Amanda Wilde (Host): Welcome to Recovery Unscripted, the Haymarket Center podcast, where we discuss meaningful conversations focused on the integration of substance use disorder, mental health, and primary care treatment. Today, we'll get an inside look at Haymarket Center's intensive trauma recovery retreats for first responders.

I'm Amanda Wilde with Dr. Dan Lustig, President and CEO, Haymarket Center. Welcome back, Dr. Lustig.

Dan Lustig: Thank you, Amanda. Really excited about today's topic.

Host: Well, for that, we are joined by police psychologist, Dr. Kammie Juzwin. Dr. Juzwin, thank you so much for being here.

Kammie Juzwin, Psy.D: It's my pleasure.

Host: Dr. Lustig, this sounds like a very specific, unique program. Why did Haymarket Center want to provide this resource for first responders?

Dan Lustig: Amanda, it happened really, truly based off of an article that I read several years ago in which first responders who based on the trauma that they've experienced, typically, 30% of them commit suicide when they retire. And I found that article to be quite disturbing, obviously. You know, I have a background, my family is in police work. And so, I found that statistic to be startling and confusing.

And so, as I began to look into the trauma that's related to the work that first responders do, I really thought about if there's ever going to be a time to have healthy communities, we need also healthy first responders. And oftentimes, the systems that they work in don't support good mental health.

And so, it took a couple of months for me to be at a function with Dr. Juzwin who we got talking about really the work that she's done relative to this population. And I felt a need that it was a pure happenstance moment that we could really, truly make a difference for individuals in not just the state of Illinois, but in Chicago. And it was really an exciting opportunity for us to do something really, really positive.

Host: So, this is a total collaboration. Dr. Juzwin, you've been in on this at the ground level. What happens at a retreat?

Kammie Juzwin, Psy.D: What happens at the retreat is—four days, it actually started at three and a half days, and we've managed to keep pushing it back because we discover we just need more time together as a group. But what happens is, it's four days of very immersive and intense focus on the personal impact of working as a responder or essential medical personnel and the cost or the impact of that job within that culture on them in every aspect of their life. And that this is not just a job, it is actually a call to service. It's a deep commitment. And across their lives, it changes their physiology, it changes their outlook, it changes their thinking, it changes their belief system.

And because they're immersed in violence and trauma, they very seldom get the person who comes in the ambulance because they ate too many cookies or calling 911 to have, you know, send a squad because, "I ate too many cookies." When they're on, it is very, very intense.

So, their exposure to trauma is it can be almost daily all the way through the very mundane. And it's an on, off, on, off kind of physiological change for them over the history. And they're different. They see the world different, they understand the world differently. and what we do for four days is, using a small group, very immersive, process, we educate and identify the impacts of the job that each person has felt that they've had, understanding trauma, grief and loss, and also understanding the physiological impact so we can start working to help manage the impact of critical and traumatic stress on our bodies.

so, using peer support-based principles and critical incident stress manage-based principles, we move through larger group discussions, small group discussions, stress management activities, as well as talking about what are the interventions. And if you were going to use therapy, what is available? Following the model of Roger Solomon, we do EMD, eye movement desensitization, which is different than the longer-term reprocessing intervention, but it's a very small community that they build the community. So, if you've come to one of these events, it will never be the same because of the different community members in it, and because we tailor what the group needs based on what they tell us they need and they want.

And so, I think that that's how we're a little bit different than other events. Yes, we have a curriculum that covers particular topics, but the way that we go about doing that is based on what our individuals have identified during the screening process.

Host: And Dr. Juzwin, what have you seen first responders learn from the retreat experience?

Kammie Juzwin, Psy.D: One of the things that I've learned is they maintain a community. At the end of everyone, people who want to will join the alumni Facebook page, or they will develop a phone text tree. We have a small community groups from four years ago when we first started who are still getting together as peers. Several of them have an ongoing Bible study, and it's interesting how they talk about that these are bonds that are formed during healing, not bonds that are formed through trauma.

