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How Mental Health Hinders Cops and How We Can Best Aid It

Police officers choose to take part in an extremely traumatic career path because of a calling. What we are just not beginning to understand is exactly how traumatic the path is. There have been a number of studies in fairly recent years about the damage that trauma can do to police officers that are constantly  thrown into stressful and harmful environments.

The first big study was done in 1999 by Stevens and Long. They found that 12-35% of their participants exhibited PTSD behaviors or do have been diagnosed with PTSD (Craddock & Telesco, 2021). They also found that over 20% of participants suffer from sleep issues including nightmares (Craddock & Telesco, 2021). We are aware of the lasting damages done by getting a lack of adequate sleep, especially when it comes to split-second decisions that are required when in law enforcement.

As the years progressed, police officers were shown to have increased levels of substance abuse and suicide than that of the general population. One of the most traumatic experiences for police officers were for those involved in the September 2001 attacks. There have been numerous follow-up studies done on them and found that they had higher than average PTSD symptoms than other cops across the country (Craddock & Telesco, 2021). They also, if they were physically able to, went back to work which would compound their already experienced stressors into more as more situations arose.

In the research conducted by Tina B. Craddock and Grace Telesco in 2021, they had many research questions and hypotheses they were searching for answers of, but their findings were interesting.

They found that the longer someone is in law enforcement, the worse that their mental health and physical health is (Craddock & Telesco, 2021). These are exacerbated by the decreased perceptions of law enforcement is today's society. Their symptoms of their decreased mental illnesses could present as more violent towards civilians or prisoners they interact with, rash decisions, and increased aggravation and possible violence towards family. These are many things that make a cop unfit for duty. They did not find a correlation between increased years on the job and increased alcohol abuse.

When it comes to aiding the police officers who are suffering from increased mental health disorders, we need to put as many tactics in action as possible. The main tactic is to have places where officers feel safe talking about their experiences (Buckhannon, 2023). This, even though a great idea, is easier said than done. A lot of police officers do not want to be involved with therapy of any kind due to its perception of being broken or weak. Instead of having a therapist at the station or that works with police officers, I think there needs to be a public hangout where police officers can meet up with each other and talk like friends. Some of the best therapy is hanging out with people that understand what you've been through and who you can blow off steam with. On a policy level, there needs to be mandated mental health care provided for police officers if they choose to take them up on the service. With this, there needs to be an additonal budget allotment so that the police officers do not see it as taking away other resources that they could be having. These are just limited examples of all of the things that need to be done to ensure that our police force works at their highest capacity. Until law enforcement, policy makers, and the government all work together to attack this threat to our law enforcement officers, this pandemic will continue to evolve and will continue to harm people in law enforcement, their families, and the communities as a whole.

References:

Buckhannon, C. M. (2023, April 4). How to help officers’ traumatic stress. Police1. https://www.police1.com/wellness-week/articles/how-to-help-officers-traumatic-stress-8tk6JlkiiOForRYE/

Craddock, T. B., & Telesco, G. (2021, November 9). Police stress and deleterious outcomes: Efforts towards Improving Police Mental Health. Journal of police and criminal psychology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575544/

Traumatic Brain Injury (TBI) — A message to the public

Phineas Gage's Traumatic Brain Injury:

In 1848, Phineas Gage, a 25-year-old railroad construction foreman, survived a horrific accident. While using a 43-inch-long, 13-pound iron tamping rod to pack explosive powder into a hole in the rock, the powder unexpectedly detonated. The iron rod propelled through his left cheek and skull, entering near the lower jaw hinge, passing behind his left eye socket, penetrating the base of his skull, and traversing the left frontal lobe upwards. It then exited through the top frontal portion of his skull and landed about 25-30 yards behind him. 

Remarkably, Gage was thrown onto his back, had some brief convulsions, but within minutes, he could stand, speak, and walk. Despite the severity of the injury, Gage made an improbable recovery and lived for 12 more years. 

The injury to his frontal lobe resulted in profound shifts in his personality and conduct, rendering him almost unrecognizable to those who knew him before. Prior to the incident, Gage exhibited traits of being composed, playful, amiable, and capable, serving as a dependable employee in the railroad industry. However, following the accident, he underwent a stark transformation, displaying hostility, irritability, vulgarity, irrationality, and a marked decline in social discernment. His outbursts of unchecked anger proved detrimental to his employment stability. While it's plausible that any individual enduring such trauma might undergo some personality alterations, the magnitude and drastic nature of Gage's changes were primarily ascribed to the physical trauma inflicted on his brain (Bartol & Bartol, 2020).

Traumatic Brain Injury (TBI) vs. Aggression:

TBI can impair the brain regions and circuits that regulate emotions, impulses, and social cognition, leading to increased aggression in some individuals. The risk and severity of aggression after TBI depend on several factors, such as the location and extent of brain damage, the presence of other psychiatric or neurological disorders, the level of cognitive functioning, the quality of social support, and the availability of rehabilitation services (Bartol & Bartol, 2020).

