12-step programs

What are protective factors in law enforcement: Ballistic vests notwithstanding

Michael Sefton, Ph.D. 12-step programs, Alcoholism, Childhood violence, CIT, Human Behavior , , , , , , , ,
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Officer wearing ballistic vest

A new paper was just published in the Journal of Police and Criminal Psychology that has to do with high rates of depression in some police officers. It is written by Emily Jenkins (2019) who is a biostatistician and epidemiologist at the National Institute for Safety and Occupational Health in Morgantown, WV.  Her co-authors include John Violante who himself is an epidemiologist and former New York State Trooper now researching police officer health and suicide.  Basically, the authors say there are factors in personality and behavior that serve to reduce the new incidence of depression in LEO’s and to reduce the associated physical debility that may be co-occurring in cases where a history of depression was previously reported. One might see this protection as a ballistic vest for emotional health and career hardiness. High resilience leads to career success, satisfaction, and reduced likelihood of developing depression. Resilience refers to adaptability and flexibility in dealing with stressful situations.  Resilience officers are able to tolerate highly stressful situations without becoming debilitated by stress and negativity.

I find the study interesting but it doesn’t connect with the troops in the field. For example, one feature listed as helpful against depression is “active coping” that includes things like agreeableness, conscientiousness, and having social support. Understanding protective factors leads to understanding who is most at risk of developing depression.  The goal is to reduce depression among LEO’s and lessen the long-term impact of depression once it has been diagnosed.  The paper cites links to depression and poor coping skills to personality features such a high neuroticism and low conscientiousness and low extraversion.  These variables may lead to higher risk for substance abuse, reduced hardiness, and a host of physical signs and symptoms.  These personality features are the biomarkers of chronic stress and its harsh consequences. They make sense to me but I rarely encounter a police officer, or anyone else for that matter that actively thinks about the core set of personality features that have defined them throughout life.

Officers across the country are being trained in peer support and crisis intervention training. At the Direct Decision Institute we are providing a variety of training programs designed for this same issue – increased officer hardiness and reduced risk of burnout, depression, and suicide. These are intuitive concepts and when talking with active duty LEO’s, I feel like the rank and file understand the words they hear but rarely will an officer offer up a personal example of times he or she may have had behavioral health issues. I have heard officers become very emotional when telling the stories of friends who have suffered with mental illness but rarely a personal story.

Two recent exceptions to this notion are Sergeant Mark DiBona, a recently retired sheriff’s department officer from Florida and Joe Smarro, an officer from Texas who is recently featured in an outstanding documentary entitled Ernie and Joe released in May, 2019 with great acclaim.  It should not be this way and there is still great secrecy behind the veil of police service.  It takes great courage to share personal struggles and one’s private experience.  Police officers are most uncomfortable with this. Officers who are signing up for CIT and peer support courses are carefully chosen and may be more open to personal self-disclosure exhibiting greater positive coping skills, hardiness, extroversion and emotional resilience.

In order to reduce stigma associated with law enforcement behavioral health issues all members of the police service need greater self-awareness, openness to self-disclosure, and understanding of the effects of repeated exposure to violence and its broad ranging vicissitudes. This is nothing new and is being taught in academy training. Police psychologists who provide pre-employment screening should analyze the test data carefully and avoid selecting men and women who are most at risk of developing depression and who are outgoing, confident, and emotionally sturdy.