And so, what we have seen is people leave lighter. As a matter of fact, we ask them to take their picture the very first day that they come, and we ask them to take their picture right before our closing group ceremony, and then we ask them to look at it. And we had one woman who said, "Oh my god, this is better than Botox." You know, she goes, "There are no lines on my face." And you see the group, they're lighter, they understand that their body is releasing grief, that if they want to fight the stigma, they are the equipment to fight that stigma. "I'm going to talk about it and I'm going to heal, and I'm going to move forward."

But the close-knit friendships and support systems that come out of this, as well as a shift to including living at home and going to work, and then passing the torch to the next shift is really a mechanism to save their lives as they go through time, and then to also really seriously reconnect with what do they want and what do they need for themselves as a person off-duty across their career. And so, that they actually begin career-shifting or career transition right then and there during the retreat, so that they start building on something to look forward to instead of going back over and over and over and over to be exposed to more trauma and more moral injury, et cetera.

Host: Dr. Lustig, is the stigma that Dr. Juzwin is talking about that first responders face similar to the addiction stigma that you have talked about previously? Are there similarities there?

Dan Lustig: There's a lot of similarities to—you know, stigma, again, is what blocks people from getting the help that they need, and it shows up in many different forms. It can show up on the job, it can show up in the environment, and it can show up in the family. And the similarities, again, block that person's opportunity for growth and healing. Stigma remains the number one cause of death for people who have substance use disorders, and it's not that far behind for those that suffer from mental health disorders. So, it's a very similar aspect, but the key thing is us trying to get people the help that they need to start the journey of healing.

Kammie Juzwin, Psy.D: If I can add to that, many of our first responders really struggle with not understanding that they may have crossed into post-traumatic stress injury, as well as PTSD in some cases, and many of them use substances, especially alcohol, gambling, relationship, or exercise to stop feeling numb and to stop the pain.

So, it there is a lot of similarity, and that dual set of problems is something that we have to look at. What are you doing to manage or cope? and because they often change their physiology, the adrenaline. Some of them that will joke that they're adrenaline junkies when in fact they're chasing the high of the pleasure, of the excitement. And your body doesn't know, doesn't recognize the onset of the course, like, what started it. It just knows it's getting this chemical dump into their brain, and they become kind of addicted to that rush.

Dan Lustig: And it's that rush that they're experiencing that, believe it or not, are some of the variables that lead to individuals attempting suicide, because it is this kind of—what is a term in the field called psych ache, and this is when an individual continues to do things that are either bad for them, or allows them to continue feeling pain and pain and pain, until it becomes not painful anymore, because they get numbed from it.

Those are symptoms and signs you don't want to see in individuals when they continue to do things, activities, that not just are a rush, but bring pain to them, because they become inoculated to levels of pain as they continue through their journey. So, it's very serious level of learned behavior that can oftentimes be missed by family members.

Kammie Juzwin, Psy.D: And family members may see anger, cynicism, disillusionment, detachment, and the anger really often motivates people to move and to do something. But in a first-responder situation, when they feel that lack of control or a lack of self-agency, the anger has nowhere to go, and you have to keep it together at work. And so, it sort of leaks out in other places. And we see that, at times, when officers commit suicide or physicians commit suicide at their places of work, that is such a huge cry that nobody's hearing how much pain we're in that's located here in this work environment.

Host: And you address that through therapeutic services incorporated into every retreat and really individualizing each retreat, as you mentioned earlier. It sounds like the program can be very much awakening, healing. It is life-affirming and perhaps life-changing, and will bring down that suicide rate.

Dr. Juzwin, how do officers and other first responders apply for the program? And is there anything else they should know before doing so?

Kammie Juzwin, Psy.D: Yes. Actually, it's very easy to apply. They can apply on the Haymarket Center Responders Retreat page. I post it on my LinkedIn on behalf of Haymarket. And I post it on a Facebook page that is a resource for responders. But I have flyers out there and every single one of our team has access to the flyers, and they're constantly out there educating in the community and passing out the flyers. We have a lot of advocates. So, that's really a wonderful thing that they call or they email me, and I return a call, and there's a brief screen.

