Critical incident stress in law enforcement.

A patrol officer observes a car with three teenagers speed through a rural intersection. The officer pulls out in an attempt to stop the vehicle, knowing that at its current speed, the car cannot navigate the series of sharp turns coming up in a few short miles.

The driver accelerates out of the officer's range of sight. The officer slows to round the first curve and hears screeching brakes, followed by a sickening thud and the crunch of crumpling metal. As the wreck comes into view, what the officer sees confirms what the sounds reported: The driver lost control of the vehicle and careened off the road. The car smashed into a tree before coming to rest on its side several yards down the embankment.

The officer immediately calls for assistance, parks the cruiser, and runs toward the car. Two of the occupants were thrown from the vehicle when it flipped over. The veteran officer momentarily freezes in horror as he recognizes them--his daughter's high school classmates. He feels sick seeing their broken, bloody bodies lying lifeless in the muddy weeds. Fearing the worst, the officer rushes to check the victim trapped inside the crumpled wreck. His brief sigh of relief that his own daughter was not in the car quickly vanishes as he sees her best friend, crushed in the wreckage. No one survived. "If only I could have stopped them," he thinks, shaken, while he waits for the ambulance to arrive.

The officer suffers no physical injury as a result of this incident, but the emotional trauma can be just as painful, if not more so. The actions taken by the department in the ensuing weeks and months will determine in large part whether he copes effectively with the stress induced by this critical incident or whether its effects become debilitating.

Every year, hundreds of officers experience intense, traumatic events that can have serious long-term consequences for them, their families, and their departments. It is incumbent upon police administrators to ensure that their officers and their departments have the tools at hand to cope with such critical incidents.

Critical Incidents

In the past, most studies of stress in law enforcement focused exclusively on post-shooting trauma. Recently, however, the research has expanded to encompass stress induced by other traumatic events, collectively known as critical incidents. A critical incident is any event that has a stressful impact sufficient to overwhelm the usually effective coping skills of an individual.

Critical incidents typically are sudden, powerful events that fall outside the range of ordinary human experiences. Because they happen so abruptly, they can have a strong emotional impact, even on an experienced, well-trained officer.

In law enforcement, any situation in which an officer's expectations of personal infallibility suddenly become tempered by imperfection and crude reality can be a critical incident.(1) Such events include a line-of-duty death or serious injury of a coworker, a police suicide, an officer-involved shooting in a combat situation, a life-threatening assault on an officer, a death or serious injury caused by an officer, an incident involving multiple deaths, a traumatic death of a child, a barricaded suspect/hostage situation, a highly profiled media event (often in connection with another critical incident), or any other incident that appears critical or questionable.

The definition of a critical incident must remain fluid because what affects one officer might not affect another. An officer who has children, for example, might be affected by responding to the death of a child more than an officer who has no children. In addition, the circumstances of an event, the personality of the officer, and the way the event is handled by the department, the media, and the officer's family all affect the officer's reactions to an incident.

Critical Incident Stress

Many U.S. soldiers returned from war "shell-shocked" and suffering from the effects of critical incident stress, often referred to as "battle fatigue." In 1980, the American Psychiatric Association formally recognized the civilian version of battle fatigue, which became known as post-traumatic stress disorder (PTSD).

Post-traumatic stress is defined as "...the development of characteristic symptoms following a psychologically distressing event that is outside the range of human experience."(2) Symptoms are characterized by intrusive recollections, excessive stress arousal, withdrawal, numbing, and depression. The signs and symptoms must last more than 30 days for an individual to be diagnosed with PTSD. An estimated 4 to 10 percent of individuals who experience a critical incident will develop a full-fledged post-traumatic stress disorder.(3)

Research also has shown that critical incident stress affects up to 87 percent of all emergency service workers at least once in their careers.(4) In many cases, the stress from one incident can be compounded by two or more factors. For example, an officer involved in an armed confrontation exchanges gunfire with a suspect. The officer is wounded, the suspect dies, and the incident becomes a media event. The injury to the officer, the use of deadly force, and the media scrutiny--conceivably three separate critical incidents--multiply the stressors on the officer.

