BELLOWS FALLS — When Covid-19 struck in March 2020, one of the early casualties was the closing of the Uniformed Services Program (USP) at the Brattleboro Retreat, Vermont’s largest psychiatric hospital.
USP, launched in 2009, brought in first responders from around the country, helping former and current military members, police, firefighters, emergency response personnel, etc. deal with the aftereffects of intense trauma — in particular, post-traumatic stress disorder.
What was originally intended to be a short-term shutdown of the program turned into a permanent closing as it became evident that Covid would go on not for weeks but for months — if not years.
That summer, rather than return to the front lines in the units, Mike Cancellieri, one of the instructors in the USP, began creating a new program for frontline services workers: Front Line Foundations of North America, Inc., or FLF.
The new organization found space to open at the Rockingham Health Center, in the former Rockingham Memorial Hospital facility, which now houses doctor and dentist offices, a psychiatric unit, community television, a gym, and an urgent care facility, in addition to FLF.
In addition to Cancellieri, the principals of FLF include his wife Lila as media officer; Jennifer Sell-Knapp, a social worker; Karen Banks, office manager; and a friend, Steve Banks.
Banks was a retired, high ranking, 30-year Coast Guard and combat veteran who was studying to be a social worker with the aim of helping veterans.
“Steve had been an intern at the Retreat,” Cancellieri said. “He had excellent organizational skills, and he also helped fund the startup.”
In addition to the classes Cancellieri teaches, Sell-Knapp runs psychotherapy groups.
Since opening, FLF has served around 100 clients. Cancellieri said they should be working with two to three times that number, but Covid in particular has been disruptive for clients entering the program.
FLF started as a two-week program, but because the majority of clients are working police and firefighters, who find it difficult to get two weeks in a row off, they’ve reduced the main program down to five days, while still offering longer programs when needed.
FLF accepts insurance and self-pay, but Cancellieri said that “any clients that are a good fit for our program are welcome here.”
‘A warrior’s ethos’
“The skills that we teach here are what you would need to stay mentally healthy in a frontline job,” Cancellieri said.
“It’s about self-care skills, mindfulness, compassion,” he continued. “I know what it’s like to be doing a crossword puzzle when an alarm goes off, and a minute later you are fighting for your life.”
The program teaches first responders how to deal with trauma before they find themselves in traumatic situations, so they will be better prepared.
One of Cancillieri’s goals is to get the FLF program into the fire and police academies and into military basic training. The practice also provides in-service trainings for area fire and police departments and other first responders.
“What I teach is totally original,” Cancellieri said, “except what I teach is thousands of years old. This is not religion, but mindfulness — the oldest, coherent system of practical philosophy.”
He described mindfulness as “Buddhist psychology” and “not religion.”
Buddhist and Taoist philosophies, along with its Western brother, Stoicism, are what Cancellieri calls “a warrior’s ethos.” The shared principles and skills in these practical philosophies provides powerful tools for dealing with life’s traumas.
“Mindfulness is what has been helping warriors for thousands of years,” he said. “It’s not the pop concept of, ’Oh, I feel all zen!’” (“What’s that?” he asks.)
Rather, mindfulness is the skill of controlling your attention. He noted also that the practice is the basis of any number of current mental health therapies.
“With PTSD, if you can catch that stuff early, [using mindfulness,] you can do something about it and it can go away,” Cancellieri said.
“The only time you can have any effect on your world is right here and right now,” he continued. “When you develop this skill, the happier you’ll be, the less anxious you’ll be.”
Cancellieri is an avid outdoorsman and nature photographer, so hikes and reconnecting with the natural world are also part of the program.
On the FLF website, Cancellieri offers a series of 2-to-3-minute mindfulness videos, which are also on his YouTube channel, “Mike Checks in From the Truck.” He records them in the front seat of his pickup while parked at a very busy gas station/deli/farmstand in Westminster.
The series, with 21 videos as of Jan. 15, provides a bit of an insider’s nod at shared trauma, he says. Frontline workers with PTSD find busy stores like this difficult to navigate, and having someone standing behind you in line can be very disconcerting.
Whose trauma is worse?
What is worse: combat, running into a burning building, trying to save a horribly injured person at an accident site, facing a suicide-by-cop incident, or having to physically restrain a 250-pound psychotic patient having a violent episode?
“Everybody comes in thinking that their trauma is less than someone else’s,” Cancellieri said. “But when you get them all in a room together talking, they realize their trauma is all the same."
Joe Gorman, a retired New York City firefighter who has worked with Cancellieri both at the Retreat and at FLF for several years, agrees with that assertion.
