Scott Allen, PhD, Senior Staff Psychologist, Miami-Dade, Florida, Police Department; Christine Jones, PsyD, Assistant Bureau Director, Los Angeles, California, Sheriff’s Department; Frances Douglas, PsyD, Chief Psychologist, Texas Department of Public Safety; and Daniel Clark, PhD, Department Psychologist, Washington State Patrol
he suicide of a police officer is a tragedy on multiple levels: the senseless loss of the officer’s life to his or her family, community, department, and the law enforcement profession. Recent estimates on national law enforcement suicides were reported to be 141 in 2008 and 126 in 2012.1 Although these numbers do not indicate higher rates than a matched demographic group in the general population, leaders can support a continuum of prevention strategies that reduces the stigma associated with asking for help and culturally deters police suicides. The fact that suicidal urges could overcome one of our “heroes behind the badge” can be shocking and unthinkable, and, for so long, it was the secret law enforcement dared not discuss.
Many in the law enforcement profession have begun to discuss this “secret” in hopes of reducing future police suicides. The International Association of Chiefs of Police (IACP) has initiated efforts to break this silence, as evidenced by past conference presentations, magazine articles, and the recent National Symposium on Law Enforcement Officer Suicide and Mental Health (“Breaking the Silence”).2 The wider law enforcement community is also embracing the concepts of wellness and resiliency with innovative programs aimed at promoting the overall health and well-being of law enforcement officers. Familiar concepts such as training, coaching, and mentoring apply not only to the success of becoming officers, but also to the resiliency officers develop throughout their careers by successfully adapting and thriving in the profession despite the many adversities encountered.
The Stress-Distress-Impairment Problem
As previously mentioned, one of the greatest critical incidents faced by police officers is the suicide of a fellow officer. When officers respond to tragedies that occur to community members at large, they rely on adaptive coping mechanisms (e.g., compartmentalizing, distancing, remaining stoic, engaging in physical activity) to help remain resilient. However, when one of their partners commits suicide, it is often experienced as a personal assault; it is not uncommon for officers to describe feeling personally violated and betrayed by one of their own whom they trusted. Reeling from this personal tragedy can often hinder the effectiveness of an officer’s usual way of dealing with human violence. To complicate matters, personal life stresses compounded with the loss can overwhelm even the strongest of officers. For example, the death of a partner could trigger prior loss experiences and tax family relationships that are sometimes barely remaining afloat. An officer feeling out of control will rely on what has worked under normal circumstances, such as compartmentalizing and distancing. If the officer’s normal coping style is ineffective, a repetitive strategy of ever-increasing intensity of established coping methods is a typical response. Not surprisingly, coping that is adaptive under normal circumstances can become maladaptive and ineffective in crisis situations. Being stuck in an unsuccessful problem-solving loop can compromise the officer’s mental well-being, work, and relationships, while extending the period of pain.
Police officers are able to show greater strength than most others in dangerous situations. They are an elite group who are courageous enough to run towards danger to protect others. Yet despite their bravery, their mind and body absorb the hits from encountering a steady diet of critical incidents and other insidious stress events. Many officers will be heavily affected by the years of law enforcement stressors. Eventually, these officers will contend with personal emotional or physical fires. Although police officers will always remain an elite group, they are not invincible. Even model cops need career-long, proactive maintenance work to maintain psychological health.
The Problem of Stigma
In police culture, a major obstacle that impedes the maintenance of psychological health is the stigma attached to asking for help. Law enforcement culture values strength, self-reliance, controlled emotions, and competency in handling personal problems. These values discourage help-seeking behavior, and there is a sense of having lost control by asking someone else to help fix the problem. If these values are held too rigidly, an officer can feel weak, embarrassed, and like a failure for seeking help from others. One study found that stigma and help-seeking attitudes were inversely related.3 In other words, a person facing a higher level of stigma for seeking help was less likely to have a help-seeking attitude. This generates concern for officers who unconditionally conform to the traditional values of law enforcement culture—they will be more likely to avoid seeking help, even when distressed, and potentially pay the price of detrimental health effects.
