Written by: Nicole Florisi, Law Enforcement Subject Matter Expert – Investigative Focus
There is a great deal of stigma attached to post-traumatic stress disorder (PTSD) in the first responder community. With all the “talk” of officer wellness, officer mental health, and resiliency there is not the decrease in negative outcomes that one would like to see overall. Why is that? In some cases, it is the label of having a disorder. Words are powerful and there is a distinct difference in the word disorder versus injury. In other cases, it is nothing more than checking the boxes and “talk” about what should be done to increase positive outcomes. We know where talking gets us. Nowhere, just like it does in the training environment. If we do not teach, implement, and model the skills we want first responders to have, we are not doing what is best.
There is a large focus on the “management” of PTSD and a lot less focus on the areas of prevention and mitigation. There is weakness in the training and application of resiliency skills for first responders to succeed. We have come to a point where individuals stigmatize the word resiliency. If you do not want your officers to have the grit and resiliency to move through the trauma they experience, you are part of the problem.
Barriers to Seeking Help
I was contacted a few months ago by an officer who had the experience of handing a case involving the burned bodies of children. He was struggling (his words) and looking for someone to talk with that would be able to support him while he worked through these events. Unfortunately, the clinician he originally saw started crying when he was sharing the events that brought him to treatment. The clinician told this officer that they could not treat him, as the events that he saw were too “overwhelming for them.”
I am proud beyond belief that this officer still sought treatment. The individuals in his department were not supportive either. He was told by someone in upper management that seeing burned bodies was part of the job and he was weak. That person told this officer that PTSD was “a bunch of crap for people who couldn’t handle life.” And we wonder why officers experience challenges in the recovery process.
On an anecdotal level, I have spoken with several first responder psychologists and therapists. The main barrier to treatment that officers face is not usually moving through the critical incident. The barrier is agency betrayal. Sit with that for a minute. We should provide an environment where it is emotionally safe for first responders to work through their experiences.
Supporting Officer Wellness
The book One Badge, One Brain, One Life: Preventative Maintenance for Your Brain While in the Line of Duty is a fantastic resource for all law enforcement. This book provides information, education, and practical skills to reduce and mitigate symptoms of trauma. You can purchase the book here: One Badge One Brain One Life | Tapia Counseling & P (drrobbie.org)
At VirTra, our V-VICTA® curriculum supports officer wellness. It provides a foundation for coping and resiliency skills that can mitigate traumatic symptoms. VirTra simulators can be a part the process of reintegration for officers after a critical incident. This entails having a framework rooted in best practices that minimizes the risk of enhancing dissociation, derealization, and depersonalization that can accompany traumatic experiences. Both education and conversation are part of reducing stigma. No matter your rank or your role, you can be part of the solution.
June is a fun month for society. People celebrate summer, fresh produce, long days and relaxation. While this time is enjoyable, it is also a time to remember that June is PTSD Awareness Month. June 27th is specifically designated as PTSD Awareness Day. This month, we encourage people to take some time to think of and care for veterans, police officers, victims of abuse and other individuals they may know who are suffering the effects of trauma.
Law enforcement personnel specifically are in the unique position where they may work with individuals suffering from PTSD. They may be suffering from PTSD while simultaneously helping those with the disorder. After all, due to the nature of the job, officers may experience PTSD after responding to difficult, traumatic or troublesome calls. According to a past study, 35% of officers met the criteria for PTSD1. Now compare this to PTSD among the general population—3.6% for men and 9.7% for women2—and it is easy to see why PTSD is being discussed more in departments and why special care must be taken for our officers.
Learning About PTSD
Officers must be taught to recognize PTSD symptoms and know how to help those affected, including their co-workers. This is where VirTra can help. To help educate officers, VirTra created the curriculum “Mental Illness Training: A Practical Approach”, which is a combination of classroom and science-based simulation training. The curriculum includes 15 training hours though lessons such as PTSD, as well as other mental illnesses, including: depression, suicide, anxiety, crisis de-escalation and more. Officers learn the material in a classroom setting before engaging in simulated scenarios to practice recognizing the signs and communicating with the subject.
Mental health training for officers is an essential addition to any department’s curriculum. Mental health and PTSD are becoming increasingly more discussed, and as such, improving departments. Help us take care of your society and officers by increasing PTSD awareness and training.
Talk to a VirTra representative to get started.
