Most clinicians who work with law enforcement officers will tell you that the experience can be a little different. Sometimes, it seems to incorporate elements of a spy thriller. First, the call from the unknown number. Then, the interrogation from the unidentified caller, asking about your experience with cops, your ability to keep secrets and if you are in any way affiliated with the department. James Bond must be on the other end of the phone.
Let’s start by exploring the impacts that a career in law enforcement can have on officers. Law enforcement officers are a special population (like military and paramilitary personnel and other first responders) who experience coexisting medical and behavioral health issues with links to job-related stressors. According to a landmark study published by researcher John Violanti with the University at Buffalo in 2012, various factors contribute to the very serious physical and mental health concerns experienced by many law enforcement officers. These factors include:
- Shift work
- Long hours
- Unpredictable schedules
- Exposure to critical incidents
- Being the frequent focus of public attention and criticism
- Various physical demands
- High rates of on-the-job injuries
The major concerns identified in Violanti’s study are high blood pressure, insomnia, heart disease, diabetes, posttraumatic stress disorder, obesity, depression, anxiety, cancer, substance abuse, relational distress and suicide. This special population often presents with higher rates of depression, substance abuse and suicide than does the general public.
In the October 2010 Issue of the FBI Law Enforcement Bulletin, Daniel Mattos, a law enforcement veteran for more than 30 years, described the psychological impact of police work: “By the very nature of what we do as police officers, we are unavoidably exposed to a host of toxic elements that can be likened to grains of emotional sand that ever so gradually are placed on our psychological backs. As time goes on, the sand increases in volume. Without the proper tools to remove it, the weight can become unbearable. In fact, in some cases, the sand becomes so heavy that it can collapse officers. The result of the sand’s weight takes a heavy toll on us; substance abuse, anxiety, depression, failed marriages, and other emotional and physical ailments that rise well above societal averages plague our profession.”
In an international meta-analytic study completed in 2012, researchers Claudia Morales-Manrique and Juan Valderrama-Zurian identified strong links between the high-demand/low-control nature of police work and the high stress levels that negatively impact the physical and mental health of police officers. In high-demand/low-control careers, individuals are required to be at constant peak performance levels, stemming from the unpredictability and wide range of scenarios that can be presented to them.
Research suggests that officer rates of completed suicides are three times higher than in the general population. In January 2014, Perry Mason, a retired Canadian constable (police officer), publicly described in an interview with The Hamilton Spectator his suicidal thoughts and a very near suicide attempt during his career. During 34 years of service, Mason also recounted that seven of his fellow officers had died from suicide. Mason admitted that he sought help, but also kept it highly secret because of his fears of possible repercussions to his career. He never disclosed his suicidal thoughts until after he retired.
Dilemmas and challenges complicating treatment
The high rates of physical and mental health conditions among law enforcement officers reflect the need for medical and behavioral support and treatment. However, treatment resistance is often a significant barrier.
In 2002, the American Psychological Association recognized the need to take a closer look at law enforcement as a special population and to define guidelines for forensic psychology. Ensuring public safety requires that officers are mentally, emotionally and physically stable and deemed “fit for duty” to perform effectively.
Law enforcement personnel often struggle to manage the challenges associated with competing demands. Very intense and difficult circumstances must be addressed while simultaneously mitigating the impact those demands have on personal health and well-being. Seeking and adhering to needed medical and behavioral treatments can present specific dilemmas and challenges.
Law enforcement officers are legally and ethically mandated to maintain good physical and mental health. However, the stressors these individuals face, ranging from inconsistent shift work to frequent and unpredictable threats to life, result in both physical and emotional challenges for the majority of officers during an average career. Law enforcement employers are legally obligated to verify and monitor officers to ensure physical, mental and emotional stability, as well as job performance capability. As a result, any signs of behavior that are in question, either on or off duty, are subject to scrutiny by the officer’s department or chain of command.