Because police officers often respond to the seriously mentally ill, police may hold a skewed view of what mental illness looks like. Although the Centers for Disease Control (CDC) has determined that the incidence of mental illness in the United States is 25 percent of the adult population with the majority of these disorders being treatable anxiety and mood disorders (e.g., depression), the limited exposure to only the seriously mentally ill by police officers contributes to the stigma against using mental health services. Moreover, the law enforcement profession’s notorious reluctance to ask for help, fear of being viewed as weak or unreliable by their brothers and sisters in law enforcement, or fear of being labeled psychologically unfit to perform their duties impairs officers’ willingness to make use of tertiary mental health services.
Supervisors can unintentionally reinforce the value of being too self-reliant by not encouraging peers and subordinates to seek help when significantly distressed. A study by a team of researchers found that men who endorsed greater restriction of emotions were less willing to refer friends and family members experiencing a psychological problem for treatment.4 Supervisors may also unintentionally perpetuate the stigma against the use of mental health services due to an unawareness of the many “faces” of mental illness and may suspect that an officer seeking mental health treatment or support may be unfit for duty. Furthermore, supervisors may caution officers not to seek mental health assistance as it could be damaging to their careers. Supervisors are in highly influential positions and should promote longevity in the profession by sending explicit and implicit messages that responsible help-seeking behavior is encouraged and respected. A supervisor who shares a personal example of going through a rough time and recovering after receiving confidential, professional help from a police psychologist can normalize the problem, make help-seeking behavior seem less threatening, and increase the willingness of other officers to ask for help. Traditionally, suicide prevention activity has been aimed at helping the “mentally ill.” Joel A. Dvoskin suggested that this emphasis, though well-intentioned, has served to increase the stigma against mental illness. Dvoskin advocates instead for prevention activities to shift focus to helping “people in crisis,” and to acknowledge that “the antidote to suicide is solutions.”5 Such an approach is highly consistent with a law enforcement wellness perspective favoring an emphasis on problem solving, resource identification, and support, which might be less stigmatizing options for officers.
A Stepped Approach to Prevention in a Psychological Health Wellness Initiative
Law enforcement organizations have a plethora of competing priorities and demands that makes it challenging to commit to a career-long strategic prevention program. A compromise might be reached in which agencies decide some prevention activities are better than none. In this case, officers might receive an occasional mental health flyer and attend a stress management or suicide prevention training sometime during their careers. Wellness messages in this format tend to be fleeting when the benefits of repeated exposures are not present.
A stepped approach to prevention begins with primary wellness initiatives that target all officers in the department. Psychological health topics tend to be more general, such as stress management, alcohol awareness, sleep medicine, suicide prevention, and dealing with critical incidents. Moreover, misperceptions can be addressed about counseling by covering the strictness of confidentiality, the most problematic presenting issues, and the efficacy of psychological treatments. Educational information is introduced in different formats, including educational articles, brochures, or flyers that are sensitive to law enforcement values, wallet cards, online videos, websites, annual mental health screenings, and trainings. These broad-reaching prevention activities can help officers and their families prepare for the impact of the job, learn healthy tools to survive and thrive, and develop trust in mental health resources.
Secondary prevention concentrates on specific, higher-risk groups of officers to identify and address their health needs. They can be at greater risk for various reasons, such as job functions (e.g., Homicide Bureau, Family or Sex Crimes Bureau) or other descriptors. For example, Caucasian males below the rank of sergeant who are 40–44 years old are more vulnerable to committing suicide than other demographic groups.6 Wellness activities are modified to boost resilience and decrease the risk factors in these specialized units. Possible formats for this higher level of prevention can look similar to the ones in primary prevention, but address more specific triggers, reactions, and coping skills that are specific to each targeted group. Other prevention activities include a department-mandated post-shooting intervention to ensure mental health recovery occurs after being involved in a shooting. In addition, trained and supervised peer support members, chaplain program volunteers, or veterans support group members can serve these specific groups to help maintain the psychological well-being of officers. Finally, first-line supervisors and those interacting with higher-risk officers (e.g., Internal Affairs, Return to Work, Personnel or Human Resources) should be trained to identify early warning signs of impairment or high distress as well as assess for suicidal thoughts. Useful guides for supervisors can be found in IACP’s Suicide Prevention CD and the Los Angeles County Sheriff’s Department video, Rolling Back-Up.7 Also available is an empirically based five-question suicide screening for laypersons referred to as the Columbia Suicide Severity Rating Scale (C-SSRS).8 Preparing supervisors to take appropriate steps to intervene and properly refer is critical to secondary and tertiary prevention.
