1. THE LAW ENFORCEMENT MENTAL HEALTH AND WELLNESS ACT OF 2018:
A POLICY THESIS
A THESIS
Presented to the School of Social Work
California State University, Long Beach
In Partial Fulfillment
of the Requirements for the Degree
Master of Social Work
Committee Members:
Mimi Kim, Ph.D. (Chair)
Janaki Santhiveeran, Ph.D.
Molly Ranney, Ph.D.
College Designee:
Nancy Meyer-Adams, Ph.D.
By Chloe Ellen Gibson
B. A., 2017, California State University, Long Beach
May 2020
3. ii
ABSTRACT
The purpose of this thesis was to present an analysis of the Law Enforcement Metal
Health and Wellness Act passed in 2018. Emphasis in this thesis was placed on the causes and
theorized causes of negative law enforcement mental health and wellness outcomes, most
common mental health problems in this population, and the strengths and limitations of this
specific policy to improve law enforcement mental health and wellness outcomes. Gil’s analytic
framework was utilized to evaluate this policy. Additionally, the implications of this policy on
the social work profession and on society as a whole were discussed. This policy analysis
illustrates that mental health and wellness concerns that have been growing over the last few
years are now at the forefront of political and social concern. It also illustrates that while there
are a number of interventions being applied for the betterment of this population, there remains a
need for the implementation of evidence-based practices specific to law enforcement officers as
a population. It is evident that a social work perspective is necessary in the creation of policy to
ensure evidence-based practices, respect for the dignity and worth of the client population, and
evaluation of environmental influences. Future recommendations for the betterment of care for
this population are also discussed.
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ACKNOWLEDGEMENTS
I would foremost like to thank my partner, Scott, for taking care of me throughout my
degree program. Without your constant love and support, I doubt I would have been able to
navigate my personal, professional, and academic life with so much ease. I am so blessed to
know that you will always be there for me to cheer me on, and to ground me when I am thrown
too many curveballs. You are a perfect partner, and after all these years I still cannot believe my
luck in finding you.
I would like to thank my family; and specifically, Mom, Dad, Grandma, and Pa. Thank
you all for everything you have done for me to allow me the ability to get a higher education in a
field that I am truly passionate about. Mom, you have always been my sounding board for ideas
and you often help me present myself as an academic rather than a conspiracy theorist; I am so
blessed to have been raised by you. Because of you, I grew into a creative, passionate, and well-
read person. Dad, your silent support has motivated me throughout my life, and I hope that you
are proud of the things I have and will accomplish in my personal and professional life. Grandma
and Pa, thank you for giving me rides to school on days when it was too chilly or wet to bike.
Thank you for our morning coffees and our Monday night smorgasbords. I could not have done
it without your faith in me, and I am so lucky to be your granddaughter. I love you all with my
whole heart.
Thank you also to my loving uncles, Jon and Kevyn, who have always accepted me with
open arms, respected my goals, and provided the best summer vacations I could have asked for.
Though you may not know it, you two had an enormous and wonderful impact on my ideologies
and values during my formative years. Thank you for helping me become a compassionate,
accepting, and sensitive person. I am proud to be your niece.
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I would like to extend a special thank you to my family members who passed away
during the course of my MSW Program. Each of them was with me in my formative years and
influenced who I am today. Because of them, and my loss of them, I was able to realize how
strong and resilient I truly am:
My beloved great-grandmother, Frances Ellen Shisko, October 23, 1923- January 17,
2019
My tenacious and organized grandmother, Jean Whitmore, July 15, 1943- February 27,
2019
My hardworking and dignified Nono, Calogero Ragusa, June 6, 1930- July 6, 2019
My sweet and tender aunt, Carole Mumaw, January 3, 1946- November 17, 2019
My sarcastic and dutiful uncle, Keith Whitmore, May 28, 1965- December 31, 2019
Lastly, I would like to thank my advisor, Dr. Mimi Kim, who motivated, encouraged, and
guided me towards completing the longest essay of my life. Mimi, thank you for pushing me to
perform to the best of my abilities. Thank you for treating me with empathy and kindness when I
was struggling, and for the much needed “tough love” every now and again. You have made a
wonderful impact on my life, and as I move towards the professional realm of social work, I will
continue to be grateful to you.
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TABLE OF CONTENTS
ABSTRACT.................................................................................................................................. ii
ACKNOWLEDGEMENTS.......................................................................................................... iii
LIST OF TABLES........................................................................................................................ vi
1. INTRODUCTION ............................................................................................................ 1
2. LITERATURE REVIEW ................................................................................................. 7
3. METHODS ....................................................................................................................... 39
4. POLICY ANALYSIS ....................................................................................................... 40
5. CONCLUSION................................................................................................................. 73
APPENDICES .............................................................................................................................. 83
A. LAW ENFORCEMENT CODE OF ETHICS.................................................................. 84
B. POLICY ANALYSIS FRAMEWORK ............................................................................ 87
REFERENCES ............................................................................................................................. 91
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LIST OF TABLES
1. Immediate and Delayed Reactions to Trauma ………………………………………………..14
2. Critical Incidents in the Law Enforcement Profession …………………………………….…16
3. Productivity Loss and Associates Costs Due to Mental Health Reasons …………………….52
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CHAPTER 1
INTRODUCTION
Problem Statement
Though careers in law enforcement have existed for centuries, law enforcement mental
health and wellness have only recently come to the forefront of the public and political
consciousness (Spence, Fox, Moore, Estill, & Comrie, 2019). For civilians, increasing media
exposure to police brutality and law enforcement officer (LEO) misconduct has caused mental
health to become an issue for concern (U.S. Department of Justice [DOJ], 2019a). For the
government, increasing attention to LEO suicides and on-the-job accidents have been a catalyst
in officials supporting increased mental health and wellness actions for this population. Both of
these concerns are influenced by mental health problems which stem from exposure to trauma
and traumatic situations (also called vicarious trauma), which LEOs are exposed to daily in
varying degrees and intensities (Spence et al., 2019).
The traumatic nature of this career along with the limited support from community and
government agencies, has compounded for LEOs in recent years and has produced a breeding
ground for mental health problems such as suicidality, post-traumatic stress disorder (PTSD),
and related symptoms including depression, panic attacks, phobias, mania, and substance abuse
(Violanti et al., 2009). Failure to address the needs of LEOs affects the safety and quality of life
of the officer, as well as the overall safety of the community (Spence et al., 2019).
As with the civilian population, mental health problems are stigmatized; however, due to
cultural influences of the career, mental health is even more stigmatized than in the general
population. This stigmatization occurs in many of the organizational aspects of the career, as
well as between officers, to the point that LEOs will avoid seeking mental health resources and
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help for fear of being demoted, ostracized, distrusted, or even fired. According to Stuart (2017),
these fears are not unfounded, as officers who have reported their mental health and wellness
problems have also reported being alienated by their coworkers and superiors. These stigmas
prevent LEOs from gaining the treatment they need, and ultimately decrease the likelihood of
LEOs regaining mental health, increase the risk of psychological and physical injury on the job,
and increase workplace costs in the long term (Wilson & Buckley, 2018).
It is evident that there is a great need for support in LEO mental health and wellness as
well as many barriers to achieving successful care. The most commonly cited barriers include
concerns over confidentiality and fear of potential negative career impacts (Fox et al., 2012).
Other barriers can be traced to LEO culture and the fear of stigmatization from colleagues.
However, one of the most daunting barriers is the absence of centralized mental wellness support
standards as different healthcare provider networks operate independently across U.S. counties
(Spence et al., 2019).
In response to these conditions, the Law Enforcement Mental Health and Wellness Act
(LEMHWA; 2017) was passed in 2018. The purpose of this act was to determine what aspects of
LEO mental health and wellness are already being broadly addressed by departments across
America, and what techniques are working as far as encouraging LEOs to seek care. A report
was submitted to Congress which summarized the findings of 11 case studies from departments
with vastly differing locations and social climates (Copple et al., 2019). The report suggested
that crisis lines, peer mentoring, and mental health checks are promising components of LEO
mental health and wellness, which are acceptable to many officers as well as being easy to
implement due to their familiarity and cost-effectiveness (Copple et al., 2019). Due to the
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recency in passing of this law, current and possible outcomes will be discussed as well as further
proposals for other trauma-informed interventions which could be effective for this population.
Purpose Statement
The purpose of this project was to create an in-depth analysis of existing policy to
support American LEOs to address mental health concerns. The analysis focuses on the
LEMHWA of 2018, currently the only federal policy in place to improve the psychological lives
of LEOs. Emphasis is placed on the likely causes of mental illness in this special population as
well as evidence-based and trauma-informed practices which could be implemented to relieve
some of the symptoms and effects of mental illness that officers might experience (Christopher et
al., 2018). Limitations of current policy and research are addressed in addition to any
multicultural concerns which are relevant.
Definition of Terms
Americans with Disabilities Act (ADA): A law which intends to protect people in the
workforce who are working with mental or physical disability (U.S. Equal Employment
Opportunity Commission [U.S. EEOC], 2019).
Fitness for duty examination (FFDE): The FFDE is a mandatory examination which an
officer must complete after a traumatic incident such as an officer involved shooting. The intent
of the exam is to determine if an officer is mentally well enough to continue their duty (Spence et
al., 2019)
Law Enforcement Mental Health and Wellness Act (LEMHWA): This federal legislation
was written in 2017 and passed into law in 2018. This law calls for research and
recommendations to be made for improving LEO mental health and wellness. In response to this
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act, the Office of Community Oriented Policing Services must submit its findings for Congress
which evaluates programs already in place which might be adaptable on a national scale.
Law enforcement officer (LEO): Law enforcement officer, which includes sheriffs,
deputies, marshals, special agents, and others who are responsibility for enforcing federal, state,
local, or tribal law.
Post-traumatic stress disorder (PTSD): A common problem among LEOs due to
traumatic work experiences and compounded trauma (McFarlane, 2013). People experiencing
PTSD often report reliving a traumatic experience through flashbacks, nightmares, or disturbing
thoughts and feelings. People with PTSD may actively avoid reminders of the distressing
incident and have negative thoughts or feelings about themselves. Another symptom is increased
arousal and reactivity which can be expressed through angry outbursts, reckless behavior, self-
destructive actions, being easily startled or scared, and having difficulty concentrating (American
Psychiatric Association, 2019).
