A Lifeline for the Helpers

Program Penn Medicine Princeton Health First Responder Treatment Services
Location Princeton, New Jersey
Health Need Behavioral HealthSubstance Use & Abuse

With heroism, comes risks.

The first responders who bravely stepped to the frontlines of the COVID-19 pandemic have not only put their health and the health of their families in harm’s way of a virus that has taken the lives of more than 500,000 Americans and sickened millions. They’ve faced an unprecedented level of stress and exposure to tragedy and trauma — less visible but equally dangerous impacts from the virus.

If left unchecked, these strains can manifest into mental health issues, substance abuse, or, in many cases, both. And for those already battling such issues, the events of the past year will only put them a higher risk of heading down an unwanted path.

“They are not Superman, though that’s what sometimes they think,” says Michael Bizzarro, PhD, director of clinical services of the Penn Medicine Princeton House Behavioral Health First Responder Treatment Services program. “It’s really challenging for them to realize when they are affected. I often tell them: ‘Even Superman was not invincible when faced with Kryptonite.’”

For years, Dr. Bizzarro and his team at Princeton have been helping first responders cope and recover, a lifeline that has continued throughout the pandemic.

The first and only program of its kind in New Jersey, Princeton’s First Responder Treatment program offers a unique set of inpatient mental health and substance abuse services and outpatient follow up for those struggling, including law enforcement, military personnel, firefighters, paramedics, EMTs, and, most recently, 911 dispatchers.

Since the program’s inception in 2013, a team of clinical social workers, clinicians, trauma specialists, and peer liaisons — many of whom are former law enforcement officers and military veterans like Dr. Bizzarro — have treated more than 1,400 first responders and helped them navigate back into their jobs and life.

“That’s what we have at Penn Medicine, a charismatic group of individuals who all have a specialty based on corrections, police, EMT, the whole package,” said Ken Burkert, the Princeton program’s senior outreach coordinator and union liaison, who served as a corrections officer for 25 years. “We are real. And we tell them the way it is. And they respect that because they know where we’re coming from. We understand what they are dealing with.”

When the pandemic hit, though, like for so many programs, things changed dramatically. Despite the added pressure and danger of their jobs serving the public, fewer first responders pursued treatment in 2020.

“We’ve seen a significant drop, but it wasn’t because the issues were gone; it was because of a reluctance to come into treatment,” Dr. Bizzarro said. “What we have seen is an increase in mental health issues compared to just substance issues: anxiety, depression, and PTSD, as a result of so many community deaths and exposure to trauma. And that can translate to an increase in substance use and domestic violence.”

“There will be a residual impact from all of this,” he added.

This is a group that already experiences a higher rate of mental health and substance abuse issues.

Law enforcement officers are twice as likely to experience depression compared to the general population, for example, and one out of four battle an alcohol or drug addiction. Too many times this toxic mixture ends in suicide. Today, more law enforcement officers are killed by their own hand than in the line of duty. And even more grim, 20 military veterans take their own life every day.

“We’re talking alphas, Type A personalities,” Dr. Bizzarro said. “So, it’s really hard for them to acknowledge and recognize that there could be a chink in the armor.”

Dr. Bizzarro is uniquely qualified to lead the program.

His own time on the police force and in the military had left him with unresolved mental health issues that sparked an alcohol addiction and so much despair he wanted to end his life.

“I lost my family, my job. I got arrested. Here I am thinking there is no way out of this vicious cycle of addiction,” he recalled. “I don’t know where it came from, but then a thought popped into my head. If I pulled the trigger, I would stigmatize my son for the rest of his life. And that was the beginning of a turning point in my own life.”

After that, Dr. Bizzarro received the treatment he needed, thanks to his cousin, a fellow officer who introduced him to a 12-step program. His next years would be spent successfully rebuilding his life, obtaining his master’s in social work and a PhD in clinical social work in 2003.

Knowing first-hand what first responders endure, Dr. Bizzarro decided to help others walking the same difficult path he did. He volunteered as one of two on-call clinicians through the New Jersey State Police Benevolent Association (NJSPBA) in the early 2000s, a time when suicides among police in New Jersey had spiked. He was an empathetic voice on other end of the phone to assist and refer first responders to help, often to an out-of-state, 28-day alcohol or substance abuse center.