Tertiary prevention involves clinical intervention because an officer is already exhibiting signs and symptoms indicative of a psychological disorder. This type of intervention can be (mis)perceived as being the most threatening to the officer and his or her career. However, with effective lower-level prevention initiatives implemented throughout the career span of officers, the stigma and fear of seeking counseling can be minimized. Furthermore, seeking help for psychological problems sooner rather than when in crisis should become more of the norm. Although psychotherapy is a key component in tertiary prevention, other intervention strategies include crisis response (24/7), post-intervention, Alcoholics Anonymous or Peace Officer’s Fellowship, intensive alcohol treatment, medication treatment, and detoxification or other medical treatment. As a last resort, voluntary and involuntary psychiatric hospitalizations are options.
A current successful program for suicide intervention conducted by the U.S. Department of Veterans Affairs for combat veterans takes a problem-solving approach.9 This program provides the opportunity to involve all of the natural helpers and supports in the military officer’s life in collaboration with the mental health specialist. The mental health specialist enlists family and friends to contract as supports for the veteran in his or her effort to ward off suicidal thoughts and impulses and develop more effective coping strategies such as problem-solving skills. This approach attempts to destigmatize treatment by focusing on suicidal behaviors, instead of psychiatric diagnoses. This treatment approach emphasizes the availability and accessibility of help (e.g., family, friends, and therapists). It establishes a clear plan of action for emergencies and emphasizes skill-building and personal responsibility. These are all concepts that are inherent elements of good police planning, training, and enforcement. Comprehensive initiatives that are geared around this focus should be a natural fit for police officers. Many of the elements and processes could be replicated in existing secondary and tertiary law enforcement efforts.
Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) can be used as an example of an issue that can benefit from a stepped approach. PTSD has a “dose-response” relationship. That is, the more potential trauma a person is exposed to, the greater the risk of developing PTSD. Potentially traumatic events include exposure to actual or threatened death, serious injury, or sexual violation. Emergency responders, by the very nature of their job, are exposed to these types of events much more frequently than non-emergency responders. The National Institute of Mental Health reports that approximately 3.5 percent of people age 18 and older have PTSD. Estimates of the prevalence of PTSD in law enforcement range from 10 to 15 percent.10
Primary prevention could involve training on stress management, self-care, the importance of adequate sleep, and common reactions that might suggest some complications. A training goal will be recognizing that responses such as intrusive memories of the event, nightmares, avoidance of the scene, reduced interest in enjoyable activities, hypervigilance, self-destructive behaviors, or increased alcohol use suggests that the officer may benefit from discussing the traumatic incident with someone.
Secondary prevention might provide a focused response to officers exposed to potentially traumatic events, such as officer-involved shootings, crimes against children, or particularly heinous crime or motor vehicle crash scenes. Rolling out peer support team members or chaplain volunteers for affected personnel to speak with is likely to help personnel maintain their psychological well-being. Remember that affected personnel could include not just officers, but also investigators, crime scene or crime lab technicians, dispatchers and communication personnel, civilian and support staff, and others who may be involved in the incidents in any way.
If officers are willing to talk with someone, there are multiple sources available, including police psychologists; trained peer support personnel; chaplain volunteers; and their personal faith-based leader, family members, and friends. If the officer is seeking a truly anonymous source to talk to, Safe Call Now is a confidential, 24-hour crisis referral service for all public safety employees, all emergency services personnel, and their family members nationwide.
Tertiary prevention involves clinical intervention because personnel are already exhibiting signs and symptoms. There are many effective treatment paths for PTSD, including talk therapy (perhaps with a police psychologist), medications, or some combination of the two.
The Police Psychologist’s Role in a Psychological Health Wellness Initiative
The role of a police psychologist in psychological health wellness initiatives can vary on a number of dimensions, mostly determined by the individual needs of the department or agency hiring the psychologist or contracting for the psychologist’s services. However, there are some specific ways in which a psychologist can function more effectively if the goal of the relationship with the department involves fostering a comprehensive psychological health and resiliency initiative.
