Get rid of behavioral health stigma once and for all

This video is about an introduction to a post that will be forthcoming in a short while it is reference to law enforcement officers and the suicide death of officers who carry trauma. The video tells about LEO stigma associated with officer behavioral health and its decline. In it, Michael Sefton, Ph.D. describes the need for understanding fluctuating moods among mid-career law enforcement officers – those most at risk for trauma-related crisis. Sefton implores departments everywhere to analyze deaths by suicide for consideration of “line of duty” designation. In stigma, behavioral health problems are a product of centuries of police culture in which perceived weakness is stigmatized. Cops know their brothers have their back, no matter what, but they still don’t want to be seen as the one who’s vulnerable” according to a recent Men’s Health article written by Jack Crosbie. He published a report about suicide in the NYPD during Mental Health Awareness month in May 2018. Over 300 clinicians and law enforcement personnel came together at police headquarters in Manhattan in April 2019 in an effort to take on law enforcement suicide. I sat amongst a row of NYPD sergeants and enjoyed their company as we learned about how to let go of the stigma and understand the impact of personal job-related experience.

In order to be considered for line of duty status following suicide, law enforcement must offer annual stress assessments and tracking and defusing after high lethality incidents. This will link any stress and behavioral health issues to calls for service that officers had during the reporting period. Just as psychological screening is done pre-employment, so too should annual stress assessments be undertaken for officer longevity and career satisfaction. Men and women found to have an elevated stress response and symptoms may rotate to other roles in the department while receiving support. After a period of time they return to their prior status and duty. This is more difficult to achieve in smaller or more rural agencies.

“The NYPD is making use of psychological autopsies, a research-based approach that attempts to better understand why someone took his or her life.” 

According to Hartley, et.al., 2007, “repeated exposures to acute work stressors (e.g., violent criminal acts, sad and disturbing situations, and physically demanding responses), in addition to contending with negative life events (e.g., divorce, serious family or personal illness, and financial difficulties), can affect both the psychological and physiological well-being of the LEO population.” This is well known. But there are factors that interfere with coping as stress increases. These factors must be studied and applied to law enforcement officers who are most at risk. Those officers who grow more distant and see fewer and fewer options for life. It is in this decoupling of frontal decision making and problem solving circuits and the narrowing of focus that suicidal behavior becomes a plausible next step. At some point, a suicidal person believes there are no other choices and that the world would be a better place without him or her.

The run away fight/flight mechanism that keeps us on guard plays a primary role on how people feel after episodes of high stress, both normal and abnormal. Career longevity depends upon developing healthy coping skills to deal with all life has to give including accumulated traumatic experiences. Feelings of frustration, irritability, lack of focus, chronic fatigue, and even depression can result from an over reliance on social media stimuli like an unfed addiction. 

The Psychological Impact of Pandemic: The best and worst of human behavior

On November 11, 2020, I presented a program on the Psychological Impact of Pandemic sponsored by Whittier Rehabilitation Hospital.  It was well attended with a mix of nurses, midlevel practitioners, social workers, and nonclinical participants. The program was presented on the zoom platform. I am now going to put to paper my perspective narrative espoused in my 90 minute presentation.  I had also invited members of law enforcement with whom I have regular contact as the information was drawn from the growing literature on mental resilience and its positive impact on coping with exposure to trauma.

ca-times.brightspotcdn

According to the PEW Research Group, 4 in 10 Americans know someone who has either been afflicted with Coronavirus or someone who has died from the virus. My mother was infected with the Coronavirus in mid April in the same nursing facility where I lost my 93-year old aunt in the first wave of the virus in May, 2020. My mother survived the virus but it has taken a significant toll on her physical and cognitive well-being. We were not permitted to see my mother during her illness and my aunt was alone on May 1 when she succumbed to the virus. Both living on a nursing unit that was doing its best to render compassionate care under extraordinary conditions, in some cases with nurses, aides, and therapists working round the clock. Both of these loved ones received extraordinary care. Nursing units across the country suffered unimaginable loss of life including over 70 elderly veterans at the Soldier’s Home in Holyoke, Massachusetts.  We all saw the images of refrigerated trucks holding victims in expiated purgatory hidden behind hospitals. It may bring horror to those who lost loved ones and never saw them again.

I saw my mother on November 12. She looked frail and disheveled.  The nurse practitioner had ordered a blood draw out of concern for her physical well-being. She is 92 and may have a blood disorder. They had three staff people hold her in place to obtain the small sample of blood which took over and hour.  She has always had difficulty having her blood drawn and this has gotten worse as she has gotten older. She fought and screamed from pain, and fear, I was told. It was torture for all those involved, including me.

Little did anyone realize the extent of disease, contagion, and trauma this pandemic would bring to the United States and the world. We waited in February and March with curiosity and vague forewarning from our leadership. We were led to believe the virus would dissipate once the weather became warm and it would essentially vanish in the heat of summer. This did not happen and public health officials at CDC and WHO were spot-on in terms of the contagious spread of covid-19 and the deaths it would bring.  Now with the approach of winter our fear borders on panic.

This virus poses significant stress and emotional challenges to us all. It raises the specter of both an overwhelmed medical system as well as increasing co-occurring emotional crisis and a collapse in adaptive coping, for many. Sales of alcohol went up 55 percent in the week of March 21 and were up over 400 percent for alcohol delivery services. Americans were in lock-down and many made poor choices. The link between stress and physical health and well-being is well documented and will be a factor as American’s find their way free from the grip of Covid-19. 