“In the group dynamic, I came to realize I’m not the only one who feels this way,” he said, his New York accent dripping with in-your-face attitude, big-city toughness, and no nonsense. “Everyone in the group is dealing with the same thing.”
Gorman is from one of those legendary New York City families who have dedicated themselves to frontline public service for generations. His and his wife’s families have together logged more than 600 years of service in the city as firefighters, teachers, nurses, and police officers.
Gorman started with the New York Police Department in 1984, when he was 20. At age 23, he buried his partner.
Shortly after, he transferred to the fire department. “I was in a real busy company,” he said. “There were a lot of traumas.”
Then the World Trade Center was attacked on Sept. 11, 2001, and his company was among the first responders.
“We lost 13 guys in all on 9/11,” Gorman said. “The guys that did come back had all sorts of health problems and began dying from various cancers. I was told that my lungs were not healthy enough to be able to return to work.”
The effect on Gorman’s life was devastating.
“I got quite disconnected,” he said. “I climbed into a bottle and stayed there for 15 years.”
Gorman said that a few years after the attack, he was invited as a 9/11 first responder to attend and participate in a Governor’s Conference in San Francisco. He said he went to all sorts of programs, spoke at some of them and at schools, but remembers none of it. His PTSD was in control.
Finally deciding to get his life in order, Gorman went into a 28-day alcohol recovery program, and from there went straight to the Retreat’s Uniformed Services Program in January 2019.
“I was introduced to mindfulness in another program,” Gorman said. “I was willing to look into it. I tried not to let my perception get in the way that this was all foo-foo bullshit. I was too much of a badass.”
‘Survivor’s guilt is a horror’
Realizing USP could really help him, Gorman said he examined his attitude.
“Fortunately, I changed my perspective,” he said. “Breathing. It began with the breathing for me. The practice keeps me in the now.”
“Survivor’s guilt is a horror,” he continued. “I’m not ashamed of my illness, my PTSD. The program gives me hope to continue my practice. It takes practice.”
During his first visit to the Retreat, Gorman met Cancellieri.
“Mike was huge in lighting the fire under me,” he said, noting the huge impact from just one week together.
Sober since November 2018, Gorman has done two cycles of the FLF program, and he plans on doing more.
Getting sober and learning the skills to deal with his PTSD have made a huge difference in Gorman’s life.
“I’m coming on 20 years retired,” he said. “My life is good. I never thought I’d have any peace. I still have PTSD, but I’m learning how to deal with it. My night terrors are much less frequent.”
Cancellieri describes Gorman as “the real deal, and he has a giant heart.”
Because PTSD is such a common thread among front-line workers, Gorman said he wants to help others. He recently got his certification as a recovery peer advocate.
“Hopefully down the road I’ll help others deal with this,” Gorman said. “It works. The program works if you work it. Practice is the key.”
When PTSD hits
Prior to his work in the Uniformed Services Program, Cancellieri had worked for 10 years at the Retreat as a front-line Behavioral Health Technician, working directly with patients to take care of their needs and teach coping and mental health skills. They are the main ones expected to respond when there are behavioral issues involving a patient.
Cancellieri had also been an instructor both in the Retreat’s protocol for restraining out-of-control and violent patients and in the Retreat’s Early Responder program, training qualified BHTs in advanced de-escalation techniques. These methods help prevent potentially volatile situations from spiraling out of control and also teach restraint techniques in case they do.
“I have significant PTSD from the thousands of codes I was involved in,” he said. “There was no way I was going back to working frontline on a unit.”
The incident that precipitated his leaving the units in the first place, Cancellieri said, was when a nurse was badly injured by a patient with psychosis.
He found that event deeply troubling, and on his next code, he said, he found himself at a loss to perform a rather simple task he had done hundreds of times and taught many others to do.
He said he simply had no idea what to do, and had to hand responsibility to a coworker who noticed his dilemma. He found himself seriously upset afterward, Cancellieri said, and he was sent home by his charge nurse.
Losing the capacity to perform a task that one has performed many times before is a common symptom of post-traumatic stress disorder.
That’s when Cancellieri moved off the front lines and into the USP.
An incident that occurred after he left the Retreat illustrated to him why he made the right decision.
When an announcement came through its public address system at a local Home Depot, it sounded very similar to the one at the Retreat, and Cancellieri said he found himself instantly moving into combat mode. He found the response very troubling, he said.
He says he still finds times when he feels his Early Responder pager buzzing on his belt, though he hasn’t worn one of those devices for years.
“I know what it’s like to be doing a crossword puzzle when an alarm goes off, and a minute later you are fighting for your life,” Cancellieri said.