In order for a psychologist to be an effective part of a psychological health initiative, there must be clarity on the part of the department, the officers, and the psychologist on the functions being served. For example, delineating the role of the psychologist as evaluator for fitness for duty from that of the psychologist providing officer support, resources, and consultations is important in building trusting relationships
The police psychologist will ideally have the ability to work with training units on developing wellness trainings at the primary prevention level on a variety of topics that can help officers to buffer stress. In addition to standard stress management and suicide awareness trainings, officers can often make use of primary prevention training to develop skills in the areas of relationships, conflict management, parenting, and other areas that can lead to a cumulative buildup of stress for an officer. At the secondary level, the police psychologist who successfully collaborates with other department officer resources, such as peer support teams, chaplaincy programs, and veteran assistance and reintegration programs, will enhance the connections between these efforts and the psychologist’s services.
More specifically, police psychologists must exhibit their willingness to work as a team by first of all demonstrating great respect for the natural healing resource of the police brotherhood. Peer supporters are the specially trained colleagues of other officers. They play an important role in the first-line response to officers who are experiencing stress, distress, or impairment. If the police psychologist can earn the respect, trust, and collegiality of the peer support providers, then peer support will act as a natural bridge to the psychologist when the peer encounters an officer in need of the special services available only from the mental health provider. Psychologists will need to play an important role in facilitating such collaborations. A consultation and client-centered approach is the hallmark of effective psychological assistance and central to the training of psychologists. Such skills can be extremely valuable in the effort to foster teamwork and establish a psychological health initiative.
A police psychologist can and should perform the traditional roles of providing an assessment of a potentially suicidal individual if the officer has reached the stage of obvious impairment, as well as implementing or arranging the appropriate type of tertiary prevention. However, the police psychologist who adopts a focus on “problem solving for people in crisis” in carrying out these professional activities can do much to reduce the stigma associated with using both secondary and tertiary suicide prevention programs and, in that way, help to prevent an officer from becoming impaired and suicidal. A police psychologist is a specialist in stress management and helps to reverse the downward cascade of poorly managed stress before it becomes distress, impairment, and ultimately problem behaviors (e.g., suicidal thoughts or acts, substance abuse, or dysfunctional relationship dynamics on the job or at home). Police officers are natural problem solvers who do not like to ask for help, but they are smart enough to seek out the experts and the specialists for DNA analysis, complex data analysis and management, or whatever else it takes to get the job done. Consulting with a police psychologist regarding the maintenance of the officer’s most important “piece of equipment”—his or her health and wellness—is just smart police work. The police psychologist who can serve as a consultant to the officer in this way can serve a valuable role.
The Specific Case of Military Veterans
Thousands of law enforcement officers are also members of the U.S. Armed Forces, a duty they perform with pride and honor. Veteran officers embody many positive characteristics such as physical fitness, leadership skills, discipline, loyalty, and experience in tactical operations. If they have mobilized, they will likely return to their agencies with enhanced weapon-handling, problem-solving, and quick reaction skills. They also are likely to have experienced working with culturally or ethnically diverse groups.
Many veteran officers successfully transition from their combat experiences and resume their law enforcement careers, perhaps repeating this cycle multiple times. The IACP, together with other criminal justice agencies, has produced several handbooks regarding prevention programs for veteran officer transition that law enforcement leaders can use to help restore, maintain, and enhance the psychological health of veterans.11
Reintegrating, however, is not as simple as changing uniforms. For some officers, the lingering effects of their deployments may provide challenges they did not anticipate. As part of any broad-based wellness program, education on assisting veterans in crisis will provide assistance from an officer safety standpoint. This education would also assist officers within an agency to better respond to their fellow veteran officers.
Veteran officers returning from mobilization may find they are overly sensitive or hyperalert to possible danger. In combat, there is minimal, if any, downtime available, so service members adapt to always being “on.” This can be difficult to turn off when they return home. Coworkers may notice potentially dramatic responses to relatively small issues. Returning veteran officers may also develop new hobbies in an attempt to recapture some of the adrenaline rush they often experienced while mobilized.
Veteran officers may return with a sense of altered priorities. They may feel angry or disappointed when their coworkers complain about “small stuff” and the veteran officers are used to making frequent life-and-death decisions. They may feel like they were making a daily difference in people’s lives while mobilized, and now they are back in the “same old, same old” where they feel like they are not making a dent in ongoing crime and violence.