Traumatic Brain Injury (TBI) vs. Related Antisocial Behavior:

An article published on Medicina (Kaunas) reviews studies that show a positive correlation between TBI and aggressive behavior, especially in the acute and post-acute phases after the injury. Multiple biological and psychosocial factors, such as depression, substance abuse, age at the time of injury, and social support, can influence aggression (Maresca et al, 2020).

Activities that may cause brain Injuries:

Traumatic brain injuries are also linked with certain sports, notably football, soccer, and boxing. These injuries have the potential to cause brain damage, which in turn may trigger shifts in personality and aggressive tendencies (Bartol & Bartol, 2020).

% in Incarcerated Population: 

Approximately 60% of the prison population in the United States is thought to have indications of Traumatic Brain Injury (TBI) in their history, in contrast to only 8.5% in the general populace. Certain studies indicate that up to 82% of individuals in the criminal justice system fulfill the criteria for having experienced a TBI at some stage in their lives (Bartol & Bartol, 2020).

Treatment and Prevention: 

There are treatments for aggression after TBI: a combination of pharmacological and psychological interventions, such as antidepressants, anticonvulsants, mood stabilizers, cognitive-behavioral therapy, anger management, and social skills training.

Also, prevention of TBI and aggression requires public health measures, such as wearing helmets, reducing alcohol and drug use, enforcing traffic laws, and promoting nonviolent conflict resolution.

Author's thoughts: 

Many people, especially those who have suffered head injuries, have encountered difficulties in controlling their behavior. Harm can result from clashes between one person's aggression and another's. I advise individuals with typically functioning brains to pause and step back to avoid being provoked by someone else's aggression.

Reference:

Bartol, C. R., & Bartol, A. M. (2020). Criminal Behavior: A Psychological Approach (12th ed.). Pearson Education (US).

Maresca G., Lo Buono V., Anselmo A., Cardile D., Formica C., Latella D., Quartarone A., & Corallo F. (2023). Traumatic Brain Injury and Related Antisocial Behavioral Outcomes: A Systematic Review. Medicina (Kaunas). 59(8):1377. doi: 10.3390/medicina59081377.

Cultural Competency and Healing Trauma in the Criminal Justice System

The intersection of cultural competency and trauma within the criminal justice system represents a critical juncture where justice, equity, and healing converge. Cultural competency involves more than mere acknowledgement of diversity; it requires a deep understanding of how critical backgrounds influence individuals’ experiences of trauma and justice. This entails recognizing the diverse beliefs, values, communication styles, and coping mechanisms present within different cultural communities. 

Trauma is not a monolithic experience; it varies across cultural contexts. Historical traumas, systemic oppression, and community violence are just some of the multifaceted factors shaping individuals’ experiences with trauma within diverse communities. Cultural norms, familial structures, and religious beliefs profoundly influence how trauma is experienced, perceived, and addressed. 

Building cultural sensitivity within the criminal justice system is imperative to ensure equitable treatment and meaningful access to justice for all individuals, regardless of cultural background. From law enforcement interactions to court proceedings and rehabilitation programs and access to resources, cultural competency must be integrated at every stage of the justice process.

Challenges abound in fostering cultural competency within the criminal justice system. Limited resources, implicit biases, and institutional barriers often impede efforts to provide culturally sensitive services. Furthermore, misunderstandings and mistrust between marginalized communities and justice institutions have exacerbated and hindered healing.

To overcome these challenges, proactive steps should be taken to promote cultural competency. This includes comprehensive training programs for justice professionals, emphasizing cultural humility, active listening, and trauma-informed approaches. Diversifying the workforce and fostering partnerships with community organizations are also vital in bridging gaps and building trust.

Incorporating cultural perspectives into policy development, program design, and service delivery is essential for creating a more inclusive and responsive justice system. This may involve establishing culturally specific support services, offering interpretation and translation services, and engaging community leaders as liaisons between justice institutions and communities. 

Cultural competency is not a static goal but an ongoing journey towards creating a more just and equitable criminal justice system. By centering cultural sensitivity in trauma-informed practices, we can foster healing, promote trust, and ensure that all individuals receive fair and dignified treatment. Embracing diversity, challenging biases, and prioritizing cultural humility are not only ethical imperatives but essential steps towards building a more inclusive society where justice truly serves all.