Mental health and wellness: Mental health and wellness refers to general comfort and
wellbeing of a LEO, including normal responses, cognitions, and other interactions in daily life
which are at baseline (U.S. Department of Health and Human Services, 2019).
Mental health problems and disorders: Refers to the most common mental health and
wellness issues among the LEO population including suicidality, anxiety, PTSD, and depression.
Police brutality: Police brutality is defined as use of extreme force perpetrated by a LEO
onto a civilian which results in bodily harm or death (Maguire & Duffee, 2015).
Social Work Relevance
As dictated by the core values of social work, the protection and wellbeing of vulnerable
populations is of paramount concern. In the case of LEOs’ mental well-being, multiple at-risk
12. 5
populations are affected. The LEOs themselves are at risk for developing mental health and
wellness problems related to the stressors and dangers of their jobs. The communities they serve
and protect can also come under risk if LEOs are not given support for the traumatic experiences
they live with because the unresolved trauma could express itself in LEO perpetrated acts of
injustice and violence.
Under the LEMHWA, services for LEOs are being evaluated for their efficacy, and
evidence is being gathered in support of practices which could be implemented. Prior to 2018,
when the LEMHWA was adopted into law, there existed an enormous gap in awareness for a
very vulnerable population which in turn affects other vulnerable populations. Social work
practices seek to implement evidence-based practice. Therefore, the LEMHWA and its
accompanying findings should be evaluated through the social work lens to ensure that evidence-
based practices are implemented and all affected populations are advocated for with integrity,
competence, service, social justice, individual dignity and worth, and centrality of human
relationships.
Multicultural Relevance
In recent years, police brutality has come to the forefront of the American consciousness.
This newfound attention is enhanced by the widespread accessibility of cell phones and social
media, although police brutality is nothing new in itself. Civilians, primarily civilians of color,
suffer and die at the hands of overzealous police officers who seem to have no regard or respect
for the life and basic dignity of other people. Many schools of thought on the cause of police
brutality are detailed by Maguire and Duffee (2015) who discuss the social, organizational, and
psychological models which may explain the origins of police brutality. However, even without
theoretical elements to explain its origins, it is likely that police brutality has some connection to
13. 6
PTSD and other outcomes of unaddressed trauma. As listed by the American Psychiatric
Association (2019), a key symptom of PTSD is emotional reactivity expressed in angry
outbursts, reckless behavior, increased startle response, or difficulty concentrating. While
elements of police culture and undertones of racism may also be catalysts for police brutality,
unmanaged mental illness in LEOs is certainly a troubling element which has long remained
unaddressed (Evans, Coman, Stanley, & Burrows, 1993). It is possible that with increased
support for LEO mental wellness and enforcement of rehabilitative programs for those
experiencing trauma, police brutality and civilian abuse might become less pervasive, thus
making communities safer and rebuilding civilian acceptance of LEOs.
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CHAPTER 2
LITERATURE REVIEW
Introduction
There are many terms for LEOs, which are used interchangeably. There are colloquial
terms, such as “cop” as well as official terms such as “peace officer” or “uniformed officer.” For
the purposes of this thesis, LEO will be used in reference to the sworn, uniformed police officers
located within approximately 18,000 departments across the United States (Data USA, n.d.).
Law enforcement officers in different states and jurisdictions will encounter varied
processes of hiring practices; however, there are many aspects of the hiring process which are
common amongst all jurisdictions (Go Law Enforcement, n.d.; Scrivner, 2006). A physical
fitness test is usually mandatory, as well as a standardized law enforcement test which tests for
common sense, reading comprehension, information recall, and basic math and reading skills.
Potential officers will usually have to submit detailed background check packets, successfully
complete a panel interview, and pass the rigorous background check process and psychological
evaluation which frequently requires the use of a lie detector test. If the potential recruit succeeds
passing these strenuous applicatory tasks, they will be approved for the next round of academy
trainings which typically last 6 months or longer (Go Law Enforcement, n.d.). The academy has
been described as closely resembling military boot camp and is both physically and mentally
rigorous (Wendt, 2018).
When a recruit has successfully completed the mandatory training period for LEOs,
referred to as “the academy,” they are sworn into service with an oath of office (Go Law
Enforcement, n.d.). This oath, similar to the one undertaken by military personnel and other
armed forces members, affirms that the new LEO will uphold the constitution faithfully, protect
15. 8
the public against all enemies foreign and domestic, and that the LEO does not have any
reservations about performing their duties during their service (Go Law Enforcement, n.d.). The
law enforcement oath typically does not include an ethical code; however, the Law Enforcement
Code of Ethics was adopted by the International Association of Chiefs of Police in 1957 (IACP;
2019). The Law Enforcement Code of Ethics calls for LEOs to uphold the law, keep their private
lives as an example for others, never act out of personal feelings or beliefs on the job, not engage
in corrupt behaviors, and maintain responsibility for their professional performance (IACP,
2019; See Appendix A).
There has been some turbulence in the LEO community in recent years due to the vast
media attention given to police brutality (Maciag, 2015). There have been calls to move from the
current Law Enforcement Code of Ethics to a timelier form of LEO Hippocratic oath (National
Police Foundation [NPF], n.d.). Those in favor of this change have called the Law Enforcement
Code of Ethics a rich document, which, although it has been a foundational part of LEO culture,
is not timeless and must be updated in light of new research and evidence-based crime
prevention practices. The Law Enforcement Code of Ethics was produced in the late 1950s, an
era focused on crime control, during which law enforcement and relentless prosecution were the
only goals of most LEO agencies (IACP, 2019; Kelly & Hoban, 2017). The Law Enforcement
Code of Ethics speaks to the protection of the weak and innocent; however, some argue that it
should be updated to acknowledge the rights of those who have placed themselves or others in
danger (NPF, n.d.). It has long been the feeling of many LEOs that police have become separate
from their communities and are treated as an isolated group which creates a barrier between
wrongdoing and law-abiding people. Those advocating for a revised Law Enforcement Code of
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Ethics state that LEOs should foremost be acknowledged as members of the community and as
people who are seeking to protect a community in which they are truly invested (NPF, n.d.).
Demographics
As of 2017, there were 789,908 sworn LEOs within the continental United States. The
U.S. police force is comprised predominantly of male employees, numbering approximately
681,000 or 86.2% of LEOs in 2017. The approximate number of female employees amounts to
approximately 109,000 employees, less than one seventh of the total number of LEOs. The most
common race of officer is Caucasian at approximately 77.7%, and the second most prevalent
race of officer is Black/African American at approximately 13.8%. The remaining 8.5% of LEO
includes Asian Americans, “others,” “two or more races,” Indigenous American, and Native
Hawaiian or other Pacific Islander. The median age for LEOs was found to be 39.1 years for
male officers and 38.5 for female officers (Data USA, n.d.).
The policing profession is mired by a legacy of racism and oppression which
significantly affects the rate at which minority officers are hired (Maciag, 2015). In minority
communities, LEOs are considered a dangerous and oppressive force that young people want
nothing to do with (Cochran & Warren, 2012). Additionally, due to the longstanding history of
racism within the police, qualified minority candidates may choose instead to take their talents to
private LEO sectors (Maciag, 2015). Another potential reason for low rates of hire of minority
officers is negative cultural feelings about police, including racial profiling and documented
racial disparities in police behavior (Cochran & Warren, 2012). Some agencies have hiring
practices that have been called biased, and some agencies do not feel that diversity is a necessary
component of community protection (Scrivner, 2006; Sklansky, 2006).
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If a police agency does not represent its civilians, it is likely that citizens will develop
distrust for the local LEOs (Cochran & Warren, 2012). Additionally, language becomes a barrier
for LEOs when the majority population is not represented by the ethnic breakdown among police
(Donohue & Levitt, 2001). Officers who are not familiar with diverse cultural practices and
social norms are more likely than ethnically diverse officers to view unfamiliar behaviors as
suspicious or dangerous (Donohue & Levitt, 2001). According to McElvain and Kposowa
(2008), White non-Hispanic officers are more likely than their Black or Hispanic counterparts to
be involved in a shooting. In a separate study, it was reported that Black officers who patrolled
Black neighborhoods were more likely to carry out supportive activities, such as giving
assistance or advice (Sun & Payne, 2004).
According to the U.S. Department of Justice’s advancing diversity in law enforcement
task force, increasing diversity in LEO departments is important because a diverse team will help
foster trust between the LEO officers and the community they serve (United States Department
of Justice Equal Employment Opportunity Commission [U.S. DOJ EEOC], 2016). The Diversity
Report asserts that decades of research confirm that when members of the public believe they are
represented and understood by their LEO force, it instills confidence in the public that their LEO
force have integrity, accountability, and fair treatment. Victims and witnesses of crime may not
engage with law enforcement if they do not perceive the LEOs as being familiar and responsive
to their experiences and concerns. Essentially, trust facilitates the LEOs being able to do their job
effectively and safely (U.S. DOJ EEOC, 2016). The Diversity Report further asserts that
foundational research suggests that diversity makes law enforcement agencies more open to
reform, accepting to cultural and systemic changes within the department, and more responsive
and sensitive to the populations they serve (U.S. DOJ EEOC, 2016).
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The Diversity Report emphasizes many barriers to diversity in LEOs within the
recruitment, hiring, and retention practices of departments. In the recruitment phase, lack of trust
of LEOs may deter individuals from “minority” communities from applying for the job (U.S.
DOJ EEOC, 2016). Additionally, the reputation of officers and their practices already present in
the community may dissuade applicants from associating with LEOs. The Diversity Report also
asserts that underrepresented communities may not be sufficiently aware of job opportunities
within the LEO career field. During hiring, the report asserts that the pre-hire examinations and
additional selection criteria are inadequate and may unintentionally (or intentionally) exclude
qualified individuals in underrepresented communities (U.S. DOJ EEOC, 2016). Other issues
which affect the diversity in the hiring process includes residency restrictions, the length and cost
of the application process, and limited ability of law enforcement agencies As far as retention is
concerned, the report cites difficulty adjusting to LEO culture and organizational structures, and
difficulty in promotion because of lack of transparency about the process (U.S. DOJ EEOC,
2016).
