Tag Archive for: police officers

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Dr. Katherine Ramsland: Cops and Cumulative PTSD

 

“Officers who deal with human trauma might not recognize its toll till too late.”

 

KEY POINTS

  • Repeated exposure to trauma can weaken the ability to cope, resulting in cumulative PTSD (CPTSD).
  • Since it’s not linked to a specific incident, CPTSD can go undiagnosed.
  • Educating police officers about CPTSD can inspire preventative treatment that benefits the whole organization.

In the Boston Globe recently, Nicholas DiRobbio described a disabling condition that forced him out of his job as a cop. One day, something just seemed to come over him. Common noises like kids shouting jarred him. He grew scared to leave his house. Some days he sat in his cruiser and screamed. He didn’t recognize himself.

“As a cop, you struggle with your identity,” he told the Globe. “You can’t reform, and you’re broken—you’re not that person and that hero you used to be.” Finally, he quit the force and sought counseling. He knew something was wrong, but he didn’t know what.

DiRobbio learned that he suffered from cumulative post-traumatic stress disorder (CPTSD), or the sum reaction to a build-up of trauma over time. It’s like piling one too many bricks on a scaffold that finally collapses.

The Effects of Cumulative Post-Traumatic Stress Disorder (CPTSD)

“I never anticipated that it feels physical,” he said. “It feels like a weight. You get pressure on the chest area, you feel this heavy burden like a pain, and you feel physically uncomfortable in your own body… I was shaking a lot, uncontrollably… Someone who is a police officer and faced all kinds of stuff, I’m not afraid, but my body wouldn’t physically let me leave the house.”

He describes his experience in Invisible Wounds, insisting it’s not a weakness of character as it’s often portrayed but a process beyond one’s control. Dr. Michelle Beshears, in the Criminal Justice Department at American Military University, agrees. “Cumulative PTSD can be even more dangerous than PTSD caused from a single traumatic event,” she states, “largely because cumulative PTSD is more likely to go unnoticed and untreated. If untreated, officers can become a danger to themselves and others.”

We hear a lot about PTSD but not much about this more nebulous condition. Yet, those on active duty who routinely deal with human trauma are vulnerable to it. Law enforcement is one of the occupations at greatest risk, given how much they’re exposed to conflict, trauma, and death.

“I went to 30 incidents of dead people,” DiRobbio recalled. “I remember every single one of them…. There [are] sights and smells and people crying; that sticks with you.”

Cerel et al. (2018) examined the results from 800 officers who’d completed a survey about their exposure to suicide incidents. Almost all participants (95 percent) had responded to at least one such scene, with an average of 31 over a career. One in five reported a scene that had triggered nightmares, and close to half reported seeing things that had stayed with them. The researchers found a significant association between frequent exposure to suicide and behavioral health consequences, mostly depression, anxiety, and sleep disorders—all signals of potential CPTSD.

Supporting First Responders With CPTSD

This mental health injury appears to be a growing issue for first responders. Valazquez and Herandez (2019) reviewed research on police mental health. “Working as a first responder,” they write, “has been identified as one of the few occupations where individuals are repeatedly placed in high stress and high-risk situations.” Typical coping strategies show a failure within organizations to recognize a developing issue like CPTSD. One of the most persistent barriers to seeking help is the stigma attached.

“It is evident that officers unknowingly advocate negative attitudes about seeking mental health support based on the organizational stigma. Organizational stigma manifests in the way the agency prioritizes officer wellness and provides supportive services.” They argue that for the greater good, organizations must address the stigma directly, diminish its impact, and encourage the use of services.

Among the types of experiences that can negatively affect cops are officer-involved shootings, vehicle pursuits, volatile domestic situations, and witnessing the aftermath of rapes, accidents, suicides, and homicides. Symptoms of CPTSD include intrusive thoughts, sleep or eating disorders, adverse mood shifts, withdrawal from friends and family, agitation, physical deterioration, and disorientation.

However, few departments have effective support in place. It’s no secret that the police culture has traditionally dodged the topic of mental health, an approach that has only added to the rise in depression, CPTSD, and suicidalthoughts among officers. They feel guilty, embarrassed, and ashamed about asking. They think their peers will now view them differently. So, instead of expressing their feelings to relieve the pressure, they withdraw. Although some departments now include critical incident debriefing for this purpose, many do not.