References:
- Austin-Ketch TL, Violanti J, Fekedulegn D, Andrew ME, Burchfield CM, Hartley TA. (2012). Addictions and the Criminal Justice System, What Happens on the Other Side? Post-traumatic Stress Symptoms and Cortisol Measures in a Police Cohort. Journal of Addictions Nursing, 23(1), 22–29.
- Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617-627.
These are difficult times to be a law enforcement officer. Already, policing is a difficult profession, more than the public realizes. No other profession requires the balance of perfect verbal de-escalation, soft and soothing mannerisms, an authoritative presence and skills to handle any person’s symptoms—all while being combat-ready and prepared for split-second moments that could be the difference between life and death.
Add these pressures to the terrible actions and events officers see and must interact with, and it is no wonder policing has a PTSD crisis.
PTSD in the Industry
Post-Traumatic Stress Disorder is becoming an ever-increasing difficulty plaguing law enforcement. Currently, it is estimated that PTSD and depression effect between 7% and 35% of officers [1,2].
Policing was complicated enough to begin with before 2020 brought new challenging events to law enforcement. This started with the first wave of COVID-19, quickly followed by riots, looting and civil unrest, which is still carrying on today.
If this wasn’t enough, consider the sharp contrast between being hailed as an essential worker, a hero of the community, then having every officer blamed for the death of certain individuals. Naturally, this would cause havoc on psychological health.
A recent online Police1 survey received 1,355 active-duty law enforcement officer responses. Of this number, “47% of the sample screened positive for PTSD, which is approximately 9 to 10 times greater than the prevalence seen in the general population.” Going one step further, 29% of responding officers had moderate to very severe anxiety and 37% tested for moderate to very severe depression. This number is roughly 5 times greater than the prevalence seen in the general population. So, what signs should officers look for in their co-workers and how do we prevent this?
Signs/Symptoms of PTSD
The most common signs of PTSD are: the inability to think clearly, not sleeping well (often due to nightmares), recklessness, constantly triggered by an event, going to great lengths to avoid similar situations and so forth.
Unfortunately, PTSD can be caused by a variety of factors: events involving children, serious on-the-job injuries and officer-related shootings are common ones, though any event can spark PTSD.
Preventing and Helping PTSD
The most important thing for officers and leadership to know, besides recognizing PTSD, is knowing how to help and prevent it—for both themselves and their fellow officers.
Instructors can implement techniques such as trauma and stress inoculation training or trauma awareness. Leaders can encourage officers to speak to a department psychologist after a difficult situation. Officers can utilize free resources such as Copline to speak to retired officers who understand and have undergone similar situations.
Talking about PTSD is more important now than ever. As shown in the P1 survey, many officers are reluctant to seek services due to the stigma that surrounds it. They worry that assistance would be seen as a weakness, and they fear job loss and other repercussions in the workplace.
Changing this stigma will take everyone. Police Chiefs, instructors, sergeants, fellow officers—this is a discussion we need to start now. Together, law enforcement is looking out for each other. Together, we are silent no more.
References:
1. Ruderman Family Foundation. The Ruderman White Paper on Mental Health and Suicide in First Responders, 2018.
2. Yuan C, Wang Z, et al. Protective factors for posttraumatic stress disorder symptoms in a prospective study of police officers. Psychiatry Research, 2011, 188:45-50.
June 27 is National Post Traumatic Stress Disorder Awareness day and with a unique approach to simulation training, VirTra’s immersive scenarios have now been put to the test by a Psychologist looking to improve the lives of those officers who have served on the force and were afflicted by the many side effects that Post Traumatic Stress Disorder (PTSD) creates. Read below for the full story featured in this month’s ILEETA Journal:
Recent studies confirm what most law enforcement professionals already know: police and corrections officers are suffering from PTSD at rates at least as high as combat veterans. But while billions of dollars and decades of research have gone into helping vets reintegrate into civilian society, many officers endure their pain behind a blue wall of silence, unwilling to seek help or undergo therapy to move past the traumas that are interfering with their personal and professional lives. Now, the use of force simulation technology solution that many agencies already use for officer training may offer hope in rebuilding the confidence of officers who are suffering the effects of PTSD.