Critical incident stress manifests itself physically? cognitively, and emotionally. The officer might experience some or all of these reactions immediately, or perhaps not until after a delay. While in most instances the symptoms will subside in a matter of weeks, a few of those affected by such stress will suffer permanent emotional trauma that will adversely affect their continued value to the department and cause serious problems in their personal lives.

Administrative Support

Clearly, administrators can no longer afford to ignore the issue of traumatic stress caused by involvement in a critical incident. Such stress impairs officers' ability to perform their duties and impacts on the operation of the department.

Police agencies can be held liable in court for ignoring lingering stress-related problems or for disciplining workers who exhibit the behavioral effects of trauma from a job-related critical incident. Courts have made significant cash awards to officers whose departments did not provide them with professional assistance. Thus, it is in the best interests of police administrators to identify stressful situations and address their effects early. Failure to do so could prove detrimental to the department, not only operationally but also financially.

The most important aspect of managing critical incident recovery is for the administration to understand that police duties can result in psychological injury. Departments should be proactive and develop a critical incident response that addresses the likelihood of psychological injury with the same attention and concern as the likelihood of physical injury. Critical incidents can inflict mental harm just as they inflict physical wounds.

Administrators should design policies and standard operating procedures for officers involved in critical incidents. Well-planned intervention programs can prevent bad relations between the department and affected employees, reduce compensation costs from potentially divisive litigation and, in turn, build morale and make employees feel valued by the department.

Unfortunately, police officers typically resist seeking available assistance because they do not want to be stigmatized as weak or crazy. By mandating a visit to a mental health professional, administrators provide officers the opportunity to express themselves and ask questions without appearing to seek help. Still, officers have the option of remaining silent while the mental health professional provides information about critical incident stress.

Budgetary Impact

One law enforcement expert stated that 70 percent of the police officers who use deadly force leave law enforcement within 5 years.(5) The impact, therefore, of an overstressed officer can be far reaching. Stress affects the officer, other employees, the department, the public, and the officer's family. It can lead to faulty decisionmaking, disciplinary problems, excessive use of sick leave, tardiness, on-the-job accidents, complaints from citizens, and high officer turnover. All of these cost the department time and money.

It costs a department approximately $100,000 to replace a 5-year veteran. This figure includes the expenses of retraining, overtime, benefits, testing for replacements, and knowledge that is lost when an officer leaves the department.(6)

In contrast, one study showed that the average cost of intervention when PTSD was detected soon after the event totaled $8,300 per victim. When detection and treatment were delayed, the average cost rose to nearly $46,000. Even though that is almost six times more than the cost of early treatment, it still is less than half the cost of replacing an officer.

As a group, employees who received prompt treatment averaged 12 weeks of recovery before returning to work and had a low incidence of permanent disability. In comparison, the delayed treatment groups required an average of 46 weeks of recovery and displayed significant long-term effects.(7)

These figures represent costs incurred when employees actually developed PTSD subsequent to a traumatic work event and do not include the money spent in cases where less serious secondary trauma occurred. In addition, the computed cost of an intervention program also should take into account the number of victim-survivor employees who did not develop PTSD as a result of the treatment approach.

Clearly, the expense of a few sessions for everyone involved in an incident, especially if conducted as a group, would be significantly less than long-term treatment and/or disability leave for those significantly involved few. Preventive intervention, then, appears to be less expensive than waiting until psychological injuries deteriorate to the point where personal and occupational life suffers.

In some larger cities, full-time psychological services units or police psychologists might already be in place. For those departments that do not employ a full-time mental health professional (i.e., counselor, psychotherapist, psychologist, or psychiatrist), such services can be contracted or retained on a per-hour or per-incident basis. It is a minimal expense and a wise investment for administrators to secure the services of a mental health professional and train peer support officers.

Pre-incident Stress Education

Perhaps the most important element of combating critical incident stress is pre-incident stress education. Providing education before a crisis strikes helps to reduce the impact of traumatic events. Educated officers who later become involved in critical incidents generally are better able to avoid or at least control stress reactions. Pre-incident stress education helps officers recover from acute stress reactions better because they recognize the symptoms early and seek assistance more quickly.(8)

Stress management training should begin with new recruits, who generally accept the message that they are vulnerable and need to take precautions to control stress. In addition, all police officers should receive stress management training as part of inservice or recertification programs. Command personnel should learn how to recognize officers exhibiting symptoms of stress so that intervention can take place early.