Trauma and Mental Health
Exposure to Trauma
For the purposes of this review, “trauma” refers to experiences which cause intense
physical and psychological stress reactions within the person experiencing them (Substance
Abuse Mental Health Services Administration [SAMHSA], 2014). Trauma can be a single event,
multiple events experienced at once or over time, or a set of circumstances which are physically
and emotionally threatening and harmful for the individual. Trauma can affect the physical,
emotional, social, or spiritual wellbeing of the victim, and can have many negative long-lasting
effects (SAMHSA, 2014).
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Law enforcement officers may experience one instance of trauma during their career;
however, it is more likely that and LEO will have chronic exposure to traumatic events
(SAMHSA, 2014). Traumatization, or the occurrence of traumatic stress reactions after exposure
to multiple events, is a significant issue for trauma survivors because they are at an increased risk
for traumatization and because those who are traumatized multiple times are more likely to have
serious trauma-related symptoms. Law enforcement officers who have experienced trauma can
be retraumatized not only by another traumatic event, but also by “triggers” or trauma reminders
associated with their experience. These can include sensory inputs like sounds and smells,
interactions with other people, and responses to certain surroundings or people (SAMHSA,
2014). As detailed in Table 1 below, trauma can have many immediate and delayed effects on a
person’s physical, emotional, cognitive, behavioral, and existential functioning (SAMHSA,
2014). These effects are important to consider, as they are long lasting and can develop or
increase severity over time. Even though a LEO may not show signs of trauma after a critical
incident, they may develop symptoms of trauma exposure or PTSD at a later time (SAMHSA,
2014). It is imperative that LEOs are able to identify these symptoms in themselves and in their
colleagues in order to better understand their own mental health and wellness, and to reduce the
likelihood of suffering in silence (SAMHSA, 2014).
Law enforcement officers witness trauma and violence in their communities on a daily
basis. While this career is reported as being rewarding, the daily realities of the job take a toll on
LEO mental wellness (Spence et al., 2019). In addition to being in a state of constant vigilance,
tired from shift work, and exposed to tragedies and interactions with people in crisis and hostile
civilians, LEOs now face scrutiny from the public for the failings of their fellow officers (Spence
et al., 2019). These stressors compile and make it difficult for officers to regulate their emotions,
20. 13
anxiety, and fearfulness, which results in narrowed perceptions, degraded cognitive functioning,
errors in judgement, and impaired cognitive performance (Violanti et al., 2009). The failure to
address these issues not only affects the wellness of the officer, but also erodes the community
support of the LEOs who may have acted in error due to mental health crises (Spence et al.,
2019). The traumatic nature of LEO work has been shown to increase LEO risk of developing
PTSD and related symptoms including depression, panic attacks, phobias, mania, substance
abuse, and increased risk of suicide (Violanti et al., 2009). Law enforcement officers have one of
the highest rates of suicide among other first responders at 28.2 suicides per 100,000 officers for
men, and 12.2 suicides out of 100,000 officers for women. In simplified terms, LEOs are at
much higher risk for mental health problems than civilian workers (Peterson, Stone, & Marsh,
2018).
Law enforcement officers are the first line of defense of a community against violence,
terror, and trauma. Although they are considered to embody flawless bravery and resiliency,
LEOs are only human and experience the effects of being exposed to trauma in the same way a
civilian might. The near constant exposure to traumatic critical incidents and trauma reminders
puts LEOs at increased risk for mental health and wellness problems, substance abuse, and
suicide. According to a study by Chopko, Palmieri, and Adams (2015), the average number of
critical incidents witnessed by LEOs in their career amounted to 188 incidents each. Chopko and
colleagues (2015) detailed the types of critical incidents which are commonly experienced by
LEOs which can help provide insight to the daily lives of LEOs.
These include issues such as mistakes which result in the death of others, witnessing
colleagues being killed in the line of duty, being taken hostage, and seeing other traumatic events
such as responding to calls with beaten adults and children, sexual assault, dangerous chemicals,
21. 14
TABLE 1. Immediate and Delayed Reactions to Trauma
Immediate Reactions Delayed Reactions
Immediate Emotional Reactions:
Numbness and detachment
Anxiety or severe fear
Guilt (including survivor guilt)
Exhilaration as a result of surviving
Anger
Sadness
Helplessness
Feeling unreal; depersonalization (e.g. feeling
as if you are watching yourself)
Disorientation
Feeling out of control
Denial
Constriction of feelings
Feeling overwhelmed
Delayed Emotional Reactions:
Irritability and/or hostility
Depression
Mood swings, instability
Anxiety (e.g. phobia, generalized anxiety)
Fear of trauma recurrence
Grief reactions
Shame
Feelings of fragility and/or vulnerability
Emotional detachment from anything that
requires emotional reactions (e.g. significant
and/ or family relationships, conversations,
about self, discussion of traumatic events or
reactions to them)
Immediate Physical Reactions:
Nausea and/or gastrointestinal distress
Sweating and shivering
Faintness
Muscle tremors or uncontrollable shaking
Elevated heartbeat, respiration, and blood
pressure
Extreme fatigue or exhaustion
Greater startle response
Depersonalization
Delayed Physical Reactions:
Sleep disturbances, nightmares
Somatization (e.g. increased focus on and
worry about body aches and pains)
Appetite and digestive changes
Lowered resistance to colds and infections
Persistent fatigue
Elevated cortisol levels
Hyperarousal
Long-term health effects including heart,
liver, autoimmune, and chronic obstructive
pulmonary disease
Immediate Cognitive Reactions:
Difficulty concentrating
Rumination or racing thoughts (e.g. replaying
the traumatic event over and over again)
Distortion of time and space (e.g. traumatic
event may be perceived as if it was happening
in slow motion, or a few seconds can be
perceived as minutes)
Memory problems (e.g. not being able to
recall important aspects of the trauma)
Strong identification with victims
Delayed Cognitive Reactions:
Intrusive memories or flashbacks
Reactivation of previous traumatic events
Self-blame
Preoccupation with event
Difficulty making decisions
Magical thinking: belief that certain
behaviors, including avoidant behavior, will
protect against future trauma
Belief that feelings or memories are
dangerous
Generalization of triggers (e.g. a person who
experiences a home invasion during the day
may avoid being home alone during the day)
Suicidal thinking
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TABLE 1. Continued
Immediate Reactions Delayed Reactions
Immediate Behavioral Reactions:
Startled reaction
Restlessness
Sleep and appetite disturbances
Difficulty expressing oneself
Argumentative behavior
Increased use of alcohol, drugs, and tobacco
Withdrawal and apathy
Delayed Behavioral Reactions:
Avoidance of event reminders
Social relationship disturbances
Decreased activity level
Engagement in high risk behaviors
Increased use of alcohol and drugs
Withdrawal
Note: Adapted from SAMSHA (2014).
disease, or decaying animal and human corpses. These events are called critical incidents
because they involve the LEO’s critical decision-making skills to resolve, as well as because
they are likely to make an impact on the mental well-being of the officers involved. Table 2
below lists critical incidents that were found to be common amongst officers within their careers
in Chopko and colleagues’ 2015 study, as well as the rate of occurrence.
Exposure to trauma has been directly linked with mental health issues including PTSD
and substance abuse which are known to be prevalent among LEOs (Menard & Arter, 2013). It
follows that LEOs who are involved in a higher number of critical incidents will be more likely
to experience compounded trauma and to suffer from negative mental health and wellness
Immediate Existential Reactions:
Intense use of prayer
Restoration of faith in the goodness of other
(e.g. receiving help from others)
Loss of self-efficacy
Despair about humanity, particularly if the
event was intentional
Immediate disruption of life assumptions (e.g.
fairness, safety, goodness, predictability of
life)
Delayed Existential Reactions:
Questioning (e.g. “Why me?”)
Increased cynicism, disillusionment
Increased self-confidence ( e.g. “If I can
survive this, I can survive anything”)
Loss of purpose
Renewed faith
Hopelessness
Reestablishing priorities
Redefining meaning and importance of life
Reworking life’s assumptions to
accommodate the trauma (e.g. taking a self-
defense class to reestablish a sense of safety)
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TABLE 2. Critical Incidents in the Law Enforcement Profession
Variable Actual
Frequency
0 1-9 10-20 21-50 51+
Mistake that
injures/ kills
colleagues
98.4 1.6 0.0 0.0 0.0
Mistake that
injures/ kills
bystander
98.4 1.1 0.5 0.0 0.0
Colleague
killed
intentionally
91.3 8.2 0.5 0.0 0.0
Colleague
killed
accidentally
94 6.0 0.0 0.0 0.0
Being taken
hostage
99.5 0.5 0.0 0.0 0.0
Being
seriously
beaten
89.1 9.3 1.6 0.0 0.0
Being shot at 66.3 29.8 3.3 0.5 0.0
Colleague
injured
intentionally
64.8 31.3 3.8 0.0 0.0
Kill or injure
in the line of
duty
83.4 15.5 1.1 0.0
Badly beaten
child
38.8 36.5 18.0 4.9 1.6
Sexually
assaulted
child
18.5 42.4 27.2 6.5 5.4
Trapped in
life-
threatening
situations
54.2 29.7 14.0 1.7 0.6
Severely
neglected
child
31.4 35.1 24.3 5.9 3.2
Threatened
with a gun
46.4 42.6 7.1 3.3 0.5
Your loved
ones
threatened
33 35.6 24.3 4.3 2.7
24. 17
TABLE 2. Continued
Variable Actual
Frequency
0 1-9 10-20 21-50 51+
Seriously
injured
intentionally
64.5 26.4 8.6 0.0 0.5
Life
threatening
man-made
disaster
93.3 5.1 0.6 0.6 0.6
Exposed to
AIDS or other
disease
27.1 37.2 24.3 4.4 7.2
Colleague
injured
accidentally
63.5 31.0 4.4 0.6 0.6
Shoot at
suspect
without injury
90.7 8.2 1.1 0.0 0.0
Threatened
with knife/
other weapon
34.2 45.5 15.2 4.3 0.5
Mutilated
body or
human
remains
51.7 34.6 10.6 1.1 2.2
Life-
threatening
natural
disaster
83.5 10.8 4.9 0.5 0.0
Life
threatened by
toxic
substance
67.8 21.2 9.4 1.1 0.6
See someone
dying
16.2 43.2 27.0 10.3 3.2
Making a
death
notification
16.8 49.9 25.5 4.3 3.3
Being
seriously
injured
accidentally
60.5 31.8 4.9 1.6 1.1
25. 18
TABLE 2. Continued
Variable Actual
Frequency
0 1-9 10-20 21-50 51+
Life-
threatening
high speed
chase
48.1 48.1 23.0 16.0 3.2
Sexually
assaulted
adult
10.8 29.2 34.6 20.5 4.9
Animal
neglected,
tortured,
killed
15.2 31.6 36.4 11.4 5.4
Decaying
corpse
15.2 43 34.2 4.3 3.3
Life
threatened by
dangerous
animals
44 38.3 14.3 1.1 2.2
Body of
someone
recently dead
4.3 19.9 31.2 31.7 12.9
Badly beaten
adult
4.8 20.0 39.7 22.2 13.2
Note: Adapted from Chopko et al. (2015).
outcomes. Not only is the impact of mental health problems on the individual concerning, but the
cost to society is high. Mental illness is usually very treatable; however, without treatment and
intervention for LEOs, functioning in daily life and on the job can be severely limited. This is of
concern as society depends on the ability of first responders to use intuition and keen decision-
making skills to protect the public.