“The human mind is automatically attracted to the worst possible case, often very inaccurately in what is called learned helplessness”

Martin Seligman

Whenever human beings are under stress they are going to utilize skills they have learned from other times when they felt under threat. Chronic stress has been shown to have negative effects on health including autoimmune functions, hypertension, inflammatory conditions like IBS, and pain syndromes. Many find it impossible to think about anything but the worst case scenario. Marty Seligman described the concept of “catastrophizing” that is an evolutionarily adaptive frame of mind, but it is usually unrealistically negative.” This leads to a condition known as learned helplessness. In another book, Dr. Seligman writes about learned optimism published in 1990. His cognitive strategies hold true today.

So many use the same coping mechanisms over and over, whether they are effective or not like drinking or gambling to let off steam. These things may help in the short term but can cause further health and social problems later on. They are not adaptive strategies. Stress is unavoidable and the best thing we can do is to understand its physical impact on us and adapt to it in healthy, adaptive ways. Stress raises the amount of cortisol and adrenaline in the body activating the fight-flight response. For many, that meant an uptick in the procurement of spirits in late March to help bring it down. Others think differently. Many began a routine of walking or running or cycling. Regular exercise contributes to reducing stress and when kept in perspective, is an adaptive response to the threat of coronavirus.

Many people in our hospital were afflicted with the virus or some other health concern and became immersed in loneliness and isolation that can lead to disconsolate sadness. It is hard not to be affected by this suffering. Most reviewed studies reported negative psychological effects including depression, anxiety, post-traumatic stress symptoms, confusion, and anger, according to Brooks, et.al. Lancet 2020. At Whittier, we had many cases of ICU delirium where patients became confused and frightened by healthcare providers wearing PPE including face shields, masks, and oxygen hoods. Many thought they were being kidnapped or that the staff were actually posing as astronauts. This made it hard to help them feel safe and to trust the core staff including doctors, nurses, and rehabilitation therapists.

Michael Sefton

We have had some very difficult cases including a man who found his wife on the floor without signs of life. He fell trying to get to her and both lay there for over 2 days. He was unable to attend her funeral because of his broken hip. We had another man who pushed us to be released from the hospital. He worried about his wife who needed him to assist in her care at home. She has Parkinson’s disease. He was discharged and died shortly after going home. His wife fell while getting ready for his funeral and is now in our hospital undergoing physical rehabilitation and receiving support from our psychology service. The table below is a list of observations from recent admissions:

  • Anxiety – what will my family do while I am here?
  • Deep felt sense of loneliness
  • Depression – loss of support; loss of control 
  • Exacerbation of pre-existing conditions i.e. sleep disturbance, asthma, uncontrolled diabetes, hypertension
  • Slower trajectory toward discharge
  • Debility greater than one might anticipate to diagnosis
  • Subtle triggers to prior trauma – changes in coping, regression, agitation, sleep and mood

What is left for us to do? Have a discussion about what it means to be vulnerable – talk about family members who have been sick with non-covid conditions like pneumonia or chronic heart disease, COPD, etc. It is important to be ready to work from home again such as when schools switched to remote learning this spring and when governors’ call for closing things down. Consider the return of college kids as campus dorms everywhere are likely to close this winter.

The 1918 Spanish Flu pandemic killed 50 million people worldwide. 500 million people were infected with the virus that lasted 2 years. The virus was said to have been spread by the movement of troops in WW I. The website Live Science reported that there may have been a Chinese link to the Spanish flu as well due to the use of migrant workers and their transportation in crowded containers leading to what we now call a super spread event. We know a lot more about this virus than we did in March 2020 when it first took hold but we need to understand the eradication will be a herculean task driven by science.

“The coronavirus has profound impact on the emotional stability of people around the world because of its unpredictability and lethality. It evokes fear, and uncertainty as it spreads unchecked. Later, the virus can serve to trigger long hidden memories in a way that can sabotage healthy human development leading to vague anxiety, physical symptoms, loss, and deep despair” said Michael Sefton, Ph.D. during a recent Veteran’s Day presentation. People must have resilient behaviors that foster “purpose in life, to help them survive and thrive” through the dark times now and ahead, according to police consulting psychologist Leo Polizoti, Ph.D. at Direct Decision Institute in Worcester, MA.

 

Law Enforcement – M.H. encounters – New documentary April 27, 2019 in Somerville

A new documentary featuring the law enforcement CIT model of police-mental health response is being featured as part of the 2019 Boston Independent Film Festival.  This entry won a prestigious award the SXSW in its film debut.  As I retired from police work my interest in law enforcement mental health interactions deepened.  As a result I met these officers in San Antonio was was taken for some days of first hand observation of their work.  The documentary took 2 years to complete and gives the viewer a front row seat in the model from San Antonio PD and Bexar County that works. The film debuts here in Boston at the Somerville Theater in Davis Square on Saturday April 27, 2019.  I strongly urge readers in the area to attend.