Pre-incident stress education should be provided by the people with whom an officer will be dealing in the event of a critical incident--the department's peer support officer and the mental health professional employed by the department. This essential introduction provides the foundation for building the trust and rapport that will come into play later between an affected officer and the assistance providers.

Peer Support

Generally speaking, law enforcement officers have been slow to recognize the positive contribution that can be made by mental health professionals. Police officers often have difficulty trusting and confiding in someone outside the close circle of sworn personnel. They also fear that seeking professional help in dealing with a traumatic event will mark them among their coworkers as incapable in some way. To counter such resistance, while still getting help for officers who need it, many police departments have established peer support programs.

Peer support officers are trained to recognize problems and make the appropriate referrals. Peers learn basic counseling skills. They use a client-centered approach that builds a climate of trust through empathy, genuine concern, and an unconditional positive regard for the employees seeking help.

Often, the most important function of a peer support officer is simply to act as a sounding board for troubled officers. Peers provide a safe place for troubled officers to ventilate and to begin to understand and articulate their feelings in a confidential, nonjudgmental environment. In a few minor instances, no other assistance is needed. With critical incidents, however, officers have problems beyond the abilities of the peer, who refers them to the appropriate mental health professional.

Peer support officers do not conduct any clinical therapy; only trained and certified professionals who are insured against malpractice can provide therapy and determine the proper course of treatment for an affected officer. Peer support officers work under the supervision of a mental health professional to ensure that officers who need help get it.

Police administrators should take several factors into account when choosing peer support officers. Selected individuals should exhibit a genuine willingness to help their coworkers. They must be trusted and respected within the ranks. Racial diversity, gender, and multicultural issues within the department also should be considered. The size of the department would determine how many peers to train.

Officers who personally have been involved in a critical incident and have successfully resolved their problems provide an excellent pool of candidates for the peer support team. Not only can they empathize but they also can relate to a troubled officer.

Support officers, however, must be strongly cautioned on the issue of counter-transference. This develops when peers begin to over-identify on both a personal and a professional basis with the officers being helped.

Peers must be prepared to navigate the difficult course of showing sufficient caring, understanding, and empathy without becoming overwhelmed by the familiarity of any given critical incident. Peer support officers need to remember the basic techniques of listening in order to be effective helpers and to let the officers involved in critical incidents express their own emotions.

Mental Health Professionals

Delivering mental health care to members of the law enforcement community is difficult. Police officers often resist counseling for several reasons. Frequently, they have a strong sense of self-sufficiency and insist that they can solve their own problems. Officers generally possess great skepticism of outsiders and have difficulty trusting counselors. At the same time, counselors sometimes do not understand police work, nor can they easily grasp the daily stresses faced by officers. For these reasons, law enforcement administrators must choose mental health professionals carefully and work to ensure that they provide the best service for the department's employees.

Counselors must have a thorough understanding of policing, as well as comprehensive knowledge of the police force and its demographics. They must be familiar with the organization of the police department and its power structure so they can understand the work environment of affected officers.

Because of their background and experience, some mental health professionals find it hard to understand who the law enforcement officer is and what the occupation entails. For example, police officers often are seen as having a warped sense of humor, sometimes referred to as "gallows humor."(9) The condition results from the many negative aspects of human nature that confront officers on a regular basis.

Officers use humor to vent anger and frustration. Those outside of law enforcement might see it as sarcastic, callous, and insensitive. They may even have problems empathizing with those in public safety. Sensing this, the police officer in turn might refuse to trust or confide in the counselor, thus defeating any chance for effective therapy to occur.

When mental health professionals start to work with law enforcement officers, they soon discover that the officers evaluate them as much as they evaluate the officers. Often, the officer-patients might want to know about the counselors' familiarity with policing, their opinions of police officers, and their previous work with police personnel. Counselors must be cautioned not to display anger or annoyance at the officers' apparent lack of trust. Instead, they should work to establish a relationship based on mutual respect.