One study of emergency responders conducted by the University of Toronto assessed the
commonality of PTSD among LEOs and other first responders and found that those affected by
this mental disorder showed performance and cognitive deficits when trying to perform complex
26. 19
cognitive tasks (Regehr & LeBlanc, 2017). These findings show that LEOs affected by PTSD
have difficulty in tasks which may include assessing risk, planning multi-step responses to a
critical situation, or paying attention to multiple stimuli (Regehr & LeBlanc, 2017). This PTSD
related distraction is especially dangerous as it impacts the decision-making capabilities of LEOs
who must be prepared for intense and complicated working conditions.
A 2011 study of 400 LEOs found that 10% of officers were involved in a critical incident
in which they seriously or fatally injured someone within the first three years of their law
enforcement career (Komarovskaya et al., 2011). This statistic, while shocking, is not widely
known by the American public. It further illustrates the severity of injurious and lethal
consequences of policy activity as well as the traumatic impact of the job. Based on the findings
of Chopko and colleagues (2015), it can be surmised that LEOs are exposed to the trauma of
others and are threatened with violence frequently within the scope of their work, which may in
turn impact the mental health and wellness of the officers. Related to the trauma they have
experienced on the job. LEOs may develop PTSD and therefore may become unreliable when
making decisions in the face of stress (Covey, Shuchard, Violanti, & Shuchard, 2013).
According to Covey and colleagues’ 2013 study, LEOs with PTSD experience disruptions in
rapid decision making due to heightened arousal to threats, inability to screen out interfering
information, and inability to keep attention as a result of the traumatic experiences of their
occupation.
Depression
Depression is a common mental illness which disproportionately affects LEOs. In a 2011
study, it was found that approximately 31% of LEOs have experienced depression or depressive
symptoms (Obidoa, Reeves, Warren, Reisine, & Cherniak, 2011). This statistic is astounding as
27. 20
only approximately 6.7% of the general population experience depression (National Alliance on
Mental Illness [NAMI], n.d.). According to Kisrchman, Kamena, and Fay (2014), LEOs are
twice as likely to experience depressive symptoms than is the general population. One reason for
this high number could be the internal expectation of LEOs that they be emotionally infallible.
Another reason for this high number could be that men are less likely to seek help for their
emotional problems than women are, and this profession is dominated by men.
A study of LEOs by Ingram, Miranda, and Segal (1998) found that low self-worth was a
predictive factor of increased likelihood of developing depression in LEOs. According to Ingram
and colleagues (1998), people with lower self-worth tend to develop negative cognitions about
themselves and devaluate themselves, which can contribute to dysphoric moods. Law
enforcement officers also experience the stressors of their work conditions, which can interact
with feelings of low self-worth and increase the tendency to develop depressive symptoms.
These issues together may further perpetuate the cycle of depression and self-worth and lead to
greater perceived stress and impairment in the work setting.
Additionally, chronic work stress has been shown to be an important risk factor for
depression and the development of depressive symptoms (Blackmore et al., 2007). While many
studies have shown the association of police stress and PTSD, few studies on LEO work stress
and depression have been done. Wang and colleagues (2010) asserted that routine work
environment stress in the lives of LEOs is significantly associated with current levels of
depression, and is, in fact, more significantly associated with depression than critical incident
stressors.
28. 21
PTSD
Post-traumatic stress disorder is another area of concern for LEOs, as fear and anxiety are
near constant aspects of the career. According to a 2012 study, the estimated prevalence for
PTSD among LEOs is approximately 35 % (Austin-Ketch et al., 2012). Law enforcement
officers are likely to experience both fear and anxiety in their daily lives either as a response to
an imminent threat or in response to the anticipation of a future threat. This type of stress can
trigger hypervigilance in a LEO which, in turn, will increase stress and have a negative impact
on the personal and professional life of the LEO (Austin-Ketch et al., 2012). Some symptoms of
anxiety which have been reported from LEOs include fatigue, difficulty thinking, snapping or
being on-edge, depersonalization, and intrusive thoughts (Austin-Ketch et al., 2012). Post-
traumatic stress disorder can take effect after a single traumatic incident or can present after
compounded trauma that a LEO experiences over a period of time. Incidents such as death,
physical pain, human and animal cruelty and the loss of fellow officers can all be triggers for this
type of mental disorder and occur very regularly for LEOs (Austin-Ketch et al., 2012). Some
symptoms of PTSD which may present in suffering LEOs include flashbacks to the traumatic
events, a heightened startle response, avoidant behaviors, hypervigilance, and self-destructive
behaviors (Austin-Ketch et al., 2012).
Suicidality
In recent years, the police suicide rate has become a significant cause for concern.
According to the NAMI (n.d.), more police die by suicide than in the line of duty. In 2017 alone,
there were 140 recorded police suicides, emphasizing the statistic that 1 in 4 police officers has
experienced suicidal thoughts during their career (NAMI, n.d.). There are many environmental
factors which impact law enforcement mental health and wellness, however in assessing the
29. 22
causes of suicidality in LEOs, coexisting mental illnesses, their causes, and the risks must be
investigated. The presence of substance abuse, PTSD, and depression are often present before
suicidal ideation and can be viewed as warning signs which can potentially save lives if
addressed (Violanti et al., 2009). Substance abuse in LEOs especially is a critical predictor of
suicide (Heyman, Dill & Douglas, 2018). According to Heyman and colleagues (2018), alcohol
abuse is present in approximately 85% of LEO suicides. Heyman and colleagues (2018) also
asserted that substance use, marital discord, health concerns, anxiety, PTSD, and depression are
all significant factors in law enforcement suicide (Violanti et al., 2009). Both alcohol abuse and
drug abuse by protective service occupants are on the rise. Often, suicidal ideation is associated
with the inability to process traumatic incidents which LEOs frequently experience on the job
(Rothman & Strijdom, 2002). Law enforcement officers report feeling as though they are not
able to manage the traumatic police work exposures and felt as though they were not able to
access resources personally or through their organization (Spence et al., 2019). The demands of
police work, when compounded with the psychological and emotional trauma, can become too
much for a LEO to navigate alone, and perceived lack of resources and support can increase the
stress felt by LEOs (Violanti et al., 2009). Depression is considered to be a significant predictor
of suicidal ideation in LEOs (DiFilippo & Overholser, 2000). Additionally, it has been asserted
by Crosby and Sacks (2002) that suicidal ideation, planning and attempts are all more likely
when a LEO has witnessed the suicide of another person. Law enforcement officers, by the
nature of their career, often investigate the aftermath of suicides or witness suspect suicides,
which causes them to have greater exposure than the general population.
Law enforcement officers must pass a psychological evaluation prior to being admitted to
the training academy (Wang et al., 2010). If a prospective LEO does not meet the standards for
30. 23
psychological fitness for duty, they will not be admitted to join the force. From this knowledge
we can surmise that there may be serious deterioration in mental health and wellness during the
course of an LEO’s career, as the LEO moves from baseline mental health and wellness to
PTSD, depression, and suicidality (Wang et al., 2010). Another factor that may affect the
prevalence of suicide in LEOs is that law enforcement is a male dominated field (Data USA,
n.d.). Males, in general, are more likely than their female counterparts to commit suicide
according to the NAMI (n.d.). Police suicide may also be exacerbated by the presence of
firearms in the daily life of a LEO, both in the home and on duty (Heyman et al., 2018).
Approximately 90% of LEOs who commit suicide use a firearm to end their life, and it is
impossible to limit LEO access to firearms (Heyman et al., 2018). Additionally, there are cultural
barriers, such as personal belief, police department culture, and American culture with its lack of
awareness of the importance of LEO mental health and wellness (Fox et al., 2012). The culture
of LEOs may have an effect on the rate of suicide due to the access LEOs have to firearms both
on and off-duty (Addis & Mahalik, 2003; Wester & Lyubelsky, 2005). Because of the nature of
the job, these officers already have greater access to firearms and lethal means of suicide than do
civilians.
Current suicide statistics may be a gross underestimation of the actual number of police
suicides (O’Hara, Violanti, Leveson, & Clark, 2013). Often, shame prevents families from
reporting a death as a suicide. In police departments, it is common for officers who have died by
suicide to be excluded from burial with their full honors, and their names are not permitted to be
added to the National Law Enforcement Memorial in Washington, DC. These facts may affect
statistical data because departments may choose to classify police suicides as a different type of
death. According to a 2013 study, approximately 17% of police suicides were misclassified as
31. 24
accidents or undetermined deaths in order for the department to avoid shame and stigmatization
(O’Hara et al., 2013).
Impact on Domestic Relationships
Law enforcement officers have a divorce rate of approximately 60%-70%, which is
significantly higher than the national average of 50% (Olson & Wasilewski, 2015b). One
potential cause of this high divorce rate may be marital discord associated with LEOs and their
spouses (Purple Berets, 2003). According to the Purple Berets (2003), domestic violence is
between two and four times more likely to occur within police families than civilian families.
