Frank Leto—Success Stories from FDNY’s Counseling Service Unit | S5 E3

SPEAKER_01 0:00

But right before 9-11, I was a lieutenant and I had come off the line for what I thought was six months to work with the counseling unit right before I was getting promoted to captain. And that's when the Trade Center happened. We built our peer team out, starting with our retirees, because the active members were at the Trade Center. I thought I knew everything. I said, okay, I've been in New York for five years, this disaster. And I show up at Hurricane Katrina a few days after the hurricane and realized I knew nothing. I think we were taught, you know, just to keep going, and that's not resilience.

Voiceover 0:45

Welcome to Respond Resilience. Today we're gonna be speaking with Frank Leto. He's retired captain and deputy director of the Counseling Service Unit, the CSU of FDNY. We're gonna be doing a deep dive into how 9-11 led to the shaping of the FDNY Counseling Service Unit. And we'll also be talking about firefighter behavioral health. We invite you to like and subscribe, YouTube Responder Resilience, Facebook, Responder Wellness Inc., and Responder TV, LinkedIn, Apple Podcasts, Spotify. And please check out our website, respondertv.com, for past episodes and guest information. This episode is made possible by the First Responder Center for Excellence. Discover more at FirstresponderCenter.org and connect with us on X, Facebook, LinkedIn, Instagram, and YouTube. We'll be right back to speak with Frank after this. In this family, more of us die by our own hands and by the hazards of the job.

SPEAKER_07 1:36

In this family, up to a quarter of 911 telecommunicators have symptoms of post-traumatic stress. In this family, our mental health and wellness are in crisis, while responders are quietly suffering.

Voiceover 1:48

In this family, many struggle with job-related stress, burnout, injury, sleep disruptions, substance abuse, and relationship problems. In this family, we can help the helpers.

SPEAKER_05 2:00

With vital information and resources, resilience strategies, and success stories of overcoming the obstacles.

Voiceover 2:08

In this family, welcome to Responder Resilience. We co-host retired Lieutenant David Dashinger, Dr. Stacy Raymond, and Bonnie Rumeley, LCSW EMTV. We'd like to welcome Frank Leto. He's a retired FDNY captain. He's been the leader in fire service behavioral health since the 2001 attacks on the World Trade Center. He travels nationally and internationally developing behavioral health protocols and aiding communities after major events. Mr. Leto is a member of the IAFF Disaster Response 2Go team, and he's worked closely with the NFFF, that's National Fallen Firefighters Foundation, and is a member of the FRCE First Responder Centers for Excellence. He's on the Behavioral Health Advisory Council. Frank, warm welcome to Respond Resilience.

SPEAKER_01 3:05

Well, thank you very much for having me. It's a real honor to be with all of you.

SPEAKER_07 3:10

So, Frank, I would like to start by asking you a question. I know that you were a fire officer at FDNY. Can you please tell us how you became involved with the counseling service unit affiliated with FDNY?

SPEAKER_01 3:27

Yeah, it's so that goes back some quite some time. Back in the I came on the job uh a long time ago in 1983, but in I I believe it was 1986 or 1987. I'm sorry, I don't have the date, but a firefighter by the name of Jack Toomey died in the line of duty. And uh uh I was at that fire, uh, and Jack was in the firehouse right next to us, and he was cutting the roof and died of a heart attack. And we were we're bringing him downstairs, and the fire that was fully involved, doing CPR on the way downstairs. And um we got back to the firehouse, and we felt bad, you know, felt terrible for Jack and his family and his two kids. But I there was nothing for for us, um, and you felt guilty for asking for anything. Um so after that, um, and I really struggled after that um that event and many events that were going on. There was a fire department counseling unit at FDMY, but it was mostly based in um in for substance abuse. So I called a director at that time and asked if we can start working with firefighters. And that was really early on um in the late 80s. So I became associated with them at that point and um would come offline for line of duty deaths and work with firefighters in their family, really not knowing what I was doing, but just being um kind of being a shoulder to lean on. Um we kind of build a peer team from that. But right before 9-11, uh, I was a lieutenant and I had come off the line for six months, um, or what I thought was six months, to work with the counseling unit right before I was getting promoted to captain. And that's when the Trade Center happened.

