Most police officers never seek mental health care, despite apparent need

Routine mental health screening of police officers may be warranted in law enforcement agencies, according to results of a survey study published in JAMA Network Open.

“Evidence suggests that exposure to law enforcement work is associated with increases in many forms of stress, including physical, psychosocial and anticipatory stress,” Katelyn K. Jetelina, MPH, PhD, of the department of epidemiology, human genetics and environmental sciences at the University of Texas Health Science Center, and colleagues wrote. “Officers are exposed to traumatic calls for service on a daily basis, including child abuse, domestic violence, car crashes and homicides. Repeated exposure to these stressors and events may be associated with development of mental illnesses, such as anxiety, depression, somatization, [PTSD] and burnout.”

Results of a prior study showed that twice as many police officers died by suicide vs. dying in the line of duty in 2018. However, research is sparse regarding patterns and barriers of mental illnesses and characteristics of officers who express interest in seeking help.

Jetelina and colleagues sought to evaluate mental illness prevalence and symptoms, as well as the characteristics of officers interested in seeking mental health care, and to describe mental health care use perceptions via surveys and focus groups among 434 officers from a single large police department. Participants reported current or lifetime diagnosis of anxiety, depression, PTSD, as well as current mental health symptoms and mental health care use in the past 12 months. The researchers collected focus group data to provide context to mental health care use.

Results showed 17% of participants sought mental health care services in the past 12 months, 12% reported a lifetime mental health diagnosis and 26% had positive screening results for current mental illness symptoms. The odds of interest in using mental health services among officers who screened positive was significantly higher for those with suicidal ideation or self-harm compared with those who had neither (adjusted OR = 7.66; 95% CI, 1.7-34.48).

The researchers also reported results of five focus groups that included 18 officers, and these identified four primary barriers in mental health service access: inability of an officer to identify when they were experiencing a mental illness; concerns regarding confidentiality; belief that psychologists were unable to relate to their occupation; and the notion that officers who seek mental health services may be unfit for duty.

“Future studies should aim to achieve a more nuanced understanding of the types of treatment sought by officers, which would be helpful to inform innovative care delivery strategies that are tailored to officers in the future,” Jetelina and colleagues wrote. “Future

interventions and, potentially, broader screening policies in law enforcement agencies appear to be needed to systematically identify and refer officers to health care services while mitigating their concerns, such as potential breach of confidentiality.”

In a related editorial, John M. Violanti, PhD, of the department of epidemiology and environmental health at the University of Buffalo in New York, emphasized the importance of addressing mental health barriers for police officers.

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