In many police agencies the call volume for mental health encounters is at or above 50 percent. That means that every other call for service requires that officers dispatched to the call have an understanding about encounters with citizens experiencing a mental health crisis. Many LEO’s lack training and are uncomfortable with these calls. Importantly, this does not mean that 50 percent of all calls involve mentally-ill citizens but those individuals experiencing some behavioral health emergency – like a job lay-off or impending divorce or financial problems. They are not mentally ill and should not be treated any differently than any other 911 call for service. Police are often called when bad things happen to normal individuals who become emotionally overwrought often made worse by chronic use of alcohol or drugs.

Training for encounters with citizen’s experience a mental illness is part of the early career academy education. Many officers are provided 40 or more hours of crisis intervention training (CIT). In-service programs are being introduced across the country because of the importance of having expertise and understanding in basic de-escalation. Agencies around the country are playing catch up in learning how best to deal with abnormal behavior. Police in Albuquerque, NM are using a monthly supervision model where the department psychiatrist case conferences specific calls and officers learn techniques for de-escalation and process details about how better to respond to future calls.

Crisis intervention training teaches law enforcement officers what to expect and allows them to practice using role playing to see for themselves how to intervene with people in crisis using de-escalation techniques. “Law enforcement officers’ attitudes about the impact of CIT on improving overall safety, accessibility of services, officer skills and techniques, and the preparedness of officers to handle calls involving persons with mental illness are positively associated with officers’ confidence in their abilities or with officers’ perceptions of overall departmental effectiveness. ” Bonfine, 2014. “When a police officer responds to a crisis involving a person with a serious mental illness who is not receiving treatment, the safety of both the person in crisis and the responding officer may be compromised especially when they feel untrained” according to Olivia, J, Morgan, R, Compton, M. (2010).


Bonfine N, Ritter C, Munetz MR. Police officer perceptions of the impact of Crisis Intervention Team (CIT) programs. Int J Law Psychiatry. 2014 Jul-Aug;37(4):341-50. doi: 10.1016/j.ijlp.2014.02.004. Epub 2014 Mar 11.PMID: 24630739

Olivia, J, Morgan, R, Compton, M. (2010) A Practical Overview of De-Escalation Skills in Law Enforcement: Helping Individuals in Crisis. Journal of Police Crisis Negotiations, 10:15–29.
While Reducing Police Liability and Injury

Police officer vulnerability previously ignored, hidden from plain site

What is currently understood as repeated exposure to trauma and its emotional impact was once thought to be a testament to toughness invoking the specter of a wall of silence. Law enforcement and first responder suicide has increased over the past several years and now exceeds the number of LEO’s killed in the line of duty. Why are cops choosing to take their lives? This is especially felt in Chicago where seven officers have taken their own lives in the last 8 months. In more than one case an officer committed suicide in the police vehicle or in the police department parking lot.

My colleague Dr. Leo Polizoti, Police Consulting Psychologist at the Direct Decision Institute, Inc. has been active in law enforcement training, fitness, and prescreening for over 40 years. He served over 30 agencies across New England and provides supportive psychotherapy as needed.

Dr Polizoti and I were recently involved in a symposium on Police Suicide in Chicago sponsored by Daninger Solutions from Daytona Beach, Florida. Among the presenters were Dr Thomas Joiner from the University of Miami, recognized expert in suicide, police sergeant Mark Debona from Orlando, Florida and Dr Daniel Hollar, Chairman in department of Behavior Science at Berthune-Cookman University in Tallahassee, Florida and CEO at Daninger Solutions.

There are many reasons why police officers have an increased levels of depression and stress.  Most are associated with repeated exposure to traumatic events like exposure to dead bodies, violence, childhood injury or death, terrorism, fatal car crashes, and more.  Most officers are able to remain professionally hearty when provided the opportunity to defuse the exposure soon after an incident. Career performance should include reducing officer depression and embitterment by building resilience starting in the academy and lasting throughout an LEO’s career.

The Mind-Body connection is well established and the role of stress in LEO career well-being is becoming a agency focus beginning in the academy.

“Not only must we as negotiators learn to take care of ourselves emotionally and physically – we must also be prepared to intervene with an actively suicidal officer. “

Dave DeMarco FOX News Kansas City

Is it any wonder officers lose hope and resilience.  There are inherent risks that LEO’s assume when they sign on like forced overtime, changing shifts, off-duty court appearances, the chance they may become injured, disabled or killed while serving the community.  There are also systemic stressors like supervisory bullying, professional jealousy, lack of opportunity to have an impact on policy, career stagnation, and paramilitary chain of command that often devalues education and innovation.  Agencies are beginning to track exposure to trauma and its correlated change police officer resilience in real time.

In Worcester, Massachusetts, LEO’s are required to attend defusing sessions following high lethality/high acuity exposure.  These sessions are kept private from members of the command staff and records are saved by the police consulting psychologist. The department has nearly 500 officers who are paid for their participation when they attend. It has been proposed that officers undergo annual “wellness checks” as a routine in some agencies such as KCMO. I have proposed a system of tracking officer call acuity and invoking mandated behavioral health assessment after a specified number of high acuity/high lethality calls for service. This is one way of reducing the stigma that officers face when they are sent for “fitness” evaluation or any sort of behavioral health care. The stigma associated with mental health may be reduced by having specified referrals following identified high profile incidents. Officers may be considered to be getting peak performance training at these defusing sessions as they are designed for enhancing officer awareness and reducing the human stress response.