The only real rule outs for not being able to attend the retreat is if you have unmanaged substance use and you're not receiving treatment, or connected with a support group. If you have had a serious head injury within the last year, and that you haven't been cleared by your physician to participate in because sometimes we've seen people with profound brain injuries and they're just not able to absorb, and they get overwhelmed by the emotion.

And then, the last is, "Have you made a suicide attempt within the last six months? And then, we talk about their level of thinking of suicidal or hopeless thinking, and really equate it to the "It sounds like you're suffering, and is it that you want to stop suffering, or is it that you want to stop living?" And in some cases, we've talked, and I've referred people to different resources. And for several people, we've been a landing place when they come out of treatment, and they're working with a therapist, and they come to the retreat to build upon their established sobriety, their maybe tentative hope and the like, and to come for support and community.

We talk about why now, "Why come now?" And also, what do you notice about the impact of your career on you physically, mentally, emotionally, spiritually, and in your life? And so often, people talk about the impact of their job has caused such problems in their personal life, that they need to get back on a steady ground. So, they need to know that they come and they stay. They can't come and go. And so, it's not a traditional seminar. You're not going to sit and stare at an instructor and maybe have some light dialogue. We do have seven modules that reflect the Illinois Standards and Training Board mental health points that officers need every three years.

So, we do cover those points, and some departments give officers that credit in their training for coming to the retreat. But it's designed to be a brief conversation, but it can be a fairly long one, because when they arrive at the retreat, because of the heightened anxiety of it, I want them to have a feeling like they know someone there, they've had a conversation with me. So, I'm always there to greet them, and to shake their hand, and to introduce them to a really remarkable peer supporter staff.

But it's super easy. Call, get the information. Email, get the information. If you want contact with someone who's gone before, I have previous participants who said, "Yes, please give out my name and number, and I'd be happy to talk to that person." And then, the wonderful thing is that we have a lot of alumni who will come back for a day to come and sit in group or come to support or have a meal with the different people and talk about their experience and what they're doing to maintain their health. So, it's very easy to get in.

Host: You do make it very easy to approach these retreats, and they are so well-thought out, and you are seeing effectiveness with these retreats. I'd like to ask you both, starting with you, Dr. Lustig, on how you're hoping to continue to grow the Intensive Trauma Recovery Program.

Dan Lustig: We're trying to grow it in several ways. We're looking at alternative locations to, encourage more people to attend. We've had a lot of support from Senator Tammy Duckworth and Senator Durbin, both who have helped to lend money to this project. So, we're continuing to find ways relative to funding. Because when we started this initiative, we started this off of with nothing. And so, now it has grown into something that's really both powerful and healing for the people that come.

Dr. Juzwin and her team work very hard at removing all barriers to why somebody would not want to come. and that's why our funding of this program is so critical. So, right now, we're looking at different stages right now. We're hoping to open up in the western suburbs to a location that could be just as exciting as the locations we've been at.

So, that's what we tend to do. We tend to expand. We want to get encouragement from other police departments to send officers to this, what I consider vital training for their mental health. We've got to get police departments to really break down the silos and not be afraid of talking and discussing about mental health.

Good mental health comes by way of discussions. And so, Dr. Juzwin has gone out of her way to meet with different police departments to really kind of break down those silos, those walls that really prevent people from getting the help that they need. So, we've got a lot of work in front of us,

Kammie Juzwin, Psy.D: I think it's really important to acknowledge that, although we hope this is therapeutic and healing for people, that this is not a substitution for therapy. It is not therapy. We don't meet any of the standards of therapy. It is peer support and critical incident stress management, plus education at a very personal and very immersive level. And it is not a train the trainer class, it is not a CIT class, and it's not therapy.