Additionally, nearly 40% of police interviewed in the 2003 study admitted to using violence
against a domestic partner within the last year (Purple Berets, 2003). As detailed by SAMHSA
(2014) the impact of trauma on a person is broad and can affect almost evert aspect of life,
including their interactions with their loved ones. A person who has been physically or
emotionally traumatized is likely to lash out at other people, even those who were not involved
with the trauma. Therefore, traumatized LEOs who do not receive treatment for their mental
wellness problems are likely to traumatize others.
According to several studies on police suicidality, marriage has been identified as a
protective factor against suicide ideation and suicide (Berg, Hem, Lau, Loeb, & Ekeberg, 2003;
Casey et al. 2006; Qin, Agerbo, & Mortensen, 2003). This may be because some LEOs feel as
though they cannot give in to suicidal thoughts in order to continue to protect and provide for
their partners and families. Additionally, LEOs’ partners may be able to provide emotional and
psychological support which lessens the loneliness and strain LEOs who cannot discuss their
problems may feel.
32. 25
Mental Health and Physical Health
Mental health problems are often deleterious to the physical health of the sufferer, and in
special populations such as LEOs can affect the ability of the officer to complete their work
(McFarlane, 2013). Law enforcement officers have an increased risk for experiencing coronary
artery disease, diabetes, stroke, Hodgkin's lymphoma, cancer and brain cancer (Gu, Charles,
Burchfield, Andrew, & Violanti, 2011; Kirschman, Kamena, & Fay, 2014). Stress hormones are
secreted by all people when faced with stressful or dangerous situations. Moderate levels of these
hormones are normal and healthy. However, if the level of hormones rises too high, they exert a
physiological toll on the body (Hartley, Fekedulegn, Burchfield, Andrew, & Violanti, 2011).
Cortisol, the hormone associated with stress, can even disrupt the immune and metabolic system
functioning. Among LEOs and other first responders, high cortisol levels are common and have
been found to be accompanied by physical health issues (Hartley et al., 2011). According to the
Centers for Disease Control (CDC), LEOs exhibited higher levels of obesity, metabolic
syndrome, and cholesterol levels than a civilian worker (Hartley et al., 2011). Physical health is
dependent on mental health, and is an essential prerequisite for success and safety in the LEO
field.
Barriers to Mental Health Interventions
Stigma
As with civilians, mental health problems and associated treatments are heavily
stigmatized within the LEO population (Stuart, 2017). This stigmatization was found to extend
even between officers, who may be feeling the same types of mental health problems and
symptoms (Stuart, 2017). In a study by Stuart (2017), it was asserted that organizational factors
play a role in why LEOs are at such high risk for emotional and mental problems. Organizational
33. 26
stressors named in the study point to a culture of resistance and distrust among LEOs and include
concerns about inequitable treatment, malicious or self-protective behavior by supervisors, and
general antipathy towards line officers. Stuart (2017) asserts that LEOs will avoid seeking
professional help for their emotional and mental wellness concerns because they fear being
ostracized, demoted or fired, being shunned or distrusted by fellow officers, or having their
conditions disclosed to their supervisors and made part of their permanent records. This fear is
not unfounded as many officers reported feeling betrayed and alienated when their operational
stress injuries (mental health problems) become known (Stuart, 2017). From another perspective,
officers will avoid time off for mental wellness so as not to be labeled as a malingerer. Both of
these stigmas create an avoidance which prevents LEOs from obtaining treatments and
ultimately will negatively impact prognosis, psychological injury, and workplace costs in the
long term (Wilson & Buckley, 2018).
Police Culture: Theories and Effects
In addition to mental health and wellness problems and its associated stigma, LEOs are
faced with the oppressiveness of the police culture. According to a study by Bell and Eski
(2015), strategies in place which seek to enhance stress prevention and mental health services
ignore the cultural aspect of LEOs. In LEO culture, there is inherent cynicism, lack of empathy,
and “macho” culture (Bell & Eski, 2015) which impedes access to support services. According to
Corrigan (2000), when a LEO fails to meet the social norms of the department, they begin to
question their worth individually and as a part of their team. In the sphere of LEOs, the
masculine values of bravery, independence, and emotional self-control are of paramount
importance (Kirschman, 2007). These values, in turn, facilitate a distrust of outsiders including
those who may be providing psychological services (Karaffa & Tochkov, 2013). According to
34. 27
Evans and colleagues (1993), police culture manifests in maladaptive coping devices, including
depersonalization, authoritarianism, emotional detachment, and substance use as self-medication.
Police culture and traditional masculine culture are both antagonists to LEOs seeking
professional help for their mental health and wellness problems (Papazoglou & Tuttle, 2018).
Police culture is unique in that it utilizes its own tenets, values, beliefs, language, and
subcultures; new members become acculturated immediately after joining the force (Andersen &
Papazoglou, 2014). Police culture is also heavily influenced by the senses of loyalty and
brotherhood between members of the force (Steinkopf, Hakala, & Van Hasselt, 2015). Law
enforcement officers are mandated to protect their communities and often feel that they must be
stronger and braver than civilians. This notion may help them in their survival in their work,
however, may negatively influence LEOs when they begin to be in need of additional
psychological support which cannot be provided by their peers or higher officers. The “us vs
them” mentality is prevalent within LEO culture, and inhibit LEOs from seeking help from
clinicians who may be viewed as adversaries rather than trustworthy allies (Steinkopf et al.,
2015). Law enforcement officers may also view a mental health referral as negative because it
may mean their superior officers view them as incompetent or unable to complete their work
professionally (Steinkopf et al., 2015).
In addition to stereotypes LEOs may hold against the civilians in their community, LEOs
might hold stereotypes against clinicians. Law enforcement officers may feel a lack of trust
towards clinicians or may fear being treated as inferiors or weak if they are vulnerable in front of
the clinician (White, Shrader, & Chamberlain, 2015). Another reason for LEO culture’s dislike
of mental health help is the redundant nature of LEO work and the constant re-traumatization
and exposure to critical incidents and stress (Karlsson & Christianson, 2006). According to
35. 28
Wester and Lyubelsky (2005), LEO culture is largely built on the ethos and value system of
Euro-American, heterosexual, White, male cultural group. Though cultural diversity has
garnered attention within the last 10 years, LEO culture is still based on this masculine ethos,
which is characterized by independence, self-reliance, suppression of emotional expression,
toughness, reinforcing approved behavior, and punishment for behavior outside of the norm
(Addis & Mahalik, 2003; Wester & Lyubelsky, 2005). The idea that men are supposed to
embody only these traits comes with severe cost to those such as LEOs who experience
emotionally and physically traumatic incidents in their daily lives. Law enforcement officers are
culturally banned from help and support seeking behaviors and exposing their needs, which are
perceived as weaknesses (Addis & Mahalik, 2003; Lindinger-Sternart, 2015). This gender-role
conflict lessens the chances of a positive outcome from a LEO being referred to clinicians for
their emotional and psychological trauma because the help-seeking behavior is seen as non-
masculine (Wester, Arndt, Sedivy, & Arndt, 2010). Adherence to traditional gender norms has
been found to impede coping and healthy processing after critical and traumatic events (Pasciak
& Kelley, 2013).
Pragmatic Barriers to LEO Mental Health and Wellness
According to Heyman and colleagues (2018), shame is perhaps the strongest of all
barriers for LEO mental health and wellness seeking behaviors. However, the pragmatic barriers
are also important to consider for LEOs, as they reasonably prevent many officers from
achieving the help they need. Convenience is one pervasive issue which makes LEO mental
health seeking difficult. Many officers work shifts which do not allow for regular mental health
meetings, as clinicians cannot accommodate late night hours or LEOs cannot schedule consistent
36. 29
meeting times (Heyman et al., 2018). Another barrier is the types of healthcare that are provided
by the department, which may not offer accessible mental health care (Stuart, 2017).
Police Brutality and Theories of Police Violence
In recent years, police brutality has come to the forefront of the American consciousness.
This newfound attention is enhanced by the widespread accessibility of cell phones and social
media, although police brutality is nothing new in and of itself. Civilians, primarily civilians of
color, suffer and die at the hands of overzealous police officers who seem to have no regard or
respect for the life and basic dignity of other people (McElvain & Kposowa, 2008; Morin et al.,
2017). Many schools of thought on the cause of police brutality are detailed by Maguire and
Duffee (2015) which discuss the social, organizational, and psychological models which may
explain the origins of police brutality. However, even without theoretical elements to explain its
origins, it is likely that police brutality has some connection to PTSD and other outcomes of
unaddressed trauma (Maguire & Duffee, 2015). As listed by the American Psychiatric
Association (2019), a key symptom of PTSD is emotional reactivity expressed in angry
outbursts, reckless behavior, increased startle response, or difficulty concentrating. While
elements of police culture and undertones of racism may also be catalysts for police brutality,
unmanaged mental illness in LEOs is certainly a troubling element that has long remained
unaddressed (Evans, Coman, Stanley, & Burrows, 1993). It is possible that with increased
support for LEO mental wellness and enforcement of rehabilitative programs for those
experiencing trauma, police brutality and civilian abuse might become less pervasive, thus
making communities safer and rebuilding civilian acceptance of LEOs.
37. 30
Policies
It is evident that there is a great need for support in LEO mental health and wellness, as
well as many barriers to achieving successful care. The most commonly cited barriers include
concerns over confidentiality and fear of potential negative career impacts (Fox et al., 2012).
Other barriers can be traced to LEO culture and the fear of stigmatization from colleagues.
However, one of the most daunting barriers is the absence of centralized mental wellness support
standards, as different healthcare provider networks operate independently across U.S. counties
(Spence et al., 2019).
The ADA is a civil rights law that was implemented in the 1990s and prohibits
discrimination against individuals with disabilities in all areas of public life. Under the ADA, an
individual with a disability includes any person who had a physical or mental impairment which
limits one or more life activities, has a record of a disability, or seems to have an undisclosed
impairment (U.S. EEOC, 2019). The ADA has five titles which relate to different aspect of
public life in which an individual with a disability might be discriminated against. In the interest
of the mandatory FFDEs taken by LEOs after experiencing on-duty trauma, Title I which details
employment rights will be explained.
