“That really, really, really took a toll on him, and it really impacted him tremendously,” said Justin’s partner Matthew Allred. “And from that moment on it really began to break him down. He was so afraid that he was going to bring it home and give it to me, or any of our friends or family.”

Growing up in Piedmont, South Carolina, Justin’s mother said his nickname from early on was Dennis the Menace because of his wild and trickster nature.

“He would pick on and play tricks on everybody. Once he rigged up a rubber band on a water bottle somehow and when I opened it up, it squirted all over me. He just laughed. And he loved that, playing those simple jokes on people. His brothers and sisters could tell you the same thing, he was a nut,” said Wandalee Adair, Justin’s mother. “He liked to push peoples’ buttons wherever we went.”

One of the first stories she shared to describe this part of Justin’s personality involved him pulling a fire alarm. 

“My mom had him at the mall when he was little, and they were in Belk, and Justin decided he was going to pull the fire alarm. Well, the police, the fire trucks, everybody came running,” she said. 

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As Wandalee described her son, one thing was becoming more and more obvious and soon enough, she shared that her son was the middle child of five. 

“He said he had middle child syndrome. One time we left him at a ball field when my other son was playing ball. We got halfway up the road and I thought, it’s too quiet in here, where’s Justin? Back around we go and he’s there playing on the playground. So, he never would let us live that down. He’d always tell everybody, ‘I’m the middle child and I have the syndrome.’”

At 12 years old, Justin took up the guitar, something that came natural to him. 

“His daddy’s side is a musically inclined family. They don’t read notes, they hear something played one time and then they can do it. And Justin was one of those,” said Wandalee. “That song from Oh Brother Where Art Thou, Man of Constant Sorrow, oh he tore that one up.”

Justin played guitar, drums, bass and sang in the band at the church where he grew up and also worked in the sound booth.

“Justin encountered some prejudice from some people at our church for him being gay. But just some people. But God says love unconditionally, period. I wasn’t gonna turn my back on my son ‘cause I loved him unconditionally,” Wandalee said. “When the time comes to go before the Lord and stand there for your judgement, I think that will be between God and Justin. The judgement from other people bothered him a little bit, but he got over it and began to be who he was.”

Matthew said that in the years they were together, Justin didn’t encounter issues associated with the prejudice and discrimination that often surrounds being gay. Justin had mentioned church members “telling him disparaging remarks and things like that,” Matthew said, “but he was true to himself and he knew who he was and he accepted himself, and he accepted us, and we were just growing along together.”

Matthew met Justin in 2014 while working for a company that provided software used in ambulances and firetrucks. The company, based in Asheville, had maintenance contracts with Anderson and Pickens counties in South Carolina. 

“We met in the course of me being there and doing maintenance work and things like that at the EMS station,” said Matthew. “We struck up a conversation and from that particular point it blossomed into our relationship. That was all the way back in 2014.” 

According to Matthew, fears of the COVID-19 pandemic and the stresses associated with his career as a paramedic weighed on Justin tremendously. However, the pandemic wasn’t the first indicator of the young paramedic’s struggles. 

Justin had been an EMS paramedic since 2007 and held a bachelor’s degree in occupational health and safety from University of Columbia South Carolina. He was a nationally registered paramedic and previously served as a privately contracted medic in Iraq during a six-month deployment. 

Matthew said that Justin had been diagnosed with PTSD when he returned home from his time in Iraq in 2013. The images Justin saw, along with the decisions that had to be made at the in-field hospital, resulted in PTSD that caused anxiety, sleeplessness, nightmares and flashbacks.

Justin’s mother described him as having a quiet strength. He would rarely complain about anything he might be going through, one reason she and her family never worried about him. 

“Never had to worry about him, at all. Whatever he did, we didn’t have to worry,” she said. 

“One of the things I learned from Justin was strength. He went through some pain with his feet, and I’ve never seen a child have to walk on the side and the inside of their feet. And when he was little, he would complain about it hurting, which I know it did. But he wouldn’t complain but just one time, and then he’d keep goin.” (Justin suffered from flatfeet, or fallen arches, a condition that can cause serious pain and swelling in the feet.) 

According to a survey conducted by the Journal of Emergency Medical Services in 2015, 86 percent of EMS workers report critical stress due to their work. For the purposes of the study, critical stress was defined as “the stress we undergo either as a result of a single critical incident that had a significant impact upon you, or the accumulation of stress over a period of time. This stress has a strong emotional impact on providers, regardless of their years of service.” 