My fear is always that related to mental health, we check a box. Wellness consultations in Illinois are optional. And those are also not therapy. Those are straight education and resource development. But departments train their personnel on the best skills that they can have, whether you're a firefighter, whether you're a police officer, telecom, et cetera.

We train people, and sometimes we do—you know, we say, "Here are the components of psychological first aid, blah, blah, blah," and they move through. But what they don't do very often is apply it through the personal, personally-centered. "I right now need support," or "I'm seeing you look so fatigued. When is the last time you slept?' Or Being comfortable having those kind of conversations, they don't have any issues saying things like when they do their shooting qualifications, like, "You didn't meet at the lowest standard. You're going to have to go through training and education for that." Why aren't we taking that same sort of thing, that same sort of approach rather, in dealing with our mental health. Because the more we invest in keeping officers, nurses, doctors, firefighters, telecom, et cetera, healthy during their career, the more productive. Actually, it benefits the agency. Morale is better, your officer health is better. I work as an embedded psychologist in one of the suburban departments, and they said that they had noticed a significant difference in their health claims and sick days after the first year I was there. And not all, I shouldn't diminish it, but what I do is I sit and I talk. I'm in the squad car. I'm talking to them, I'm asking about their families, I'm helping them resolve conflicts, problem solve, pointing out, and acknowledging some of the mental health issues. You might want to give that some though. It's really normal that people feel like that after that sort of thing. So, it benefits everybody.

Host: And from the program planning perspective, how do you see that evolving into the future?

Kammie Juzwin, Psy.D: Dr. Lustig spoke about potentially the expanding out in here into the western suburbs. And with that, we have a couple of models that we're exploring how we could do that, that would involve everything from a drop-in center to a counseling center, to extended retreats, yoga, somatic work. I'm really advocating for the swimming pool. So, stay tuned to see if that happens.

But healthy nutrition, a place to go for true respite and retreat and for counseling, if that's what you need, and a drop-in place to go to if you're just getting off of a rough shift and you need a transition before you go home. But as that's our big plan, as we look forward to '27 and '28, what I put in for is probably going to keep the grant writing team really busy. But we dream big because the worst that could happen is that we have to pull scale back, right?

But we want to continue with our traditional four-day immersive program that runs Sunday through Wednesday afternoon, keeping our census capped at 14, sometimes we'll move it to 16 if we have a peer returning at a different level, and potentially have the opportunity to have five-day programs where we can really build in more of the somatic exercises, and we're looking at professional education that would involve potentially, financial planning, something that might include spouses.

But the most excited about doing is having a cultural competency for mental health professionals who are at the postgraduate level where there's a series of four or five classes that we're looking at where they would take the classes to have exposure to each of the areas, law enforcement—well, first off, just the culture, law enforcement, disaster terrorism, and then the medical, fire service, whereas telecom is part of all of that because they're like the line that ties them all together, but to have cohorts of professionals that we ultimately have in the retreat and shadowing the retreat and then looking at whether or not we have a space for them in our roster of our team.

I have to say, I get the pleasure of working with some of the best in the world out there. I mean, they're amazing people, and I could go through their bios, but I don't know how much time we have. But they're just amazing. And what's really exciting is before we had the grant, these people showed up for four or five days coming from across the country, coming from the region, giving their time.

So, they're really remarkable people. Some are still active, many are retired. But this is their giving back and giving to. So, if anybody out there is listening, come to meet them. I mean, they're extraordinary people. So, we're wanting to grow both serving in the field, but also to help give mental health an opportunity to learn about this trauma from a culturally-competent perspective.

Host: Dr. Joswin, Dr. Lustig, Thank you so much for your comprehensive focus on trauma recover and support specifically for first responders and for sharing your vision for the future of Haymarket Center's Intensive Trauma Recovery Retreats.

Dan Lustig: Thank you so much, Amanda.

Host: For more information, visit hcenter.org. Make sure to subscribe to our podcast, share, and connect with us on social media at hcenter.org/recoveryscripted. Thanks for listening to Recovery Unscripted with Haymarket Center.