Over the last fifty years, the understanding of post-traumatic stress disorder (PTSD) has undergone a radical transformation. What was once thought of as fatigue, nervousness, or even cowardice in the face of danger is now understood to be a multi-dimensional set of interlocking symptoms that can persist for years after exposure to trauma. This growing understanding of the disorder and increased awareness of its symptoms and effects have created greater urgency among law enforcement agencies to confront PTSD with support and treatment.
This growing awareness is shown in initiatives like the recent passing of SB57 in Missouri. The bill recognizes the impact of PTSD on law enforcement officers and creates funding and programmatic support for routine check-ins with mental health professionals every three to five years. It also provides crisis support for officers and departments after critical events.
This is just one example. Across the country, law enforcement leaders and policymakers are ramping up efforts to confront PTSD in the law enforcement community. What follows is a look at some of the impediments to effective treatment and the methods departmental leaders have developed to break down those barriers.
Overcoming barriers
Though police culture is not monolithic, there are common elements expressed throughout the profession – especially the notion that officers act as protectors for the rest of society. This notion can engender a cultural belief among officers that they “need to be stronger and braver than ordinary civilians” to fulfill their mission of service. Moreover, many in the profession see law enforcement as a kind of family unit subject to the highest levels of trust. In the most intense situations, a fellow officer may be the difference between survival and a far-worse outcome while on duty. While this is useful in maintaining unit and agency cohesion, it can also lead to an “us versus them” mentality when dealing with outsiders.
Staff psychologists and mental health professionals are frequently seen as outsiders within a department. In many agencies, they work on a part-time basis or are contracted from an outsider provider. Furthermore, the relationship between officers and mental health professionals can often begin as a negative experience. In most cases, a recruit’s first encounter with mental health staff is in a pre-employment psychological evaluation which can be thought of as a potential impediment to the recruit’s career goals (disqualifying them from service). After the academy, subsequent encounters with mental health staff often come from a referral from a supervisor or Internal Affairs (IA), contributing to the feeling that the interactions are punitive and a “blocker” in an officer’s career path.
PTSD Treatment That Works
Organizational and cultural changes are beginning to break down some of these barriers, and, with increased awareness, many officers now voluntarily seek help for PTSD symptoms. Evidence-based treatment options (EBT) are, by definition, the most effective means of confronting PTSD. Researchers and mental health professionals have studied these methods showing demonstrated and, importantly, repeatable patterns of efficacy in proactively addressing PTSD and offering viable treatment options that serve the unique needs of law enforcement officers. The American Psychological Association strongly recommends four specific PTSD treatments:
Cognitive Behavioral Therapy (CBT)
CBT examines relationships between thoughts, feelings, and behavior. For instance, by exploring one’s patterns of thoughts and better understanding them, a patient can see improvements in emotions and behaviors.
Cognitive Processing Therapy (CPT)
This therapy seeks to help a person challenge and modify unhelpful beliefs about the trauma they experienced. By creating a new understanding of the trauma itself, CPT can reduce its ongoing negative impact.
Cognitive Therapy
An offshoot of CBT, this treatment involves “modifying the pessimistic evaluations and memories of trauma, with the goal of interrupting the disturbing behavioral and/or thought patterns that have been interfering in the person’s daily life.”
Prolonged Exposure
A person incrementally approaches the memories, feelings, and stimuli associated with their trauma using this therapy. By retelling their experience with guidance in a supportive environment, the patient confronts the fear and anxiety associated with the experience.
These techniques represent recommended PTSD treatment for the broadest segment of the population. Research suggests that law enforcement officers have needs that can be different from that of the general public. Recognizing that, departmental leaders can enhance their efforts at combatting PTSD with the following strategies:
Peer-support
When discussing what is shown to address mental health and wellness among officers, the conversation often turns to the necessity of peer-support networks. No one “gets” the stress of policing like fellow officers. This inherent rapport can break down some barriers to seeking help for a mental health challenge like PTSD. These were typically informal networks of more senior officers providing advice and guidance to their more junior colleagues in the past. In many departments, these networks have become more formalized and are being incorporated into the mental health programming offered by departments.
Becoming an insider
Mental health professionals are not powerless when countering the “outsider” narrative that can hinder their work. They can and often do attend police social functions, making themselves part of the fabric of the department’s community. Ride-alongs have also shown results in increasing rapport and trust between mental health providers. The Bend, OR Police Department’s mental health staff has participated in ride-alongs since 2015, and the NYPD has an established program for embedding members of the public with officers, to name just a few.
Changing the Narrative
A police officer’s work increases their likelihood of experiencing traumatic events that can lead to PTSD. Though the disorder is not inherently different in law enforcement officers compared to the general population, their profession and culture create unique needs. By better understanding those needs and how they may be addressed, law enforcement leaders and policymakers can potentially change the narrative of how PTSD is confronted and treated within the law enforcement community.