Every single law enforcement officer undergoes fit-for-duty evaluations that entail a combination of psychological testing and interviewing. In the book Practical Police Psychology: Stress Management and Crisis Intervention for Law Enforcement (2006), Laurence Miller writes that failure of the evaluation may result in job loss or suspension. An unintended consequence is that the majority of officers are hesitant to seek help with mental, emotional, relational or even physical issues because it could result in their inability to work.
According to retired police officer and psychologist Joel Fay in the April 2012 issue of the POA Journal, officers presenting with medical or mental health concerns often struggle taking medications as prescribed to address symptoms. Officers are restricted from having certain types of medications in their systems. For the safety of the public and the officers, police departments have policies against the use of certain classifications of medications such as strong painkillers and benzodiazepines. An officer-involved accident or shooting is often subject to a review of the incident that includes blood tests to determine the possible presence of chemicals or medications that may have played a role in the incident. Officers recognize that doctors may be unaware of these restrictions. Unable to fully understand the classifications of medications, officers may consequently resist taking prescribed medications.
So, what can we do as clinicians to help reduce the stigma and minimize the fear that going to counseling has for many law enforcement officers? The first step is to help officers understand their rights to privacy. I asked the legal experts at Bruno, Colin & Lowe P.C., with more than 60 years’ combined experience in protecting the rights of law enforcement officers in Colorado, and Mariya Dvoskina, a police and public safety psychologist with Nicoletti-Flater Associates, experts in the evaluation and critical incident response for law enforcement officers, to give me “just the facts.”
Collectively, we identified eight myths that keep many law enforcement officers from seeking support through counseling. Because each state may have some independent legislation in this regard, it is important for clinicians to verify the legal standards in the individual states in which they practice.
Departments/agencies have the right to obtain information about officers that seek help from licensed mental health professionals.
False! Licensed mental health professionals are legally and ethically bound to protect client privacy. If an officer reaches out to a therapist on his or her own — in other words, if the officer wasn’t ordered to see a therapist by a court or the officer’s department — then the employer doesn’t even have the right to know that the officer is attending therapy. Nothing that is said in counseling can be released to anyone without the officer’s written consent. The U.S. Supreme court has ruled that the confidential relationship between a psychotherapist and an officer is privileged. To learn more, see http://www.apa.org/about/offices/ogc/amicus/jaffee.aspx
The only times confidentiality can be broken are for the reasons below, which apply to every client/patient.
- A suspected incident of child abuse or neglect must be reported.
- A threat of imminent physical harm by a patient must be reported to law enforcement and to the person(s) threatened.
- A mental health evaluation must be initiated for a patient who is imminently dangerous to self or to others, or who is gravely disabled, as a result of a mental disorder.
- A suspected threat to national security must be reported to federal officials.
- Suspected abuse of a senior adult (70 years of age or older), including institutional neglect, physical injury, financial exploitation or unreasonable restraint, must be reported.
Rights to privacy change if you use your insurance or employee assistance program (EAP).
False! Treatment by a licensed mental health professional that is paid for by your insurance company or your EAP is protected by HIPAA (the Health Insurance Portability and Accountability Act), and the same rules apply.
Sometimes patients choose not to use insurance benefits so that their outpatient treatment remains separate from their medical record.
There is no reason to see a licensed professional because the rules are exactly the same with a peer support team.
False! Limits to confidentiality vary by department and the standards may be different than those that licensed professionals have. The peer support member must disclose these limitations in the first meeting. In addition to the exceptions to confidentiality listed in Myth #1, most peer support teams are also expected to report crimes and sometimes policy violations. Outside of those limitations, conversations between a peer support member and an officer are confidential.
The department or agency automatically has a right to know if an officer receives a mental health diagnosis or takes medication.
False! HIPAA protects both diagnosis and medication or other treatment methods because they are part of the clinical record and therefore confidential. If an officer would like the department to know this information, he or she must sign a release of information. Otherwise, the professional treatment provider cannot disclose anything related to the client/patient to the department or anyone else.
If an officer seeks help from a hospital or a rehabilitation facility voluntarily, the department automatically has the right to this information.