This disappointment, and potential home problems, may lead to depression, sleep difficulties, increased substance use or abuse, additional difficulties reintegrating to civilian life, and problems on the job. Returning veteran officers may also experience survivors’ guilt, questioning why they may have survived an event and one or more of their buddies perished. These issues can lead to suicidal thoughts.
Some may also return with medical or mental health concerns, such as physical injuries, amputations, and post-traumatic stress or the more debilitating PTSD. These post-trauma sequelae may increase the challenges in successfully reintegrating to civilian life.
On a positive note, military veterans, as individuals, have additional resources available to them. For example, if they do experience suicidal thoughts, they can call the National Suicide Prevention Lifeline, which provides access to people knowledgeable in veteran issues. Additionally, Military OneSource is a confidential Department of Defense–funded program providing comprehensive information on every aspect of military life at no cost to active duty, National Guard, and the reserves component members, and their families. Information includes, but is not limited to, deployment, reunion, relationship, grief, spouse employment and education, and parenting and child care.
A fairly recent development in the reintegration process for returning veterans is the establishment of veterans courts. Veterans courts were initiated in 2008, and there are now more than 168 veterans courts nationwide.12 Veterans courts “specialize in working with troubled veterans to get them counseling, link them to government benefits, help them regain the sense of discipline and camaraderie they had in uniform, and steer them onto a more positive course in life.”13 Additional resources available may include “food and housing resources, employment counseling and legal advice for those who also face civil court issues such as child support.”14
Suicides within the law enforcement community are not random and spontaneous events committed in isolation, but, rather, an intent that is communicated by the individual within his or her psychosocial environment. Suicide is neither a disease nor an irrational act but rather a complex problem-solving behavior.15 Therefore, the progressive law enforcement agency will optimally provide training to its members to understand the underlying processes of law enforcement suicide and the prevention strategies to mitigate and prevent suicidal acts.
The lasting success of a comprehensive prevention initiative is dependent on police department leaders, mental health providers, supervisors, and individual officers working together to overcome the barriers to optimizing psychological health. This long-term commitment requires a multilevel, integrated strategic plan to (1) continuously reduce the stigma of seeking help, and (2) roll out a continuum of mental health programs that offers a range of graded interventions. Designating the elements of suicide intervention as problem-solving assistance rather than as mental health assistance can also help to destigmatize these efforts and make the programs more acceptable and useful to officers. A successful prevention program instills values that include psychological well-being, solid work performance, physical health, relationship satisfaction, and a willingness to access help early on and to recommend others get help early on. It is hoped that with the upcoming release of the IACP Symposium on Law Enforcement Officer Suicide and Mental Health: Breaking the Silence on Law Enforcement Suicide (in press), the recommendations to further develop prevention materials will make it possible for police agencies to operate a full-scale prevention program.16
Management of the suicidal police officer—that is, preventing the individual in crisis from committing suicide—is the critical area of focus. To reduce departmental suicides, what is needed is incisive, pragmatic suicide training that also inculcates individual responsibility for competent identification, understanding, interaction, intervention, and referral (hospitalization). Anything less obliges the suicidal law enforcement officer to determine the solution alone. ?
1Andrew F. O’Hara et al., “National Police Suicide Estimates: Web Surveillance Study III,” International Journal of Emergency Mental Health and Human Resilience 15, no. 1 (2013): 31–38.
2IACP Symposium on Law Enforcement Officer Suicide and Mental Health: Breaking the Silence on Law Enforcement Suicide (in press).
3David L. Vogel, Nathaniel G. Wade, and Paul L. Ascheman, “Measuring Perceptions of Stigmatization by Others for Seeking Psychological Help: Reliability and Validity of a New Stigma Scale with College Students,” Journal of Counseling Psychology 56, no. 2 (April 2009): 301–308.
4David L. Vogel et al., “Referring Men to Seek Help: The Influence of Gender Role Conflict and Stigma,” Psychology of Men and Masculinity 15, no. 1 (January 2014): 60–67.
5Joel A. Dvoskin, “Can Mental Health Services Prevent Mass Homicide?” APA Division 18 webinar, January 22, 2014.