The myths and risks to individuals with mental illness

Michael Sefton, Ph.D. 12-step programs, Alcoholism, Human Behavior, terminal rage , , , , , ,
WESTBOROUGH, MA April 8, 2018 The myths attributed to persons afflicted with mental illness need to be directly addressed and corrective programs must evolve provide enhanced understanding and awareness of mental health.  Police officers encounter citizens with mental illness daily and often are called upon to calm a volatile situation often with very little formal training. This fact is changing as more police officers are trained in Psychological First Aid and Crisis Intervention Training – 2 programs that afford front line officers with the behavioral observation skill and communication necessary to reduce risk to police and the public from highly charged persons exhibiting signs of mental health crisis.
Psychological experts believe mentally ill persons lack the higher order planning to execute the complex steps necessary for anything more than petty crime – more often associated with co-morbid substance abuse.  This is where the problem lies. “The myth is you have to be “crazy” to do something like this (active shooter). So retrospectively, you look at people and you say, wow, this obviously – that guy should have been branded – but alcohol accounts for a great deal more violence than mental illness does.” according to Joel Dvoskin in an APA interview dispelling myths about the mentally ill.
Remember it is a fact that those with mental illness are rarely violent and those who commit violence are rarely mentally ill.
Until recently,  here in Massachusetts many smaller police agencies are forced to pay overtime for police officers to sit in hospitals or outside of jail cells watching a mentally ill person who has been arrested. This policy grew from the fear of litigation if someone dies in police custody who is known to be a mentally ill person.  Specifically, if a police officer arrests a person with a known history of suicidal ideation it has been policy among many agencies to provide an officer to monitor the prisoner to assure for a safe transfer to court. If this occurs on a week end night that often means that someone must have eyes on the person in custody until the next available court date.
But is this truth or is this part of the myth associated with those taken into custody for crimes committed while suffering from a substantive mental illness? Or is the problem really associated with substance abuse?
“Pre-arrest diversion also has been shown to be successful when law enforcement and mental health professionals respond together to behavioral health emergencies. Individuals are more often referred to the services and treatment that they need, rather than enter the criminal justice system as an offender. This co-responder model has delivered great results in Massachusetts to date. Programs run by Advocates, a human services agency, in partnership with several police departments in Middlesex County and funded in part by the Department of Mental Health have generated over 4,000 diversions and $11 million in savings since 2003.” Diane Gould Worcester Telegram February 2018
Dvoskin, J. (2018) Speaking of Psychology: Dispelling the myth of violence and mental illness Episode 27 American Psychological Association

On Police Identification of the mentally abnormal

Michael Sefton, Ph.D. 12-step programs, AA, Alcoholism, crisis intervention, Health Psychology, Human Behavior, Police officer behavior, psychological relevence , , , , , , , , ,
How to recognizeWestborough, The police-mental health interaction continues to be one that neither party exhibit great confidence nor take great pride in.  Myths abound about how to treat those so afflicted – especially among law enforcement personnel. I have provided classes for LEO’s and generally they are not well attended and tend to bore the average officer. In Maine, LEO’s are required to have regular training in working with the mentally ill in order to maintain their LEO credentials. Other states in New England have similar requirements and now focus on psychological first aid and deescalation protocols.  I have presented on topics of assessment of risk and dangerousness with some success.  In- service training must be short and to the point or students will quickly lose interest.
The photograph above shows the cover of a guide book first written in 1954 that was instructional for police officers.  It was written to teach the law enforcement officers of the day to recognize signs of mental illness then defined as “abnormal people”.  It was written by 2 Louisiana State University psychologists and first used by a police agencies in the late 1950’s.  I have been trying to find a copy of this early version that was re-published in 1979 and now costs over $100.  It was written because police officers needed training and experience identifying features of psychiatric emergency. This was thought to reduce the uncertainty, fear and confusion around handling these cases by providing education including signs and symptoms.
After nearly 60 years, law enforcement is not significantly closer to understanding the mentally ill than they were in 1954. A colleague, police psychologist Leo Polizoti, Ph.D. has an original copy of this booklet although I have not seen it as yet.  Dr. Polizoti provides consultation to law enforcement, officer selection interviews, and teaches a proactive approach psychological resilience to police officers that can afford them greater career satisfaction, professionalism, and longevity. Dr. Polizoti is tasked with supporting officers who are exposed to the daily grind of violence, suicide, homelessness, and its cumulative impact on a cop’s personal narrative.  His model suggests a fundamental change in how police officers interpret their experiences over time and acceptance of what cannot change and healthy adaptation.  He is a great asset to the Central Massachusetts community and across New England and espouses a model of stress resistance through adaptation.
“In 1954, the National Association for Mental Health first issued the book “How To Recognize and Handle Abnormal People: A Manual for the Police Officer.” Included were techniques on dealing with all kinds of “abnormal persons,” from psychopaths, drug addicts, and the “mentally retarded” to civil protestors and those involved in family disturbances.”  Posted by David Pescovitz, 2015
Text from 1954 How To Recognize and Handle Abnormal People: A Manual for the Police Officer is provided below.  It points out many of the outward signs of disturbed thinking often an underlying feature of those with mental illness – in this case something called ideas of reference. These signs are common among persons with early paranoia and are sometimes missed – even by members of the immediate family. This is still a common symptom of mental illness today and is considered to be the prodrome to a more serious loss of contact with reality. Ultimately, it comes down to who is at more risk for violence?  And how can we be sure?
It takes a healthy and educated police officer to observe, understand, and control unpredictable situations. Officers are required to adapt to the demands of individual calls for service.  A colleague Dr. Leo Polizoti has identified a model for coping with the strain of police service.  He cites the importance of avoiding apathy, withdrawal and bitterness on the job.  “Understanding the 3 C’s of hardiness, Challenge / Commitment and Control will assist officers to manage stress more effectively, resulting in fewer emotional and medical problems. By viewing each new situation as a challenge, instead of a threat, you become committed to that challenge. You can readily see yourself in control and better able to deal with the situation. You will enhance your “hardiness” or resistance to stress” Polizoti, 2018.   
“He may think, for example, that announcements made over the radio have something to do with him personally. He may even hear his name mentioned. These are called ideas of reference which, of course, means that the patient thinks people are referring to him in one way or another. In the beginning, ideas of reference may occur only occasionally, but they gradually become the rule rather than the exception, and finally they may develop into definite delusions of persecution or grandeur.”
The list below are the signs of “abnormal persons” that are printed in the booklet published in 1954:
  • He shows big changes in his behavior.
  • He has strange /losses of memory, such as where he is or what day it is.
  • He thinks people are plotting against him, or has grand ideas about himself.
  • He talks to himself or hears voices.
  • He thinks people are watching him or talking about him.
  • He sees visions or smells strange odors or has peculiar tastes.
  • He has complaints of bodily ailments that are not possible.
  • He behaves in a way which is dangerous to himself or others.
Interestingly, the bullet points above remain accurate today with the understanding that too many individuals suffering with a major mental illness also have substance abuse/dependence.  It is this fact that confounds most LEO – mentally ill encounters.  “Beyond the rigors of police work, lie the demands of a personal life, specifically a wife or husband and children. Maintaining a healthy and happy family life is on its own a demanding responsibility. Add these powerful life stressors and demands to the burdens of police work and  an officer may begin to feel the weight upon his or her shoulders.” Polizotti, 2018.  Emotional and physical strength and endurance requires hardiness that comes from personal responsibility and comittment to excellence and peak performance.  Greater focus on sobriety – including opioid and alcohol dependence is essential. If this can be maintained mental illness may remit to the extent that subjects can remain in the community. Programs like A.A., N.A., and other 12-step groups are free and often afford subjects great support.  In most cities there are 12-step meetings every day morning, noon and night.  The problem is getting people to realize they have a problem.  Even airports hold A.A. meetings for travelers in need of the 12-steps. We are working on a replacement manual like the one cited in this post.
Polizoti, L. (2018) Personal Life Demands. Presentation – Direct Decision Institute.
How To Recognize and Handle Abnormal People: A Manual for the Police Officer (1954) Matthews, R. M.D. and Rowland, L. Ph.D. NATIONAL ASSOCIATION FOR MENTAL HEALTH, INC. 10 COLUMBUS CIRCLE, NEW YORK 19, N. Y.