Dealing with CopShock using simulators
When a police officer is involved in a shooting incident, the aftermath might include recovery from physical injuries, departmental investigations, media attention, and administrative processes. However, there are other things going on under the surface – self-doubt, depression, increased use of alcohol, anti-social feelings, uncontrollable emotions – that can make the ordinary stresses of police work almost unbearable in the wake of a trauma. These are the text-book symptoms of a condition referred to over the years as “shell shock,” “combat fatigue,” “CopShock,” or the current clinical designation, Post Traumatic Stress Disorder (PTSD). Observed in combat veterans and others victimized by severe violence, it can destroy personal relationships, lead to substance abuse issues, and cause erratic behavior on the job. Research and clinical practice have led to the development of effective, evidence-based treatments that can help people who have PTSD develop skills to cope with feelings triggered by reminders of the trauma. These involve patients re-imagining their trauma in increasingly vivid details, acknowledging their stress and discomfort, and finally proving to themselves they can function normally in familiar situations.
It takes a cop to treat a cop
Dr. Lamaurice Gardner is one of the leading practitioners in the emerging field of police PTSD treatment. He witnessed all the signs of the PTSD epidemic first hand when he began his practice as a clinical psychologist 30 years ago working with military veterans. But when he tried getting law enforcement officers to open up about their experiences, he was often told, “Only cops understand cops.” That’s when Dr. Gardner took an unusual step; he enrolled in a police reserve academy and became a law enforcement officer. He currently serves on the force of Oakland County Sheriff’s Office, adjacent to Detroit, Michigan. When patients come to him for treatment, they see a fellow officer with a badge and a first-hand understanding of police culture. That trust helps him give traumatized officers the help they need to get their lives and careers back on track.
Helping officers put trauma in the past
Dr. Gardner says situations police encounter every day can trigger PTSD in anyone: it’s a normal human reaction to surviving a life-or-death encounter, only made worse by the additional pressures of investigation, media scrutiny, second-guessing, and the financial strain of losing overtime and court pay during an internal review. He employs a multi-step process to get officers facing these situations back on their feet. This process is called PET (Prolonged exposure therapy). The first step is “Imaginal Therapy,” where the patient is encouraged to visualize and verbally recount the traumatic experience several times in each session, offering a self-assessment of how much emotional stress they are under. With enough verbal repetitions, anxiety eventually recedes into a manageable territory, and the patient gains emotional distance from the traumatic events. The next step is to have the officer face the traumatic memories in the real-life situations associated with them, from drawing and firing their weapon to the routines of wearing the uniform, riding on patrol, and interacting with other people in their professional role. As in Imaginal Therapy, these “In Vivo” sessions can start with very high levels of discomfort and stress. Through repetition, patients learn to deal with stressors in their environment without losing control.
Immersion as the final step
Dr. Gardner found a powerful tool to help take In Vivo therapy to the next level: VirTra’s simulator that many departments now use for officer training and certification. Because the systems offer complete immersion in a wide range of real-world scenarios and include the ability to customize backgrounds using panoramic photos of actual places, they allow officers to experience the kind of pressures they would see on the job, but without the life-or-death consequences. He uses the simulator to evaluate and reinforce their reactions in increasingly high-stress, high-stakes scenarios, starting with non-violent interactions, moving to confrontations involving weapons, and finally moving to ambiguous scenarios where the officer has to decide in the moment whether or not to use deadly force. The goal, says Dr. Gardner, is to get their anxiety down, normalize their reactions, to give them comfort and confidence. “One of the biggest symptoms we see is hesitation liability, where officers are reluctant to assert themselves,” says Dr. Gardner.
In moments of crisis, the inability to act decisively can be dangerous or deadly. The session with the simulator takes about 60-90 minutes. “Most people get their anxiety levels down and are ready to return to work,” he says. “Officers say the simulator was crucial to their reintroductions. We need to broaden use beyond just training to reintegration.” The use of simulation for PET is not a new concept. The US ARMY, along with the University of California Institute for Creative Technologies, conducted similar research in 2012 with another less immersive systems with good results. Dr. Gardner says he used the simulator to help hundreds of law enforcement professional resume their lives and careers. “I serve and protect those who serve and protect. Re-integration is my first purpose.”
To learn more about how your agency can benefit from using VirTra simulation training to improve the mental health of your officers, click here to contact our team.
References:
Brennan, J. (2012) Bravemind: Using Virtual Reality to Treat PTSD. The National Psychologist.
Public Affairs, and UC Berkeley. “Correctional Officers at High Risk for Depression, PTSD, Suicide, Survey Finds.” Berkeley News, 23 Aug. 2018, news.berkeley.edu/2018/08/23/california-correctional-officers-at-high-risk-for-depression-ptsd-and-suicide-new-survey-finds/.