Culture of Silence, Stigma Prevent Police From Seeking MH Care
Abstract
Though police officers are typically more resilient than the general population, they are more likely to die by suicide than in the line of duty.
When Robert Douglas, D.Min., lost a good friend and fellow Baltimore City Police Department officer to suicide in the 1980s, he wanted the funeral to include all the honors that are given to an officer who had died in the line of duty.
But he ran into challenges. Not everyone agreed with him, and few even knew how to talk about suicide. “We had never had any training in this area,” said Douglas, who retired from the department after 20 years and founded the National Police Suicide Foundation.
Though his friend’s funeral was ultimately what Douglas hoped it would be, the experience showed him just how completely the law enforcement community had cloaked suicide and mental health in silence.
According to a 2018 white paper commissioned by the Ruderman Family Foundation, first responders such as police officers are more likely to die by suicide than in the line of duty. Officers are also five times more likely than the general population to experience posttraumatic stress disorder (PTSD), the paper stated.
A 2011 study published in the International Journal of Emergency Mental Health found that the percentage of officers with depression was nearly double that of the general population (12% versus 6.8%).
Just this year, 10 New York City Police Department (NYPD) officers died by suicide. Typically, there are about four or five deaths by suicide a year, Commissioner James O’Neill told CBS New York.
Yet despite the prevalence of mental health problems and suicide in law enforcement, stigma is pervasive, presenting a substantial barrier to care.
Risk Factors
Those in law enforcement often come into the career with protective elements that can help them deal with trauma, explained Craig Katz, M.D., a clinical associate professor of psychiatry, medical education, system design, and global health at the Icahn School of Medicine at Mount Sinai. Officers are trained to respond to intense situations, and they often have informal support networks, such as the close-knit connections they develop with their peers.
The culture within law enforcement is shifting to be more accepting that officers may experience mental health problems and need help, says Craig Katz, M.D.
“People who are drawn to this work are typically more resilient,” Katz said. While they bounce back from suffering, he explained, it doesn’t mean they are impervious.
The sheer amount of trauma to which officers are exposed presents an enormous risk factor for such common posttraumatic problems as depression, PTSD, and substance use issues, any of which can extend to suicidality, Katz said.
Peer Program Can Build Trust Between Officers and Physicians
Peer support programs have long been acknowledged as a promising way to engage law enforcement officers. “A mental health professional won’t get a cop to talk as easily as another cop would,” said John Petrullo, a former New York Police Department (NYPD) officer and director of Police Organization Providing Peer Assistance (POPPA), a peer support organization for NYPD officers. “We’re a set of ears that are going to listen to them and get them to a mental health professional.”
In an October report, the Police Executive Research Forum (PERF) recommended that agencies offer a range of programs to prevent suicides, such as peer support.
“There’s a feeling in law enforcement—and other occupations, as well, where there’s a level of special training and exposure to danger—where you feel, whether for right or wrong, that other people just will not understand,” said Christine Moutier, M.D., chief medical officer of the American Foundation for Suicide Prevention. POPPA volunteers, many of whom are active-duty officers themselves, help bridge the gap of trust between police officers and mental health professionals, Petrullo explained. But the organization now does much more, with outreach programs and initiatives before officers experience crises.
The 10 suicide deaths of officers this year have generated more calls to the POPPA helpline, Petrullo said, adding that three or four of the calls were by officers experiencing suicidal ideation. “At least we were able to get some of them help,” he added.
In light of the suicides, the NYPD has created an internal peer support program to train officers so they can identify peers who may be in crisis. The program is “extremely beneficial,” said Deputy Inspector Mark Wachter, commanding officer of the NYPD’s Health and Wellness Section.
Petrullo is a big believer in what he calls “the starfish story.” He explains it like this: A boy and his father are walking on the beach, and the boy starts throwing starfish that had washed up on shore back into the water. The father explains that the son cannot possibly throw all the starfish back. “The son picks up another one,” Petrullo said, “and says to the father: ‘But you see this one? I saved this one.’