I found an article that described three scenarios in which an individual has been wrongfully imprisoned. It then described the immense mental toll it took on that individual. The first story was that of "Mr. X". He is a middle-aged man who was wrongfully imprisoned for a short amount of time but suffered lasting trauma mentally and physically. He suffered high blood pressure before the incident, so once he was imprisoned and going through the process, his blood pressure rose exponentially causing him to be in pain. Once he was released, he continuing had nightmares and trauma from the arrest which had taken place in the middle of the night by surprise. He was also mocked socially, this led him and his family to leave their home to join a new community. Although wrongful imprisonment may be a rarity, once it does occur, that law enforcement body or city should inherit the responsibility for individuals to reach adequate, if not better, standards of living than before. Providing treatment, financial settlement, or public address to clear the individual's name who is not truly guilty would be a great start.

https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=26c551bbceded450ee840030e1f61c9dad40fbad

Animal-Assisted Intervention and Trauma

There are several different therapeutic approaches available to trauma victims. One of which is called animal-assisted intervention (AAI). AAI is defined as “the utilization of various species of animals in diverse manners beneficial to humans” (American Veterinary Medical Association, 2023). The most common form of this approach seen in everyday life is through the use of service dogs. Psychiatric service dogs are specially trained to assist their handlers in the areas where assistance is needed, especially if the handler is incapacitated (Rousseau, 2023). However, service dogs go far beyond providing physical assistance. They also provide mental and emotional assistance as well. Studies prove that the use of AAI has proved to be beneficial in a number of populations such as trauma victims suffering from post-traumatic stress disorder (PTSD), individuals with dementia and children diagnosed with autism spectrum disorder (O'Haire, et al., 2015).

In regards to individuals suffering from PTSD, researchers found that emotional numbness and isolation are common symptoms. AAI has proven to be beneficial to individuals with PTSD because the presence of an animal such as a dog encourages positive emotions and warmth (O'Haire, et al., 2015).  Further, animals have been demonstrated to be social facilitators, which connect and unite people thus reducing loneliness and ultimately isolation (O'Haire, et al., 2015). Animals also require routine care, which can mean daily walks, a trip to the store for food, and bathroom breaks. All of which encourages an individual with PTSD to get out of the house and socialize with the world.

As such, animal-assisted intervention is an effective therapeutic approach worth considering for trauma victims.

References

American Veterinary Medical Association. (2023). Animal-assisted interventions: Guidelines. American Veterinary Medical Association. https://www.avma.org/resources-tools/animal-health-and-welfare/service-emotional-support-and-therapy-animals/animal-assisted-interventions-guidelines#:~:text=Animal%2Dassisted%20intervention%20(AAI),types%20of%20animal%2Dassisted%20intervention.

O'Haire, M. E., Guérin, N. A., & Kirkham, A. C. (2015). Animal-Assisted Intervention for trauma: a systematic literature review. Frontiers in psychology, 6, 1121. https://doi.org/10.3389/fpsyg.2015.01121

Rousseau, D. 2023. Module 4: Pathways to Recovery: Understanding approaches to trauma treatment. Boston University.

The Adverse Childhood Experience (ACE) Study

The Adverse Childhood Experience (ACE) was the biggest study of its kind ever created (Rousseau, 2023). In 1958, Dr. Vincent Felitti and his colleague Dr. Robert Anda of Kaiser Permenente studied more than 50,000 patients, finding clear characteristics or commonalities (Rousseau, 2023). It is highlighted that the most damaging statistic found is how the trauma could later manifest into adults (Rousseau, 2023). Furthermore, as the number of ACE  categories higher, the number of conditions also increases (Rousseau, 2023). When there is exposure to one category, there is an 80% likelihood of exposure to another category (Rousseau, 2023). These ACE categories include, alcoholism and alcohol abuse, chronic obstructive pulmonary disease, depression, drug use, heart and liver disease, risk of partner violence, smoking, suicide, and overall decline in quality of life (Rousseau, 2023). 

Expanding more about the ACE study, Felitti and Anda spent more than a year creating ten new questions that involved defined categories of adverse childhood experiences which included, physical and sexual abuse, physical and emotional neglect, and family dysfunction like having parents who were divorced, mentally ill, addicted, or in prison (van der Kolk, 2014). Ultimately, the ACE study showed that traumatic life experiences during childhood and adolescence are a lot more common than previously expected (van der Kolk, 2014). It is stated that the study respondents were mainly White, middle class, middle aged, well educated, and financially secure enough to have good medical insurance, highlighting that only one-third of the respondents stated no adverse childhood experiences (van der Kolk, 2014). Additionally, the study revealed that the effects of trauma permeated these patients’ adult lives (van der Kolk, 2014). An example mentioned is that high ACE scores turned out to correlate with higher workplace absenteeism, financial issues, and less lifetime income (van der Kolk, 2014). 

