Critical Incident Peer Support for Law Enforcement

1. Critical Incident Peer Support for Law Enforcement Module One: Stress and Critical Incident Stress Overview

2. Learning Objectives • The participant will be able to distinguish between stress and critical incident stress. • Participant will be able to: • Define stress and identify where it comes from. • Identify manifestations of stress. • Recognize stress on the job. • Recognize sources of law enforcement stress. • Define critical incident stress. • Identify critical incident stressors. • Recognize the disorders and diseases that can occur as a result of untreated critical incident stress.

3. Module Overview • Stress • Definition • Manifestations of stress • Stress on the job • General sources • Critical Incident Stress (CIS) • Definition • Characteristics • Officer involved critical incidents • Stressors • Signs and symptoms • Disorders/Diseases

4. Module One Introduction Video

5. BJ Lyons—Critical Incident Images

6. Stress—Definition • Alternative terms—fear, frustration, and anxiety • Nonspecific response • Adjustive demand • Special physical or psychological demands • Adaptive or coping behavior

7. Where Does Stress Come From? • Research • Holmes and Rahe—43 critical life events related to the onset of physical and mental disease • Lazarus—cumulative effects of stress • Sewell—144 law enforcement specific stressors • Overall research has found that the impact of stress depends on several factors.

8. Symptoms of Stress • Sudden changes in behavior • Gradual changes in behavior • Sleep disturbances • Erratic work habits • Increased sick time • Complaints • Accident/injuries • Alcohol/drug abuse • Sexual dysfunction • Fatigue • Other physical signs • Other emotional signs

9. Manifestations of Stress Physiological Psychological Sociocultural

10. Physiological • Heart/cardiovascular disease • High blood pressure • Circulatory problems • Digestive disturbances, including ulcers • Kidney disease • Premature death

11. Psychological Depression Burnout Anxiety clusters

12. Depression Insomnia and excessive sleep (hypersomnia) Poor appetite accompanied by weight loss, or increased appetite accompanied by weight gain Inability to concentrate Restlessness or boredom Lack of interest in food, sex, or life in general Feelings of worthlessness or hopelessness Physical hyperactivity or inactivity Loss of energy; feelings of fatigue Recurrent thoughts of death or suicide

13. Burnout • A state of mental and/or physical exhaustion caused by excessive and prolonged stress • An accrual of stress caused primarily by frustration felt by conscientious people whose jobs are designed to almost guarantee they will fail (Sewell)

14. Symptoms of Burnout • Chronic fatigue • Anger • Self-criticism • Cynicism, negativity, and irritability • Exploding • Headaches and gastrointestinal disturbances • Weight loss or gain • Sleeplessness • Depression • Shortness of breath • Suspiciousness • Risk taking • Helplessness • Feeling overwhelmed • Frustration

15. Anxiety Clusters Nightmares/bad dreams Phobias Some addictive behaviors (including alcoholism and overeating)

16. Sociocultural Suicide Alcohol/drug abuse Divorce

17. Suicide • Inability to make a rational decision • Way out of the pain • Permanent solution to a temporary situation—“The Forever Decision”

18. Myths About Suicide • People who commit suicide are crazy. • Good circumstances prevent suicide. • People who talk about or threaten suicide, cut their wrists, or do not succeed with other attempts are not at risk for suicide. (10% will succeed if nothing changes.) • Talking about suicide to people who are upset will put the idea into their heads. • People who are deeply depressed do not have the energy to commit suicide. • People often commit suicide without warning.

19. Signs • Poor appetite • Weight loss • Sleep disturbances • Loss of interest in hobbies and activities • Loss of energy • Feelings of worthlessness • Difficulty concentrating • Repeated thoughts of suicide • Neglected appearance • Fatigue • Poor frame of mind • Perceptions/illusions • Slowed thinking • Expressed feelings of hopelessness or helplessness

20. Alcohol/Drug Abuse and Dependency • Dissolves the “wall of resistance” that often keeps suicidal individuals alive • Found in the blood of most completed suicides–whether or not they were problem drinkers • Alcohol is a depressant and makes depression worse!

21. Myths About Alcoholism/Drug Abuse • Myth • 25-30% of LEOs abuse alcohol on a regular basis, considerably higher than the general population. • Truth • Prevalence is much higher in general populations. • Eight other professions have significantly higher rates.

22. Signs of Dependency • Growing preoccupation with drugs • Growing rigidity in lifestyle • Growing tolerance • Loss of control

23. Divorce • Myth • Law enforcement officers have a significantly higher divorce rate than other professionals. • Truth • Approximately 40-50% of all new marriages end in divorce. • Some professions have a higher than average rate of divorce, but not law enforcement. • The most significant factor in divorce rates is where a person lives. • Agencies with organized programs for stress management, especially those in which spouses are involved, apparently have a lower incidence of divorce. (CDC & the Dept. of HHS)

24. Stress on the Job Costs in the workplace Costs at home Management perspective

25. General Sources of Law Enforcement Stress • External to the agency • Internal to the agency • Endemic to the profession • Personal/unique as a result of the job

26. Critical Incident Stress (CIS) Normal person’s response to an abnormal event Unusually strong emotional or physical reactions Frequently surpasses coping skills

27. Critical Incident An incident in which the officer experiences a threat (actual or perceived) of death or serious injury to self or others, with a response of “intense fear, helplessness or horror.” It is not the event itself, but the meaning it has for the individual that makes it traumatic.

28. Critical Incident Stressors • The event is sudden and unexpected. • The event represents a significant threat. • The event can include an element of loss. • An officer’s values or beliefs are challenged.

29. Critical Incidents for Emergency Personnel • Death of fellow officer • Serious injury to fellow officer • Suicide of fellow officer • Terrorist or WMD Event • Multiple-casualty event • Death involving children • Media interest and public scrutiny • Exposure to infectious diseases • Litigation • Powerful events

30. Top Ten Law Enforcement Critical Life Events Violent death of a partner in the line of duty Dismissal from or loss of job Taking of a life in the line of duty Shooting someone in the line of duty Suicide of an officer who is a close friend Violent death of another officer in the line of duty Murder committed by a law enforcement officer Duty-related violent injury, such as a shooting Violent job-related injury to another officer Suspension from the job

31. Critical Incident—Officer’s Story Why did this happen to me? • A police officer’s recounting of the shooting death of a suspect and how the agency dealt with the aftermath • He discusses feelings of: • Anguish • Guilt • Anxiety • Fear • Rage

32. Signs and Symptoms of CIS Physical: Body reaction Emotional: Feeling Cognitive: Understanding Behavioral: Actions Spiritual: Beliefs and values

33. Factors that Affect Stress Reactions • Individual factors • Personality factors • Interpersonal factors • Community factors • Prior coping behavior • General aspects of the incident • Terrorism or natural disaster specific aspects • Lack of training • Organizational factors

34. Stressors Specific to a Disaster Event • Chemical, biological, radiological, nuclear, or explosive (CBRNE) hazards • Command and control issues • Secondary devices • Crime scene issues • Building’s structural instability • Mass casualties

35. Disengagement from a Disaster Event • Personnel engaged in response to a WMD event may face mixed feelings after their involvement with the incident ends, including: • Sense of loss/let down • Difficulty transitioning back to normal roles • Sense of overwhelming grief • Overwhelming fatigue (frequently without the ability to sleep)

36. Practical Exercise • Identify the Stressors • Divide into groups of four to five to discuss the three scenarios described in your Student Guide. • You will have 20 minutes to complete the group discussion and return to the class. • List the critical incident stressors evident in these scenarios. • Identify and list the potential stressors specific to your role in this event.

37. CIS Disorders/Diseases Trauma Acute Stress Disorder (ASD) Post-Traumatic Stress Disorder (PTSD) Secondary Traumatic Stress (STS)

38. Trauma Defined “The experience of violence and victimization, including sexual abuse, physical abuse, severe neglect, loss, domestic violence and/or the witnessing of violence, terrorism, or disasters” (National Association of State Mental Health Program Directors, 2006)

39. Acute Stress Disorder (ASD) • Within a month of the incident, hyper-arousal, intrusions, avoidance, and psychic numbing are experienced. • Symptoms must last for at least two days, but not more than four weeks. • Traumatic stressor was perceived as, or was, potentially harmful or life threatening to self or others.

40. Post-Traumatic Stress Disorder (PTSD) • The development of characteristic symptoms, present for more than one month, following a psychologically distressing event that is outside the range of normal human experience • Symptoms: • Anxiety • Dissociation • Fear • Helplessness

41. Secondary Traumatic Stress (STS) • The symptoms a person experiences as a result of close contact with a direct victim of a traumatic event • Sometimes referred to as compassion fatigue

42. Review—Check on Learning What is stress and where does it come from? How does stress manifest? How can you recognize stress on the job? How can you recognize sources of law enforcement stress? What is critical incident stress? What are some critical incident stressors? What disorders and diseases can occur as a result of untreated critical incident stress?