The survey also revealed that 37 percent of EMS workers had contemplated suicide and 6.6 percent had previously attempted suicide. Those statistics are around 10 times higher than national averages, according to information gathered by the Centers for Disease Control and Prevention. 

Another study conducted in 2019 by EMS World found that EMS providers report high degrees of workplace stress. The most common factors contributing to this stress are traumatic calls, poor sleep quality, long shifts, lack of downtime after difficult calls, low salary and low job satisfaction. The study concluded that at least 31.3 percent of respondents reflected increased risk for future suicidal behavior and 27.2 percent reported suicidal ideation in the past year — a rate seven times higher than the general population according to the Substance Abuse and Mental Health Services Administration.

The EMS World study found that males, as is true in the general population, were more likely to be at risk for suicidal behavior. The three most common suggested problems were the need for downtime after difficult calls; lack of support from peers, supervisors and the organization for which they worked; and lack of resources available for individuals struggling with suicidal thoughts, including employee assistance programs (EAPs), and more specifically, that EAPs did not typically include experts who were familiar with or had any prior EMS experience. 

Fiona Thomas is a licensed paramedic and President of the Code Green Campaign, a suicide prevention and mental wellness advocacy organization created by first responders, dedicated to first responders. According to Thomas, the organization has seen an increase in the need for mental health services in places hit hard by the pandemic. She said she expects that need to transition across the country as the virus spreads and additional waves hit. 

Justin Mitchell pictured with his partner Matthew Allred. Donated photo

One of the greatest obstacles to implementing change in EMS mental health culture relates to the stigma associated with suicidal ideation and mental healthcare. According to EMS World, “the EMS culture is one in which providers experiencing suicidal ideation can’t always discuss their concerns with colleagues or superiors or seek other forms of help. They may fear being perceived as weaker than their peers or retaliation from supervisors. The ‘suck it up, it’s part of the job’ mentality is all too common within the profession.”

The stigma surrounding accessing help for mental health struggles was not an issue for Justin. He had previously reached out to The Code Green Campaign. In a Facebook post from January 2019 he urged fellow EMS workers and anyone struggling with mental health to reach out for help, “not to give up and give in.” 

Matthew said Justin told many about the Code Green Campaign. Like Justin’s urging for people to reach out when they need help, there is some hope that the stigma around mental health for EMS workers is changing. 

“Years ago, the mentality was always, suck it up buttercup. That’s not where we’re at these days. We want people to know that it’s okay to talk about how they feel and if they’re having issues, and that it’s normal,” said Travis Donaldson, Haywood County emergency management deputy director.

On March 31, 2020, Justin was informed that he had previously transported Haywood County’s first positive COVID-19 patient. 

According to Donaldson, after an EMS worker comes into contact with a positive COVID-19 patient, that EMS worker is required to self-monitor to ensure they don’t begin exhibiting symptoms. There is also special housing designated for any EMS workers worried about exposing people in their home. 

“If they have elderly family that lives at home, or children and they don’t want to expose those family members, there are measures in place to allow them to lodge at a different location,” said Donaldson. 

Another stressor for Justin was a packet he received from his workplace after the pandemic began. According to Matthew, the packet asked for information regarding everything the county should know about in the event of his death or injury. It asked for emergency contacts, relationships, funeral arrangements, whether you prefer flowers or not, any kind of personal possessions that would be on property. 

“I remember him telling me that the only time he had ever seen a packet like this is when he deployed to Iraq. And that day, that was also a huge anxiety trigger for him,” Matthew said. “It was just one of those things that just triggered anxiety with him because of the totality of the information that it was asking for. It was very specific and very final.”

Donaldson said Haywood County began distributing this packet, called a Last Wishes Packet, to EMS workers a couple of years ago after a paramedic passed from a medical complication. “Because a lot of people starting in this business are young, we have a lot of people in the field that may have never even thought about the concept, no will or last wishes or those kinds of details of their life,” he said. “So once a year, I think we started about two years ago, but once a year, the ones that have filled them out before get handed back the packet and we let them open it up and look at everything and make sure something in their life hasn’t changed, to where they’re going to do something differently or want something different.”

According to Donaldson, the packet was not related to the COVID-19 pandemic, it just happened to be the time of year for EMS workers to reassess their packet. Justin had not previously been required to fill out one of the packets. 