Furthermore, Felitti and his team discovered that adverse experiences are interrelated, even though they are usually studied individually (van der Kolk, 2014). For example, people do not usually grow up in a household where one brother is in prison, but everything else is okay (van der Kolk, 2014). Incidents of abuse are never ‘standalone’ events, and for each additional adverse experience reported, the toll in later damages rises (van der Kolk, 2014). Felittti and his team also discovered that the impact of childhood trauma initially became noticeable in school (van der Kolk, 2014). Referring to the ACE study results, more than half of those with ACE scores of four or higher reported having learning or behavioral issues, which was compared with three percent of individuals with a score of zero (van der Kolk, 2014). It is expressed that as the children matured, they did not ‘outgrow’ the impact of their early experiences (van der Kolk, 2014). Felitti highlights, ‘“Traumatic experiences are often lost in time and concealed by shame, secrecy, and social taboo”’ (van der Kolk, 2014). However, the ACE study revealed how the effects of trauma permeated these patients’ adult lives (van der Kolk, 2014). 

Moreover, after Robert Anda presented the results of the ACE study, he realized that they had found the gravest and most expensive public health issue in the United States, which is child abuse (van der Kolk, 2014). Anda’s calculations entailed that the overall costs surpassed those of cancer or heart disease (van der Kolk, 2014). In addition, eliminating child abuse in America would lessen the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters (van der Kolk, 2014). Eradicating child abuse in America would also have a huge impact on workplace performance, and greatly lessen the need for incarceration (van der Kolk, 2014). Furthermore, follow up studies and papers are still showing up around the world regarding the ACE study. However, the day to day reality of those who suffered child abuse, as well as children in outpatient clinics and residential treatment centers around the country remains the same (van der Kolk, 2014). The only difference now, is that they receive high doses of psychotropic agents, which makes them more manageable, but will also affect their ability to feel pleasure and curiosity, to grow and develop emotionally and intellectually, and to ultimately become contributing members of society (van der Kolk, 2014). 

Expanding more on psychotropic agents, the reason why taking medications could be effective, is because it could be used to lessen extreme or debilitating symptoms as an initial step in trauma recovery (Rousseau, 2023). A few of the symptoms that could be lessened with medication include, sleep disorders, hyperarousal, emotional reactivity, depression, and intrusive or recurring thoughts and images (Rousseau, 2023). However, it is highlighted that an approach that may work for one person, may not work for another, potentially even increasing the other person’s experience of trauma symptoms (Rousseau, 2023). Nonetheless, pharmacotherapy, or the use of medication, is one approach to addressing the impact of trauma, specifically in situations where people will experience symptoms like anxiety, depression, or other mental health problems associated with traumatic experiences. Pharmacotherapy would be a very effective approach, especially in tandem with other therapeutic approaches, like psychotherapy in order to provide a comprehensive treatment plan (Alcohol and Drug Foundation, 2021). 

Elaborating more on pharmacotherapy, from a neurology perspective, there are many different neurotransmitters in one’s brain (Rousseau, 2023). All in all, pharmacotherapy works by manipulating neurons and neurotransmitters to gain the desired effect (Rousseau, 2023). In addition, medications can be effective in reducing specific symptoms associated with trauma such as, intrusive thoughts, nightmares, or panic attacks. Furthermore, medicines that target the autonomic nervous system, like propranolol or clonidine, could help in lessening hyperarousal and reactivity to stress (van der Kolk, 2014). This group of drugs works by blocking the physical effectiveness of adrenaline and the fuel of arousal, therefore lessening nightmares, insomnia, and reactivity to trauma triggers (van der Kolk, 2014). Additionally, blocking adrenaline can help to keep the rational brain online and make choices possible (van der Kolk, 2014). Ultimately, a detailed approach by a mental health professional is crucial to identify the most appropriate treatment approach, whether it involves medication, psychotherapy, or a combination of both.

Lastly, referring back to the importance of the ACE study, the implementation of this research could be very beneficial if integrated in one’s workplace. For example, providing training among professionals to recognize and respond to people affected by adverse childhood experiences. This could provide more awareness into one’s potential trauma history, guiding more efficient and sensitive methods. Another implementation could be developing support systems that consider the findings of the ACE study in order to help those affected by childhood trauma. Overall, the goal is to use the ACE study’s findings to apply more informed, understanding, and efficient approaches when dealing with people who have experienced childhood traumatic events.

Resources:

Australian Drug Foundation. (2021). Pharmacotherapy for young people. Alcohol and Drug Foundation. https://adf.org.au/talking-about-drugs/seeking-help/pharmacotherapy-young-people/what-is-pharmacotherapy/#:~:text=Pharmacotherapy%20is%20the%20treatment%20of,with%20a%20legally%20prescribed%20substitute.

Rousseau, D. (2023). BU Learn. Retrieved from https://learn.bu.edu/bbcswebdav/pid-12438217-dt-content-rid-91014393_1/courses/23fallmetcj720_o2/course/module1/allpages.htm

Van, K. B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma.