Reflecting on Inequality: A Clinician's Perspective on Police Diversity and Return-to-Work Processes

Before the Journey Started

As an experienced occupational therapist specialising in vocational rehabilitation (VR), I have focused on supporting police and correction officers in their return-to-work (RTW) process. Through my practice, I have observed notable variations in rehabilitation outcomes among officers with comparable injuries and responsibilities. This has prompted me to explore the factors that influence recovery duration and success, as well as the reasons why some police officers experience longer or less favourable recovery trajectories. My aim was to understand police officers’ experiences when returning to work following musculoskeletal injuries to enhance the effectiveness of rehabilitation services provided. By addressing these questions, I aspired to contribute to the field and improve health outcomes for injured officers.

I anticipated that rehabilitation provider's approach would significantly influence the RTW process and its outcome, as I have observed improved results with increased experience. Additionally, I expected to receive feedback on how peer and societal expectation of police officers may impact the RTW process, either positively or negatively. I was aware that being a female police officer presents unique challenges, based on conversations with previous clients, particularly given the stereotypes of policing as a “boys club” and an organisation that encourages a “tough it out” mentality. I have also gained experience working with Māori officers (Indigenous people officers); however, I had not previously considered how this might specifically affect the RTW process. Upon reflection, I suggest this is influenced by my worldview and my commitment to a person-centred approach in all aspect of my work, valuing the client's expertise as an integral part of the rehabilitation planning process. Consequently, what the individual considers important is always worthy of consideration within my clinical perspective.

As a clinician working under Accident Compensation Corporation (ACC) contracts, operating within limited timeframes and budgets presented challenges, including establishing and maintaining rapport, which can sometime impact the quality of care provided and contribute to health disparities. Given the Western-centric framework of ACC, there is often limited opportunity to incorporate Māori perspectives of care, such as allowing time for whakawhanaungatanga (building relationships) and extended whānau (family) hui (meetings) to support the recovery process. This may result in Māori clients feeling cautious or hesitant to engage fully in rehabilitation services, potentially prolonging their recovery and overall wellbeing (Accident Compensation Corporation, 2020; Graham & Masters-Awatere, 2020). These experiences underscore the importance of understanding the current barriers and facilitators within vocational rehabilitation and RTW programmes to promote equitable care for Māori police officers as tāngata whenua (Indigenous people).

Societal Context

Revelations During the Journey

The following discussion is based on my Master's research, which employed interpretative phenomenological analysis (IPA) (Harper & Thompson, 2011) to examine the personal experiences of six purposive sampling (Palinkas et al., 2015) of police officers who had sustained musculoskeletal injuries. Among the participants were one individual identifying as Māori and two female officers who engaged in a structured return-to-work programme following recovery from their injuries. Data were collected through semi-structured interviews conducted either via Webex or in person between September 2021 and April 2022, in accordance with COREQ reporting standards and with all necessary ethical approvals obtained, University of Otago Human Ethics Committee (Health) and Research Ethics (Health) standards (Reference: H21/085). Analysis followed the five step IPA process (Tindall, 2009)).

The current return-to-work processes appear to contribute to ongoing disparities within the police workforce, particularly concerning the underrepresentation of Māori and women. These significant experiences highlight the need to address potential systemic challenges and facilitate an important dialogue for vocational rehabilitation professionals.

Māori Officers

Regarding the commitment to Te Tiriti, the police health and RTW approach reflected disparities affecting tāngata whenua, as this study identified the absence of cultural considerations during the RTW process.

A conversation with one participant in particular was quite revealing. When asked whether return to work information incorporated cultural factors, Ben (pseudonym), who identified as Māori, noted both the lack of cultural consideration and a low expectation that such factors would be addressed.

At the Police as well as you know many other organisations and government as well. They, they speak the lingo, but they don’t walk the talk because they don’t, they don’t truly understand what they’re talking about (Ben, mid-rank officer, Interview 2).

This response was unexpected, as both the healthcare sector and society generally expect services to be responsive to Te Tiriti and to promote equitable care. Additionally, I anticipated a higher level of culturally informed service from the police service, given their use of Māori advisors.