Title I prohibits all employment agencies, labor unions, private employers, and state and
local government employers from discrimination against individuals with disabilities in the
processes of applying, hiring, firing, promotions, compensation, training, and other areas of
employment (EEOC, 2019). If an employee can perform essential job functions with or without
accommodation, they are qualified for employment and cannot be discriminated against.
Employers are required to make reasonable accommodation for disabled employees if the
accommodation will not impose “undue hardship” on the business. If the accommodation will be
38. 31
significantly difficult to accomplish, or greater than the employer’s financial resources can allow,
an employer is not required to make accommodations as they will lower quality and production
standards. Title I states that employers can request medical examinations of its employees as
long as they are job related and consistent with the business needs of the employer (EEOC,
2019).
Although the ADA prevents employers from requesting medical examinations that are
not consistent with the necessity of the business, mandatory FFDEs are not considered a
violation of the ADA’s business necessity standard by the EEOC (Mayer & Corey, 2016). In the
2013 EEOC v. Steel case, it was ruled that in vocations which exist to advance public safety,
tests which might reduce any risk for unfit employees are justified for the greater good of the
public safety. Under this framework, law enforcement employers are able to consistently
evaluate officers who have been exposed to significant traumas or high-stress assignments which
have a higher risk to impair job functioning even though it might violate the ADA’s guidelines
(Mayer & Corey, 2016).
In the 1986 City of Greenwood v. Dowler case, an appellate court decision was held that
an officer’s attempted suicide was grounds enough to terminate the officer from the workforce
(Mayer & Corey, 2016). As cited by Mayer and Corey (2016), the panel of said court wrote that
law enforcement is:
… not an occupation for the fainthearted, a person with weak nerves, or a person
with questionable emotional maturity. Such unfortunate afflictions go to the very
heart of the qualifications of a police officer. Lack of control and bad judgment
can result in grave consequences…From all the evidence, reasonable people may
conclude (though reasonable people could disagree) that [the officer] had become
39. 32
sufficiently emotionally unstable as to be unreliable as a policeman in stress
situations. (p. 95)
In the 2010 case Brownfield v. City of Yakima, the right of the police chief to order an
FFDE before objective evidence of impairment was collected, was upheld (Mayer & Corey,
2016). This is because the court determined that officers engage in stressful and dangerous
situations daily, and are therefore in the position to do harm if psychological impairment causes
them to act irrationally.
These rulings demonstrate that there is nothing which can ultimately bar an employer
from requiring an FFDE evaluation if the employee’s job affects public safety, if the employee’s
impaired performance might have catastrophic consequences for others, or if the mandated
FFDE is reasonably expected to reduce risk (Mayer & Corey, 2016). This mandate has helped to
create a distrust by police officers of the FFDE and other therapeutic settings which they might
equate with the FFDE (Olson & Wasilewski, 2015a). Due to LEO culture and organizational
structure, this distrust remains pervasive and prevents many LEOs from receiving the help they
need.
The LEMHWA was passed into law in 2018, and calls for research to be gathered on
current practices that support LEO mental health and wellness, and practices which should be
further implemented to support this at-risk population. According to the LEMHWA report, no
agency exists which serves the unique health needs of LEOs (Spence et al., 2019). The
LEMHWA also asserts that a barrier to creating widespread effective programs lies in the lack of
empirical evidence that interventions are actually effective for this population (Spence et al.,
2019). Indeed, lack of evidence on the efficacy of different mental wellness strategies with LEOs
is an issue which prevents the furthering of resource creation and implementation.
40. 33
Interventions
Evidence-Based and Trauma-Focused Interventions
In order to design programs to support law enforcement mental health and wellness, it is
critical to evaluate the risk factors associated with this line of work, where they stem from, and
protective factors which may provide relief (Spence et al., 2019). Due to the stigma associated
with seeking mental wellness resources and distrust for mental health workers, LEOs are likely
to avoid seeking help (Stuart, 2017). There are many types of peer support and processing
groups, individual therapeutic interventions, and recommendations to lessen the trauma
experienced by LEOs (Spence et al., 2019). However, because all LEOs are part of different
departments which have diverse structures and have access to different resources based on their
geographic area and health care plan, it is difficult for practitioners to create standardized
practices and responses to LEO trauma (Stuart, 2017). Additionally, many departments report
not having enough funding for the implementation of new programs and officer resistance to
mental health interventions (Spence et al., 2019).
Despite these many barriers, a number of interventions have been developed to address
LEO mental health and wellness. While LEOs may be resistant to treatments for many reasons,
the government, associated clinicians, and some members of the public understand the
significance of providing care to this special population (Spence et al., 2019). Evidence-based
practices exist which have been proven to reduce the effects of PTSD, depression, and suicidality
exist, and can be tailored to fit this population for the betterment of the officers and of the public
they protect (Spence et al., 2019). These interventions have the potential to be implemented to
departments across the United States and may be more cost effective than replacing LEOs whose
lives have been lost to mental health and wellness problems.
41. 34
Since its development in 1997, critical incident stress debriefing (CISD) has been the
most utilized intervention for trauma exposed first responders, such as LEOs, despite the lack of
evidence supporting its effectiveness (Addis & Stephens, 2008; Devilly & Cotton, 2003). In fact,
the bulk of CISD research questions the efficacy of the practice (Thomas, Burrell, McGurk,
Wright, & Bliese, 2008). Critical incident stress debriefing is a structured session during which
LEOs can debrief with their peers about their emotions and memories related to a traumatic
incident (Bledsoe, 2003). Though Everly and Mitchel (1997) suggest that CISD is applicable any
time within 10 days after the critical incident, typically, CISD is conducted hours after the
critical incident. A trained facilitator is usually present to educate the LEOs on recognizing
symptoms of trauma, giving support, and receiving support (Pasciak & Kelley, 2013). This type
of intervention is heavily used in most departments; however, it has been shown to draw
resistance from LEOs due to their desire to save face in front of colleagues and maintain a stable
demeanor of emotions (Regehr, 2001).
Peer-based support is popular among LEOs due to its anonymous nature, convenience,
and accessibility which does not conflict with shift scheduling. Use of the reciprocal peer support
model, inside knowledge and acceptance of the culture, and the ability to connect to peers, as
well as professionals, is a similarly important determinant of acceptance by LEOs (Copple et al.,
2019). Cop 2 Cop is an example of a reciprocal peer support (RPS) program which was created
for LEOs and has won the trust of many LEOs because it is staffed both by retired officers and
clinicians. The retired officers can offer support and maintain the cultural connection with active
officers, while the clinicians are able to do risk assessments, case management, and resilience
building with LEOs. The RPS model is visible in this example, as the four research-based steps
are maintained including connection and peer presence, information gathering and risk
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assessment, case management and goal setting, and resilience, affirmation, and praise. In this
way, the active LEOs are treated in a way that only understanding peers can provide. According
to Copple and colleagues (2019), the average relationship between peer counselor and LEO is
approximately six months. During this time, the peer counselor can make referrals, gather
information, and encourage resilient behaviors.
Mindfulness-based resilience training (MBRT) has been assessed as a feasible and
acceptable intervention from the viewpoint of LEOs (Christopher et al., 2018). The goal of this
training is to shift the LEO’s relationship to their traumatic experience rather than to alter the
memory of the experience itself, which simply means to help the LEOs process their reactions to
their work experiences. Mindfulness-based resilience training has been shown to improve
psychological health outcomes for LEOs as well as improvements in potential mechanisms
(Christopher et al., 2018). Health outcomes which showed improvement included burnout,
organizational stress, and sleep disturbances. Potential mechanisms which showed improvements
included psychological flexibility and non-reactivity. Mindfulness-based resilience training did
not show any improvements in areas of anxiety, depression, or suicidal ideation. However,
MBRT did show a significant improvement in lessening aggressive behavior among LEOs.
Anger symptoms remained the same as baseline, but the LEO reaction to anger became less
aggressive, which illustrates the goal of MBRT. The largest barrier to MBRT trainings for LEOs
was the changes in scheduling which LEOs experience at a high rate. These changes create a
barrier to mental health and wellness care access, as many practitioners do not have the
flexibility to work with LEO schedules. Adherence to almost all interventions has been found to
be an important factor as a client who does not continue to practice the skills learned in
interventions will not continue to experience positive results (Virgili, 2015).
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Post-traumatic stress disorder can be a debilitating mental health problem if it is not
treated with evidence-based practices (Watkins, Sprang & Rothbaum, 2018). Prolonged exposure
therapy (PET), is based on the emotional processing theory of Foa and Kozak (1986), which
asserts that trauma is not processed at the time of the incident, but is processed later and can
manifest itself in physiological reactions and emotional reactions. Fear structures are an integral
part of this theory and can include representations of the feared stimuli, the fear response, and the
meanings associated with each. When a fear response presents when there is no credible threat,
the fear response has become dysfunctional. Prolonged exposure therapy focuses on changing
the fear structures so that they are no longer dysfunctional, and once again are correctly
associated only with a real threat or real danger. During PET, the fear must be activated, and new
information must be added to the dysfunctional structure to correct it.
Prolonged exposure therapy typically takes between eight and fifteen sessions to
complete, and includes psychoeducation, breath training, in vivo exposure, and imaginal
exposure (Foa, Hembree, & Rothbaum, 2007). The psychoeducation helps the client understand
PTSD, while the breath training is meant to help the client cope during the exposure. In vivo
exposure is used to help the client address the areas or situations they have been avoiding due to
PSTD. For LEOs this may include the site of a critical incident. Imaginal exposure is when the
client recounts the traumatic incident and processes the emotional content of the recounting with
a clinician. Prolonged exposure therapy has been found to be a common and effective practice
across cultures, types of survivor, and length of time between the incidents and the PTSD
symptomology (Powers, Halpern, Ferenschak, Gillihan, & Foa, 2010). Individuals who have
participated in exposure therapy have been shown to have significantly greater reductions in
PTSD symptoms than clients who only attend supportive counseling (Bryant, Moulds, Guthrie,
44. 37
Dang, & Nixon, 2003). This type of therapy is effective, however, it is necessary for the LEO to
work individually with a clinician and may not be cost effective for many departments.