False! The department can only access information that an officer has granted it permission to have, as is the case with any other medical condition.
If an officer is placed on an M-1 hold, he or she automatically loses their right to carry and possess a firearm.
False! When there is a court-approved certification for an involuntary mental health hold, restrictions to weapons are limited while the certification is active. If the provider that requested the certification acknowledges that the client/patient is no longer a danger to themselves or anyone else, then the restriction can and should be released as well.
If an officer seeks the support of a licensed mental health professional, that automatically means that the officer is not fit for duty.
False! Seeking counseling voluntarily would NEVER automatically mean that an officer is unfit for duty.
Counseling is the same as a fit-for-duty evaluation.
False! The most important question to ask is “Who is the client?” If the officer is seeking support on his or her own, all of the rights stated above belong to the officer. If the department is the client, as is the case in a pre-employment evaluation or a fitness-for-duty evaluation, then the information most often belongs to the department.
Jessika Redman is a licensed professional counselor, a national certified counselor and the founder of Well Relate LLC (http://www.wellrelate.com) in Castle Rock, Colorado. Contact her at email@example.com.
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.
Excellent article! It is clear that Jessika put a great deal of research into this, and the information is invaluable for any of us who do work with law enforcement. I plan to link this article to my website so others, as well as potential first responders can learn from this most important, information.
Outstanding article and to the point on every one of the concerns officers have made to me as a Peer Advisor. Telling them is one thing but them believing you is another. Confidentiality is codified in statute and explaining this to them most times helps with being apprehensive at first, but they become more and more comfortable as time goes on. The entire program relies on this as its foundation.
Thank you for this information. I am currently researching information to assist our Law Enforcement Officers for my Department. Generally mental health services are only provided when an officer is involved in an OIS. This area does not look into other aspects of stress related incidents. Thank you for your input.
what would be the APA citation for this specific article?
Well I don’t know what state this is, but I was fired because I received treatment. And if you don’t turn over your records that’s an automatic termination in NJ. My I add these Doctors here just continue to try and diagnose you so you can continue to pay for therapy. Never had a mental health history and a nurse wrote in my records that I had a past history. I was enduring chronic pain due to an on duty injury ( disks in neck). It was pain that I wish on no one! Felt as if my head was going to explode, couldn’t remember anything or talk properly. Went to my pcp and my heart rate was extremely high, also was having nose bleeds. Long story short because I was a cop and I thought I was dying some moron nurse says I wanted to shoot myself. At the time because I was injured I had no weapon. Long story short I knew nothing about this nurse writing this in my records until a year later. Though I am fighting for my job back I am happy to say that I receive neck surgery and my physical pain in at a low. If you do get treatment bring someone with you and always request your records.
Sorry that this happened to you.
Also what the author fails to mention is that law enforcement agencies, and also the military (Military Entrance Processing centers) CAN demand officers/recruits to sign consent of release of privileged medical or mental health records as a PREREQUISITE for hiring… should they suspect that you’ve ever had treatment or counseling.
My experience has been that if you have a work related claim of any kind but especially if you have a stress/psych claim you are required to release ALL current and previous mental health records. My understanding is that they want to apportion whatever part of the injury to your personal life that they can and not the job, which reduces their liability. I hope this changes so that those that need help can simply get the help they need and move on, like the rest of us, and not have to worry about it following them years later when it does not apply.
Great article and valid replies. The policies toward obtaining mental health has to change. A police officer receiving the much needed assistance for psychological challenges is in better shape than the one who suffers in silence. Burn out in addition to the many other diagnoses can be remedied in the therapeutic process and improve an officer’s overall intelligence (Emotional, social, self, cultural). I recommend private pay as a safer route to obtaining help. Officers are being penalized for their honesty when asking for assistance and it isn’t right. If I can help please don’t hesitate to reach out.