SPEAKER_05 5:27

Now, Frank, in reflecting back on 9-11, can you talk a little bit about how your response as a fire officer, um, how that and then the ensuing mental health crisis subsequent to 9-11 really shaped the counseling services mission?

SPEAKER_01 5:43

Yeah, sure. I uh um you know, the day of the Trade Center, uh, fortunately, um I I usually were I worked in Lower Manhattan, that's where the counseling unit was. Um, and everyone that responded from that building, uh the the office that I was uh died that day. So I had a dentist appointment. Um and so I I would I didn't go to work that day, uh, but as soon as the Trade Center, as soon as I saw it, um I drove in and uh responded, but the second tower had fell fallen when I got to the to the uh to the towers with my team and worked there that day. Um probably uh as a as a firefighter as uh as frightened as I've ever been in my life, um really you know, shaking to my bones uh the whole day, the whole day long. Um but on some level uh felt an honor to be there. It felt like an honor to be there. I knew that every firefighter in the country, um, every firefighter in the world wanted to be where I was. Uh so um again, as as terrible as it was, um I I knew I was where I belonged. Uh and you know, so subsequently, uh we um you know that day as it went on, we realized the scope of of the disaster. Uh not only that we had lost thousands of civilians, but we um we had lost um you know it turns out 343, but we didn't know ex the exact number um that that that day. That that we were working as we were working at the Trade Center, um I I was pulled out around two in the morning um because they were setting up a hotline for for um for families of the first responders, and they wanted me to um set up a hotline in this place called Fort Fort Totten. So we they took me to Fort Totten uh again in my in my my bunker gear, and as I was getting, as I got to Fort Totten, they um they were stringing phone lines to this in back then, you know, the the cell for service wasn't really a thing, it was just starting to be a thing, and they were stringing phone lines into this building, and they said what we're going to do is we're going to set up a phone bank, and families are going to call this number if they're if they're um if they haven't heard from their firefighter son or husband. And so we we I I called people from retired guys in, we had set up this the we were all ready to go, and we had a we had a temporary list of of firefighters, we didn't know who was under the the under the buildings, and I told them I was we were ready, and as soon as that happened, they started stringing the number for fi for families to call, and the phones just lit up. And um, and then we had the list, and if if a wife had called or fiance or mom and saying, I haven't heard from my son, we would look on the list and let them know that their son was officially on the list, or if not, um if they weren't officially on the list, we would get back to headquarters and say we just got a call from you know so-and-so's wife. Um they haven't heard from them. So part of the list was built that day from this phone, these phone calls, and it was probably just had being at the Trade Center, it was probably the worst I've ever felt in my life. And watching watching the men, uh, it was all men at the time, um, answering the phones, crying like babies, uh, because they had relationships with the people that were were killed. We were um you know talking to family members. So um, you know, that was my experience that day before I went, you know, after that was set up and it was rolling, I went back to the Trade Center.

SPEAKER_00 10:27

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Voiceover 11:35

Frank, can you kind of give us a picture of where the CSU was and you just described, you know, just the rapid kind of ramping up um with the phones and the accountability piece. Um in terms of the counseling unit itself, like where was it before 9-11 and then what were like the what was the expansion like? How did you deal with the challenges of expanding to so quickly to deal with uh the aftermath of 9-11?

SPEAKER_01 11:59

So I I I think the FDMY CSU was probably the most progressive uh counseling service unit in the country when it came to uh you know firefighters' mental health. But we were a small uh we were a small unit, one location, about 12 people working there. The director was Maliki Corgan, who was really a progressive uh thinker, um uh a civilian and progressive thinker. So it was it was one location, a lot of uh substance abuse, which was the focus. There was so much stigma around mental health and PTSD, uh depression um uh back then, still is to some sense. So when it became apparent the scope of of the tragedy, now we had 343 firefighters that were killed. The grief that that went throughout the department was was unbearable. Um the trauma that was still going on um was was really remarkable. Uh we had 600 kids that had lost their dads. It the it's just even saying these things today, it's really even hard for me to to grasp uh the gravity of what what happened. And we we knew immediately um that we needed to uh to make some tremendous changes. And in in short order, we expanded to six different locations. We had three or four clinical uh people to start with, and we went to 20 or 30 clinical uh support um uh you know in the in those in those uh those different locations. We we re we built our peer team um out, uh starting with our retirees because the active members were at the Trade Center. We we we threw so much stuff at the wall. Um many of it didn't work. Um and I think those are the lessons learned that that you know departments that go through these tragedies should hear. Um and uh some stuff worked, and and and we can you know we we built on that. Um but we we tried a lot of different things.