Now, the KCMO department has mandated yearly wellness exams for officers in certain units like homicide and those dealing with child abuse. This was initiated to decrease the impact of traumatic events on police officer well-being. Officers at KCMO can also get up to six free anonymous visits to a mental health clinician each year, and the department has a peer support team.  Mental health clinicians must have experience working with law enforcement officers for best results.  Training for clinicians should be provided to best work with LEO’s and first responders. This is especially true for officers who self-refer.  Clinical hours should be supervised by the police consulting psychologist.

Into the darkness and away from the blue line

Most departments have officers trained in CISD whom provide peer support to brother and sister LEO’s who are in crisis. Key among these relationships is the hand-off to mental health professionals when indicated according to Sefton in a recent blog (2018).

The factors contributing to law enforcement officer suicide vary from one to the other but LEO resilience may be lost as a function of emotional embitterment that occurs over time. Police job-related stress is well-identified and reported in the media daily and the rates of suicide nationwide are being debated by Aamodt and Stalnaker. Rates of suicide among LEO’s are actually less than one is led to believe but even one law enforcement officer suicide is too much. A closer look at the precipitants will help future generations of LEO’s to modulate trauma and process trauma in real time. The perceived stigma of depression, emotional vulnerability, and the cumulative impact of the worst of all human experience may lead LEO’s into the darkness. When suicidal officers are identified there must be a planned or intervention response using a peer support infrastructure that provides for a continuum of service depending upon the individual needs of the LEO and the supports available. In many agencies, especially smaller departments lacking resources, officers’ languish and sometimes spiral downward without support and without somewhere to turn.  Police officers must have support available to them long before they are expressing suicidal urges (Sefton, 2018).

Prevention of law enforcement suicide is paramount according to Sefton (2018).  As recently as early November, 2018 a former police chief died by police assisted suicide killed by his former officers after charging them with a kitchen knife.  And in Baltimore County, MD, School Resource Officer Joseph Comegna, a 21-year veteran of the force, took his own life at his desk in the public school.  “And unlike line-of-duty incidents, which tend to receive a great deal of media coverage, law enforcement suicides rarely get much press, says Al Hernandez, a 35-year veteran of the Fresno Police Department (FPD) in California. Hernandez helps connect officers to mental health care.” according to Jack Crosbie writing in Men’s Health (2018).

Embitterment grows out of frustration and the build-up of chronic negativity, perceived helplessness, and resentment over lack of support according to Leo Polizoti a police consulting psychologist in Massachusetts. It stems from chronic discontentment within the ranks and grows with the strong belief that nothing will change. It may start with a single officer and grow to additional officers on the shift or within an outlier division or district. It is derisive to the camaraderie brought forth by the thin blue line. It is a cancer affecting what is the embodiment of a healthy law enforcement agency by trust and commaraderie. The corrosive perturbation of embitterment strips away trust in the “job” among individual officers leading to a darker reality and sometimes destructive inner narrative. Gradually, LEO’s grow weary over perceived lack of support from members of leadership and the community. In becoming alienated they often lose the support of peers growing increasingly marginalized.

Without light there is only darkness without hope

“The “typical” officer who committed suicide was a white, 36.9 year-old, married male with 12.2 years of law enforcement experience. The typical suicide was committed off-duty (86.3%), with a gun (90.7%), at home (54.8%).” Aamodt, 2001


In 2018 the Chicago Police Department went the extra step of releasing a video titled, “You Are Not Alone!” to put a spotlight on police suicide prevention and mental health. The video production is shown below and makes an effort to reduce alienation among officers suffering from the cumulative impact of trauma by reducing the stigma associated with seeking help for behavioral health afflictions. The cumulative stress associated with a career in law enforcement cannot be understated. 

In the setting of police stress and stress support there is an intervention protocol that relates to the peer-support program continuum as I cite in a recent blog (2018).  Depending on where officers enter the peer support network will impact the level of intervention they may require in the P-SIC program.  Peer support is not psychotherapy but officers occasionally must hand off the officer in trouble to a  higher level of care.  These hand-offs are key to linking at-risk LEO’s with range of professional support needed to keep them on the job and must be done in real time with the lethality of LEO distress being the guiding intervention.  


Officer suicide in Chicago represents strongly felt stigma associated with
behavioral health crises

There have been notable cases in which an officer brings himself to his station house and chooses to end his life in a place where colleagues will surely find him. In a single agency, an officer hanged himself in the department parking lot while peer support officers raced the immediate neighborhood after a ping of the officer’s phone led them to his whereabout in an effort to find him before he died. In another agency an officer killed himself while parked in the district station lot before or after his shift. A female recruit recently committed suicide at the police academy after the halfway point in her training.

These acts will have a formidable impact on LEO’s everywhere in terms of the cumulative impacts of acute stress – especially those men and woman who were exposed to the individual cases or knew the officer involved and his family. Are signs of imminent suicide missed? In general there are signs of depression and anxiety that precede an attempt of suicide. Sometimes more than one. The severity and lethality of these depends on multiple underpinnings including coping strengths and weakness, co-occurring illness – including substance abuse, alienation from peers and family members, and other significant stress, e.g. impending divorce, loss of job, age, and serious financial trouble. History of heightened emotional response to stressful events is predictive of subsequent stressful responses later on.