6O’Hara et al., “National Police Suicide Estimates.”
7IACP and Bureau of Justice Assistance, Preventing Law Enforcement Suicide: A Compilation of Resources and Best Practices, CD-ROM; Rolling Back Up, Los Angeles, California, Sheriff’s Department, Quicktime Movie, http://www.theiacp.org/Sample-Training-Materials, 25 min. (accessed April 1, 2014).
8Kelly Posner et al. “The Columbia Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies with Adolescents and Adults,” American Journal of Psychiatry 168, no. 12 (December 2011), 1266–1277.
9C.J. Bryant, “Brief Cognitive Therapy for Suicide Risk: Ethics and Practice” (presentation, Bexar County Psychological Association, San Antonio, TX).
10See “The Numbers Count: Mental Disorders in America,” http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml#CensusBureauTable2 (accessed April 2, 2014); and see also Ingrid V.E. Carlier, Regina D. Lamberts, and Berthold P.R. Gersons, “Risk Factors for Posttraumatic Stress Symptomatology in Police Officers: A Prospective Analysis,” Journal of Nervous and Mental Disease 185, no. 8 (August 1997): 498–506; Berthold P. Gersons, “Patterns of PTSD among Police Officers Following Shooting Incidents: A Two-Dimensional Model and Treatment Implications,” Journal of Traumatic Stress 2, no. 3 (July 1989): 247–257; and Holly M. Robinson, Melissa R. Sigman, and John P. Wilson, “Duty-Related Stressors and PTSD Symptoms in Suburban Police Officers,” Psychological Reports 81, no. 3 (December 1997): 835–845.
11 IACP and the Bureau of Justice Assistance (BJA), Office of Justice Programs, U.S. Department of Justice, Combat Veterans and Law Enforcement: A Transition Guide for Veterans Beginning or Continuing Careers in Law Enforcement (July 2010); IACP and BJA, Double Duty: A Guidebook for Families of Deployed Law Enforcement Officers (July 2011); IACP and BJA, Employing Returning Combat Veterans as Law Enforcement Officers (July 2009); and IACP and BJA, Law Enforcement Leader’s Guide on Combat Veterans: A Transition Guide for Veterans Beginning or Continuing Careers in Law Enforcement (July 2010); all can be retrieved at www.theiacp.org/Employing-Returning-Combat-Veterans-as-Law-Enforcement-Officers (all accessed April 1, 2014).
12Jim McGuireet al., An Inventory of VA Involvement in Veterans Courts, Dockets and Tracks (2013), http://www.justiceforvets.org/sites/default/files/files/An%20Inventory%20of%20VA%20involvement%20in%20Veterans%20Courts.pdf (accessed March 2, 2014).
13William H. McMichael, “Finding a New Normal: Special Courts Help Vets Regain Discipline, Camaraderie by Turning to Mentors Who’ve Served,” The Military Times Newspapers, February 14, 2011, www.nadcp.org/MilitaryTimes%20-Veterans-Treatment-Courts (accessed March 2, 2014).
14Kevin Graman, “Special Courts in Wash. Designed for Veterans,” Army Times, September 20, 2010, www.armytimes.com/article/20100920/NEWS/9200313/Special-courts-in-Wash-designed-for-veterans (accessed March 1, 2014).
15Scott W. Allen, “Suicide and Indirect Self-destructive Behavior Among Police,” in Psychological Services for Law Enforcement, eds. James T. Reese and Harvey A. Goldstein (Washington, DC: U.S. Government Press, 1986), 413–417, https://www.ncjrs.gov/pdffiles1/Digitization/104098-104131NCJRS.pdf (accessed April 2, 2014); Scott W. Allen, “Suicide Prevention Training: One Department’s Response,” in Suicide and Law Enforcement, eds. Donald C. Sheehan and Janet I. Warren (Washington, D.C.: U.S. Government Printing Office, 2001), 9-15.
16IACP Symposium on Law Enforcement Officer Suicide and Mental Health: Breaking the Silence on Law Enforcement Suicide (in press).
Please cite as:
Scott Allen et al., “Keeping Our Heroes Safe: A Comprehensive Approach to Destigmatizing Mental Health Issues in Law Enforcement,” The Police Chief 81 (March 2014): 34–38.