Who Watches Out for the Watchmen?

Better mental health care needed for law enforcement.

Law enforcement personnel receive a lot of scrutiny from the press, citizens’ groups, government watchdogs, and their supervisors when it seems they may have done something wrong and caused injury or worse to suspects or bystanders. But who watches out to make sure they don’t injure themselves?

There are police unions and fraternal organizations, but they don’t often seem to be worried about the mental health of our first responders.

Law Enforcement and Mental Health

Police work is sometimes excruciatingly dull and full of boring routine. The mantra used to be that something like 90% of police (though a Pew survey put the percentage at 27%) have never had to discharge their weapon while on duty.

Nevertheless, they have to be prepared to do so, causing stress, anxiety, maybe depression.

Those who have had to fire their weapon have it even worse, and those who have had to wound or kill someone have it worse still. Post-traumatic stress disorder (PTSD) may follow, as with combat military personnel.

Among the factors contributing to law enforcement officers’ mental (and sometimes physical, too) health are:

• Long hours and unpredictable schedules. When individuals don’t have a consistent schedule, their bodies and minds have a difficult time adjusting. Socially, it makes it harder to meet with friends or spend time with family.
• High injury rates and exposure to stressful incidents. Being injured, seeing people being injured or dying takes a toll.
• Public attention and criticism. Even if the public thinks that police can get away with murder, any incident in which a law enforcement officer discharges a gun or otherwise injures or kills someone gets investigated. That investigation won’t be stress-free. Civilians and onlookers with camera phones shooting video of their actions can misrepresent the facts and rile the public against the officers.

The fact is that few people, with a badge or not, can take a life without being affected by it.

We may celebrate movie heroes who kill bad guys like killing bugs, with no remorse or a second thought, but that is one of the signs of a sociopath. We would not knowingly put sociopaths on the police force.

Police have higher rates of mental health issues, and this affects their personal life as much as or more than it affects citizens in general. A 2017 Ruderman Family Foundation study found that law enforcement professionals and other first-responders:

• Are more likely to die by their own hands than in the line of duty.
• Five times as likely to have depression or post-traumatic stress disorder (PTSD)
• Are dissuaded from seeking the help they need and deserve by shame and stigma.

An obvious solution to the problem of shame might seem to be a guarantee of privacy, but they already seem to have it.

In 2018, the American Counseling Association wrote that law enforcement professionals, like other people, have a legal right to confidential treatment. Anecdotal reports, however, indicate that some have been outed and their careers damaged by seeking counseling.

Most Common Law Enforcement Mental Health Disorders

Many law enforcement personnel and other first responders may suffer from several mental health issues or a combination of them.

PTSD and Other Mental Health Problems

The most common may be post-traumatic stress disorder—also known as post-traumatic stress injury (PTSI)—but it is not limited to first responders. It can be a problem for soldiers in a combat zone, and survivors of domestic violence or automobile accidents, too.

There are at least three kinds of PTSD, and one person may experience more than one:

• Flashbacks. Triggers, such as loud noises or emotions, may cause individuals to relive the traumatic event: feeling the same fears, sweating profusely, having a rapid heartbeat or respiration. They may not even be safe while sleeping, as these can become recurring nightmares.
• Hyperarousal. Individuals are tense all the time, expecting something to happen, and easily startled. They may be angry all the time and have insomnia. These are all signs of hyperarousal.
• Avoidance. To prevent flashbacks, individuals might avoid all possible triggers, suppress memories, and shut themselves off from the world. Substance abuse—drinking excessively, misusing prescription drugs, or using illegal drugs—may begin as a way to assist this avoidance.

In January, before COVID-19 sucked all the oxygen out of the room, the Wisconsin legislature was considering a bill to guarantee 32 weeks of worker’s compensation for first responders with post-traumatic stress disorder (PTSD), but it failed to pass in April.

Other common types of mental health issues for law enforcement include:

• Anxiety disorders. These may include phobias, panic disorders, obsessive-compulsive disorder, social anxiety, sleeping and eating disorders, and substance abuse.

  

• Depression. More than feeling blue once in a while, depression can be a serious mental illness (SMI) that can lead to feelings of hopelessness, that doing anything is too difficult or pointless. At the same time, the individual may feel guilty for feeling that way, start abusing alcohol or drugs to correct it, or even attempt suicide.

Substance Use Disorders 

Substance use disorder (SUD) is now the preferred term for alcoholism or drug addiction. Experts recognize SUD as a chronic brain disease with a likely genetic component or predisposition.

The three main types of SUDs are:

• To drink alcohol to excess (more than a drink or two daily).
• To misuse legal and prescribed drugs such as oxycodone (OxyContin, Percocet, and hydrocodone Vicodin, Norco).
• To use illegal drugs such as heroin and cocaine.

With a substance use disorder (SUD) the use continues despite its negative effects on the:

• Body. A SUD causes people to neglect proper nutrition and exercise—even hygiene—and makes them more prone to disease or other life-threatening medical conditions, including overdose.
• Mind. A SUD makes seeking more of the substance these individuals’ priority.
• Relationships. People with SUDs neglect friends, family, neighbors, and co-workers. They only associate with other alcohol- or drug-dependent “friends.”
• Ability to take care of themselves. Maintaining a home, paying bills, even going to or keeping a job becomes increasingly difficult, if not impossible.