Aamodt, M. G., & Stalnaker, N. A. (2001). Police officer suicide: Frequency and officer profiles. In Shehan, D. C, & Warren, J. I. (Eds.) Suicide and Law Enforcement. Washington, D.C.: Federal Bureau of Investigation.

Sefton, M. (2018). From anonymity and stigma grows resilience. Blog Post Taken January 10, 2019 https://wordpress.com/block-editor/post/msefton.wordpress.com/5294

Sefton, M. (2018) Police Stress Intervention Continuum: An introduction for LEO’s and command staff to reduce officer suicide. Blog post taken 1-23-19

Polizoti, L. (2018) Personal correspondance.

Ortiz, E. (2019) Chicago’s cluster of police suicides. NBC News: https://www.nbcnews.com/news/us-news/chicago-s-cluster-police-suicides-raises-alarms-heroes-need-saving-n954386 Taken 1-23-18

The Elevated Stress Response: Selling when Nobody’s Buying

I am preparing for an upcoming presentation at the annual Society of Police and Criminal Psychologists in Sarasota, Florida held in early October each year.  So far I have offered several police departments an opportunity for free in-service training in the area of risk assessment and domestic violence.  No interest.  I can even say that one of the chiefs I approached is a friend of mine and still there was no interest in hearing about updated issues in domestic violence and the risk associated with intimate partner abuse. This has been both a surprise – given my passion about the topic and self-ascribed expertise, but also because it brings up great anxiety when I think about the expectation for my presentation at a national conference consisting of my peers.  This post is all about how to deal with the flood of anxiety associated with presenting one’s ideas to an audience that may not be interested in what I am selling.
“If we perceive our available resources to be insufficient, along comes the ‘threat’ mindset. When threatened, stress has a catastrophic effect on our ability to perform. We receive an enormous sympathetic surge (adrenaline/noradrenaline dump), and our HPA axis pumps out cortisol. High cortisol levels have a very detrimental effect on higher cognitive processes – decision-making and prioritization” or triage as described in a blog written by Robert Lloyd and physician in the U.K.
Lloyd goes on to say “that breathing is the only autonomic process that we can consciously control (other than blinking – less useful). By doing so, we access the ‘steering wheel’ of our sympathetic nervous system, and can regain a feeling of self-control in a moment of extreme stress. Heart rate and blood pressure come down when practiced. The process of deliberately controlling ones breath in the midst of a stressful moment that is key to lowered autonomic overdrive and greater physiologic homeostasis.  Mindfulness and reslience training converts a ‘threat’ to a ‘challenge’ mindset by building resilience to a controlled stressful stimulus.” It arms you with prophylaxis against condition black when the organism is fighting for its life.
   Stress has undeniable impact on all human functioning and public health. Not enough is being done to infuse knowledge and understanding into the emotional maelstrom created by chronic stress (Sefton, 2014).  Healthy coping and productivity breaks down when uncontrolled stress occurs over and over. According to Leo Polizoti, Ph.D., the primary author of the Police Chief’s Guide to Mental Illness and Mental Health Emergencies stress can lead to a breakdown in adaptive coping. “Learned resilience can be taught and leads to reduced stress and psychological hardiness rather than psychological weariness. Psychological weariness is a drain on LEO coping and adaptation to job-related stress and the efficiency for handling everyday calls for service. As the demand for police service becomes more complex, officers must adapt their physical and emotional preparation for service or risk premature career burnout” according to Polizoti. Resilience and career satisfaction are important components of law enforcement and individual officer training, behavior and longevity. Positive resilience will reduce officer burnout.
In its absence police officers and their agencies are at greater risk for conflict both internally and with the general public in the form of civilian complaints of police officer misconduct.
So in anticipation of my own decrease in internal homeostasis and elevated production of stress hormones, I will breath and adjust my thinking for a positive outcome and not be hurt by the buyer beware myth my topic may evoke. I will take a few moments to relax and breath slowly in anticipation of the quiescence it will bring and my belief in learned resilience.

