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Invited Commentary
Public Health
October 7, 2020

On Policing—A Matter of Psychological Survival

Author Affiliations
  • 1Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo
JAMA Netw Open. 2020;3(10):e2020231. doi:10.1001/jamanetworkopen.2020.20231

There is little doubt that police work involves physical danger. Often overlooked, however, are the psychological dangers of this work. The recent article by Jetelina et al1 helps to bring this problem to the forefront. This article discusses the prevalence of mental illness among a sample of police officers and reasons why they do not seek professional help. Twelve percent of officers reported a mental health diagnosis, and 26% reported current symptoms of mental illness. Officers reported that they would be unlikely to seek mental health care because of lack of confidentiality, stigma, loss of job, and mistrust of mental health care professionals who do not understand police work.

There are various conjectures as to why police experience mental distress. One of the earliest studies2 performed on police mental health was an analysis of New York City police suicide during the 1930s. The study suggested that although police have a “social license” for aggressive behavior, they are at the same time restrained as part of public trust, placing them in a position of psychological strain. This situation may be reflective of the same situation police find themselves today. Freidman3 also argued that the police are at higher risk for suicide because of the demand of interpersonal giving beyond their personal ability to provide this to others. This feeling is somewhat similar to present-day compassion fatigue, a feeling of mental exhaustion caused by the inability to care for all persons who are in trouble. Other researchers4 have suggested that the stress police officers experience leaves them feeling cynical and isolated from others. The socialization process of becoming a police officer is associated with constrictive reasoning, viewing the world as either right or wrong, which leaves no middle ground for alternatives to deal with mental distress.

As the article by Jetelina et al1 points out, 26% of police officers reported symptoms of mental illness. In previous research,5 the most prevalent types of mental symptoms among police were depression, posttraumatic stress disorder, and a sense of hopelessness. Police officers are repeatedly exposed to traumatic events throughout their working lives, including motor vehicle crashes, armed conflicts, and witnessing violent death. For this reason, rates of posttraumatic stress disorder and depression may be higher in police officers than in the general population. A sense of hopelessness may occur among officers given the negative aspect and perceived futility of their work and work-related stress. For example, officers may work years on 1 case only to have it dismissed in court on a legal technicality or feel that their efforts against increasing crime are futile. Much of the strain of mental difficulties is often exacerbated by use of alcohol. The police have a risk of alcohol abuse because of stress, peer pressure, isolation, and a culture that approves alcohol use. Officers tend to drink together and reinforce their own values. That these mental difficulties (and alcohol use) are associated with suicide is borne out by the fact that nationally police have a 69% increased risk of suicide above that of the US general working population.6

To date, no prospective studies have found an association between police mental health problems and childhood abuse or neglect. However, conversations with mental health professionals who work with police estimate that approximately 25% of all police clients had a history of childhood abuse or neglect.7 Many of those police clients also expressed suicidal ideation. The history of childhood abuse before entering law enforcement is a promising area of future research.

An important point in the article by Jetelina et al1 was that few officers seek mental health care. Stigma is one of the most frequently identified barriers to mental health care and is substantial among the police. Influenced by the police culture, officers may feel that if they admit mental health problems and seek help, they will be less trusted by peers and supervisors and may lose opportunities for promotions. This problem can be alleviated by establishing a greater trust between officers and police administration. Establishing such trust is problematic because officers consistently report that the organization itself is a significant source of stress.8 With trust, the police organization can help to reduce mental distress by fostering a sense of support and help officers overcome negative experiences and potential mental strain.

Confidentiality is another a big issue. Police officers fear that supervisors will find out about their mental status. One possible solution is a peer support program, allowing distressed officers to first confidentially talk with peer officers trained in counseling and then seek professional help if necessary. An assumption underlying peer support is that police peers will be more trusted by officers in distress. A more recent intervention found useful in police work is mindfulness.9 Mindfulness has been used by officers to manage stress and increase cognitive flexibility in dealing with trauma and crises. A previous study10 on police officers applied a mindfulness-based intervention among police officers and found improvement in several areas, including reduced stress and increased resilience.

Education concerning mental health and effective treatment is needed for police officers. The stigma attached to mental illness and the reluctance of officers to seek help can only lead to further increases in mental strain and suicide among police. Policing is an essential occupation to preserve the rule of law, and those who serve in law enforcement deserve proper protection from the mental strain associated with this task. It is a matter of psychological survival.

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Article Information

Published: October 7, 2020. doi:10.1001/jamanetworkopen.2020.20231

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Violanti JM. JAMA Network Open.

Corresponding Author: John M. Violanti, PhD, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, 270 Farber Hall, Buffalo, NY 14210 (violanti@buffalo.edu).

Conflict of Interest Disclosures: None reported.

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