Critical Incidents, Substance Abuse, and Suicide: Hidden Risks in the Line of Duty

1. Critical Incidents, Substance Abuse, and Suicide: Hidden Risks in the Line of Duty Dennis H. Sandrock, PhD CFG HealthSystems, LLC Marlton, NJ

2. East Jersey State Prison(Rahway)

3. A.C.S.U. EJSP

5. New Jersey State PrisonTrenton, NJ

6. Points to Cover Types of traumatic responses Review type/incidence of critical incidents Risk of suicide Review health risks to staff Case Discussions A shift in attitude Methods to intervene Recommendations

7. Body’s Response to Stress Fear Response Fight or Flight Stress Response Autonomic Arousal Crisis Reaction A series of biological reactions to a perceived threat

8. Body’s Response to Stress Increase heart rate Increase blood pressure Increase respiration Decrease peripheral blood flow Increased perspiration Designed to protect you from danger

9. Traumatic Event An incident outside the normal range of human experience (APA, 2015) This definition loses traction when applied to law enforcement. Witness to another’s trauma is traumatic

10. Core symptoms of PTSD PTSD symptoms are divided into four separate clusters: Re-Experiencing. Re-experiencing, or reliving, the traumatic event. Intrusive Avoidance. Actively avoiding people, places, or situations that remind you of the traumatic event includes these symptoms. Numbing Hyperarousal. Hypervigilance, exaggerated startle Negative Thoughts and Beliefs

11. Intrusive memories Recurrent, unwanted distressing memories of the traumatic event Reliving the traumatic event as if it were happening again (flashbacks) Upsetting dreams or nightmares about the traumatic event Severe emotional distress or physical reactions to something that reminds you of the traumatic event

12. Avoidance Symptoms of avoidance may include: Trying to avoid thinking or talking about the traumatic event Avoiding places, activities or people that remind you of the traumatic event Alcohol and drug use Feeling emotionally numb Lack of interest in activities you once enjoyed

13. Hyperarousal/Hypervigilance Being easily startled or frightened Always being on guard for danger Self-destructive behavior, such as drinking too much or driving too fast Trouble sleeping Trouble concentrating Irritability, angry outbursts or aggressive behavior Overwhelming guilt or shame

14. Negative changes in thinking and mood Negative thoughts about yourself, other people or the world Hopelessness about the future Memory problems, including not remembering important aspects of the traumatic event Difficulty maintaining close relationships Feeling detached from family and friends Difficulty experiencing positive emotions

15. Two types of trauma experiences Acute, single incident Chronic, ongoing PTSD symptoms can be immediate or delayed

16. Exposure to Critical Events In one survey of 193 police officers from small and midsize police departments, officers reported the number of critical events that they had witnessed during the course of their career. The average number of events witnessed by officers was 188 (Chopko, Palmieri, and Adams, 2015).

17. Critical Incidents in the Law Enforcement Profession (Chopkoet al., 2015) • Mistake that injures / kills colleague • Mistake that injures / kills bystander • Colleague killed intentionally • Colleague killed accidentally • Being taken hostage • Being seriously beaten • Being shot at • Colleague injured intentionally • Kill or injure in the line of duty • Badly beaten child • Sexually assaulted child • Trapped in life-threatening situation • Severely neglected child • Threatened with a gun • Your loved ones threatened • Seriously injured intentionally • Life-threatening man-made disaster • Exposed to AIDS or other diseases • Colleague injured accidentally • Shoot at suspect without injury • Threatened with knife / other weapon • Mutilated body or human remains • Life-threatening natural disaster • Life threatened by toxic substance • See someone dying • Making a death notification • Being seriously injured accidentally • Life-threatening high speed chase • Sexually assaulted adult • Animal neglected, tortured, killed • Decaying corpse • Life threatened by dangerous animal • Body of someone recently dead • Badly beaten adult

18. Mental Health Outcomes

19. Work Setting and PTSD Caterina Spinaris is a psychologist who, in 2003, founded Desert Waters to study and provide relief for corrections officers’ mental health. A 2013 study she conducted among corrections officers found that 31 percent of them suffered from PTSD, more than four times the national average and on a par with veterans returning from armed conflict. Some 17 percent were suffering from both PTSD and depression.

20. Desert Waters Correctional Outreach

21. Rate of Depression in COs In one survey of 220 corrections officers, researchers identified a depression rate as high as 31%(Obidoa, Reeves, Warren, Reisine, & Cherniack, 2011). This figure is astounding in light of the 6.7% prevalence rate in the general population (National Institute of Mental Health, 2017).

22. Headlines News Why are suicide rates so high among corrections officers? By Associated Press January 9, 2018 | 10:34pm | Updated PTSD, Depression, Suicide, and Divorce are Highest Among Correctional Officers.

