Mental Health Triage, Pt. 2
Lack of trust in the aftermath ...By David J. Thomas, Ph.D, LMHC | Jan 4, 2018
[Publisher’s Note: This is the second of a two-part series. Click here for Part 1: Tools for LEOs.]
The police personality is mythical at best. At the root of much of the perception of this personality are fear and mistrust. When officers find themselves in need of mental health services, they are afraid they will be ostracized or labeled as weak or a “head case.” To avoid these labels, officers hide behind the persona of the police personality in hopes that no one will notice that they are in pain or coming apart.
Another aspect of mental health services is the lack of trust that an officer might have for his or her administrators. This is often coupled with the perceived power of the agency’s mental health service provider. Officers fear that the administration will use their service provider as a tool in an officer’s termination. Whether an officer’s fear and paranoia are legitimate, they are not without some merit: Officers are aware that with the stroke of a pen he/she could be designated as “unfit for duty,” which is considered by many as career-ending.
Officers should be aware that everything stated during sessions is confidential—to a point. Officers should understand that if it is determined that the officer is a threat, the service provider is obligated by law to contact the administration. For mental health providers, it’s known as a “duty to warn” and is outlined in Tarasoff v. The Regents of the University of California 1976. The other exception to the rule of confidentiality is a “fit for duty evaluation,” where the findings are reported to the administration.
The fear and paranoia associated with job loss often interfere with the pursuit of mental health treatment. Even if ordered to receive treatment, officers will deny their symptoms and suffer in silence long after the mandatory sessions conclude. In essence, the department pays for the services, officers fear outcomes, and nothing is accomplished (Clark and White, 2003; Blau, 1994).
Effectively Dealing with Psychological Trauma
How well an officer handles these incidents is incumbent upon a number of variables: age; years on the job; training and preparation; training to handle post-incident stress; healthy coping mechanisms; support systems; and conditions of their personal lives.
Of everything discussed, mental health wellness is dependent on three variables:
Support Systems. Officers will argue that their significant others don’t understand what an officer’s job is, nor the decisions officers make on a daily basis. When pushed into therapy, officers fear what their significant other might say or think. The greatest fear officers have is that family members opinions of the officer will change once the officer shares their daily experiences.
Officers need to understand that if they share they will be surprised at the level of understanding. This is especially important if officers are involved in major incidents, internal investigation, or find that their coping mechanisms have failed or are failing. Other officers are great to share with but not more important than family or support system.
Healthy Coping Mechanisms. Some officers fish. For some it’s family, children, travel, sports, exercise, yard work, meditation, and so forth.
Two unhealthy, but common, coping strategies are alcohol abuse and extramarital affairs. Both are a form of emotional numbing. Another unhealthy coping mechanism worth mentioned—because it seems to be increasing—is playing violent video games. Violent video games are asource of escape that allows officers to immerse themselves in a make-believe world where they are rewarded for acts of gratuitous violence.
Training and Preparation. There can never be enough training and mental preparation for the task at hand. However, it doesn’t stop there.Officers must be able to understand when their mental health has been compromised. Symptoms an officer might experience include depression, anxiety, suicidal thinking, low energy states, withdrawal, paranoia, and obsessional thinking. Recognize these symptoms. If you can’t sleep understand that the symptoms will only get worse. Don’t wait until it’s too late talk to your significant other. Take a few days off, and if there’s no relief then go see a mental health professional.
R.E.S.T. & Daily Mental Health
The acronym R.E.S.T. was designed as a tool to assist officers in maintaining their daily mental health. The goal is to keep your mind clear: think of it as dumping unnecessary data. However, there will be times when one’s coping skills may become overwhelmed and an officer will need the assistance of a mental health professional or trained clergy member. The key here is to find a clinician that you can trust and in doing so be honest.
Reflection: Find quiet time after you get home and review your day. Reflect on your calls for service and if one or several were stressful. Self-reflection is deep. Often we find things that we don’t like. The one thing I will say is that you must be honest with yourself and this should be done while you are alone and without drinking alcohol.
Evaluate. During your reflection, if you determine that there was a call(s) for service that caused you undo stress evaluate your performance, attempt to find the source of the stressor. Here are some examples of stressors: Are you lacking a skill set? Were you afraid? Is something in your personal life spilling over into your professional life causing poor performance? Are you exhausted or fatigued? Have you suffered a loss of some sort? Have you or a fellow officer been a victim of a physical assault or attack?
Symptoms. What are you feeling as a result of your evaluation? Feelings is a word that, especially, male law enforcement officers have difficulty with. It’s OK to have feelings! Where we get into trouble is in denying them.
There are a couple of things to keep in mind. First, to keep our feelings bottled up is self-destructive and, second, the longer you keep them bottled up the more they will impact your performance. No matter how much we attempt to contain our feelings, they will find a way to be exposed usually through outbursts of uncontrolled and unwarranted verbal abuse and/or unwarranted and unnecessary excessive force.Symptoms include anxiety, depression, inability to sleep, obsessive repetitive thoughts, intrusion of thoughts, worrying, withdrawal from those close to you, and excessive absences from work. Words associated with these feelings include fear, powerless, anger, distrust, disillusioned, overwhelmed, isolated/lonely, numb, and sad. Don’t be afraid to use these words or others that describe your feelings.
Triage. Triage should be done as needed. The goal is not to become overwhelmed and to resolve those feelings as soon as you can. It’s critical to have a network with which to share your feelings. One of the greatest sources for triage is your significant other or spouse. He or she is the one person that you can trust and bare your soul to. They will never understand if you don’t give them a chance. The alternative is shutting your significant other out and chance losing them.
Historically, law enforcement officers count on other officers to hear them out. This is bad practice because it is usually done while drinking. Discussions with fellow officers while drinking minimizes poor decisions, reaffirms bad behavior, and the daily trauma is never resolved. In fact, in these situations, what often happens is the officer’s true feelings and behavior are never addressed, which could lead to consequences that can be catastrophic.
As noted earlier, law enforcement officers by the very nature of the profession are fixers and control is central to an officer’s daily life be it work, with friends, and/or their families. An officer is an officer, 24/7. However, an officer’s survival is more than just tactical skills, it is understanding their individual mental health needs, being honest with one’s self, and when you feel you are out of sync address the problem. The key to longevity in this profession is developing a comprehensive system that supports you and more importantly one where you can trust those you allow into your inner circle.
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