Stress and trauma among police officers: Implications for social work research and practice

Abstract

Racial justice movements sparked by police killings of Black and Brown persons have led to a reassessment of the role of policing in America. This has promoted important conversations about how best to improve public safety and design law enforcement practices that are equitable and just across communities. A component of this conversation is addressing stress and trauma faced by police as a routine part of their duties, as it can affect the quality of policing. Job-related stress and trauma experienced by police officers are an international phenomenon, yet underexplored areas in social work research and practice. Police officers experience high levels of stress from routine exposure to traumatic situations, leading to high rates of post-traumatic stress disorder, substance use, and depression. Officers who are actively experiencing symptoms of stress and trauma are more likely to engage in misconduct, including the unnecessary use of force. This study explores the stress and trauma-related experiences of police officers. We conducted one-on-one, semi-structured interviews with 23 officers from an urban police department in St Louis, Missouri. Analysis of interviews addressed three areas: (1) stress and trauma experiences associated with police work, (2) negative effects of stress and trauma on officers, and (3) factors impacting officer access to treatment. We conclude that social work can contribute to improved policing outcomes by helping officers address their job-related stress and trauma through engaged research and practice.

Keywords

Stress trauma treatment police law enforcement

Introduction

The wave of racial justice uprisings across the United States in the wake of the police killings of unarmed Black, Indigenous, and Persons of Color (BIPOC) has led to a rethinking of the role of policing in America. BIPOC Americans, particularly those who are poor, male, disabled, and young are far more likely to be killed by police than their white counterparts (Edwards et al., 2019; Lett et al., 2020). Economically disadvantaged persons in the United States also experience intensive police scrutiny and surveillance. They are much more likely to be exposed to incarceration, police violence and harassment, and the risk of family separation than their more economically secure counterparts (Purnell, 2021; Roberts, 2022; Stuart, 2016). This recognition has led to a range of police reform discussions in the United States, some of which advocate for abolition or divestment in policing in order to better fund social service programs and neighborhood-level initiatives designed to enhance public safety and the economic and social wellbeing of communities, such as conflict mediation services, healthcare, housing and food access, and poverty reduction, among others (Dettleff, 2022; Jacobs et al., 2021; Purnell, 2021).

The profession of social work is also in the midst of its own reckoning with its participation in systems that uphold white supremacy and racial discrimination (Dettleff, 2022; Jacobs et al., 2021; Purnell, 2021). The intersection of policing and criminal justice systems within child protection services, mental health, schools, domestic violence services, and other social services comprise the prison industrial complex that targets poor and disadvantaged communities and families and places them at increased risk for surveillance, incarceration, family separation, and violence (Purnell, 2021; Roberts, 2022; Stuart, 2016). Social work’s role in these systems, especially in the policing of families and participation in other aspects within this carceral system, has come under scrutiny in recent years, with some calling for the end of carceral social work (Dettleff, 2022; Jacobs et al., 2021).

While these important debates unfold, police officers will remain in communities. Police officers are called upon to address the various effects of economic inequality on BIPOC and persons with disabilities, such as intimate partner violence, child welfare, homelessness, substance use, and mental illness, which can far exceed their training, resources, and capabilities (Purnell, 2021). In addition, being a police officer in America is undoubtedly a dangerous and stressful profession. St Louis, where this study takes place, has one of the highest violent crime rates in America (Fieldstadt, 2020). In addition, between 2010 and 2020, four St Louis police officers were killed while on duty (Officer Down Memorial Page, 2021), and within a 7-month period in 2020, 10 St Louis police officers were shot while on duty, including one fatally (St Louis police officer shot, 2020). It is beyond the scope of this study to fully explore these complex, at times contradictory, and certainly charged debates about the role of policing and social work in America. (See Dettleff, 2022; Jacobs et al., 2021; Purnell, 2021; Stuart, 2016; Roberts, 2022 for a critical review of policing and social work). However, understanding the experiences of police officers as it relates to their mental health and job-related stress may illuminate the factors relevant to their mental health and wellbeing that can, in turn, help them heal and positively influence their ability to perform their duties effectively and safely.

In this study, we explore the mental wellbeing of police officers and the role of social work in offering and supporting therapeutic interventions to police officers. While the profession of social work is obligated to dismantle systems of discrimination and oppression, particularly those in which it participates, the profession is also obligated to provide effective services to those in emotional and mental distress, which can include police officers.

Social work and policing in America

While some police and social work reform discussions have centered on divestment in policing and child welfare departments in order to build new social programs and structures that liberate neighborhoods, reduce social inequality, and increases citizens access to resources, other police reform discussions have centered on interprofessional collaborations between social work and law enforcement as a means to offer alternatives to people better served by the social service or mental health systems (Watson et al., 2021). Social workers and police officers have collaborated to address social problems for over 100 years (Brownell and Roberts, 2002). Currently, social workers and officers in both the United States and internationally collaborate on tasks forces and planning councils, particularly in the areas of domestic violence (Bledsoe et al., 2006), child welfare (Bertram, 2008), and crime prevention (Kelman and Hong, 2016), and on responses to community crises, often to assist persons with psychiatric crises (Blais et al., 2022).

We focus on an intersection of policing and social work neglected in the social work literature, the role of social workers in providing therapeutic services to address job-related stress and trauma experienced by police officers. A search of Social Work Abstracts identified only five articles focused on this topic. Three articles addressed the treatment of officers (Becker et al., 2009; Borum and Philpot, 1993; Papazoglou et al., 2019), one described resilience among 9/11 first responders (Freedman, 2004), and one presented a statewide critical incident stress debriefing team for first responders that was developed by a hospital social work department (Spitzer and Neely, 1993). Only two of the articles were authored by social workers (Freedman, 2004; Spitzer and Neely, 1993). This has occurred despite social work’s attention to stress and trauma in other populations, including immigrants and refugees (e.g., Singh et al., 2011), interpersonal violence survivors (e.g., Kelly, 2015), and LGBTQ individuals (e.g., Mason and Lewis, 2015), to name a few. One possible explanation for the lack of studies of social work services to address stress and trauma in police officers is that social workers are unaware of stress and trauma among officers. Alternatively, social workers may include officers in their counseling practices, but research on this population is not reflected in the professional social work literature.

Stress and trauma among officers are appropriate areas for social work research and practice because policing is a highly stressful occupation (Purba and Demou, 2019; Syed et al., 2020). Police officers have regular exposure to traumatic situations, including viewing dead bodies; responding to cases of abuse and sexual and other violent assaults; addressing people in mental health crises; receiving threats to their own lives; and experiencing injuries to themselves or co-workers, sometimes resulting in death (Purba and Demou, 2019; Syed et al., 2020). These exposures are associated with officers having significantly higher rates of suicide (Stanley et al., 2016), post-traumatic stress disorder (PTSD), and depression (Syed et al., 2020) when compared to the general public. Police officers and social workers have similar reactions to job-related stress and trauma. In a qualitative study of police and social workers investigating cases of child sexual exploitation, both professions tended to underemphasize how the stress generated from this work affected their mental wellbeing and reported infrequent use of coping strategies, particularly within their workplace (Ahern et al., 2017). Negative effects associated with policing are not unique to police officers in the United States. Systematic reviews of policing and mental health concluded that the negative effects of stress on police officers are found internationally (Purba and Demou, 2019; Syed et al., 2020).

At least three reasons exist for social workers to be involved in the treatment and research of police officer-related stress and trauma. First, social workers have the expertise to provide effective clinical services to treat stress and trauma. Second, providing effective treatment to police officers is one way for social workers to improve policing. Officers who experience symptoms of stress and trauma are more likely to exhibit poor policing behaviors and engage in misconduct, including inappropriate verbal behaviors and the unnecessary use of force (Bishopp et al., 2020; Kop and Euwema, 2001). Third, it is the duty of social work to address systemic oppression, particularly that in which the profession participates such as in carceral social work. The social work profession possesses the research expertise and organizational understanding to create new approaches that are responsive to the mental health needs of the police officers and the needs of communities.

The current study

The primary purpose of this study is to provide first-hand accounts of police officers’ sources of job-related stress and trauma, their associated negative effects, and factors impacting access to treatment. The study was conducted with officers working in St Louis, Missouri, a flashpoint in the social justice movements calling for a structural reassessment of the role of law enforcement on Black and Brown individuals after the 2014 killing of Michael Brown in nearby Ferguson, Missouri. The study was conducted 5 years after the killing of Michael Brown and 2 years after former St Louis police officer Jason Stockley was found not guilty of first-degree murder in the killing of Anthony Lamar Smith in 2011. The verdict led to several days of protests in the St Louis metropolitan area. During this time, police were required to work extensive hours during intense heat and endured verbal threats and risk of physical harm from protesters. Several officers were injured from bricks, rocks, and water bottles thrown by protesters. In addition, the police response to protesters was also characterized as being unconstitutional and involving excessive force. Officers interviewed for this study were directly or indirectly involved in the aftermath of one or both protests. By learning of their experiences, we hope to better prepare social workers to successfully treat stress and trauma among police officers and encourage social work research into strategies to accomplish this.

Methodology

This study employed one-on-one semi-structured interviews with 23 police officers from an urban police department in St Louis, Missouri. Participation was voluntary. Participants received a statement identifying risks and benefits of participation and provided verbal consent at the start of the interview. Interviews were held and audio recorded at a place of each participant’s choosing and conducted from September 2019 through April 2020. Sessions lasted approximately 0.75 to 1.5 h. Recordings were later transcribed. To protect confidentiality, audio recordings were destroyed after transcription and written transcripts were reviewed and redacted. Each participant was offered a $50 gift card for their time. Gift card costs were funded through two grants associated with this project. The Institutional Review Board (IRB) of the researchers’ affiliated university approved this study.

Inclusion criteria were that participants be current police officers with the St Louis, Missouri, police department and have at least 5 years of policing experience. Setting the 5-year criterion ensured that participants could speak about changes in policing over time, before and after the 2014 death of Michael Brown, which we will include in a future publication. Participants were recruited using snowball sampling methods starting with two officers. Potential participants were provided fliers and IRB-approved materials explaining the purpose and requirements for the study. Interested participants contacted the research team at a Gmail account created solely for the purpose of the study. The sample of 23 participating officers was 61% white, 35% Black, and 4% other races; 91% male; 26% currently working as patrol officers and 74% performing other duties; and an average of 11.8 years as an officer (range 5–26 years). The sample is similar to the characteristics of the entire police department, which is 66% white, 31.5% Black, and 3.5% other races; 83.5% male; and an average of 13 years as an officer (range 0–30 years). The percentage of subjects currently working patrol assignments (26%) is lower than the department as a whole, which, anecdotally, is believed to be around 50%. All participants had worked patrol assignments sometime during their careers.

We based interview guides on a review of the literature on stress and policing. The guide had 17 questions that explored changes in policing, morale, stress, and improving effectiveness as an officer. Questions specific to stress and policing included: (1) What are the biggest sources of stress you confront? (2) What effect, if any, has stress had on you physically and psychologically? (3) How would you contrast your experiences with the stress of police work itself compared to stress within the department? (4) How do you cope with stress? and (5) How can the department better equip officers to deal with stress and symptoms of stress?

Transcripts were examined using thematic analysis (Boyatzis, 1998; Braun and Clarke, 2006). The research team consisted of two social work faculty members, a criminology faculty member, a social work doctoral student, and an MSW student, all members of the university’s School of Social Work. The research team independently coded three interviews and synthesized the codes to create a formal codebook with initial codes, categories, and sub-categories (Saldana, 2013). The lead researcher then independently coded the remaining transcripts. Memo notes were used to generate and synthesize early themes, surprises, negative cases, and tensions, and to document analytic decisions (Charmaz, 2006; Padgett, 2008; Shenton, 2004). Initial codes were updated and collapsed into larger categories, which were compared and refined into general themes and sub-themes through peer debriefing discussions (Boyatzis, 1998; Saldana, 2013). We used reflexive thematic analysis methods to develop the final themes and sub-themes. This iterative process involved several authors discussing how the initial codes and categories came together to form a coherent set of themes and related sub-themes. We then checked and grounded our themes in the data and literature in order to yield a final set of themes.

Trustworthiness was established in multiple ways (Padgett, 2008; Shenton, 2004). First, interviews were conducted until saturation was achieved. Second, researchers engaged in member checking during the interview process by asking participants to clarify comments and checking for accuracy of interpretations. Third, researchers engaged in peer debriefing to collaboratively confirm consensus on codes and develop and refine themes and sub-themes. Fourth, the research team established an audit trail to track analytic decisions.

Reflexivity

Understanding of the data required authors to be aware of their lived experiences and presuppositions. One author is a parent of an adult child who is a police officer. He recognized that he naturally empathized with stories of participants having heard about and observed first-hand the stress and trauma police officers often experience. A second author reported several decades of experience working within and around police organizations. A third author, with a history of criminal legal system involvement, identified as a trauma-informed social worker and advocate for criminal justice reform. As a person who uses his lived experiences with the criminal legal system in his scholarly and advocacy work, he was forced to be aware of and reckon with his own emotional responses during the study. A fourth author lived in Ferguson during the Michael Brown uprising. As a Black woman, she was socialized to be wary of the police as an entity that did not always serve the interests of Black communities, especially poor Black communities. A fifth author reported being a facilitator in racial justice work and has engaged in direct social justice protests advocating for police reform. He, too, reported having to recognize, acknowledge, and examine emotional reactions to some participant responses.

The authors possessed a wealth of personal and professional experiences. This range of expertise contributed to the understanding of how the stress and trauma experienced by the officers can impact the mind and body and afforded the team the ability to position the data within the broader social work and criminal justice fields as it related to policing, criminal justice reform, social work-police collaboration, and trauma-informed practice. The author team also acknowledged a range of lived experiences that they identified as important during the analysis process. Through a reflexive process, each author recognized, examined, and challenged how their personal and professional beliefs and lived experiences impacted their understanding of the data. Reflexive conversations during theme development and article writing allowed the authors to fully explore and integrate the experiences and perspectives each brought to the process. This helped the team to better understand the nuances of the data and experiences of the participants.

The setting and timing of this study are also important. St Louis was the epicenter of racial justice protests in 2014 following the killing of Michael Brown, an unarmed Black man, by a white officer in Ferguson, Missouri. Additionally, in 2017, former St Louis police officer Jason Stockley was acquitted of first-degree murder charges in the shooting death of Anthony Lamar Smith, a Black driver, following a high-speed chase in 2011. The acquittal sparked intense racial justice protests across the St Louis region for several weeks. While the majority of protests were peaceful, some became violent, resulting in injuries to several officers and protesters. In 2017, St Louis County elected a new prosecuting attorney, Wesley Bell, a Black man and former Ferguson City Council member. Bell’s win was seen by many as a rebuke of long-time prosecuting attorney Robert McCulloch, who refused to use a special prosecutor and failed to get an indictment of the officer who killed Michael Brown. Also in 2017, Kimberly Gardner became the first Black Circuit Attorney for St Louis. Gardner was the prosecuting attorney on the Stockley case. Bell and Gardner are known to be part of the movement of progressive prosecutors seeking criminal justice reform through expansion of drug diversion programs, eliminating cash bail, and not prosecuting low-level drug offences.

Results

Analyses of interviews resulted in eight themes organized around three topics.

The stress of police work and trauma experiences

The stress of police work and trauma experiences included three overlapping themes: primary and secondary traumatic experiences, heightened scrutiny and negative attention, and lack of support.

Primary and secondary trauma experiences

Officers encountered many events perceived as traumatic and/or life threatening. Primary trauma experiences are those where the officer experienced or witnessed trauma directly. Some officers described being shot, shot at, assaulted, witnessing another officer being shot, witnessing a man burn alive, and engaging in high-speed vehicle pursuits. Their traumatic experiences were persistent and regular. One participant offered, “This past week we’ve had three officers get shot at. I don’t know many officers who haven’t been shot at. It’s just that’s the basic stress level. Not a year goes by without someone pointing a gun at me” (PO16).

Secondary trauma includes experiencing trauma indirectly, such as when responding to a homicide. Officers discussed witnessing crime and accident scenes that involved dead bodies and other forms of bodily trauma. They described working with victims who experienced death, sexual violence, hostage taking, torture, and kidnapping; some traumatic experiences involved children. “I’ve seen dead kids for 6 years now. I see a…few a year. It makes me angry. Makes me sad. It makes me think, do I want kids?” (PO5). Another participant described an event that still haunted him years later.

A robbery. [Drug] dealers came over. I guess dad owes some dope money. Two people come by, kick in the door, put a pistol to the dad’s head with his seven kids inside the house 11 and younger. Then, he [dad] is like, ‘We don’t have anything in here. You can look.’ They pull a pistol on the seven-year-old’s head. They’re like, ‘I bet you got money now.’ The 11-year-old girl goes into her piggy banks. You know what I mean? Just horribleness (PO3).

Officers described the trauma of learning about injuries and deaths of fellow officers. These experiences had significant negative effects on officers’ wellbeing. “I’ve been a part of shootings. I’ve had people who I’ve trained, not only die [but]…fall off roofs, been hit with cars. I’ve had friends who essentially had nervous breakdowns” (PO3). Another officer described how the level of stress from traumatic events was incomparable:

You have combat vets that come back that are less damaged than cops that have been doing this for five years because it’s—every single day is an argument. Every single day is a fistfight or a foot pursuit, or you’re driving 140 miles an hour because your friend just got shot, and you’re watching him bleed on the ground (PO5).

Evident in their stories are intense feelings of anger, despair, shock, and resignation. These experiences were common across interviews; virtually all participants explained experiencing repeated negative events as a routine part of their job. The accumulation of these experiences can take a significant negative toll on the mind and body, as we examine later.

Heightened scrutiny and negative attention

Officers reported feeling the impact of increased scrutiny in the aftermath of the Michael Brown and Anthony Lamar Smith killings. As one officer noted, “There was much happier times my first 15 years [on the job]” (PO15). Participants identified that increased stress is partly driven by increased criticism of police officers. The participants worked in a department only a few miles from Ferguson, Missouri, where Michael Brown was killed. Officers believed that subsequent media coverage of that event and other shootings of unarmed Black men exacerbated “us versus them” attitudes between police and communities. “They’re [police] stressed, and they’re broken, and they’re damaged…taking care of the people that fucking hate them and wouldn’t piss on them if they were on fire” (PO5). Another officer offered, “It’s almost in fashion now to hate the police. Everybody’s going along with it….It just seems like more and more people hate us and hate what we do” (PO12).

Participants indicated that increased public criticism has been accompanied by heightened scrutiny and demands for accountability which has led to a perceived sense of abandonment wherein police no longer feel that the public, the department, or the local prosecuting attorney trusts them to carry out their duties. As mentioned previously, two relatively new progressive prosecuting attorneys now serve St Louis City and County. These attorneys are part of a wave of progressive prosecutors that took office in the aftermath of racial justice protests in 2014 and 2020. They seek to reform the criminal justice system through increased scrutiny of policing practices and other structural changes in law enforcement. In many cases, the increased scrutiny has officers concerned about the security of their jobs and well-being. “Am I gonna lose my job for whatever it is that we’re doing? It’s a constant question in the back of your head” (PO7). The stress of having their actions scrutinized led officers to increased hesitation and delayed decision making while responding to calls due to the fear of being reprimanded, losing one’s job, or being prosecuted.

Lack of support

Officers reported a lack of support from a variety of sources, including the prosecuting attorney’s office, the general public, and the media. Lack of institutional support was identified as inherent in the organizational structures and processes related to policing. Nearly every officer discussed the impact of not feeling supported by the prosecuting attorney. They believed this lack of support translated to less faith in the system and impeded their ability to do their job.

Our relationship with the current circuit attorney doesn’t help anything. You put a good case forward, and [she] refuses it because she’s tryin’ to make a social justice name for herself or trying to implement social justice changes. What all it does is lets the bad guy out to victimize neighborhoods that need these people locked up the most. (PO13).

A second area reported by officers was the lack of support from the public, media, government, and the police department itself. This manifested through supervisors second-guessing officers’ actions and failing to “back” officers. Many officers indicated that the internal politics associated with this lack of support were as stressful as the emotional demands of police work itself. Additionally, many officers related that leadership within their department was inadequate, too politically motivated, and out of touch with officers’ daily realities.

A third area of low support was the lack of adequate staffing. Officers perceived that increased public criticism had resulted in policing being a less desirable career choice, leading to fewer and less qualified applicants. Simultaneously, the agency was losing veteran officers who were opting to retire early. “It [policing] was an easy job to make it to 30 [years]. Not a very easy job to even make it to 10 [years] now” (PO15). Staying within the profession until retirement was once considered possible due to adequate support and less stress. According to officers, the stress of policing now results in higher turnover and less longevity, leading to an inexperienced police force. Others described decreases in staffing. “We have less manpower. When I first came on…we were supposed to be at 1200 police officers…I think we’re below 900 right now” (PO17). Moreover, officers indicated increased workload, particularly in high-crime neighborhoods. The consistently high call volumes, coupled with low staffing, mitigated an officer’s ability to address crime appropriately.

The call volume is so high that they’re constantly calling for cars to come in service, and you don’t have time to write a report. You may have 5 minutes to sit down and write a report…It makes for a lesser quality, which leads to less convictions, which leads to more criminals on the streets (PO12).

Approximately half of respondents perceived a lack of preparation and training to manage social issues related to domestic disputes, addiction and overdoses, suicide attempts, and calls related to persons in need of behavioral health support. Officers noted that having enough officers to staff a shift and having specific personnel with specialized training in these areas of practice would be helpful.

We’re all asked to be caretakers, psychologists, sociologist, babysitters, peer mediators. We have every job under the sun. We have to do that at people’s worst times, and we have to do it with a smile on our face and show no emotion on our end. We have to know every law under the book, every little thing. Frankly, we’re underprepared and undertrained (PO13).

Many officers indicated a lack of expertise in dealing with individuals with mental illness or substance abuse issues. Officers were not given opportunities to identify and move individuals toward alternative treatment options. One officer shared his desire to integrate other professionals into police work. “Now we’re supposed to be experts on dealing with people with mental illnesses….We wish we could have some more of the behavioral health side come in and help out” (PO13). Some officers identified the need for an increased co-location of social services or diversion of calls to social service agencies where other professionals could be deployed instead of the police.

Not having the necessary equipment was also experienced as a lack of support for officers. Several participants indicated a need for better equipment to help them do their job effectively. Officers also expressed that inadequate equipment decreased safety for officers and citizens.

It’s very stressful not having the basic tools you need to perform your job…. it’s more than just a gun and a radio. We need a working vehicle. It’d be nice to have a vehicle where it’s not raining inside of it or the heat works or the AC works…Equipment is a stressor when the officer gets in the car and it doesn’t even have the basic things to pull off the lot or have to spend the first part of their shift takin’ a car to maintenance (PO9).

Effects of stress on police officer health and wellbeing

In addition to sources of stress and trauma, police officers discussed the effects of stress and trauma on their personal and professional lives. This topic included two themes.

Professional estrangement

Several officers indicated that the stress they experienced led to hypervigilance and a sense of disengagement, fatigue, and apathy toward police work and life in general. One police officer offered, “When I was in patrol, it [stress] was a constant 10 [out of 10]. The ‘Can’t get out of bed these days,’ that’s calling in sick because I just can’t” (PO19). Constant stress led to periods of fatigue and apathy toward the job. Working patrol requires rotations between day and evening shifts every 3 weeks in the study department. Officers indicated that the stress of constantly changing work shifts led to negative emotional, physical, and social consequences. “We switch every 3 weeks which is considerably hard on the body if you have a family. It affects everyone in your family, your childcare. It affects everything” (PO9).

Participants described becoming increasingly hesitant and disengaged from policing due to increased scrutiny and public criticism. This disengagement led to officers viewing policing less as a career and more as just a job and paycheck. “[Police work] it’s just a job to me. It’s a means to an end. It used to be a career. I used to work 80 h overtime’ cause I just loved being at work” (PO5). This disengagement as the result of increased stress and a perceived lack of support was described as something that led many officers to leave the police department or retire early.

Negative impact on physical and mental health

Officers described how the constant fluctuation in stress and adrenaline had long-term negative effects on their physical health. “Physically, to me, 1 year is like five on your body… When you’re not sleepin’ or when you’re workin’ 60 h, 70 h a week, and then you’re still parenting or whatever you do in your personal life, I think that takes a toll on your physical body” (PO9). Two commonly discussed physical health consequences of dealing with stress were poor eating behaviors, including over- and undereating, and neglecting to exercise. “We’ll all make jokes like, ‘Oh, look at that guy. He just came out of the academy 2 months ago, and he’s put on 60 pounds.’ Well, there’s probably a reason for that” (PO6). The stress experienced by officers also contributed to increased exhaustion due to insomnia and chronic hypervigilance.

The effects of stress on officer mental health were significant. Participants described the impact of chronic stress and trauma as leading to many common post-traumatic stress symptoms, including re-experiencing (e.g., “terrible nightmares”), arousal (e.g., “anger at the world,” hypervigilance), and negative alterations in cognitions and mood (e.g., numbing, paranoia, depression/low mood, anxiety). One officer described paranoid delusions he had about his wife that he attributed to the effects of heightened stress.

I had these delusions that my wife was cheating on me with absolutely no sort of any underlying evidence. It was just a thought that crept into my head. It attached itself...I knew it wasn’t real, but I didn’t. It’s very hard to explain (PO6).

Over time, the stress associated with policing altered the way participants saw the world and led to a combination of pessimism and numbing (e.g., lack empathy or concern for others). One officer offered this example.

This guy’s brains could be on the ground, but we’re investigating…That’s just almost a piece of evidence, just like a shell casing. When I was first startin’ out, that was a human, and it always hit hard. My father noticed it a lot, that it was takin’ its toll on me. At the time, I was—I still am religious, but at the time I was more religious, and I would actually say a prayer for the person that was killed in my first three, 4 years. As that’s gone on, I’ve noticed that it’s gone away (PO7).

Participants discussed traumatic stress responses leading themselves or co-workers to engage in maladaptive coping behaviors, including excessive drinking and promiscuous sexual behavior. “Officers whose lives are kinda destroyed by alcohol, officers who I think were very promiscuous and not faithful to their wife or whatever. In big part, that’s their way of self-medicating, instead of dealing with the stress” (PO2). Many participants said that alcohol use was a common way officers coped with stress; excessive use, manifesting in drinking problems, had significant relational and other consequences, such as divorce. Drinking as a form of self-medication for stress was identified by several officers. “They’re not doing it to have fun. They’re not doing it to screw around. They’re doing it because there’s—they need help” (PO5). Another officer stated,

I do know at least two people have—the stress has led them to drinking, which is probably a problem in police work in general anyways, but the drinking led to fights with their wife, and now they’re divorced. That was one of the officers that had to go out ’cause of stress ’cause he went through a divorce, and he was contemplatin’ suicide and stuff like that (PO10).

The stress experiences of officers often manifested as problems in their interpersonal relationships. Officers described “blowing up on…family at home,” and “yelling at people at work” in response to an overabundance of stress. Divorce and difficulty interacting with their children were commonly discussed relational consequences of stress.

As one of the 50% of cops that have divorced, sure. It definitely took its toll on my marriage, and I still see it taking its toll on my kids at times when you don’t have as much patience as you should. Then you snap, and then you’re sittin’ there going, ‘Oh, shit. I shouldn’t have yelled at my kids (PO7).

Factors impacting police officer access to treatment

Police officers identified several factors that influenced their access to treatment, organized around three themes.

Lack of adequate treatment options for officers

Participants discussed the capacity and appropriateness of departmental services in helping to mitigate their stress. The department offered two options through its Employee Assistance Program (EAP) as the official sources of mental health counseling and treatment. Most officers indicated that neither program provided effective services to meet their mental health needs. In addition, participants did not trust the purported, confidentiality, quality, or benevolence of these resources. Rather than helping them, officers believed these programs were set up to protect the department from lawsuits. As one officer shared, “I think they’re worthless. Smoke and mirrors, man” (PO1). Another similar sentiment was offered, “Nightmare, horrible. Officers will tell you who have been involved with it [EAP], ‘Never get involved with it. Go through your private health insurance’” (PO2).

Participants who disclosed struggling with mental health issues reported avoiding the EAP, either because of vicarious knowledge regarding the bad experiences of others, or through prior direct bad experiences. Some officers shared that they were forced to take sick leave when they used the service. Most officers indicated that if you used EAP services, you placed your job and reputation at risk. Trust and satisfaction in the program were low; fear of retribution for using the program was high. These factors led officers to avoid the EAP. As one officer stated:

… it’ll show a sign of weakness if you go to it [EAP]. Also, police officers don’t like to talk about their feelings, and especially don’t wanna talk about, ‘Hey, I’m having these thoughts,’ because guess what? I’m gonna take your gun away and you might not get it back, so they bottle it up, keep it inside ’til maybe they go postal (PO13).

Many officers indicated that utilizing EAP was “one of those things that’s very rarely talked about” among officers. Even in cases where officers were bound by department policy to go to EAP (e.g., being involved in a shooting), participants indicated that officers “don’t take it seriously. They go in and give the answers they know they have to give and get out” (PO7). Only one police officer was favorable toward the EAP, although that officer had no direct experience with it.

Pervasive stigma

Seeking counseling services was outside of the norm among participants and the negative stigma associated with seeking counseling was pervasive. “God forbid anyone around the police department find out you’re using it [counseling services]. It always comes with that stigma of you weren’t able to handle the shit, essentially. You were ‘less than’ because you sought help” (PO7). Another participant related a story about handling a homicide in which he had to crawl into an overturned car to gather evidence while the victim’s distraught family members were also trying to get into the car. He felt imbalanced after clearing the call and went to his sergeant to ask about being allowed to go home for the rest of the shift. His sergeant was dismissive of the request, telling him he needs to get used to dead bodies if he was going to work homicides.

Numerous examples were given that reflected the stigmatization of officers who seek mental health services. One officer described what a colleague experienced when it was discovered he sought EAP services. “Great guy. No one’s ever said a negative thing about him until people found out he was going to EAP, and everyone was mocking him for it. I was like, ‘you probably should’ve either kept that to yourself or went out of pocket for the thing’ (PO3). Due to reduced help seeking, many officers would let mental health symptoms worsen until they engaged in erratic behavior on the job or experienced suicidality. Participants indicated that lack of help may lead to maladaptive coping responses, such as drinking on the job, and negative repercussions such as discipline, demotions, or firings. These outcomes were blamed partly on departmental negligence in offering officers adequate treatment options.

Access to a range of effective treatment options for officers

Some participants reported that seeking treatment outside of the EAP had increased over time. Officers had moved toward increased engagement with counseling services through recommendations from other officers and increased awareness about mental health issues (e.g., officer suicide rates, primary and secondary trauma, PTSD). Officers described the informal recommendation process for counselors outside of the police department, which they often paid for out-of-pocket so it could not be traced by the department. As one example, an officer stated, “I know a lot of the officers are going to the same person, because they’re passing cards around, so they’re kind of in the same circle…, but they don’t wanna go through the department because then the department has a file and it knows of it” (PO13). Officers valued these peer recommendations for counselors. They appreciated it when officers who had engaged with services talked to them about connecting with a counselor and what counseling may be like. This helped to mitigate the fear of going and neutralize the stigma associated with help-seeking. A few officers indicated that they had utilized a therapist who they felt understood policing as a profession. These officers said that they felt heard and could more easily form a therapeutic alliance.

Likewise, police officers described being amenable and receptive to peer support groups wherein they interacted with officers who shared similar experiences. One officer stated, “I’m talkin’ about you’ve been shot, I’ve been shot. We have somethin’ in common” (PO1). Peers allowed them to feel understood and embodied mutual respect. Having a range of trauma-informed mental health resources was important; having readily accessible information about processes associated with help-seeking would encourage this type of behavior. Lastly, officers indicated that supervisors should be trained to identify significant signs and symptoms of stress and learn skills to address it appropriately, as this might increase the chances that officers deal with stress adaptively.

Discussion

Results are consistent with other studies on forms of stress and trauma within policing and their effects on officers’ wellbeing (Purba and Demou, 2019; Syed et al., 2020). The results are not unexpected given the high level of violence and trauma exposure in the jurisdiction policed by the study participants, including numerous officers who had been wounded or killed in the line of duty in recent years (Officer Down Memorial Page, 2021; St Louis police officer shot, 2020). Officers reported directly experiencing frequent violent encounters (e.g., being shot at or physically assaulted) and discussed the stress and grief associated with colleagues who were severely hurt or killed in the line of duty. Officers also discussed the effects of routinely experiencing highly emotional events and the aftermath of violence and tragedy as part of their work, such as seeing dead bodies and working with injured persons and families directly after experiencing tragic events. In addition to trauma, high job-related stress was identified in several other areas. Officers reported that they routinely experienced overwhelmingly high call volumes and that many of their calls were for non-crime-related issues, such as domestic calls, persons experiencing mental distress or substance use, welfare and wellness calls, and disturbances. In addition, officers reported chronic understaffing, equipment shortages, and work schedules that limited their ability to strike a healthy balance of work and family life by being routinely asked to work extended shifts and overtime.

The experience of chronic stress and traumatic events can have a profound impact on the body and mind, leading to increased risks for physical diseases and behavioral health problems, including major depressive disorder, anxiety disorders, addiction, violence, and suicide (Burke-Harris, 2018; Pietrzak et al., 2011). Not only do stress and trauma affect officers themselves, but officers actively experiencing symptoms of stress and trauma are more likely to engage in unnecessary use of force (Bishopp et al., 2020; Kop and Euwema, 2001). Our data suggest that despite frequent exposure to toxic stress and trauma, officers indicated that their wellbeing and mental health were not departmental priorities. Further, participants reported that access to high-quality, safe, confidential, and affirming mental health care was not readily available within the department. Participants’ accounts indicated that help-seeking behavior might be low due to mistrust of services or fear of stigma from other officers and supervisors. Our findings support other research that has found high levels of stigma toward mental health services in law enforcement, resulting in decreased levels of help-seeking (Drew and Martin, 2021). Barriers to help seeking related to stigma were identified as including a perceived lack of confidentiality, seeing the need for services as a sign of weakness, and concern that therapists will not be able to understand their problems. These findings have also been found elsewhere (Drew and Martin, 2023; Jones et al., 2020; Newell et al., 2022).

Help-seeking is influenced by several factors, including having an awareness of mental health symptoms and a belief that treatment is helpful; an understanding when it is time to seek help; the openness to seek help; the encouragement and support of others; and accessible resources that enable treatment, such as insurance coverage and the availability of effective and trusted services (Farrer et al., 2008; Stanhope and Henwood, 2014; Wuthrich and Frei, 2015). Both a mistrust of treatment resources and a lack of access to effective services will invariably lead to a reduced likelihood of help-seeking. Further, stigma or negative stereotypes toward help-seeking can reduce the likelihood of seeking and engaging in treatment (Corrigan and Watson, 2002).

These results are troubling given that police officers experiencing significant stress and untreated behavioral health issues are unlikely to perform optimally, placing themselves and others at risk. Officers noted that an organizational culture that valorized stoicism and invulnerability while stigmatizing help-seeking behavior may be to blame. Officers feared if they discussed or demonstrated any sign they were struggling that they would be put on leave, dismissed, and/or shunned by fellow officers. In addition, officers reported a rise in negative media coverage of policing, public criticism, and increased calls for greater police accountability following the killing of Michael Brown in Ferguson as sources of stress and anger without ever mentioning the reasons for this increased scrutiny, such as repeated incidents of excessive use of lethal force against unarmed Black citizens by police, excessive and perceived militaristic responses against protesters, and others. While participants believed this reduction in community support has resulted in decreases in officer morale and job satisfaction, leading to higher levels of turnover and police officer stress, at no point did officers explicitly acknowledge racial injustice, officer misconduct, or lack of officer accountability as reasons for this increased scrutiny and negative attention. This culture can also blind officers to the racial injustices that are inherent in policing as well as promote the stoicism, invulnerability, and stigma that leads to a lack of help-seeking and access to effective treatment for officers who are struggling.

Much has been discussed about divesting in police and structurally reassessing how law enforcement functions. Any discussion about police reform should also include implementing trauma-informed practices for officers that focus on enhancing wellbeing, preventing burnout, and increasing the ability of officers to access treatment. Reducing police budgets without strategically re-aligning police practices, work policies, and responsibilities will likely lead to increased officer stress and lower quality officers on the street, increasing the likelihood of violent encounters and inappropriate uses of force.

Implications for social work practice

Officers indicated that they viewed the profession as a vocation and entered it with the noble intentions of serving the community, removing criminals from the street, reducing crime, and increasing public safety. Many we talked with had become disillusioned with policing due to the sheer magnitude of the problems they have been called upon to address and the perceived lack of support they receive from their departments and communities. Most officers agreed with employing strategies and alternatives that help shift responsibilities for noncriminal social and behavioral health issues from law enforcement to the proper mental health, substance use, school, and social service systems (Watson et al., 2021). Employing departmental policies that increase the ability of officers to access effective care without fear should also be a priority.

What role, if any, should the social work profession play in this reform? Some have argued that social workers should not participate in carceral systems that continue to routinely engage in racial injustice (Dettleff, 2022; Jacobs et al., 2021), while others claim that social work can and should help these systems improve and be more socially just. In light of our findings, we take a “both…and” approach. While social work must carefully consider any collaborations with law enforcement and ensure that practices do not lead to or compound racial or gender inequities, social work is obligated to both dismantle systems of oppression and serve people who are negatively impacted by these systems. This includes serving both members of disadvantaged communities impacted by poverty, social inequality, and police violence and the police officers who are negatively impacted by the stress and trauma of a toxic organizational culture and inherently dangerous profession.

How social workers should or should not collaborate with police is beyond the scope of this paper, as is the broader debate about police and social work reform. However, we offer several areas in which social work could play a role in reshaping modern policing. First, social work can help police departments expand the range of wellness services available to officers and implement trauma-informed departmental practices and programs. It is clear from officers’ descriptions that the police department does not operate from a trauma-informed lens, nor does it understand how trauma impacts officers’ minds, bodies, and behaviors. Incorporating trauma-informed practices may lead to a reduction of stress and its effects on officer conduct and experiences. Trauma-informed practice environments focus on safety while promoting a sense of collaboration, trust, and healing. Providers and organizations that operate from a trauma-informed lens explicitly recognize that trauma impacts physical and behavioral health and incorporate an awareness of these effects in their policies, procedures, and practices. They engage in routine trauma screening and assessment, identify and eliminate re-traumatizing or stigmatizing practices, and deploy trauma-responsive practices to those who may have experienced trauma (Mancini, 2021; Substance Abuse and Mental Health Services Administration, 2014). A range of trauma-informed interventions are available to reduce symptoms and help officers cope. These interventions can include Prolonged Exposure (Foa et al., 2007), Eye Movement and Desensitization and Re-Processing Therapy (EMDR) (Shapiro, 2017), and Cognitive Processing Therapy (CPT) (Resnick et al., 2016). CPT and EMDR may be particularly effective for officers, as both have been used with people in various situations (Bisson et al., 2013). CPT helps people address the meanings and cognitive distortions around their experiences, while EMDR focuses more exclusively on reducing the intensity of trauma symptoms, such as re-experiencing or arousal, by targeting the most troublesome aspects of the trauma. EMDR can also be provided in a brief, targeted format.

Increased recognition of the need to expand and improve access to mental health services for police officers led to the bi-partisan passage of the federal Law Enforcement Mental Health Wellness Act passed in 2017 and signed into law in 2018. This law provides funding to all law enforcement agencies in the country to expand access to mental health services for officers, implement mental health wellness checks for officers, and expand crisis lines and peer mentoring programs (Spence et al., 2019). This represents an opportunity for the profession of social work to assist police departments in providing family-focused, trauma-informed services to officers in need as part of a comprehensive program to provide a range of mental health services for officers in need, enhance mental health literacy for all officers, and create an organizational culture of support and wellbeing. The successful implementation of these types of training, wherein officers are apt to be open to information provided and integrate it into their policing practice could perhaps, best be led by patrol officers themselves, particularly sergeants or other well-respected officers. This would reduce the chances that officers view these often-mandated trainings as political propaganda from disconnected administrators who are out of touch with policing.

While EAP services are widely available in most police departments, their underutilization may indicate that these services are provided by agencies and practitioners will little training in how to effectively assist police officers and that officers are concerned that EAP services will not be confidential (Drew and Martin, 2023). Officers who access external services overwhelmingly access general practitioners, with a much smaller percentage accessing intensive, trauma-informed therapy services (Drew and Martin, 2023). This represents a missed opportunity in which officers needing more intense services described above are not receiving them. The existence of a larger wellness initiative with a range of easily accessed services can create a culture that normalizes help seeking behavior and encourages use (Drew and Martin, 2023). Furthermore, our data points to the need for family-focused therapy services, given that any mental health challenges experienced by officers can reverberate throughout the family system. Social work should be involved in developing expanded wellness initiatives because of their ecological focus and family orientation.

Second, there is a need for workforce development initiatives that can increase the number of social workers and other behavioral health practitioners who can effectively engage and respond to the experiences of law enforcement officers in need of trauma-informed services. Police officers and other first responders represent a unique clientele requiring specific training and experience. Creating social work specializations or certification programs that specifically train social workers to provide these services to officers and their families represent an important practice area for social work. This could be accomplished by developing collaborative networks of police departments, community-based agencies, advocacy groups, and academic departments of social work, public health, and criminal justice. These networks could partner to help design field specializations, develop coursework, establish field placements, and design collaborative research projects to assist in training, implementing, and evaluating expanded wellness initiatives for police officers.

Third, police departments and mental health service providers can take several steps to improve help seeking and service utilization. To reduce mental health stigma and increase help seeking across departments, police departments should provide universal mental health first aid training to all officers (National Council for Mental Wellbeing, 2023), implement routine wellness checks, and provide formal mental health awareness campaigns to increase mental health literacy and change organizational culture and climate around help seeking behavior. In addition, service utilization could be improved by deploying peer support officers. Peer support officers are routinely used and are often preferred in officer debriefing situations. Their roles could be expanded to include serving as service navigators and behavioral health liaisons that provide mental health education and assisting officers to access more intensive family and individual services in the community by practitioners with specific expertise in serving police officers and other first responders. This could increase officers’ readiness to seek help and engagement in trauma-informed behavioral health treatment services (Mancini, 2019, 2021; Syed et al., 2020). Lastly, treatment should seek to increase social support networks, both between police officers, and between officers and their friends and family members, to enhance the positive effect of treatment (Gachter et al., 2011; Syed et al., 2020).

Limitations

This exploratory study has limitations. We relied on a small purposive sample focused on veteran police officers working in an urban area. Using snowball sampling techniques may have led to a sample of officers with similar perceptions, experiences, and attitudes that may not represent all police officers or tell the whole story of police officers’ experiences. We took several methods to ensure trustworthiness. These included interviewing until saturation, member checking within the interviews, and peer debriefing across transcripts to ensure accurate interpretation of officers’ stories. However, given the complex nature of the topic, it is unlikely that we explored the full range of officer experiences.

Conclusion

As America is seeking to improve policing, one contribution social workers can make is to help officers address their job-related stress and trauma, at the same time working for structural changes in policing to promote better mental health among its officers. To successfully engage and treat police officers, mental health services must be expanded for officers. This includes workforce development initiatives that increase the number of social workers and other behavioral health practitioners who can competently serve law enforcement officers. Social workers and police officers must often negotiate exposure to similar forms of direct and vicarious trauma, particularly when working around behavioral health and child and family violence. Both require access to appropriate workplace coping strategies (Ahern et al., 2017). As a result of these shared experiences, perspectives and strategies that may help social workers cope with workplace stress and trauma can be adapted and applied to police officers as well. The Veterans Administration (VA) represents another model that could inform the expansion of services for police officers. Social work has worked closely with the VA to provide trauma informed services to veterans. This may be, in part, a viable model for how social work can support law enforcement and other first responders with specific training and services (Spence et al., 2019). A range of resources are available to social workers and other providers of therapeutic services to better prepare them to work with police officers and their families (Blau, 1994; Kirschman et al., 2014; Miller, 2006). In addition, the need exists for more research to better inform prevention and treatment of stress and trauma in police officers (Stanley et al., 2016; Syed et al., 2020).

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Emmett J. and Mary Martha Doerr Center for Social Justice Education and Research, an endowed center within the School of Social Work at Saint Louis University, St. Louis, Missouri, and the Tegeler Foundation, St. Louis, Missouri.

ORCID iD

Donald M. Linhorst

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