yorker about the closeness she and Kip share despite his crimes.

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.