Trauma Risk Management (TRiM) is a peer-support process that aims to erase stigma and encourage seeking help. Watson and Andrews (2018) found that in military populations, this instrument has shown beneficial effects. Studies with TRiM in police departments in the UK are ongoing, but early reports indicate a positive reception.

Ignoring mental health problems in cops won’t erase them. Education, training, and support are needed to ensure the welfare of those who keep us safe.

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References

Beshears, M. (2017, April 3). Police officers face cumulative PTSD. Police 1.https://www.police1.com/health-wellness/articles/police-officers-face-c…

Carlson-Johnson, O., Grant, H., & Lavery, C. (2020). Caring for the guardians—Exploring needed directions and best Practices for police resilience practice and research. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2020.01874

Cerel, J., Jones, B., Brown, M., Weisenhorn, D. A., & Patel, K. (2018). Suicide exposure in law enforcement officers. Suicide and Life-Threatening Behavior.doi.org/10.1111/sltb.12516

Velazquez, E., & Hernandez, M. (2019). Effects of police officer exposure to traumatic experiences and recognizing the stigma associated with police officer mental health: A state-of-the-art review. Policing: An International Journal,42(4), 711-724.

Watson, L., & Andrews, L. (2018). The effect of a Trauma Risk Management (TRiM) program on stigma and barriers to help-seeking in the police. International Journal of Stress Management,25(4), 348–356. https://doi.org/10.1037/str0000071

Velazquez, E., & Hernandez, M. (2019). Effects of police officer exposure to traumatic experiences and recognizing the stigma associated with police officer mental health: A state-of-the-art review. Policing: An International Journal, 42(4), 711-724.

Watson, L., & Andrews, L. (2018). The effect of a Trauma Risk Management (TRiM) program on stigma and barriers to help-seeking in the police. International Journal of Stress Management, 25(4), 348–356. https://doi.org/10.1037/str0000071

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This article originally appeared in the October 18, 2021 of “Psychology Today.” It is published here with the permission of the author, Katherine Ramsland Ph.D.

Cover photo by Katherine Ramsland.

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Katherine Ramsland teaches forensic psychology at DeSales University, where she is the Assistant Provost. She has appeared on more than 200 crime documentaries and magazine shows, is an executive producer of Murder House Flip, and has consulted for CSI, Bones, and The Alienist. The author of more than 1,000 articles and 68 books, including How to Catch a Killer, The Psychology of Death Investigations, and The Mind of a Murderer, she spent five years working with Dennis Rader on his autobiography, Confession of a Serial Killer: The Untold Story of Dennis Rader, The BTK Killer. Dr. Ramsland currently pens the “Shadow-boxing” blog at Psychology Today and teaches seminars to law enforcement.

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Police Officers as Emergency Medical Responders: The Comprehensive Trauma Kit 

Police officers, especially those working patrol assignments, are typically the first officers to respond to emergency situations. Not only are they called to scenes involving criminal activities, they are often the first responders to show up at scenes involving medical emergencies. Therefore, it makes sense that officers would possess, at minimum, a basic knowledge of first aid procedures.

When I attended the police academy part of the curriculum was a mandatory 40-hour First Responder certification course (not to be confused with the broadly-used, generic term “first responder,” meaning police, fire, and EMS personnel). To avoid confusion the name “First Responder” was eventually changed to “Emergency Medical Responder” or “EMR.”

The First Responder certification course offered training in the skills needed to provide emergency medical care, such as patient assessment and care, diagnostic signs, and how to treat life threatening emergencies, such as severe bleeding, seizures, choking, broken bones, and more.

In addition to the First Responder/Emergency Medical Responder certification course, each recruit was required to complete and pass an Adult CPR and Pediatric CPR certification course. The only exemption to the training was to have current CPR certification and a current certification at the First Responder level or higher (EMT, Paramedic, etc.). At the time, I was an EMT and a CPR instructor for both the American Heart Association and Red Cross. I taught taught CPR at law enforcement and jail training academies, and at the Virginia Department of Corrections training academy. I also taught CPR at local hospitals and churches, rescue squads and ambulance services, and fire departments, etc.

Unfortunately, in many areas, if not most, First Responder/Emergency Medical Responder in-service training is not required. Therefore, without refresher courses many of those lifesaving skills and bits of valuable knowledge eventually fade from the minds of officers (If you don’t use it you lose it!).

Fortunately, help has arrived! Yes, the Comprehensive Trauma Kit is just what the doctor ordered. It’s a medical toolbox packed with an assortment of medical supplies designed to help police officers address critical emergencies. The kit is also available for businesses, or anywhere it may be needed.