“When I’m out talking to 100 cops, how many aren’t listening? How many are on their phones or reading the paper?” Petrollo continued. “But every time we do an outreach, somebody picks up the phone and calls. Somebody’s listening. And that’s my starfish. As long as I get that one, then it’s worth it.”
“When you’re seeing the worst depravity, the worst evils that people can do to one another—this can add up and take a toll,” explained Frank Dowling, M.D., a clinical associate professor of psychiatry at the State University of New York at Stony Brook and medical advisor to Police Organization Providing Peer Assistance, a peer support organization for NYPD officers.
View of the Mental Health Profession
Officers frequently think of themselves as protectors, Dowling explained. “They can feel embarrassed, weak, even guilty that they’re affected by mental health challenges.”
Additionally, officers often do not seek help because they fear that supervisors and peers will think they are weak or unable to do their jobs, according to an October report by the Police Executive Research Forum (PERF) on police officers and suicide.
There is also a feeling of mistrust among officers about talking to mental health professionals. The limited times they see or meet with psychiatrists in their professional work is when their fitness for duty or carrying a gun is questioned or when bringing people with serious mental illness into the emergency room.
“They see the worst of mental illness, and the worst of the mental health system,” Dowling said. “They may believe that psychiatrists can’t understand police culture or stress and can’t help them.”
It’s important that psychiatrists acknowledge the uniqueness of officers’ experiences, says Anand Pandya, M.D.
“We’re the people who could prevent them from advancing their career,” said Anand Pandya, M.D., co-founder of Disaster Psychiatry Outreach and co-author, along with Katz and Frederick Stoddard, M.D., of Disaster Psychiatry: Readiness, Evaluation, and Treatment (American Psychiatric Association Publishing). “We’re the people who could delay their work on a given shift.”
Pandya recommended that when working with officers, psychiatrists should accept their coping strategies as the first step, even when those strategies are different from those that the psychiatrist might encourage. “Acknowledging that they have a way of coping—which often does not involve verbalizing it or focusing attention on it—is a very important first step in the process of engagement,” he said.
He also encouraged psychiatrists to be upfront about whether the discussion could result in reports back to officers’ supervisors. “The benefits of avoiding that conversation so as not to alarm the patient are outweighed by the devastating impact on the therapeutic relationship if one talks to the patient’s supervisor when the patient wasn’t expecting it,” he said.
Changing the Culture
While mental health issues, including suicide, are pervasive within the law enforcement community, there are numerous local and national efforts working to change the culture.
“I’ve seen more police officers who are open to acknowledging that they may not be coping well in the last few years than I ever did when I was starting,” said Pandya, who has worked with first responders for about 20 years.
Groups such as PERF, which held a meeting on police suicide earlier this year along with the NYPD, have developed recommendations to prevent officer suicides, such as holding routine mental health checks to reduce stigma and creating confidential support programs and trainings. Some police departments like the NYPD have ramped up their efforts to address the problems.
The department has partnered with New York Presbyterian Hospital so officers can access free, confidential counseling; added an app to all department smartphones that shows what resources are available; and is launching a resiliency program, said Deputy Inspector Mark Wachter, commanding officer of the NYPD’s health and wellness section. The idea is to help officers with their problems early, including everything from financial issues to marital problems. “If we can help them early on, then we have a very good chance that this won’t lead to the tragedies that we’ve been seeing,” Wachter said.
Sometimes police tend to think, “We can’t get help because we’re stronger; we have to help the people who are helpless,” Wachter said. “But ultimately, … we’re all human. We all suffer.” ■
“The Ruderman White Paper on Mental Health and Suicide of First Responders” is posted here. “An Occupational Risk: What Every Police Agency Should Do to Prevent Suicide Among Its Officers” is posted here. “Health Disparities in Police Officers: Comparisons to the U.S. General Population” is posted here.