SPEAKER_07 14:30

So um what had to be done to increase the buy-in, you know, to peer support or using the services um for the counseling center, since there was such a stronger stigma back then?

SPEAKER_01 14:44

Yeah. So again, I I think what we came to realize um, and it took us a while to realize it, um, but it was really sitting right in front of us is that the magic was us, that um that the buy-in was going to come through people that had the same lived experience, uh, that had credibility within the department. Um, and that if they needed that extra level of care, uh that we had to find culturally competent uh clinical support and other resources. So it was really you know sitting right in front of our faces, and it took us a while to realize that. Um one of the projects that I was um in charge of, and you know, kind of we we thought, well, okay, we have now we have funding coming in. Um let's let's see if we can get clinical support into the firehouses. We had 62 firehouses that had lost at least one member, um, and some you know, many, many uh, you know, uh 10 and 12 members. So we um interviewed dozens of clinicians and you know, and psychologists and and many of them from NYU and that group. And we we vetted them and assigned them to the firehouses and said, go there 10 hours a week. And now we had funding, we could pay them. Go there 10 hours a week, you know, don't do therapy, but just let them become familiar with um with clinical, uh, you know, what what a clinical support looks like or what a clinician does, um answer their questions. And the program was basically a failure. Um and what we what we had to do, to my amazement, now it's now it I understand it. Um we had to start doing support groups for the clinicians. And um and so at first I'm like, okay, this is this is ridiculous. Um and um it wasn't because they were not used to the level of grief and trauma um that we were and we were we were experiencing regularly, uh not just from the trade center where for a pediatric call or whatever, we'd big get back to the station and have these conversations, and now they became privy to to our world. Um and so there were some clinicians in this group. I don't want to just blanketly say um that they all were not, it all didn't work. Uh, there were uh two or three that really did a good job, and we kind of brought them in and said, What do you what do you got? You know, like what is it that's working with you? Um but and uh you know, one of them, um son, she was a little Hispanic woman, she worked in the prison system, and her son went on to write Hamilton, uh believe it or not. Um but um she was tough as nails. Uh but um so we we realized we realized there that that wasn't going to be the answer. That the first line of defense had to be us. Um so we had to we had to educate uh members of the department that had a passion for this and um and keep educating them and and get them to knock on doors of the of the stations uh and spread the word. Uh as that happened and as more people came in to get help, they they would spread it through through uh through the department. And it didn't happen overnight. It didn't. It ha it it it took it took years to to reduce and lift the stigma. Um but it did happen.

SPEAKER_06 19:02

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SPEAKER_05 20:07

Now, what advice, Frank, do you have for someone listening who's trying to get a peer support program or a behavioral health program going in their department or agency? What advice do you have for those people listening?

SPEAKER_01 20:19

Um patience really is probably the first one. You know, really try to get leadership buy-in. You know, try to get uh union or their local buy-in. Uh it's really helpful um to have that. Uh if you have a chief that has uh understanding of behavioral health, that's great. If not, try to get an audience with him or her um with a short, you know, um elevator pitch because they don't have a lot of time, uh, just letting them know that this is going to make this department so much better. Uh and then um find your champions in the department, you know, who and those champions typically have had their own struggles um and have come through it. Uh and so I I I would say be patient, I would say um be proactive, don't wait for something to happen. Um it's been my experience, Bonnie, when you build these programs after something happens, they typically don't sustain. Um so um, you know, if you start now uh uh and and and you know take baby steps in building the part and building your program, uh that's usually the most effective.

Voiceover 21:52

Frank, I'm gonna ask you to shift gears and maybe shift hats to uh your IAFF hat and um talk about when you're first showing up um arriving on the scene of a disaster as a behavioral health coordinator. What do you what are your first steps? What do you set out to do and what do you need to do initially to establish support for the first responders on scene?