Eye movement desensitization and reprocessing (EMDR) therapy has been proven to
reduce the effects of PTSD. It is a psychotherapy technique which has more than 30 studies
validating its usefulness thus far. The EMDR Institute has shown that after only three 90-minute
sessions, between 84% and 90% of single trauma victims no longer show signs of PTSD (Copple
et al., 2019). These sessions may not be cost effective for departments to implement, but for
LEOs who are suffering from the effects of moderate and severe PTSD, this is a viable option for
rehabilitation.
Conclusion
Despite the numerous occupational risks and stressors which are present in law
enforcement, there are many interventions which are evidence based, and that may reduce the
effects of mental wellness problems for LEOs across the nation (Watkins et al., 2018). When
considering accessibility, it is important to note that many LEOs have built distrust for mental
health professionals due to FFDEs (Stuart, 2017). Exams associated with FFDEs are not
confidential and are perceived to result in negative consequences for LEOs, which creates
resistance for LEOs to seek help from clinicians (Stuart, 2017). Masculine social norms as well
as LEO social norms of emotional infallibility and flawless resilience are important factors to
consider when assessing why the prevalence of LEO mental illness is so high (Bell & Eski,
2015; Corrigan, 2000). Due to the organizational structure and vast differences between
departments, not all officers have the same access to mental health services (DOJ, 2016). Stigma
between LEO peers and stigma from society as a whole against mental illness may also be
barriers to LEOs accessing mental health care (Stuart, 2017). In order to treat LEOs and to
45. 38
provide the much-needed evidence-based care for mental health and wellness, these risk factors
must be accounted for, as well as the financial costs and availability of professionals, to help this
population. With the introduction of legislature which seeks to identify and support evidence-
based mental health and wellness practices for LEOs, it may soon be possible to gain support for
and implement practices which will yield real results for this population (Spence et al., 2019).
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CHAPTER 3
METHODS
Analytic Framework
The following analysis of the LEMHWA of 2018 utilized David Gil’s 1992 analytic
framework as presented in his book Unraveling Social Policy. Sections A, B, and C, of this
framework were used to analyze various aspects of the policy and its effects. Section A
addressed issues which the policy encompasses. Section B addresses the objectives of the policy,
value premises, theoretical positions, target segments, and substantive effects of the policy.
Section C addresses the implications of the policy and the outcomes of the policy being applied.
The abbreviated framework utilized can be found in its entirety in Appendix B.
Sampling
A secondary review of existing literature was used for this policy analysis in order to
analyze the proposed effects of the LEMHWA on the protections for LEO mental health and
wellness. Data sources include government and public agency documents, online data sources,
and academic journals.
Instrument
This study was conducted through the analysis of secondary data, therefore no
measurement tool was necessary in this research.
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CHAPTER 4
POLICY ANALYSIS
This chapter provides an analysis of the LEMHWA of 2018 using David Gil’s (1992)
framework of policy analysis. Since there have been several other organizations and government
agencies attempting to improve LEO mental health and wellness, other legislation and agencies
will be referred to throughout.
Section A: The Issue or Problem Constituting the Focus of the LEMHWA Planning Task
Nature, Scope, and Distribution of the Issue of LEO Mental Health
According to the census data from 2018, there are nearly 800,000 LEOs assigned to
protecting civilians from danger and disaster across these 50 vast and diverse states (Data USA,
n.d.). Though they are charged with protecting vulnerable populations, LEOs themselves may be
considered a vulnerable population due to mental health and wellness concerns which are unique
to this career type and have gone long unaddressed.
Law enforcement mental health and wellness as a concern is not new; however, the
increased concern for mental health and wellness outcomes for first responders gained critical
traction after the tragic events of 9/11. According to Neria, Nandi, and Galea (2008), exposure
intensity is a primary risk factor for negative mental health outcomes among first responders
exposed to tragedy. Although the trauma witnessed and experienced by LEOs in the community
policing setting is not at the scale of the events of 9/11, the compounding of trauma over time
and consistent exposure may result in risk factors that can reach levels more similar to those of
9/11. Additionally, chronic PTSD was found to be associated with increased number of stressors
following 9/11. This finding suggests that even LEOs unaffected by the tragic events of 9/11 are
at risk for chronic PTSD if they are exposed to consistent stressors after a critical incident takes
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place. According to research utilizing the World Trade Center Health Registry, Ghuman and
colleagues (2014) found that among symptomatized individuals affected by 9/11, more than one
third reported having unmet mental healthcare needs. In another study by Cone and colleagues
(2015), this statistic jumps to half, stating that after 10 years, the symptoms of PTSD are still
present and are possibly worsening among 9/11 first responders.
Due to the unprecedented magnitude, the 9/11 attacks had an increased effect on the
mental health of those who were highly exposed, namely, first responders at the site of the attack
(Lowell et al., 2018). In a study by Lowell and colleagues (2018), the longitudinal impact of 9/11
exposure on the prevalence of PTSD in civilian and first responder populations found that
although the rate of PTSD in the general population declined over time, the rate of PTSD among
the exposed first responders shows a substantial increase in prevalence after the first three years.
It is possible, according to Ghuman and colleagues (2014), that increasing rates of PTSD over
time for first responders may be due to cultural factors such as resistance to help-seeking and
underreporting of mental health and wellness needs and concerns. According to the findings of
these longitudinal studies on first responder mental healthcare, needs remain unmet, symptoms
worsen for this population over time, and continuous stressors following exposure to a large-
scale stressor are conducive to increased mental health concerns.
Studies of first responders following 9/11 set an important precedent for concern
regarding and research documenting the serious and untreated mental health impacts among
LEOs (Cone et al., 2015; Ghuman et al., 2014; Neria et al., 2008). The LEMHWA was passed in
2017 in response to growing attention to the alarming rate of LEO suicides and addressed the
broader concerns of mental health as a whole in this population of first responders (Copple et al.,
2019). The findings following 9/11 highlighted LEO frequent exposure to trauma and vicarious
49. 42
trauma as they are the community’s first line of defense against violence and other tragedies.
This vicarious trauma compounded with negative public opinion, work and environmental
stressors, and feelings of seclusion from civilian friends and family contribute to negative mental
health outcomes, including high levels of PTSD and increased suicidality. These outcomes are
negative for LEOs as individuals, for the community they are protecting, and have further impact
with regard to the cost efficiency of the local governments who employ them. Despite the high
human costs, research and interventions related to LEO mental health remained and continue to
remain scant (Fox et al., 2012). The LEMHWA was signed into law in an attempt to propose
cost-effective and evidence-based programs which will improve the areas of concern in LEO
mental health and wellness.
The primary office through which LEO wellness is addressed is through the Community
Oriented Policing Services (COPS) Office. The COPS Office is a part of the U.S. DOJ which
works to advance the practice of community policing throughout the nation’s law enforcement
agencies through information and grant resources (Matthews, 2019). The COPS Office has been
active since 1994 and has invested more than $14 billion towards advancing collaborative
community and police solutions to address underlying contributors to mental health and wellness
problems, change negative and harmful behavioral patterns, and allocate more money towards
the creation of mental health resources (Matthews, 2019). Through use of the COPS program,
the LEMHWA allocated funding for projects that further knowledge regarding officer mental
health and wellness, increase awareness of effective mental health strategies, increase the skills
and abilities of LEOs to address mental health needs, and increase relevant stakeholders for
mental health related programs (Matthews, 2019). The bill specifically prioritized allocations to
50. 43
peer mentoring, project design that will further the recommendations in a LEMHWA report, and
peer-led mental health support programs (Matthews, 2019).
While this law passed without contest, this federal law was preceded by state level
legislation addressing LEO mental health, proposals that were less well received. In 2018,
Oregon state attempted to pass legislation that would provide mental health supports for LEOs
while also addressing barriers to mental health services identified by the research. The Oregon
bill would mandate LEOs to receive therapy twice a year which could not be used as a mental
health evaluation and that they would be provided at the expense of the law enforcement agency
in which they are employed (Oregon SB 1531, 2018). The bill also mandated that any officer
involved in a critical incident, such as a deadly shooting or use of deadly force, attend two
additional therapy sessions which were also to be paid for by the agency which employs them. In
addition, the bill mandated that for the 72 hours following involvement in a critical incident, the
involved officer may only be involved in low-trauma duties, but that their pay or benefits could
not be lowered as a result. This bill would have arguably improved the working conditions of
LEOs by providing them with free therapy twice a year, therapy which would be confidential and
could not be used against them in terms of their employment. These stipulations were in contrast
to FFDEs which mandate non-confidential psychological evaluations in which anything
disclosed can be used against the officer and which have contributed to high levels of LEO
distrust of therapy. The fact that the therapy would be mandatory was intended to reduce the
stigma that LEOs currently have against going to therapy or seeking help from mental health
professionals.
This bill was presented to the Oregon Senate with the support of 11 Democratic and one
Republican lawmaker. Notably, law enforcement representatives were the driving opposition
51. 44
behind this bill. One issue raised was that the proposed bill would pose an extra cost to the law
enforcement agency for which no additional federal funding would be available. Another issue
was that officers may object to participating, may not need the mandated therapy at all, or may
not cooperate enough to benefit from the mandated therapy (“Oregon Legislators Propose,”
2018). According to an article on Law Enforcement Solutions’ site, an advocacy group for
LEOs, many retired or current officers responded to the introduction of the bill with comments
that clearly indicated their negative opinion of the legislation (“Oregon Legislators Propose,”
2018). Comments such as, “what can you expect from Oregon liberals,” (para 8) further illustrate
the fundamental distrust of LEOs with regard to mental health care, and the dichotomy of
political ideologies in regard to mental health and wellness concerns.
However, LEO opposition to these types of proposed mental health and wellness policies
are not uniform. In an opinion piece, Andy O’Hara, a 24-year veteran of law enforcement and
founder of the Badge of Life organization, described the battle for mental health and wellness for
LEOs as a tug-of-war between agencies that feel that mental health and wellness programs are
too costly and unnecessary and those that feel that mental health problems and suicides have
become an epidemic in the field (O’Hara, 2017). O’Hara stated that while peer support is gaining
popularity among agencies, these program types are not enough. Critical Incident Stress
Management (CISM), chaplaincies, and peer support are not comparable to mental health
professionals and therapy for officers who are experiencing PTSD or other mental issues as a
result of trauma (O’Hara, 2017). O’Hara asserted that even LEOs who are not experiencing life
threatening symptoms are often affected by marital or financial stressors and may still benefit
from professional support as part of their normal routine (O’Hara, 2017).
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As is evidenced by the mixed social, political, and economic opinions on mandatory LEO
mental health screenings and therapy, there is no one solution which can satisfy all affected
populations. If therapy, in the case of Oregon Senate Bill 1531, is not mandated, LEOs are likely
never to utilize this resource due to distrust of mental health workers and the mental health
system. If therapy is mandated, LEOs are possibly going to continue resistance and not utilize
the therapy as they could to benefit themselves. Agencies see the need for LEO mental health
and wellness; however, they also remain concerned with the cost of mandated therapies and
treatments for LEOs. And, as supporters of mental health reform for the American people are
largely proposed by Democratic lawmakers, the overwhelmingly conservative LEO population
may refuse based on political bias, regardless of the helpfulness of the propositions. Given the
widespread resistance to mental health and wellness services, particularly in the form of
mandates, the passage of the federal LEMHWA can be viewed as a significant move forward.
Causal Theories Concerning LEO Resistance to Mental Health Services
One major issue which perpetuates LEO resistance to accepting mental health and
wellness care is the culture of law enforcement agencies (Bell & Eski, 2015). The main theories
applicable to this law encompass how and why LEOs developed and continue to have a distrust
of mental health workers and disclosing the need for mental health and wellness support in their
professional lives. These niche cultural theories are relevant in many spheres; however, in law
enforcement they are particularly important to consider due to the unique nature of this career.
As discussed throughout the LEMHWA Report to Congress, police culture and social
norms are the main determinants as to why LEOs do not seek mental health support (Spence et
al., 2019). According to a study by Bell and Eski (2015), the cultural aspects of the law
enforcement profession are often ignored in planning for programs which may be implemented
53. 46
to benefit this population. This assertion is validated through the LEMHWA Report to Congress,
in which cultural training for mental health workers is supported as an integral part of working
with the LEO population more successfully (Spence et al., 2019). Evans, Coman, Stanley, and
Burrows (1993) also assert that police culture itself manifests in the maladaptive coping
mechanisms which perpetuate LEO mental health and wellness issues. Bell and Eski (2015) posit
that “macho culture,” cynicism, and lack of empathy are endemic to the culture of policing,
which can certainly be seen as a limitation in accessing this population. Therapeutic
interventions to support increased mental health and wellness require a certain emotional
vulnerability which may not be achievable for a population which has to cut itself off from
vulnerability in order to protect themselves physically and emotionally from the trauma of their
jobs. The social norms present in law enforcement typically do not allow for vulnerability or the
disclosure of needing support, as these are seen as behaviors indicating weakness. Law
enforcement officers who identify themselves with the in-group report significantly less
occupational stress than the out-group officers. Potentially, the subculture of LEOs can be
considered a protective factor from occupational stressors (Rose & Unnithan, 2015). However,
according to Corrigan (2000), any deviation from the norm can result in a LEO becoming
ostracized from their peers and questioning their self-worth.
According to Kingshott, Bailey, and Wolfe (2004), entitlement theory can be used as a
lens for evaluating why LEOs develop impairments in their ability to empathize with others.
Kingshott and colleagues (2004) posit that the developmental entitlement theory is relevant in
the development of police attitude because it influences LEO outlook on others as well as self-
concept. One of the two basic entitlement working models states that a person cannot expect
others to care about them, which in turn implies that that person is unworthy of care. This is
54. 47
called under-entitlement, and it is reinforced from the moment a LEO enters the academy and is
perpetuated by the culture. Kingshott and colleagues (2004) state that LEO coping skills and
mental health are directly related to their sense of entitlement or lack thereof. These authors posit
that a person with a healthy sense of entitlement would not feel ashamed or weak in asking for
help and additional support in times of stress.
Beginning with the first moments of training, under-entitlement is reinforced by the
hierarchical militaristic style of the academy, including verbal harassment, humiliation, and
punishment for evidence of weakness (Kingshott et al., 2004). Additionally, in the academy,
LEOs must relinquish any appearance of personal identity which includes having the same
physical appearance as their peers and not calling attention to any unique skill other than those
related to law enforcement. When a LEO graduates from the academy and assumes a role over
the new cycle of recruits, the dysfunctional system of under-entitlement and power-over model
perpetuates. Officers are raised with emphasis to loyalty to the group which implicitly demands
that LEOs deny their personal needs and feelings for the good of the group as a whole. As LEOs
move from a place of under-entitlement to a place of over-entitlement, many seek to establish a
false sense of power by overpowering others. Kingshott and colleagues (2004) assert that over-
entitled people seek out the weakest and most vulnerable to hold their power over, which can
often be their spouses or children, suggesting the reasons why rates of domestic violence are high
among this population.
The other population that is affected by the over-entitlement of LEOs is those they
protect and serve. Kingshott and colleagues (2004) posit that over-entitlement causes LEOs to
target groups of socially under-entitled peoples such as ethnic minorities or women. Police
culture is fraught with implicitly agreed upon hierarchies of “others” in society which promotes
55. 48
some people to a place of power while others are forced to the bottom of the social hierarchy.
For LEOs the emotional inner self is neglected, causing emotional deficits as LEOs’ needs for
support and safety are not met. Dysfunctional manifestations of LEO stress are visible across
many studies and include physical and psychological symptoms (Bell & Eski, 2015; Kingshott et
al., 2004; Kupers, 2005). The most notable symptoms include cynicism, suspiciousness,
emotional detachment, reduced efficiency, absenteeism and early retirement, excessive
aggressiveness, alcoholism and substance use disorders, marital or family problems, and
domestic violence (Violanti et al., 2009). When analyzed from the viewpoint of entitlement
theory, it is evident that officers who are acting out have been affected by a history of under-
entitlement and have shifted unstably into a role of over-entitlement. Even if LEOs wanted to
reach out for help, their culture prevents them from doing so and their emotional needs continue
to go unmet (Kingshott et al., 2004).
Another cultural trait common among LEOs is “toxic masculinity,” or the amalgam of
socially regressive male traits which foster domination, homophobia, devaluing of women, and
violence. According to Connell (1987), the contemporary hegemonic masculine standard is
supported by two pillars: the hierarchy of internal dominance, and stigmatization of non-
masculine traits. Kupers (2005) asserts that the current version of hegemonic masculinity present
in American society is one which includes ruthless competition, inability to express emotion
other than anger, unwillingness to admit dependency or weakness, and the devaluation of
feminine traits in men. In instances where men are in close working proximity to one another,
such as in the male dominated realm of law enforcement, a “male-code-of-conduct” tends to
proliferate (Kupers, 2005). As with the entitlement theory, the effects of toxic masculinity as an
integral part of the LEO culture that creates a division among officers who are considered strong
56. 49
and officers who are considered weak, such as those who ask for and accept help in times of
stress or emotional fragility.
Another important factor that may affect LEO culture is the social perception of police
officers in the larger American culture. Police are often portrayed as stoic, no-nonsense, heroic,
recklessly tough, and as “lone-wolves” (Mason, 2010). These portrayals of LEOs are present
across all forms of media and influence the understanding of LEOs beginning as early as in
childhood. Due to cultural portrayals, civilians who become law officers may in fact adopt
personality traits they associate with the media portrayal of LEOs that to which they have grown
accustomed (Mason, 2010). The adopted attitudes may also be reinforced in LEOs by their
superior officers, militaristic training, and peers to the point where the attitude has become
ingrained as a core characteristic of the career (Mason, 2010). The related lesson in the Stanford
prison experiment is not that all humans are likely to descend into tyranny, but that certain
institutions and environments demand and change certain behaviors of people (Smith & Haslam,
2012). In terms of the roles of police officers, there are certainly social ideals about police
officers themselves which may inform the way officers act and react in real life. According to
Zimbardo, “the mere act of assigning labels to people, calling some people prisoners and other
guards, is sufficient to elicit pathological behavior” (Smith & Haslam, 2012, p. 129). In the
context of policing, embodying the label of “LEO” can influence that person to elicit certain
behaviors they might not otherwise exhibit as a civilian. Law enforcement officers consider
themselves to be the “thin blue line” between lawful good and chaotic anarchy. This division
from both the good and bad of society may be one example of how officers begin to embody the
demands of the job. Adhering to other portrayals as part of police culture may influence why
LEOs reject help and support from peers and outsiders regarding their mental wellness.
57. 50
Traditional portrayals of LEOs do not allow for any type of weakness, physical or mental
(Mason, 2010).
Stigmatization is yet another cultural barrier that LEOs face in addressing their mental
health and wellness problems. Although civilians experience mental health stigma in their daily
lives, LEOs experience increased stigma in their workplace (Stuart, 2017). With stigma extended
between officers who may be suffering the same mental health and wellness concerns, it has
been asserted that the organizational structure of law enforcement agencies plays a role in
distrust for mental health workers (Stuart, 2017). Stressors within the workplace related to
mental health emphasize a culture of resistance to mental healthcare. Officers often express
concerns about inequitable treatment, malicious behavior by supervising officers, and general
antipathy towards line officers. Stuart (2017) asserts that LEOs avoid seeking mental healthcare
because they are fearful of being ostracized, fired, demoted, shunned, or distrusted by their peers.
In a career where masculinity and stoicism are valued so highly, and officers rely on their tightly
knit enclave, it is understandable that an officer might rather be unwell than ostracized from their
only source of community (Stuart, 2017).
Section B: Objectives, Value Premises, Theoretical Positions, and Effects of the LEMHWA
LEMHWA Objectives
The LEMHWA of 2017 was written to address the poorly researched and resourced
support of mental health and wellness of LEOs in America, as well as to expand access to mental
health and wellness support for LEOs in an effort to provide a better quality of life, better
performance, as well as a prolonged workplace effectiveness (LEMHWA, 2017). The
LEMHWA first called for the DOJ to submit a report to Congress on the mental health practices
and services used by the U.S. Department of Defense and Veterans Affairs as a model for
