So what is good about Hardiness?

I am working on a Police Chief’s Guide to Mental Illness with a colleague here in Massachusetts.  Part of the project involves offering tips for career success for law enforcement officers.  The guide is written to identify signs of MH involvement and add strategies for LEO’s to handle calls for service involving the mentally ill.  These calls have grown in number over the recent past largely due to a desire to reduce the population of people with mental illness who are being held in county jails and state prisons. Jail diversion programs shunt cases from the criminal justice system into treatment for mental illness.  In doing so, the subject with mental illness is more likely to fall off police radar and reduce the need for direct police intervention in the future.

Hardiness is a personality or cognitive style marked by increased levels of control, commitment, and challenge (Kobasa 1979; Maddi and Kobasa 1984). “Sisu” is a Finnish term related to concepts such as resilience, perseverance and hardiness.  Hardiness can be learned and requires practice. “Learned resilience to stress leads to psychological hardiness rather than psychological weariness.” according to Leo F. Polizoti, Ph.D. of the Decision Institute in Worcester, MA.  Dr. Polizoti teaches law enforcement officers methods of reducing stress and developing career hardiness.  
High hardy individuals believe they can control or influence events and are strongly committed to activities and their interpersonal relationships and to self, in that they recognize their own distinctive values, goals, and priorities in life as described by Bartone in his 1999 publication. “Research on stress management, coping with trauma and post-traumatic growth all suggest that there can indeed be deep-seated, positive benefits to be gained from hardship. These include strengthening of character, a deeper experience of purpose and meaning, and increased resilience, as well as enhanced relationships and greater appreciation of life” in a blog by Emilia Lahti 2018.
“Sisu is a Finnish word generally meaning determination, bravery, and resilience. However, the word is widely considered to lack a proper translation into any other language. Sisu is about taking action against the odds and displaying courage and resoluteness in the face of adversity. Deciding on a course of action and then sticking to that decision against repeated failures is Sisu.” Backpacker Filth Blog 2015
People high in hardiness also tend to interpret stressful events in positive and constructive ways, construing such events as challenges and valuable learning opportunities (Bartone 1999). Hardy subjects have been described as optimists with a tendency to evaluate challenging situations in a positive manner (Cole et. al. 2004) and to label these types of situations as understandable and meaningful. This makes hardy persons more proactive, leading to the use of proactive coping behaviors.  Hardiness as an important stress-resiliency resource across a wide range of domains, such as psychological well-being and physical strain, as well as performance.

Bjørn Helge Johnsen, Roar Espevik, Evelyn-Rose Saus, Sverre Sanden, Olav Kjellevold
Olsen, Sigurd W. Hystad. Hardiness as a Moderator and Motivation for Operational Duties as Mediator: the Relation Between Operational Self-Efficacy, Performance Satisfaction, and Perceived Strain in a Simulated Police Training Scenario. Journal of Police and Criminal Psychology, , Volume 32, Issue 4, pp 331–339.

Bartone, P.T. (1999). Hardiness protects against war: Additional work is needed to evaluate the related stress in Army reserve forces. Consulting potential value of hardiness for commissioned Army Psychology Journal. 51, 72-82.

Polizotti, L. (2018) Personal Correspondence. Career reslience and hardiness. Decision Institute training curriculum.

Lahti, E. (2018) Sisu Begins Where Perseverance Ends. Blog post: Taken May 28, 2018

Loss of hospital beds impacts us all: The Real Impact of Deinstitutionalization

Posturized aerial photograph of once resplendent state hospital campus in Massachusetts – now crumbling and unsafe to enter.

The age of deinstitutionalized mental health began in the 1960’s with the advent of medicine that helped to control the symptoms experienced by the afflicted and institutionalized. It was liberating. The collective conscience of the day believed that by releasing the mentally ill we would reintegrate into society the thousands of people and bring them back into our liberal family. The legion of state hospital beds were no longer to be needed. Or so we were told.

On the one hand, there were many who embraced the idea of deinstitutionalizing thousands of patients. They were to be promised catchment area clinics where they could see their doctors and receive on-going care. Many thrived in community-based programs but there were just as many who where frightened by the sudden loss of structure and routine afforded them by the state hospital system that had become their homes. For many they had nowhere to go. There was nothing for them in the communities across the country and no welcome mat to offer comfort.

“In Massachusetts, as elsewhere in the United States, the closing of state psychiatric hospital has been a highly contentious issue” (Ahmed & Plog, 1976; Morrissey, 1989).

It is well known that the state hospital system across the country was not sustainable. Here in Massachusetts, there were more psychiatric beds than there were medical beds. As the pharmacology of mental illness became better understood there was less need to keep people with severe mental illness in hospitals. Treatment options became community-based including access to a broad range of therapy now available for management of symptoms of mental illness.

“In Massachusetts, as elsewhere in the United States, the closing of state psychiatric hospital has been a highly contentious issue” (Ahmed & Plog, 1976; Morrissey, 1989). Yet, then Governor William Weld had closed the majority of state hospitals by 1993.

Thus, the closure of hospitals began in earnest, in the late 1980’s, so patients could be released to communities everywhere to live their lives in the least restrictive environment needed assured of their right to treatment and the right of free choice. The problem was that many of the institutionalized were unprepared for the world that awaited them. They were afraid to take the medications being pushed on them and refused to comply. Many had no welcoming family and many had no friends. Some slowly evaporated into a cold society who were unkind to people who were strange and muttered to themselves.