“We send those back out to all of our employees to look at or to have the ability to fill one out, that way if something does happen to them, whether it be a line of duty accident, side of the road wreck or something like that, or if it’s not even related to work and their family has no idea of any of their wishes, then we can pull their employee folder out and open up their envelope and actually see what they wanted,” said Donaldson. 

Justin also struggled from isolation. Being away from family and friends was difficult, because as Matthew said, this was a constant release for him. 

“Just being able to socialize and hang out with people and interact was a way that he could destress,” he said. 

As people of the mountains know, when the weather slowly warms each year, with it comes the urge to be outside, to socialize after winter months full of cold and isolation. The joy of sitting on a patio in the sun, enjoying a drink with friends is akin to snakes shedding their skin. Essential. 

“We had concerts scheduled for this spring that obviously were canceled. So things like that, and just the sheer cabin fever of not being able to go out and do what you’ve normally done was really a struggle as well. Cause that’s not normal you know, and a lot of people need that more than they need other things,” Matthew said. “We’re trying to be cautious, but sometimes I think it causes more harm than good.”

Matthew is aware of the stress of the EMS career on providers and it has been hard not to dwell on the impact it had on Justin. 

“His training in EMS and his years of experience taught him how to handle that [stress] in front of a patient and be professional and deal with it,” said Matthew. “The stress of the job itself. But I also realize now that the profession for our first responders does not teach them how to offload that stress.”

Donaldson said “first responders deal with people during their worst of times, humanity at its worst, as well as people physically in their worst condition and on their worst day, or one of their worst days of their lives.” 

“And us as responders put all of that on our shoulders, and on our shelves. And sometimes when those shelves get full, we need the opportunity to be able to empty those shelves,” he said. “That’s where a lot of folks get affected, is not having that ability to clear their shelves off like they need to. We essentially don’t have room to deal with our personal emotions and feelings and stressors, because we carry the world’s stressors on our shoulders.” 

Perhaps it is the case that Justin’s shelves were full of everything he saw and dealt with. Mental health is extremely individual and personalized. Yet still, people close to those we lose, like Matthew, end up blaming themselves for the things no one ever could have seen coming. 

“I look back now and I see signs, there are phrases in his text messages that are pretty indicative of someone that is contemplating suicide and that’s a struggle now is just beating myself up for not recognizing the signs,” Matthew said.

Justin died by suicide April 20, 2020. He was 31 years old. “I am not sure if a kind word of thanks or an acknowledgment or a handshake could have saved Justin.” Matthew later said “I do know that it couldn’t hurt. I don’t know if honest conversations would have eased his mind enough to prevent his suicide, but it may have. I can’t say if peer support or debriefings may have altered his course, but it is worth a shot. Now more than ever, it seems we need to watch over each other as a good shepherd. We don’t know what someone else is going through or what's on their mind. Kindness and caring do go a long way.”

Matthew said it was Justin’s random expressions of kindness that stood out to him, and others that knew him most. 

“He had the ability to connect, and I don’t mean that in a magical way, but he did have a way of connecting to people in need or in sorrow, more than I’d ever witnessed out of anybody else,” he said. “And it was not a traditional connection with them. He didn’t go the route of saying ‘my condolences’ or ‘smile everything will be better, tomorrow will get better.’ He had a way of reaching people in that moment or that instant and it could be as simple as bringing someone a cup of coffee, out of the blue.”

Matthew recalled “a smile goes a long way, and he had a beautiful one. He was witty, but he was also very chivalrous. He was always ‘yes ma’am, no ma’am, yes sir’ always very southernly polite.”

But his politeness and chivalry extended well beyond his words. Matthew said there were several times he would go with Justin to someone’s house who had called and needed help with a loved one. Justin would regularly give his phone number out to friends and acquaintances telling them to call him to help with their aging family member or even a family member in hospice. 

“There were many times I went with him, because someone called him and needed help with their loved one. Getting them from the chair to the bed or helping change their oxygen tank,” Matthew said. 

“I believe Justin touched so many lives in ways that people really needed. One way or another, with a smile or a talk, or whatever. Justin would listen. He just loved life,” Wandalee said. 

When asked what message he had for people who may be suffering in a similar manner to Justin, Matthew repeated Justin’s own words from a Facebook post in January of 2019: “folks, if you’re suffering, check them [Code Green] out and ask for help. Call on those you stand beside every day on the unit. It’s OK to ask for help. Don’t give up and give in.”