The Rise of Embitterment and its Impact on Health

September 2, 2018 Have you ever met someone who appeared chronically angry? Someone who is bitter about everything as if they have been screwed over by the entire world. Embitterment grows out of frustration and the build-up of chronic negativity, perceived helplessness, and resentment over lack of support.  They pay a substantial price for being so embittered and are likely to have chronic health-related consequences such as hypertension, chronic pain, sleep disturbance, substance abuse, risk of cerebral vascular attack, and more. Law enforcement officers develop coping skills early in their career and many are now being taught strategies to avoid becoming embittered and chronically angry over what they encounter and witness over years of policing.
     Research on the impact of high stress lifestyles is supportive of what LEO’s experience over the course of their professional career.  People who grow up in war zones demonstrate a malfunction in their system of arousal marred by hyper vigilance due to perpetual release of stress hormones and the health-related effects.  This is the result of chronic exposure to unpredictable chaos and the changing physiology associated with a lack of personal control and chronic, intermittent threat to life and well-being.  Neuroscientists can now pinpoint the impact of stress on hardwired changes in the brains of people growing up in places without lasting peace and this research approximates the experience of LEO’s who may be bored one moment and in a fight for their lives the next.
    Embitterment has large implication on LEO productivity, career satisfaction, job performance, citizen complaints, and officer health. Mentoring in the field and supervisory support reduce officer isolation and sometimes powerful feelings of negativity that can fester over time. The physical consequences are well documented and raise the specter of work-related injury from stress and untreated traumatic exposure. In Massachusetts an officer with acquired cardiac disease has presumptive work-related debility if he or she is shown to have been healthy when first hired.
     Ostensibly, resilience is the opposite of embitterment. Have you ever worked with someone who rolled with the punches – literally and figuratively?  They can have felony cases dismissed and be nonplussed maintaining a positive attitude and a “better luck next time” belief system.  They cope with a range of career inequities by having a rich family life, a healthy self-concept, and a positive sense of humor.  Resiliency requires positivity and using innate resilient coping strategies.  “By using alcohol to cope instead of resilient thinking one often develops other problems and this can lead ultimately to suicide. Alcohol is often related to suicidal behavior.” according to Leo Polizoti, Ph.D at the Direct Decision Institute in Worcester, Massachusetts. To survive these incidents one needs to have resilience also known as the psychological resources to process the experience with all of its ugliness and to know that you did what was needed with the training and experience you bring to the job every day.
     After a stressful event, your body and mind must return to its baseline calm and ready state so that the officer may again activate and serve in whatever capacity is required without the baggage of the calls gone by.  As this “baggage” builds unfettered the likelihood of a decline in officer job performance grows sometimes exponentially.  “Like anxiety, depression or other stress reactions, it can become pathological when it reaches greater intensity and is accompanied by feelings of helplessness, dysphoric mood, intrusive thoughts, aggression towards others and suicidal ideation towards oneself, withdrawal from others, phobic avoidance of places and persons that can remind oneself of the critical event, or multiple somatoform (physical) complaints” (Hauer, Wessel, & Merckelbach, 2006).
“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.” Leo Polizoti, 2018.
     Law enforcement officers work in highly stressful situations and their bodies are exposed to external threats that activate the autonomic nervous system. Many are conflicted over the need for overtime versus the need for family time.  “In times of crisis, fight-or-flight (adrenergic) responses may cause elevated heart rate and blood pressure. This can lead to hypervigilance or a feeling of being on overdrive. If the mission is extended in the case of large-scale disasters, there may be problems with sleeping, changes in appetite, irritability, and impatience. Often, there is profound fatigue caused by long shifts with limited down time and limited space for sleep and relaxation” according to Laura Helfman, M.D. in a 2018 paper on coping and trauma. The longer the mission, the greater the risk of shifting from normal to maladaptive responses.” Helfman, 2018.
     Stress has undeniable impact on all human functioning and public health.  Not enough is being done to infuse knowledge and understanding into the emotional maelstrom created by chronic stress (Sefton, 2014).  Healthy coping and productivity breaks down when this occurs over and over. According to Leo Polizoti, Ph.D., the primary author of the Police Chief’s Guide to Mental Illness and Mental Health Emergencies, “learned resilience leads to reduced stress and psychological hardiness rather than psychological weariness. As the demand for police service becomes more complex, officers must adapt their physical and emotional preparation for service or risk premature career burnout.”

Helfman, L. (2018) How do First Responders Experience and Cope with Trauma. Quarterly Technical Assistance Journal on Disaster Behavioral Health. Volume 14,  Issue 1, Page 14
Linden, M. et al. (2009) Post-traumatic Embitterment Disorder Self-Rating Scale. Clinical Psychology and Psychotherapy Clin. Psychol. Psychother. 16, 139–147.
Polizoti, L. and Sefton, M. (2018) The Police Chief’s Guide to Mental Illness and Mental Health Emergencies. (In press) Decision Press, Worcester, MA
Sefton, M (2014) Stress: The human cost of Technology. Blog post: https://msefton.wordpress.com/health-psychology/stress-the-human-cost-of-technology/. Taken 8-22-2018