Well written article. I can tell by the replies that most Departments are not on the same page. Foe instance “Every Officer receives a fitness for duty duty evaluation” is certainly not true in the Midwest. After 30 years I have never had one. Where I am employed they do not care to hear the letters PTSD and ignore them if they do. There is no thought or plan to examine the cause and effect. We have Officers fired because of their stress related actions when if they had treatment it would have been avoidable. We do have a peer support group but I have never heard of anyone actually using it for the reasons you pointed out. I had private counseling and underwent EMDR. It helped greatly but I am still in of treatment and ready to retire.
Another fairly common and mindless myth about police officers is that divorce rates are higher amongst law enforcement officers. However, according to a recent research conducted by Journal of Police and Criminal Psychology it was found that divorce rate amongst police officers is lower as compared to that of general population.
I think this article is a bit naive about the realities of confidentiality. I am a 40 year therapist who chooses not to be licensed because I believe my first and only duty is to my client. We lose so many people to lack of trust. A court order can open up just about any file including one of the dead.
Dr. you are right on the money with your reply!
Serving for decades as under-cover creates it’s own dilemmas’ , the line somehow gets blurred when you have to protect yourself & your families’, yet upholding the Principals & guidelines of your authority ; If I had to do it all again , know knowing the aftermath and degree of sheet you go thru to attempt to return to the fold ,Not In Your Life , granted saving Lives has it’s own awards , however , doing the right thing isn’t always following the Law . (started in 1971-till 2005).
Wow, I am a 30 year retired L.E Officer. This article is a myth, don’t believe it. They have no idea what they are talking about. Departments could care less about your rights as an officer. Never, ever seek counseling or treatment where any records are kept. those records are subject to court disclosure orders. This may have drastic consequences on a career and your civil rights. These records if brought to disclosure could affect you long after retirement, With new “Red flag” laws it may strip you of your right to own a firearm, hunt or other activities. Don’t be stupid and trust this B.S. that your records are safe. It’s total B.S. If you need help, seek anonymous counseling groups or friends. .
Another option for officers is to seek out a nonprofit with highly trained staff in dealing with trauma issues. They can often self-pay at lower rates on sliding-scale and the information never goes outside to the Medical Information Bureau where insurance companies log medical and mental health records for other insurance companies to verify during future application processes. As long as the officer never discloses they are attending counseling, no one can access the records. Seeking help early, at the first signs of stress is a good prevention, before it is desperate, and also ensures there is no reporting duty on the part of the counselor. Nonprofit does not mean substandard. Many have more experience dealing with trauma issues than most private practitioners–especially those agencies providing services to victims of crime.
Great article. As the spouse of an officer who receives therapy I see a total change in his stress level. He is a better husband, father and commander. All around, he’s a better person. The best result of this experience has been that he is finishing his masters degree to allow him to counsel those who need it most. I am a firm believer that every department across the country should have an embedded mental health counselor readily available to all staff.
I am writing from Canada. I am a retired police officer and now work as a life and vocational coach for police and justice professionals, seeking (in part) to work with them proactively and help them before they get “injured.” Sadly, most of my clients prefer to work with me “off the record” because what you call “myths” are all-too-commonly not myths but facts. Not only did I experience this personally, but as a further example I recently had one client who was required to go for an “annual psych assessment” whereupon their NCO sought out the results and my client was eventually forced off the job. That client is presently in litigation with their former PD. It’s a muddle. When I was serving, my wife and I decided that our lives and marriage were more important than the alternatives so we sought out help. But we did it on the sly and paid for it all ourselves, even though we had benefits.
I was happy to read an article that actually supported counseling for law enforcement officers but see this is from 2018. I am a member of ACA and have been very disappointed regarding the lack of support and advocacy for law enforcement in recent years in response to the terrible and highly publicized actions of some bad actors. I had recently reached out to ACA in search of some educational supports for counselors. I found no helps through the website. In fact, any material I did find there was dated. Recent ACA focus was almost exclusively upon injustices inflicted by law enforcement and nothing about the challenges they face or how to help them. I reached out with my concerns and ask for assistance and never received anything of substance back. As therapists, we are taught to approach all counseling needs through a lens of non-judgmentalism and to avoid bias. ACA should lead by example.