Not a weakness of character, as it used to be supposed, a SUD rewires the brain so that alcohol or drug abuse becomes “normal” and stopping causes physical and mental pain (withdrawal).

SUDs are not limited to law enforcement officers, but it can be more deadly for them and those around them because the stakes are so much higher.

According to an anonymous survey of more than 800 officers nationwide:

• Less than half (47%) admitted to any drug use (marijuana, stimulants, opioids) before being hired by law enforcement.
• Less than 2% (1.7%) while so employed.
• Of that 1.7%, 15% (roughly one quarter of 1%) admitted to becoming addicted and that it affected their work performance.
• 7% of the 9% who admitted taking physician-prescribed drugs said they took more than were prescribed.

(The study didn’t seem to address alcohol use disorder.)

If the self-reported survey is accurate, there doesn’t seem to be a lot of law enforcement personnel abusing drugs, but it’s hard to be sure. Post-employment drug testing is rare. Even if it is a small percentage, they still need help.

Dual Diagnosis (Co-Occurring Disorders)

Another disorder, closely related to SUD is dual diagnosis or co-occurring disorders. That’s when there are two mental health issues at the same time, possibly related.

About half of all cases of substance use disorder also have a co-occurring disorder such as PTSD. Substance abuse may even begin as an attempt to self-medicate for that mental health problem.

Because of this interrelationship, both problems must be diagnosed and treated, preferably at the same time, in an inpatient drug rehab.

The opioid crisis, the Affordable Care Act’s inclusion of mental health and substance use disorder services among essential health benefits, and the growing awareness of the threat of PTSD seems to be making help more available in theory.

Privacy is more problematic. Fear of dismissal or loss of reputation deters many from seeking help early when there has been less damage and it’s easier to stop.

One thing is clear: it is better to admit to a problem and seek help before it is apparent to everyone around you. The culture must change to make that outcome more likely.

Resources

Here are some resources that might point you in the right direction:

• The Police One mental health page has useful information for law enforcement personnel, including:
  • A four-minute video on mindfulness techniques for police
  • A list of five self-stigmatizing statements on mental illness to avoid such as “I am weak”, “I am abnormal”, and “Mental illness brings disgrace to myself and my family”;
  • Seven ways “police leadership can respond to officer mental health crises.”

• The Law Enforcement Employee Assistance Program of the US Department of Health and Human Services’ Federal Occupational Health agency offers medical programs and services. Visit the frequently asked questions page or call toll-free 800-222-0364.

• The Law Enforcement Mental Health and Wellness Act (LEMHWA), signed into law in January 2018, but it is still in the process of being implemented. Its website reports the latest news.

• The All Clear Foundation has 100s of resources for first responders and their families to help them improve their wellbeing and life expectancy.

• The 100 Club of Arizona is offering the mobile Bulletproof app for iPhone or Android. A department-specific code is necessary; request it from your agency’s wellness coordinator.

• The Disaster Responder Assets Network (DRAN) lists online peer support group meetings. Times are Pacific Standard Time.

Sources

1. First Responders: Behavioral Health Concerns, Emergency Response, and Trauma – https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf

2. What Police Think About Their Jobs – https://www.pewsocialtrends.org/2017/01/11/behind-the-badge/

3. Why Do Cops Avoid Counseling? – https://ct.counseling.org/2018/01/why-do-cops-avoid-counseling-eight-myths-about-law-enforcement-officers-and-mental-health-treatment/

4. The Ruderman White Paper on Mental Health and Suicide of First Responders – http://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/TrainingDocs/First%20Responder%20White%20Paper_Final%20(2).pdf

5. Mental Health and First Responders: How Their Jobs Can Cause More than Just Stress – https://ohsonline.com/articles/2020/01/21/mental-health-and-first-responders-how-their-jobs-can-cause-more-than-just-stress.aspx

6. Post-Traumatic Stress Disorder: Overview – https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml#part_145373

7. How Much Drug Use Occurs in Law Enforcement? – https://inpublicsafety.com/2017/09/much-drug-use-occurs-law-enforcement/

8. Mental health & substance abuse coverage – https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

9.  Mental Health – https://www.policeone.com/mental-health/

10. Video: 3 mindfulness techniques for cops – https://www.policeone.com/police-training/videos/3-mindfulness-techniques-for-cops-FDRj7M5ofJHR4ucS/

11. Protect your mental health: Stop saying these 5 things – https://www.policeone.com/health-fitness/articles/protect-your-mental-health-stop-saying-these-5-things-dDAEhHdbGorEhly3/

12. How police leadership can respond to officer mental health crises – https://www.policeone.com/chiefs-sheriffs/articles/how-police-leadership-can-respond-to-officer-mental-health-crises-3zrmdFnjtpoYLOyR/

13. Law Enforcement Assistance Program – https://foh.psc.gov/whatwedo/EAP/Law/LawAssist.asp

14. Law Enforcement Employee Assistance Program FAQ’s – https://foh.psc.gov/whatwedo/EAP/Law/FAQ.asp

15. Public Law 115–113, 115th Congress: An Act – https://www.congress.gov/115/plaws/publ113/PLAW-115publ113.pdf

16. Law Enforcement Mental Health And Wellness (LEMHWA) Program Resources – https://cops.usdoj.gov/lemhwaresources#:~:text=The%20Law%20Enforcement%20Mental%20Health,well%2Dbaeing%20of%20their%20employees