SPEAKER_01 22:13

I mean, I I go back to the first time um I did this, and so I was running or the deputy director of the program in New York uh for five years when Hurricane Katrina happened. Um and I think about myself back then and what I didn't know, um, but I thought I knew a lot. I thought I knew everything. I said, okay, I've been in New York for five years of this disaster, and I show up at uh Hurricane Katrina a few days after the hurricane and realize I knew nothing. That this was a completely different event, this is a completely different culture. Um, and from there, um I now when I respond, I understand that this um that I am a guest um in this community. Um I try to fill any practical need that's that they need. I don't tell them what they need, I ask them what they need, I give them some suggestions, um, you know, kind of a Chinese menu of things that we can do. I understand that I'm there just for a moment, um, and that it's their task to carry on. So um, you know, I I you know try to um, if they want, to arm them with some information that may be helpful. I don't tell them what they're going to experience because I have no idea, um, but I can let them know what's happened in in the past and other places. Um, and I always am honored uh to be there. Um and um and and and the people that work with me um you know go there with the gratitude of of being in a in a place um that needs some support. Um and that's that's the way we operate. Um uh we we don't go in as the expert. I always say the expert is here, um, but it's you, not us.

SPEAKER_07 24:25

So, Frank, with you have so many years um that you've spent supporting others through unimaginable tragedies. How do you personally cope um with the inevitable step stress that you take on? Like what do you do to help yourself and and what do you tell other people like yourself in in the same role?

SPEAKER_01 24:48

Yeah, I I mean I um probably it took me a couple of years after the Trade Center to get into therapy. Um, and um, you know, I was preaching it and not doing it, um, but I knew I needed it, uh, you know, probably a year out. Um I mean, I was really good at work, um, but not so good at home. Um and it, you know, I um wherever I was, I felt guilty about not being at the other place. I mean, I had three kids um and a wife, um, and still, you know, that I still have the same wife, and our relationship is is really good now. Um, and I my relationship with my kids are is good. I just had a grandchild, my first grandchild. Um, but I was all I always felt tremendous guilt wherever I was. If I was home, I felt like guilty, I wasn't at work, and vice versa. And I spent, you know, the hours at work. Um I can't even, I I I don't even know. I mean, I I I was my wife is a nurse, and I drove past her hospital. She's retired a couple of years, and I said, Um, we talk about how much she worked, and I said, I must have spent 60 hours a week. And she's like, Frank, you spent 90 hours a week, and when you weren't there, you were on the phone, and you know, like you were, and I was like emotionally absent um for many, many years. Um, you know, just kind of I felt like I was in a play when I was at home, and I was just acting out what a dad and what a husband should do, um, because my mind was somewhere else. So therapy helped me there. Um, and just I think maturity um helped me. Um knowing, learning about boundaries, um, and you know, I think there is a silver lining uh to this. Um, you know, having you know, there is growth in in tragedy as well. So it it did take years, um, but I you know today I think I'm there. Um, you know, I if that answers the question, I don't know.

SPEAKER_05 27:05

It does. And I want to thank you for being so vulnerable and candid about your own story because it helps our viewers and it helps our listeners. Um, because I know a lot of them feel similarly, that guilt, the the torn feeling, especially when you're leading anything in the first responder world, that that feeling seems to always be there.

SPEAKER_01 27:25

Yeah, I mean, yeah, I think you have you you you have to listen to your body. I mean, I think we were taught, you know, just to keep going. Um, and and you know, that's that that's not resilience. You know, like you know, you you have to understand where you know where to stop. Um, because if you keep going past that breaking point, it you you're just going to it over time, you're just gonna wear out.

SPEAKER_05 27:53

Right.

SPEAKER_01 27:54

Um, so you you have to listen to your body, you have to listen to your emotions, you have to look at your behaviors, what are you doing? Uh if you're not sleeping, you're not eating right, like so. Um I I I think um I learned to do that. It it it took years, and it um but I I think I'm there now.

SPEAKER_05 28:20

Well, I'd love to ask you, do you have a success story or just a situation that comes to mind with all of the work that was done there that just hits you in this moment that you'd like to share?