The police health and RTW policies currently utilise the Te Whare Tapa Wha model (Māori model of health) to guide consideration of cultural health. The Meihana Model (Matenga & Westenra, 2022) is a contemporary and comprehensive framework that emphasises cultural responsiveness rooted in a Māori worldview. It thoughtfully incorporates considerations of colonisation, marginalisation, racism, and migration, while also reflecting the holistic Te Ao Māori perspective on health and well-being (Matenga & Westenra, 2022; Pitama et al., 2017). The author acknowledges potential limitations in understanding and interpreting the Meihana model from a Western perspective, recognising that certain aspects can only be fully understood through a Te Ao Māori lens. Nonetheless, findings from this study indicate that the inequalities among minority groups are amplified by existing RTW policies and procedures. These results align with other research (Blakely et al., 2011), underscoring the need to address healthcare disparities affecting minority populations. The author recommends further efforts to enhance VR services and interventions aimed to improving health outcomes for Māori within the police organisation. Ben described the importance of authentic collaboration with Māori concerning rehabilitation and RTW processes, highlighting that such efforts are most effective when conducted genuinely.

And for people that…come to learn about Māori, in particular Te Ao Māori and the Māori perspective world view…yea it underpins everything that Māori people do and so absolutely we should get recognition and be managed in some way but it's gonna take the right people [tangata whenua] to do that, you know (Ben, mid-rank officer, Interview 2).

As a white European from South Africa, I found this insight to be highly valuable. It reinforced my understanding that, as a clinician, culturally responsive practice can contribute to equitable outcomes. However, meaningful and lasting change necessitates systematic reform. Involving tāngata whenua at every level of service delivery is essential to achieving genuine equity (Graham & Masters-Awatere, 2020).

Female Officers

The findings from the study indicates that female officers are frequently assigned more emotionally demanding tasks, especially during the VR process, regardless of their individual psychological needs. This is consistent with existing research, which demonstrates that female officers tend to experience higher levels of emotional stress compared to their male counterparts (Berg et al., 2005; Violanti et al., 2016).

In discussion with Anna (pseudonym), she described the challenges faced by female officers as having additional difficulties that impede recovery. She noted that the standard practice of assigning higher workloads involving emotionally charged situations to female officers was heightened, which made it more difficult for her to recover from her injury. Anna reflected on the emotional impact this has had on her during the recovery process:

…but as a police officer, you know being a woman, especially being a woman investigator you’re gonna be given all the hard, emotional jobs as a rule anyway…and so you, then when you’re on light duties your gonna somehow just get way more of these jobs and you’re gonna absorb this reflective grief and then you’re already feeling like ‘ah man I can’t do this and that’ and then it's so negative. It's just very bad for people (Anna, senior officer, interview 1).

Another conversation that stuck with me was; while undertaking the interviews, Sue (pseudonym) shared with me that female officers often face significant challenges, feeling there is an expectation for them to outperform and demonstrate greater strength to justify their presence in a male-dominated industry. She also discussed the additional layers of difficulty experienced by double minority groups, such as Asian female police officers. These factors can contribute to feelings of occupational alienation (Hocking, 2017), which may be heightened during the RTW process.

These officer's insights resonated with me as I reflected on the various pressures female officers encounter daily. In addition to fulfilling the same responsibilities as their male colleagues, there is often a perceived need to prove their resilience and competence. When combined with injuries and the associated limitations, temporary or otherwise, along with emotionally demanding workloads and personal responsibilities, these factors can significantly impact occupational participation and satisfaction (Morgan, 2010). Such challenges can influence their occupational identity (Kielhofner, 2002) and overall wellbeing within the workforce.

After: Learnings to Take into Practice

Female Officers

I found it insightful to learn of the high level of emotionally demanding tasks assigned to female officers, based on the perception that they may be more capable of handling such responsibilities due to societal progression regarding gender roles. This workload can impose a significant psychological strain on these officers, even prior to injury. During the RTW process, the intensity of emotionally charged tasks, such as cases involving child abuse or sexual misconduct often increases, potentially intensifying the psychological impact on female officers who may also be balancing other life role and stressors, in addition to managing their injuries. Implementing a comprehensive health model that considers the interconnectedness of contextual factor with the overall wellbeing of injured officers, including personal factors, could be beneficial when planning return to work strategies for female officers and other minority groups. Further research into the experiences of female officers during the return to work, especially concerning mental and emotional health, would provide valuable insights for developing workplace support systems aimed at enhancing overall wellbeing and supporting retention of highly skilled female officers. These findings may also have relevance for other minority groups within the police service.

Key Points