Then, in 2013, New Jersey union officials decided they needed to connect with an in-state program to treat both addictions and the trauma. Princeton Health recognized the need and developed Princeton House Behavioral Health First Responder Treatment Services, with Bizzarro as director.

He, along with Burkert and others, developed the “Brother’s Keeper Doctor-Peer Protocol” for the NJSPBA and the Department of Corrections, and later, New Jersey’s firefighters.

Princeton House has now evolved into what Dr. Bizzarro refers to as “the hub,” an intensive seven to 10-day inpatient hospital course, followed by an individualized treatment course that may include a longer-term residential treatment facility, partial hospital (day treatment), or intensive or traditional outpatient treatment.

“If you were to tell me that I would come full circle and do what I did, I would have said, ‘No way,’” Dr. Bizzarro said. “I’m just extremely grateful to be given another chance at life and to extend a helping hand to a brother and sister caught in the grips of despair.”

Eight years after taking the helm, Dr. Bizzarro is as committed as he ever was, as his community faces some of the biggest challenges they’ve had in recent time.

Many of Princeton’s outpatient programs pivoted to a virtual format and integrated telehealth options during the COVID-19 pandemic, drawing on even more experts to provide evidence-based trauma treatment to those in inpatient treatment. They also launched an online support group called “Too Strong for Too Long” for first responders and family members.

To help improve resiliency and coping skills among active first responders during these times, Princeton’s program has been holding virtual trainings and wellbeing workshops in New Jersey and Pennsylvania. The goal is to promote behavioral health awareness, point people to appropriate and effective resources, and motivate them to come forward.

“In addition to being able to help fellow first responders, I learned how to help myself,” said one detective sergeant who attended a training. “I have been struggling to find a new therapist and today I am relieved I can get one through people who understand [law enforcement officers].”

One such training served the 6,000 members of New Jersey’s Firefighters Mutual Benevolence Association and the Paterson, New Jersey Fire Department—which attends to some 30,000 calls a year.

For a high-call traffic unit like Paterson, outreach is critical, Bizzarro said. This is the time when breaking down barriers, like stigma, and bringing awareness to all the dangers of the pandemic is needed the most.

“There is a lot of internal and external pressure from the community, as well as what’s happening on the home front, because families are feeling financial stress, kids are not school, and there is not much of a break,” Dr. Bizzarro said. “There are so many factors contributing to additional stress that just weren’t there before.”

Finding Balance

For Liz Cleary, a New Jersey corrections officer who battled alcohol addiction for almost four years and is now sober, Princeton’s First Responder Treatment Services program was a safe harbor.

“It’s a place where I learned healthy and appropriate coping skills, so that when the challenges of life came my way, when I was overwhelmed by loneliness, fear, depression, or anxiety, I was able to [face them], hit pause, and reset,” Cleary said.

She began abusing alcohol when the weight of the stresses in her life and high-intensity job became too much to bear. “I went through a mid-life crisis, where I was disappointed in where I was at in my life,” Cleary said. Drinking became her escape, she said, and a way to connect with her emotions. But once she was able to feel, it became too much, and she began using alcohol as a way to suppress those emotions.

Feeling the pressure, she reached out to the police hotline, Cop2Cop, for help and ended up being admitted to the Princeton program to get healthy in 2017.

But the 54-year-old New Jersey native, who has been a corrections officer for over 20 years, didn’t complete the program that time. “I went as a way to preserve my job,” she said. “But I didn’t really embrace the problem I had.”

She returned a year later, under the direction of her employer after a drinking-related incident sent her to the emergency room. This time was different: She was admitted back into the program with a new mindset and attitude, and continued through with the outpatient program.

“I was willing to commit to all the changes and really submerged myself in therapy. I delved deep,” she said.

Cleary said she learned to express herself and share her concerns and worries with people who can relate to her and won’t judge her. She also regained her athleticism and was introduced to her church, where she said she developed a relationship with God.

“I’m much better at self-care and recognizing the balance that is needed,” she said.

For others suffering with substance issues, Cleary said keeping it inside will only make it worse. It’s crucial to open up and share in an environment like Princeton’s program.

“Isolation is probably the worst thing, that feeling that you are on your own,” she said. “People need to get the weight off their backs. Opening up will relieve yourself of the burden.”