SPEAKER_01 28:33

Um so I I I think there are so many of those um those success stories. I I the the the I mean we mentioned it before, but the peer support, um watching that grow, um, watching it evolve from just men and women leaning on each other uh to actually building a program where we had resources and we can direct people to meet their needs. And it you it wasn't, you know, it doesn't take a trade center. You know, you don't need a major disaster like that. Every day in a in a fire station, you know, 10 or 15 percent of the people that are working there are struggling. And it it it it's personal struggles, it's relationship issues, it's you know, their 16-year-old daughter that they're worried about. And watching watching the New York City fire department go from these men and women that were too tough to ask for any help to reach reaching out, um trusted members of the department reaching out and getting the the the help that they need. You know, I had heard um data saying that um the average individual uh after a trauma or a group of traumas, uh it will take 10 years um before a PTSD diagnosis. So that there's the trauma, and then it's 10 years in between, and then the diagnosis uh uh of PTSD, which is made by a clinician. And always thought about what happens during that 10 years. It's a gradual decline. We watch them, and we enabled in in at FDNY in every department, we watch them lose their family, we watch them drink more, we watch them, you know, eat ridiculously, we watch them lose their health and eventually die of of their of their diseases uh from PTSD. So watching it at FDNY, us being able to shorten that time, prevent it altogether, we knew that we were not only affecting that individual and you know making their quality of life better, but their family and generations later. Um and just lifting that stigma, having proper clinical support. Uh we we were changing lives. And um, you know, as I you know move on um and you know from from this career, and you know, I'm getting to that point in a few years, um that's uh if if anything I'm proud of, it's that.

Voiceover 31:48

Well, thank you for sharing that, and that that really wraps up the um kind of like the evolution or the the arc of um where you started with the CSU and to see that it's it's gotten to that place today is uh is pretty amazing, to say the least.

SPEAKER_04 32:02

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Voiceover 33:20

Just take us through a little bit of what you're up to these days with the NFL F and FRCE. Um, any anything you want to touch on with that, events coming up, any kind of uh special uh projects?

SPEAKER_01 33:32

Sure. I mean, uh there's uh a group that I'm working with, um Responder Strong, and I'll get to FRC, NEEF F and um and the IFF as well. But uh Responder Strong with Sarah Janke, who's a close friend and a um a fire uh uh a researcher. And um what what I've recognized um in responding to the events that I have responded to over the years is that we are doing a a really a much better job with in with fire service at these events and after these major events. But almost always um there are people that are not being served. And um, for instance, at the Lahaina Fire, um which was uh about 18 months ago, uh we were there uh working with Maui Fire and um the USAR teams, but there were heavy machinery operators from the community that were lifting these buildings off of their neighbors, and they did not have any education nor were getting any support. The emergency room nurses, the um the the electric line uh people that were stringing electric lines into back into their community, um that were getting the wrath of the community because the electric companies were you know being blamed for the fire, and meanwhile, these people, it was their community, they were stringing lines uh seeing this devastation. I think of teachers uh that are uh in in these shooting, uh active shooting um uh situations. I think of teachers that are doing drills with with first graders, lining them up, even if there's not an active shooting, and watching these kids hide into their desk or go into the hallways or whatever, and the trauma that that that brings on. Um recently working with the EPA um about you know the uh environmental protection agency responding to disasters all over the country um and there for months. Oil spill uh people that are responding to oil spills as well. I I I think we have to expand um what we think of as first responders, um, and think about all the people that are responding to events in the in our changing world. One of one of the first um one of the first exposures I had to this was um uh there was a shooting, a theater shooting in Aurora, Colorado many years ago. And I went there as the behavioral health coordinator um for the IFF, and we were there working with fire and police and EMS, and um I asked if um uh somebody had mentioned dispatch um and what they had to go through with getting calls from the from the civilians in the theater. So one afternoon or late evening after we worked with the fire, I said, let's go. I went with my team, uh a couple clinicians from New York, and I said, Let's go visit the dispatch. And we walked into the office of the dispatch, and men and women just started to cry. Because no one ever thought of them. And they were crying like you know, like just and we didn't do anything. We just kind of we just showed up. Um and I I started to recognize that you know it's it's great to work with the fire service, um, but uh this is you know one big world and one big community when it comes to first responders that we really need to think about um everyone that's on the scene.

