Rethinking mental health for cops: When ‘good intentions’ aren’t enough

Why We Wrote This

What’s the best way to help those who regularly expose themselves to stress and trauma to protect others?

Emily Schmall/AP
A Fort Worth police officer and vehicles are seen outside a Veritex Bank in Fort Worth, Texas, July 19, 2018, following a shooting inside the bank. The Fort Worth Police Department has a 40-person support team trained in a suite of practices known as critical incident stress management.

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Law enforcement agencies are now expected to have some kind of in-house team to help officers manage work stress. It's a far cry from the days when first responders were expected to process traumatic incidents on their own time, if they were able to process them at all.

But as mental health services have improved, another question has emerged: Are first responders receiving the best short-term care?

“It’s an important discussion to be had because I think we’re becoming more educated in policing to understand evidence-based practices,” says Renee Mitchell, of the American Society of Evidence-Based Policing.

The Stockton Police Department in California created a wellness program for its officers that is now hailed as a national model. Officers are introduced to the “wellness network” with an eight-hour training during orientation, educated on how stress can affect the mind and body, and taught mindfulness techniques and other methods to keep themselves on an even keel.

For her part, a variety of mental health support options is what Sergeant Mitchell in California wants to see.

“Often [in policing] we don’t realize that just doing something, even though we have good intentions, doesn’t mean that the outcomes are always good.”

Late last month, Fort Worth police officers responded to reports of a quadruple homicide at a home in a quiet suburb, near an elementary school. When they arrived, two of the victims were young children, reportedly killed by the father, who then turned the gun on himself. 

That is when they called Billy Mitchell.

Officer Mitchell and his 40-person support team are trained in a suite of practices known as critical incident stress management (CISM). As the department’s volunteer peer support team, they use CISM to help their fellow officers process traumatic incidents – hopefully mitigating or preventing long-term mental health effects. Their methods are used around the world, including by hundreds of police and fire departments in the United States.

“We were called by my commander because one of the troops, and one of our homicide investigators, was disturbed by the scene,” recalls Officer Mitchell.

Over the following weeks, perhaps months, those peer support officers will talk with their colleagues who had responded to the scene, telling them what psychological reactions to expect, debriefing them together, and seeing that their basic physical and emotional needs are met.

As the stigma around mental health has decreased in society as a whole, so it has for first responders as well. Law enforcement agencies are now expected to have some kind of in-house team helping their officers manage the daily stresses and trauma of their work – not just to maintain a happier workforce and longer careers, but to reduce legal liability for the agency. None of this existed decades ago, when first responders were expected to process traumatic incidents on their own time and in their own way, if they were able to process them at all.

But a new issue has emerged in recent years. Demand for mental health services has increased, and so has scientific research into the effectiveness of various practices. Are first responders receiving what mental health professionals consider the best short-term care after traumatic incidents?

“It’s an important discussion to be had because I think we’re becoming more educated in policing to understand evidence-based practices,” says Renee Mitchell, an executive committee member for the American Society of Evidence-Based Policing.

“Often [in policing] we don’t realize that just doing something, even though we have good intentions, doesn’t mean that the outcomes are always good,” adds Sergeant Mitchell, who also serves in a California police department. 

Do debriefings help?

Debriefings after traumatic incidents, specifically, are a practice that Sergeant Mitchell, and some other researchers and agencies, have concerns about.

She went through a critical incident stress debriefing (CISD) herself after two officers she supervised went through an officer-involved shooting in 2005. In the past year, though, she became aware of numerous studies and meta-analyses – which examine several studies on a single topic – concluding that CISDs are ineffective or possibly even harmful to individuals who participate in them.

Debriefings are typically structured in a specific way, and they can force an individual to relive an event or confront a trauma before they’re ready, or can interrupt their natural coping processes, research has found. In one 2014 study, researchers interviewed firefighters about their CISD experiences.

“I went mainly because there was another guy on the shift that was pretty upset by” an incident – a young child who had drowned in a whirlpool spa – one firefighter told the researchers. “We went to this debriefing, and all they did was tell us about this kid and tell us about his family and all this stuff. I didn’t need to know that. That made it worse.”

The fire service has for the most part stopped using debriefings, according to Richard Gist, a co-author of the 2014 study.

“We’ve gone in very different directions, but it still seems to have a foothold in law enforcement,” says Dr. Gist, a public health psychologist who has worked at the Kansas City (Missouri) Fire Department for 20 years. 

Fire departments and other agencies have instead begun to adopt methods known as “psychological first aid,” which calls for three broad responses to help first responders after critical incidents: recreating a sense of safety, establishing meaningful social connections, and re-establishing a sense of efficacy.

Psychological first aid is “proven to improve outcomes, lessen complications, and shorten recovery times for both the general public and emergency service personnel,” wrote Mike McEvoy, an EMS coordinator for Saratoga County and EMS director for the New York State Association of Fire Chiefs, in a 2005 article in Fire Engineering magazine. He noted that one meta-analysis found that CISDs proved neutral when compared with no debriefing at all for the 40 percent of rescuers for whom it was appropriate.

Instead, he argued, “It’s time to expand what we offer our members using what scientific evidence shows is our most powerful and effective mental health tool: helping each other.”

One stress management tool

But others argue that CISD is an effective tool. It was created by a paramedic in Maryland named Jeffrey Mitchell in 1972, who spent 11 years developing the debriefing method before publishing an article about it. CISD “is one tool in the whole field of critical incident stress management,” he says.

Several studies critiquing debriefings, Dr. Mitchell notes, didn’t study the group debriefings of emergency responders he developed and promotes – instead studying debriefings of civilians or one-on-one debriefings of emergency responders.

In the late 1980s, he co-founded the International Critical Incident Stress Foundation (ICISF), which has become one of the leading organizations promoting and training agencies on CISD and CISM. There are currently more than 1,500 CISM teams around the world who are trained by the ICISF.

The Fort Worth Police Department’s peer support group is one.

“They were the standard, and we wanted to go with what we considered was the best,” says Officer Mitchell, who began leading the peer support group in 2009. The core training “hasn’t changed a whole lot,” he adds, but it works.

Dave Barrows, a former president of the Northern Illinois CISM team, agrees. His team of about 60 people – created in the mid-1980s as one of the first ICISF-trained teams – responds to incidents in a nine-county area around Chicago. In the first four months of this year, his team responded to 32 incidents, a similar figure to last year.

The training has expanded beyond debriefings over the years, and police officers and firefighters they have worked with have later chosen to join his team. “While that’s not a quantifiable, double-blind research study, I think it says a great deal that what we do is effective,” he says.

Commander Barrows’ team does not operate in the city of Chicago. The police department there has been responding to six officer suicides in an eight-month period, and recently released a video series encouraging their officers to seek mental health support. Other police departments around the country have been trying other methods of psychological support for their officers.

The Stockton Police Department in California created a wellness program for its officers several years ago that is now hailed as a national model. Officers are introduced to the “wellness network” with an eight-hour training during orientation, educated on how stress affects the mind and body, and taught mindfulness techniques and other methods to keep themselves on an even keel.

A variety of mental health support options is what Sergeant Mitchell in California wants to see.

“We’re sending [officers] out in the field with guns. And we have [one of] the highest suicide rates there is in any profession,” she says. “We don’t do any research to examine, to evaluate whether our practices work or don’t work. We just adopt whatever the next agency is doing.”

Editor’s note: This article has been updated to clarify that Renee Mitchell supervised two people who went through an officer-involved shooting in 2005.

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