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Mentally ill American’s and their proclivity to act out against authority

Michael Sefton, Ph.D. 12-step programs, AA, Alcoholism, crisis intervention, domestic violence, Health Psychology, Human Behavior , , , , ,

The popular press is filled with ideas and criticism about what best to do with those afflicted with mental illness.  The resources available to law enforcement are practically nothing in the average community.  I have answered calls in west central Massachusetts where a citizen asked for referrals for counseling for a family member who was addicted to something or other.  Too often I had nothing to offer.  Generally speaking unless someone has money to pay for psychiatric services they are left to languish on the waiting lists of community mental health centers.  In emergencies many show up or a taken by ambulance to the emergency mental health center nearest their place of residence.  This usually ends up costing them thousands of dollars and hours of their time only to be told they must follow-up with a primary care physician. The entire process can be demeaning and inhumane.

In a prior post I have advocated for the use of 12-step recovery programs to help those with substance abuse and dependence.  These are not psychotherapy and are often leaderless meetings. There are have daily meetings in every city and town.  12-step programs teach the understanding addiction and loss of control from addition, coping by taking one moment at a time in order to remain substance free and belief in a higher power. In many cases new members of AA or NA – or any compulsive behavior recovery group – may have a sponsor who comes forth and provide 24/hour support. I encourage family members to attend meetings with their loved one in show of support. Sobriety can begin tonight at the 7 PM meeting in Watertown, Worcester or Anytown, USA.

The interaction of substance abuse and mental illness is complex.  Persons with drug and alcohol addiction must be expected to become sober with the help of substance abuse treatment and family support. The risk of violence and suicide declines when sobriety can be maintained.   Michael Sefton, 2017

“We have to get American police to rethink how they handle encounters with the mentally ill. Training has to change” according to Chuck Wexler, executive director of the Police Executive Research Forum, an independent research organization devoted to improving policing. People carrying a dual diagnosis are at greatest risk for self-destruction – including intimate partner violence and suicide by cop.

Sefton, M (2017) Blog post: https://msefton.wordpress.com/2017/01/16/police-as-therapist-the-inherent-risk-of-unconditional-positive-regard/ Taken 17 November 2017