Money spent keeping thousands people Americans in state hospitals could now be funneled into community clinics and those with mental illness could return to their homes. The ground swell for this model resulted in hundreds of thousands of institutionalized human beings being released to alternative programming that, for some, was both disruptive and tortuous or never materialized. The promise of “cures from mental illness” was laid at the feet of the purveyors of psychotropic medication and the pharmaceutical companies across the country. There was money to be made by opening the doors of the state hospitals in community-based programs like the Los Angeles County Mental Health in Long Beach, CA – my first assignment as a psychologist.

So now we are at ground zero in terms of programming for the 2-3 percent of individuals with major mental illness like schizophrenia, bipolar disorder, paranoia, major depressive disorder, and others. They wander the streets moving in and out of shelters. They are a herd in some cities and are driven from one side of the street to the other. And back again, as political whims dictate. They frequently come into contact with law enforcement who may not wish to go “hands-on” with someone who is hallucinating and raving about his demons.

In 2020, CIT teams are trained in de-escalating the crazed for their own safety while a co-response model brings a licensed mental health worker to the scene to call for a bed or lend a supportive ear. Many are repeat encounters or “frequent flyers” as they are known. Sadly, the access to hospital beds is a closely guarded secret and there is often no place to send them. The personnel serving the mentally ill make call after call looking for someplace to admit the person now on their radar screen. This can take hours. It is tough work, I have done it, and took pride in the cases I was able to help. But the burn out rate is very high and jobs are always available.

Stabilization and hospitalization of people in crisis is a moral responsibility of us all. Without resources there is a large part of our society for whom there is no safety net suffering with emotional illness that often leaves them marginalized, despondent, and on the brink. And no one is better off with a system that is as impoverished as this. The pendulum should slowly swing back toward a new model that may accommodate the seriously mentally ill while bringing stabilization to those who require respite from the scary place in which they live filled with demons, too often in their heads.

Desperate Victim’s plea for help

DV_note B&W
Victim passed this note to Veterinarian staff – Photo VCSD

WESTBOROUGH, MA  June 6, 2018 A case of domestic violence unfolded on Memorial Day weekend in Volusia County, Florida when a female victim was being held by her live-in boyfriend. The note implores staff members of the DeLand Animal Hospital to call police because her partner was threatening her and had a gun.  These kinds of desperate measures occur occasionally and are dramatic and newsworthy. The staff at the DeLand Animal Hospital are to be commended.  But there are intimate partners everywhere who live in fear just as the indomitable victim who passed this note had been living.

“From coast to coast LEO’s are caught in this moth eaten, patchwork system that lacks resources for both the mentally ill and those addicted to alcohol and drugs.” Michael Sefton, Ph.D. 2018

As the story goes, her boyfriend had beaten her and was refusing to allow her to leave the couple’s home.  To her credit (perhaps life saving) she convinced the man that she needed to bring the dog to the veterinarian.  He agreed but would not allow her to go without him. Upon arrival this note was passed to a member of the hospital staff who knew just what to do.  The man is now behind bars being held without bail – manning his defense.

There is a consensus among experts in domestic violence that victims are abused multiple times – often threatened with death – before they call police for help.

As a society, more needs to be done to fill-in the holes in the system designed to keep families safe.  Safety plans and orders of protection are not enough.  From coast to coast LEO’s are caught in this moth eaten, patchwork system that lacks resources for both the mentally ill and those addicted to alcohol and drugs. The holes in the system allow for violence prone individuals to allude police and coerce victims into silence.  But every once in a while, a silent victim writes a life saving note and gives it to the right person.

Domestic violence happens in family systems that are secretive, chaotic, and dysfunctional.  This lifestyle pushes them into the margins of society – often detached from the communities in which they live.

The abusive spouse makes his efforts known within the system by his barbaric authoritarian demands.  He keeps his spouse isolated as a way of controlling and manipulating whatever truth exists among these disparate family members.  The consequence of this isolation leaves women without a sense of “self” – alone an emotional orphan vulnerable to his threat of abandonment and annihilation.

Successful intervention for these families must slowly bring them back from the margins into the social milieu. Arguably, the resistance to this is so intense that the violent spouse will pull up stakes and move his family at the first sign of public scrutiny.

Police officers are regarded as the front line first responders to family conflict and DV.  For better or worse, the police have an opportunity to effect change whenever they enter into the domestic foray.  This affords them a window into the chaos and the opportunity to bring calm to crisis.  In many cases, the correct response to intimate partner violence should include aftermath intervention when the dust has settled from the crisis that brought police to this threshold.  When this is done it establishes a baseline of trust, empathy, and resilience.

Community policing has long espoused the partnership between police and citizens.  The positive benefits to this create bridges between the two that may benefit officers at times of need – including the de facto extra set of eyes when serious crimes are reported.  But the model goes two ways and requires that police return to their calls and establish protocols for defusing future events meanwhile processing and understanding the current actions of recent police encounters. When done effectively the most difficult families may be kept off the police radar screens for longer periods of time that can be a good thing when it comes to manpower deployment and officer safety.