From taboo to treatment: Addressing high rates of mental illness among officers

Survey finds officers are often unaware they may be experiencing an illness and may need treatment


Police officers experience chronic stressors due to their unique occupational duties. Officers routinely experience or witness traumatic incidents, work long shifts that can frequently change during reorganizations and sustain high rates of job-related injuries. Additionally, the political climate, social justice movement and media coverage have increased stress among officers in recent years.

While past research has identified higher rates of mental illness in officers than the general public, few studies describe the context of officers living with mental illness, including patterns of mental healthcare utilization.

A recent article published in JAMA Network Open identified the pervasiveness of mental illness in law enforcement and the barriers officers perceive when seeking needed mental healthcare based on a survey of officers in an urban police department. [1]

Departments need to continue the ongoing task of de-stigmatizing officers’ receipt of mental health services.
Departments need to continue the ongoing task of de-stigmatizing officers’ receipt of mental health services. (Getty Images)

Study methodology

More than 400 Dallas Police Department personnel participated in an anonymous survey that included questions that screened for current mental illness and queried about diagnoses of psychological and physical health conditions and assessed socio-demographic (education level, gender, military history, etc.) and occupational characteristics (e.g., years of experience, rank, shift, station) of the officer.

Screening tools measured current symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal ideation.

After the survey, officers who had a prior or current mental illness received a final question about whether they were interested in receiving mental health service information.

In addition, focus groups were conducted with 18 officers to explore the impact of high-stress calls, including coping styles and mental healthcare utilization. Qualitative findings from the focus groups were grouped by theme and compared to existing literature.

Main findings

Prevalence of mental illness

Overall, 12% of officers reported receiving a lifetime mental health diagnosis, which includes both past and present conditions. Of these individuals, around one-third had sought mental healthcare within the previous year.

Twice as many officers (26%) screened positive for symptoms of depression, PTSD, anxiety, or suicidal ideation, with PTSD being the most common positive screening (representing 61% of positive screens).

Among officers who screened positive for mental illness, fewer than one-fifth of officers had sought mental health services in the previous year.

Females and police supervisors (e.g., sergeant, lieutenant, or higher) were more likely to have a lifetime diagnosis of a mental illness.

Additionally, officers with past military experience had over three times the odds of having a lifetime diagnosis and over three times the odds of current symptoms of a mental health condition compared to non-veterans.

Barriers

While the police department provided free psychological services to officers, several impediments kept officers from seeking mental healthcare, including concerns about confidentiality, fitness for duty evaluations, and two novel findings:

1. Failure of officers to understand that they are experiencing a mental illness. Officers often gauge their feelings as being “part of the job” and believe that their comrades feel a similar strain. As a result, officers are often unaware they may be experiencing an illness and may need treatment.

2. Doubtfulness that psychologists can relate to officers. While there are currently more psychologists who were previous officers than in past decades, most psychologists do not have law enforcement backgrounds. As a result, officers may think psychologists will not understand their occupational duties and often opt to talk to friends or family (or no one) about their feelings or concerns.

Implications

This study showed that physician diagnoses and current symptoms of mental illness are both common among police officers. While officers receive a pre-employment psychological evaluation, routine psychological screening may be needed throughout officers' careers, given that one of four officers screened positive for a mental health condition.

The study also identified reasons why officers do not seek mental healthcare, including confidentiality concerns, failure to recognize that they are experiencing a mental illness, and a perceived inability of police psychologists to relate to their experiences as an officer.

To address some of these barriers, departments might consider using independent agencies for police counseling and psychological evaluation purposes and detaching the psychological/fitness for duty exam from ongoing counseling services. Ideally, these counseling agencies would have broad experience working with, and potentially employing, law enforcement officers.

It would also be beneficial for departments to implement annual screening procedures for officers that could be used to link offices to needed resources. Routine screening would reduce mental illness stigma in law enforcement agencies while identifying officers who are not comfortable enough to seek out services proactively.

Particular subsets of the police population may need additional attention, given their increased odds of mental illness. For example, female officers experience unique stressors [2], including increased experiences of harassment, issues handling pregnancy and breastfeeding, and a lack of perceived support from supervisors [3]. As a result, female officers are more likely to experience burnout than male officers. [4]

Finally, departments need to continue the ongoing task of de-stigmatizing officers’ receipt of mental health services. A commentary on this study by John Violanti emphasized the need for education regarding mental health and treatment among this population. [5] If the stigma around mental illness persists in law enforcement agencies, officers may continue to refuse care despite its availability. Officers who are aware they need care but are dissuaded from seeking it may experience an exacerbation of their symptoms. Therefore, officers must feel supported in expressing mental health concerns and seeking treatment, which will take a combination of education, a regular and open discussion of mental health, and buy-in from supervisors and departmental administration.

Law enforcement is one of the most stressful occupations, and it is not surprising that officers' mental health is affected by the acute and chronic strain experienced on and off the job. However, just like physical injuries, mental illness among officers must be identified and addressed to optimize public safety for officers and civilians alike.

NEXT: What is the state of officer mental health in 2020?

References

1. Jetelina KK, Molsberry RJ, Gonzalez JR, Beauchamp AM, Hall T. Prevalence of mental illness and mental healthcare use among police officers. JAMA Netw Open, 2020; 3(10):e2019658.

2. Jetelina KK, Beauchamp AM, Reingle Gonzalez JM, Molsberry RJ, Bishopp SA, Lee SC. Cumulative, high-stress calls impacting adverse events among law enforcement and the public. BMC Public Health, 2020; 20(1):1137.

3. Violanti JM, Fekedulegn D, Hartley TA, et al. Highly rated and most frequent stressors among police officers: Gender differences. Am J Crim Just, 2016; 41:645–662.

4. Elliot D, Garg B, Kuehl K, DeFrancesco C, Sleigh A. Why are women law enforcement officers more burned-out and what might help them? Occupational Medicine & Health Affairs, 2015; 3(3), 204.

5. Violanti JM. On policing—A matter of psychological survival. JAMA Netw Open, 2020; 3(10):e2020231. 

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