Voiceover 37:39

And that's something that we've touched on before, and and you really drive home the point that um we don't even consider some of the people that are responding to emergencies, and some of them on a regular basis, tow truck uh operators. Um, we're seeing a lot of the same stuff we're seeing at M MVAs. Um, I'm sure they don't have CISD and um access to peer support and things like that. So yeah, it's such an underserved um community. Can you um just share with us a little bit about your ongoing work, FRCE, LF, and any uh cool projects or events?

SPEAKER_01 38:14

Yeah, so um I don't know if they're cool, but um it's uh yeah, I just um I was just uh uh we just built out um and and I just sent it all off over to Frank. I hope he accepts it, but uh we were looking at stress first aid, um, which is a model that was built from um from the military, uh, had been converted to the fire service. And I I um Patricia Watson and um Vicky Taylor are very um prominent in that. And um I I thought that we needed to kind of advance stress first aid and see where it fits in a department, so um, and how to make it sustainable in a behavioral health program. So um been working on the the last couple of months on on building a program for that and just uh delivered that to the FRCE. So I'm excited to see that um uh see that work. Um I continue to work on on the Go team with the um the the uh the IFF. Um fortunately this this year um uh it we just we we had one major disaster. Um it's been uh with North Carolina and um which is terrible and and the and the in and and Florida hurricane, but that that's been a very active part of my life. Uh you know, and um it's it that seems to just be getting worse and worse this year. It's just awful what what happened in in North North Carolina. Um again, working with responder strong uh to to

Voiceover 40:00

expand out um the support that we have in in in the community uh so um you know that's really what i'll i'll be focusing focusing on over the over the next year um is um trying to um i i don't want what we've learned um to to kind of just dissipate so um i i i'd i'd like to um uh to let people know the lessons learned from uh from from the major disasters and and from new york and from my experience so that that's kind of what i'll my plan is over the next couple of years um uh there's a new generation um which is great um uh and where um i just wanted to part uh that information to them so they can hit the ground running that's incredible an amazing body of work and uh we salute you for all that you're doing and continue to do Frank where can people get in touch you or find you on social media internet anything like that well I'm not so good uh at that but they can always email me um yeah I I try my best um I've I've learned to try my best to stay um uh away from social media uh it's just healthier for me uh particularly uh uh and I would I I would mention that to people that are in communities that are um that uh experience a disaster uh the rumor mill and the things that you see on social media uh can really be hurtful um you know I I just got back from a meeting um with Maui Fire um and um uh they the the the healthiest ones there uh said that they stayed off of social media um you know they um and the ones that were glued to social media uh hearing the rumors of who's gonna get fired and they did the wrong thing and they did this they did that um really had a lot of sleepless nights and um and worse so um hey listen we're uh we can't turn the clock back um and this is or the this is the world that we live in but yeah I I I would I would say really be careful with that I I know that's not the question you asked but it came up um and I think it's I think it's important but my email um I hope that to well frank I I want to thank you on behalf of our profession for everything you've done for New York and beyond um we're all on the same page with our missions and thank you as a fellow brother first responder for tending to your people and your family um you've done great work and I hope when that day comes to retire you you can hold your head super high knowing you did everything you could well I I appreciate that so much Bonnie and and like I said to start with it it's been an absolute honor um I I can't express the gratitude I have um um and the trust that people have put in put it put in me and I just want to say Frank I you I think you're a fountain of good advice you've been through a lot of uh learning experiences and it's great that you're so willing and passionate about passing on this is what works and uh this is you know I've seen this I've seen what doesn't work and I see what does work so and I really appreciate your passion to help other people doesn't matter where they are and and uh I admire that well thank you very much Stacy well I can say as I'm looking forward to seeing you in person in in March in uh Nashville and um want to thank you for being here with us today and kind of giving us the scope of uh of all this that you've uh you've been involved with and continue to move forward in the in our profession especially um as it pertains to the next generation I think that's super important to to uh you know have share with them your knowledge and expertise so thank you for being with us and uh look forward to our next conversation thank you remember to like and subscribe YouTube responder resilience Facebook responder wellness inc and responder tv linkedin apple podcast spotify and go to our website responder tv.com for past episodes and guest information until the next time stay safe be kind to yourself take care of the microphone