Some law enforcement agencies in the U.S. have assigned these trauma kits to their officers/deputies.

Each kit contains:

  • First aid supplies
  • A built-in integrated tablet that includes the Mobilize Rescue app
  • The Mobilize Rescue app guides users with on-screen real-time step-by-step instructions
  • Clearly organized and color-coded supplies with alpha-numeric labels that correspond to the instructions in the app
  • OSHA-compliant medical supplies
  • The ability to create a time-stamped summary of actions to share with EMS

Trauma Supplies

4 | SOF-T Wide tourniquet

2 | QuikClot bleeding control dressing

2 | 6″ flat emergency trauma dressing

2 | Hyfin chest seal

2 | Water-Jel universal burn dressing

2 | triangular bandage

2 | 4.5″ sterile conforming stretch gauze

4 | 5″ x 9″ sterile combine ABD pads

2 | 10″ x 30″ sterile multi-trauma dressing

1 | 36″ SAM emergency splint

2 | 4″ elastic wrap bandage

1 | 4″ x 5″ cold compress

1 | adhesive tape 2.5 yd

 

Medical Supplies

1 | CPR face shield with bite block

1 | 81mg chewable aspirin (bottle)

1 | 12mg dissolvable allergy tablets (box)

1 | 15mg Insta-Glucose

2 | emergency space Mylar blanket

1 | portable charger and charging cord

1 | USB charging cube

1 | inspection card

12 | proof seals

2 | bag with biohazard markings

1 | trauma shears

10 | nitrile gloves

1 | user manual and inventory card

 

OSHA-Compliant First Aid Supplies

2 | eye pads

16 | adhesive bandages (assorted sizes)

10 | burn cream packets

10 | triple antibiotic ointment packets

10 | antiseptic wipes

1 | tweezers

10 | hand sanitizer packets

1 | eye wash

1 | first aid guide

 

To view the kit, its contents, and how it can be utilized during a medical emergency, please click on the video below.

 

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Cops See the Darnedest Things

Cops truly see and experience the odd, weird, and often dark side of society, and this experience is not limited to dealing with criminals and all the lovely things bad guys offer their communities. For example:

  • The preacher who killed his lover, a woman married to another man. The reverend shot her dead because because she was sleeping with another man, a fellow who was also not her husband. During the fit of jealous rage the murdering minister also killed the “other man.”
  • While checking what was thought to be an abandoned vehicle parked at the end of a deserted, cracked asphalt stretch of dead-end country road, a deputy was surprised when he discovered a local government mental health professional inside the car engaged in frantic sexual activity with a young girl under the age of 17. One of the official duties of the professional person was to counsel victims of sexual abuse.
  • A 911 call from an area by-the-hour motel led law enforcement officers to a room rented by a known prostitute. She dialed the police when her “client” began to get a bit too rough for her liking. The client was a prominent business leader who also taught Sunday School at his church.
  • A probation officer was shot to death when he was caught having sex with a probationer’s girlfriend. The recently released offender arrived home early from work, discovered the pair in bed, and then quickly grabbed a gun and proceeded to fire rounds at the man who was in charge of his supervised release. Well, the shooter’s aim was pretty good because he shot the nude man in the back as he climbed out of the couple’s bedroom window with his clothing in hand.

The probation officer managed to stumble a few steps before collapsing onto the sidewalk. When police arrived they found the probation officer’s naked body curled in a fetal position. Lying next to him were his clothing, including the shiny badge that was still attached to his belt.

  • While working graveyard shift, an officer parked his patrol car on a side street where he began to complete a bit of paperwork. While there he witnessed a state law enforcement agent park his government vehicle in a dark area of a neighborhood. The agent opened the car door and shut is slowly and quietly and then trotted to the side door of a house. The door opened and a woman let him inside. The woman was the wife of a corrections officer who worked night shift at a prison. The agent’s wife who was most likely at home asleep, had no idea that her husband was cheating with one of her friends.
  • While running radar late at night on a lonely stretch of highway, an officer stopped a car that was swerving from side to side. When the officer had a look inside the vehicle he saw that the male driver wore a corrections uniform.  His passenger, a totally nude (male), was handcuffed to the car door. His corrections uniform was on the backseat in a crumpled pile. The pair of COs said they were merely out for a late night, relaxing drive to unwind after finishing their shift at the prison.
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