From anonymity and stigma grows resilience

Today there is still a great deal of stigma associated with reaching out for peer support within police departments. Officers’ fear being misunderstood and seen as weak if they acknowledge their vulnerability years into the job. The blue line bleeds each time an officer takes his or her own life yet the silence within the ranks is stunning. An officer may act heroically in their efforts to save a child who isn’t breathing and fail.  An officer may be first-in to a call for domestic violence homicide and fail.  An officer may be dispatched to a horrific motor vehicle crash and come upon an overturned minivan with a shamble of entrapped human misery and death and still feel a failing.  These events create a chink in the armor and sometimes reveal gaping personal anguish that accumulates over time. The cumulative impact of trauma adds to the layers that belie the outward calm.  As a former police officer there are calls I covered that are painful to this day. Abject failure. Exposure to subclinical, traumatic events takes a toll of both physical health and emotional wellness and can lead to PTSD, secondary traumatic stress disorder, and burn out.
Prevention of law enforcement suicide is paramount.  As recently as early November, 2018 a former police chief died by police assisted suicide killed by his former officers after charging them with a kitchen knife.  And in Baltimore County, MD, School Resource Officer Joseph Comegna, a 21-year veteran of the force, took his own life at his desk in the public school.  “And unlike line-of-duty incidents, which tend to receive a great deal of media coverage, law enforcement suicides rarely get much press, says Al Hernandez, a 35-year veteran of the Fresno Police Department (FPD) in California. Hernandez helps connect officers to mental health care.” according to Jack Crosbie writing in Men’s Health about a suicide death of an NYPD officer who died in early 2018.
The impact of stress on the lives of LEO’s is well known and can have pervasive impact on officer well-being both in and out of uniform.  Hypertension, cardiovascular disease, substance abuse, and depression are just a few of the behavioral health consequences that may result from repeated exposure. Ongoing vulnerability to traumatic events can result in anger, resentment, strong negative emotions, and reactive embitterment that can erode job satisfaction and job performance (Sadulski, 2017). Critical Incidence Stress Debriefing plays an important role for police by helping LEO’s manage their trauma and post-traumatic stress. It should be provided as part of an integrated system of peer support. Most departments have officers trained in CISD whom provide peer support to brother and sister LEO’s who are in crisis. Key among these relationships is the hand-off to mental health professionals when indicated. Peer support is not treatment and the relationship between the peer support and psychological treatment should be clearly defined.
Each of us in law enforcement has a duty to reduce suicide among the men and women in blue whenever possible. This requires a substantive understanding of the risk factors associated with LEO self-destruction. Chief among law enforcement is the camaraderie that bonds officers together during times of stress. Peer support is a key factor in reduced emotional suffering among law enforcement officers. 
Risk factors for suicide increase when the conventional need for belongingness among law enforcement officers which is thwarted by the estrangement or isolation.  This comes with individual officer discipline, e.g. suspension, or some other factor pushing him/her out that can be isolating and evoke feelings of thwarted belongingness according to Thomas Joiner (2009). Social alienation is a powerful emotional dynamic that results from the experience of being estranged from a core group of supportive friends, colleagues, and immediate family. This occurs in many ways including change in social reciprocity and reduced exposure to primary interpersonal ties resulting in powerful feelings of loss and growing belief of being a burden. This may be the result of disciplinary actions toward the officer, on-the-job injury, or departmental requisite following officer-involved use of force. 
Embitterment has large implication on LEO productivity, career satisfaction, job performance, citizen complaints, and officer health. It grows slowly as a function of career experience perceived support, and critical incident debriefing and peer support are vital to officer longevity.  Mentoring in the field and supervisory support reduce officer isolation and sometimes powerful feelings of negativity that can fester over time according to Polizoti, 2018.  Ostensibly, resilience is the opposite of embitterment. Have you ever worked with someone who rolled with the punches – literally and figuratively?  They can have felony cases dismissed in court and remain nonplussed maintaining a positive attitude and a “better luck next time” belief system.  
Lethal Self-Injury – Acquired Ability
The final risk factor involves a gradual desensitization to pain and human suffering according to Joiner (2009). Over time, exposure to repeated violence, homicide, intimate partner violence, and other “salient fearsome experiences”, the self-preservation instinct gradually disintegrates into a residual fearlessness in the face of life threatening danger and an acquired capacity to ignore the horror and humility of violence with a higher tolerance of pain and substantive capacity for suicide (Joiner, 2007).
Joiner believes that the capacity for suicide is acquired over time from the repeated exposure to trauma such that the reaction to horrific traumatic events, e.g. domestic homicide, loses the ability to evoke a normal emotional response and habituates to a decreased emotional reactivity, a higher tolerance for pain, and a fearlessness in the face of death. Given this proclivity toward feeling “numb” in the face of high levels of violence, over time researchers look for protective factors such as reducing isolation and more frequent debriefing after every critical incident rather than wait until LEO coping goes the way of attachment and perceived support. 

References
Sadulski, J. (2017). Promoting Police Resilience through Peer Support. Law Enforcement. Blog post taken November 20, 2018
Joiner, T. (2009). The Interpersonal-Psychological Theory of Suicidal Behavior: Current Empirical Status. Science Briefs, APA, June.
Polizoti, L. (2018) Critical incident resilience training. Personal correspondence, September.

 



Resilence and management of high stress situations

 The likelihood of becoming involved in an on-the-job shooting in one’s career is generally quite low across law enforcement officers in the US and Canada. However, there is a high degree of likelihood of almost daily encounters with high stress calls involving intimate partner violence, substance abuse, children at risk, unbearable human suffering and death.  I recall being involved in a search for a middle age male who did not return home after a night of drinking.  His route typically brought him across an abandoned rail road bridge.  As you might guess he did not make it across the bridge on that cold night instead falling off and drowning. He was found partially submerged and caught on some tree branches visible only by his L.L. Bean jacket which he had bought for those cold walks back from the neighborhood watering hole.  He was known to most of the police officers – two of whom were charged with going out into the river and retrieving his remains.  The body had been in the water about 48 hours.  It was not something I had seen before. I stood by for the retrieval and was involved in the notification.  My first of many.
These kinds of calls stay with you.  Especially early in one’s career.  The response of the family to losing their 50-year old father was especially difficult as he had young children from his second wife.  But I know officers and EMS first responders who have had one
images 2
Boston Police Officers react to Marathon bombing  ABC TV – photo credit
experience after another just like this and worse. A colleague described rolling up a driveway to an open garage and bearing witness to the home owner hanging from a ceiling joist. Suicide. Imagine the psychic imprinting officers experienced responding to recent mass shootings in Las Vegas or to a small church in rural Texas where so many people are killed or maimed and to be unable to stop the bad guy before it all happened. It happens every day it seems.
Here in Boston, 3 people were killed over 300 people were badly injured after two homemade bombs were set off during the Boston Marathon setting the stage for a complete shutdown of the city while area police officers searched for the suspects.  MIT University Police Officer Sean Collier was killed by the bombers while seated in his patrol vehicle on duty 3 days after the bombing.  Within hours a firefight ensued in Watertown, MA as the bombers were found in a hijacked SUV.  The brave officers from Watertown, MA, Boston Police, MBTA Transit Police, and Harvard University PD fought it out for 8 minutes with Dzhokhar Tsarnaev and his brother Tamerlan who was killed in the gun battle and run over by his brother. MBTA officer Richard Donohue was shot during the gunfight nearly losing his life. After a year of rehabilitation he returned to duty and was promoted to sergeant but ultimately could not recover from his wounds and retired in the line of duty. It took extra days and over 1000 police officers to locate the second bomber cowering in the covered boat of a Watertown resident. His image was published in the Boston Herald depicted with the snipers red dot on his forehead.  Citizens applauded law enforcement as they left Watertown on that night.
To survive these incidents one needs to have resilience also known as the psychological resources to process the experience with all of its ugliness and to know that you did what was needed with the training and experience you bring to the job every day.
By using alcohol to cope instead of resilient thinking one often develops other problems and this can lead ultimately to suicide. Alcohol is often related to suicidal behavior.” according to Leo Polizoti, Ph.D at the Direct Decision Institute in Massachusetts.  
After a stressful event, your body and mind must return to its baseline calm and ready state so that the officer may again activate and serve in whatever capacity is required without the baggage of the calls gone by.  As this “baggage” builds unfettered the likelihood of a decline in officer job performance grows sometimes exponentially.  There should be opportunity and on-going training to process the images in order to put them away and restore emotional equilibrium.  In some department realistic training includes use of simuntions where officers actually shoot their weapons at active shooters during training exercises.  The weapons are full sized handguns fitted with special projectiles that do not cause lethal injuries.  All training is conducted with head and face protection.  Many departments are building resilience training into their recruit academies – no only building physical strength but emotional wellness too.  “Current training teaches officers about biological awareness (bio-awareness) since psychological and physical reactions in the body arise from biological responses to the environment. Mental and physical states don’t happen independently and both must be addressed in reality-based training” Anderson, et. al., 2017.
“When a person encounters a threatening situation, they experience a surge of natural chemicals, such as adrenaline and cortisol. These chemicals allow the body to respond quickly. When this biological threat response is moderate, it enhances performance through more accurate vision, hearing, motor control, and response time. However, when the threat response is severe, the response can negatively affect performance by creating distortions in thinking, vision and hearing, and by increasing motor control problems, which can result in slower reaction times.” Anderson, et. al., 2017
Police in Massachusetts and throughout America are faced with the worst of all human experience.  Arguably, everything from unattended death, domestic violence, child abuse, and a fatal motor vehicle crash may show up on the call board of any dispatcher on any day or night as I posted in May, 2015. In the case of traumatic events – officer safety demands CISD and in the long run physical health and well-being are the underpinnings of a resilient professional who will be there over and again –  when called upon for those once in a lifetime calls that most of us will never have to answer (Sefton, 2015). “Psychological benefits include reducing distress, enhancing confidence in abilities and recognizing psychological responses that need the attention of a mental health professional” Anderson, et. al., 2017.  When necessary police officers undergo critical incident debriefing and peer support. Some benefit has been demonstrated using biofeedback to reduce the trending autonomic arousal through a paced breathing protocol to ameliorate the sympathetic-parasympathetic mismatch that has well described negative impact on physical health, emotional embitterment, and job satisfaction (Sefton, 2017).
“The primary goal of all modalities of biofeedback including physiologic modalities and neurofeedback is to restore the body to its “normal” state of homeostasis.  The process promotes mindfulness and paced breathing to gradually lower respiratory drive, reduce heart rate and blood pressure, and enhance other abnormal physiological readings such as skin conductance, abnormal finger temperature, and elevated electromyography.  It takes practice and understanding of its value.” Sefton Blog post 2017
Ultimately law enforcement and all first responders must be afforded support along with training to adapt to situations most human beings would never choose to confront and do so in a manner that instills personal dignity,  integrity, and continued professionalism.

Polizoti, L. (2017) Psychological Resilience: From Surviving to Thriving in a Law
Enforcement Career. Direct Decision Institute presentation.
Judith Andersen, Ph.D., Harri Gustafsberg, M.A., Peter Collins, M.D., Senior Cst. Steve Poplawski, Bsc., Emma King, M.A., Performing under stress: Evidence-based training for police resilience. RCMP Gazette Magazine Vol. 79, No. 1.
Sefton, M. (2015) Critical Incident Debriefing: The cumulative effects of stress. Blog post: https://msefton.wordpress.com/topics/dv-and-trauma/police-service/critical-incident-debriefing-the-cumulative-effects-of-stress/ Taken 12-30-17.
Sefton, M (2017) Biofeedback: Teaching the body to return to a proper homeostasis. Blog post: concussionmanagement.wordpress.com https://wordpress.com/post/concussionassessment.wordpress.com/3682, taken 12-30-2017