An important dynamic in the relationship between officers and mental health professionals is that officers often fear being betrayed. Self-disclosure frequently intimidates them because of what it might reveal about themselves. More intimidating is the fear that counselors will divulge what the officers share with them.

Building rapport and assuring officers of the confidentiality of the information revealed take time and diligent effort on the part of the mental health professionals. Only by taking this time will the therapeutic effects of counseling be realized.

Family Reactions and Support

Some incidents in the careers of police officers leave a profound effect not only on the involved officers but also on their family members. Side effects of traumatic events might surface at home in the form of anger, depression, frustration, grief, insecurity, confusion, and disillusionment. Family members frequently become the convenient targets of officers' misplaced emotions.

In addition, the families of officers involved in critical incidents might show similar signs of stress. Spouses might adopt the roles of either supporter or victim. Frequently, they find themselves alternating between those roles, at times being able to support and nurture the officer, while at other moments feeling terribly vulnerable, alone, and in need of support themselves. As the children of officers who suffer from post-traumatic stress disorder mature, they also might exhibit the same fears, emotions, and cynical attitudes as their affected parent.

To help officers and their families prepare for the stress of a critical incident, a "significant other" stress course can help. Conducted when officers first enter the department and again periodically during the course of their careers, such a course can allow spouses to feel less excluded and to gain valuable insights into the behaviors and reactions of their loved ones.

Families need support and intervention, and they must not be forgotten. While conceivably few municipal authorities would endorse police departments providing counseling for family members, police administrators might consider referring families to mental health professionals familiar with police-related issues.

Conclusion

No one can predict how powerful an incident will be or what effects it will have on them. It is incumbent upon police administrators to prepare their employees for such incidents by teaching them the signs and symptoms of critical incident stress and establishing policies that enable them to get help when they need it.

The officer who responded to the terrible accident described earlier need not succumb to the debilitating effects of critical incident stress. With the proper support from his department and counseling from a certified professional, he and his family will learn to deal with the trauma, and the department likely will keep a valued employee.

Endnotes

(1) W. Fowler, "Post Critical Incident Counseling: An Example of Emotional First-aid in a Police Crisis," in Psychological Services for Law Enforcement, eds., J. Reese and H. Goldstein (Washington, DC: U.S. Government Printing Offices, 1986). (2) Diagnostic and Statistical Manual of Mental Disorders, 4th ea., rev. (Washington, DC: American Psychiatric Association, 1994). (3) R. Blak, "Critical Incident Debriefing for Law Enforcement Personnel: A Model," in Critical Incidents in Policing, eds., J. Reese, J. Horn, and C. Dunning, rev. ed. (Washington, DC: US Government Printing Office, 1991), 23-30. (4) T. Pierson, "Critical Incident Stress: A Serious Law Enforcement Problem," The Police Chief February 1989,32-33. (5) Jerry Vaughn, former director of the International Association of Chiefs of Police, quoted in J. Horn, "Critical Incidents for Law Enforcement Officers," in Critical Incidents in Policing, eds., J. Reese, J. Horn, and C. Dunning, rev. ed. (Washington, DC: U.S. Government Printing Office,1991),143-148. (6) R. Fuller, "An Overview of the Process of Peer Support Team Development," in Critical Incidents in Policing, eds., J. Reese, J. Horn, and C. Dunning, rev. ed. (Washington, DC: US Government Printing Office,1991),99- 106. (7) R. Freidman, M. Framer, and D. Shearer, "Early Response to Post Trauma Stress," EAP Digest, February 1988, 45-49. (8) S. Miller and A. Birnbaum, "Putting the Life Back Into `Life Events:' Toward a Cognitive Social Learning Analysis of the Coping Process," in Handbook of Life Stress, Cognition and Health, eds., S. Fisher and J. Reasons (New York: John Wiley and Sons, 1988). (9) M. Silva, "The Delivery of Mental Health Services to Law Enforcement Officers," in Critical Incidents in Policing, eds., J. Reese, J. Horn, and C. Dunning, rev. ed. (Washington, DC: US Government Printing Office, 1991), 335-342.