24. Suicide Rates of Law Enforcement Officers versusMales 25-64 years, New Jersey, 2003-2007(NJSP Suicide Task Force, 2009) Annual Suicides Population Crude Rate (per 100,000) Current LE 7.4 40,000 18.5 Corrections only 2.4 6,900 34.8 Police only 5 33,200 15.1 New Jersey Total population 536 8,700,000 6.2 Males 25-64 years 322 2,300,770 14.0 *Average 2003-2007; excludes retired officers and officers on disability. ***Law enforcement population data from 2006 UCR

25. Main components of suicide risk Fearlessness of pain or death Perceived burdensomeness Thwarted belongingness Significant substance abuse Adapted from T. Joiner, 2016

26. Correctional Officers (COs) have the second highest mortality rate of any occupation. 33.5% of all assaults in prisons and jails are committed by inmates against staff. A CO’s 58th birthday, on average, is their last. A CO will be seriously assaulted at least twice in a 20 year career. On average a CO will live only 18 months after retirement. CO’s have a 39% higher suicide rate than any other occupation, And have a higher divorce and substance abuse rates then the general population. Sources: “Stress Management for the Professional Correctional Officer”, Donald Steele, Ph.D., Steele Publishing 2001 “Corrections Yearbook 2000, 2002”, Criminal Justice Institute, Middletown, CT “Sourcebook of Criminal Justice Statistics 2003”,

27. Centers for Disease Control and Prevention Researchers compared several health indicators between a cohort of police officers and the general American population. The study found that “a higher percentage of officers were obese (40.5% vs. 32.1%), had a metabolic syndrome (26.7% vs. 18.7%), and had higher mean serum total cholesterol levels (200.8 mg/dL vs. 193.2 mg/dL) than the comparison employed populations (Hartley, Burchfiel, Fekedulegn, Andrew, & Violanti, 2011). With physical health so dependent on mental health, we are doing ourselves a disservice by ignoring the mental health crisis among first responders.

28. Time to Re-focus Craig Steckler, the President of the International Association of Chiefs of Police, “Officer mental health is an issue of officer safety, and we should treat it as such. From body armor and seatbelt use policies, to self-defense and verbal judo training, we can all list a variety of measures available to ensure our officers’ physical safety. But what are we doing to actively protect and promote their mental and emotional health? Sadly, in many cases, it is not enough.” (IACP, 2014)

29. Federal Recognition In January of 2018, President Trump signed into law the Law Enforcement Mental Health and Wellness Act. This law provides funding for peer mentoring programs, designed to enable law enforcement officers to get help from those who truly understand their experiences – their law enforcement colleagues. The law also calls for an evaluation of the effectiveness of other initiatives, including crisis hotlines and mandatory mental health wellness checks. This is a critical step in the right direction, as it explicitly addresses pragmatic barriers by providing funds for services.

30. Obstacles to Change • Administration and Supervisors: • Main focus is to limit liability • Discipline who didn’t follow policy • Avoid political fallout • Litigation for wrongdoing • Shamed into not asking for help • Where is the blame to fall rather than “are you ok?”

31. Case Examples Suicidal Ideation Alcoholism Drug Abuse Stalking Off Duty Shooting Psychotic symptoms

32. Sensible Options Peer support and employee assistance programs should ensure that first responders receive care from others who understand their unique experiences – other first responders. Family training programs alert family members to the warning signs of depression, PTSD, substance abuse, and suicide, so that families can look out for their loved ones and refer them to care if needed. Some departments encourage annual mental health check-ups. Procedures for departments to follow after an officer experiences a critical incident: mandatory mental health services, or time off to facilitate access to mental health services. Recommendationsfor ways in which a department can honor the life of an officer who died by suicide.

33. Areas to Reconsider Initial Selection Process Initial Training Period Annual Training Components Early Warning System?

34. Early Warning Systems PolicyMarch 2018 NJ Attorney General Directive 2018-3 establishes a uniform policy requiring all law enforcement agencies statewide to establish early warning systems to identify officers at risk for harmful behavior and mandate remedial programs for them before their conduct escalates.

35. 3 Incidents within 12 months Internal affairs complaints against the officer, whether initiated by another officer or by a member of the public; Civil actions filed against the officer; Criminal investigations of or criminal complaints against the officer; Any use of force by the officer that is formally determined or adjudicated (for example, by internal affairs or a grand jury) to have been excessive, unjustified, or unreasonable; Domestic violence investigations in which the officer is an alleged subject; An arrest of the officer, including on a driving under the influence charge; Sexual harassment claims against the officer; Vehicular collisions involving the officer that are formally determined to have been the fault of the officer; A positive drug test by the officer; Cases or arrests by the officer that are rejected or dismissed by a court; Cases in which evidence obtained by an officer is suppressed by a court; Insubordination by the officer; Neglect of duty by the officer; Unexcused absences by the officer; and Any other indicators, as determined by the agency’s chief executive.

36. Initiate Remedial Action Training or re-training; Counseling; Intensive supervision; Fitness-for-duty examination; Employee Assistance Program referral; and Any other appropriate remedial or corrective action.

37. Mental Health First Aid Began in Australia in 2001 Brought to the USA in 2008 By 2012 in the US 1,850 instructors trained over 50,000 first aiders Model a 5 step action plan: ALGEE

38. ALGEE Assess for risk of suicide or harm Listen nonjudgmentally Give reassurance and information Encourage appropriate professional help Encourage self help and other strategies

39. A Word of Caution "People who received psychological debriefing exhibited more severe symptoms of post-traumatic stress disorder than controls; the intervention increased the risk of the stress disorder, and critical incident stress debriefing, in particular, was potentially harmful,"write Magdalena Szumilas, Yifeng Wei, and Stan Kutcher in an analysis of the research on psychological debriefing published in the Canadian Medical Association Journal.

40. Proven crisis interventions include sticking to the following priorities: promoting a sense of safety, calmness, a sense of self and community efficacy (resilience), and a sense of connectedness and hope.

41. International Critical Incident Stress Foundation RITS—Rest Information Transition Services CMB—Crisis Management Briefing Defusing CISD—Critical Incident Stress Debriefing

42. Thank You Thank you for your time and attention. Dennis H. Sandrock, PhD CFG HealthSystems, LLC dsandrock@cfgpc.com C: 732-606-6590