Protecting Against Stress & Trauma - Part 4: Audience Q&A

RACHEL ANDERSON:  Rachel Anderson. I am a AAAS fellow at the National Institutes of Health and former fellow here at NIJ. I've really appreciated listening to your discussion this morning. One thing that I didn't hear anyone mention was substance abuse. I'm sure most people here have the same sense that coping with stress and trauma is often cited as a factor that drives alcohol and other substance use. And in particular, chronic alcohol use disregulates brain stress systems and exacerbates symptoms of stress-related disorders like PTSD. So I'm hoping that some of you might have some comments on the need or experiences that you've had with preventive efforts or treatment interventions for substance abuse, for individuals in this high stress profession.

CHRISTOPHER SCALLON: That's my day to day. So here's the deal with substance abuse. It's a symptom. And often agencies focus on the symptom. I know you probably never heard of it but there's been a cop once or twice get a DUI. We immediately treat that as a, oh my God, he messed up or she messed up, blah, blah, blah. We're not asking the right questions. We should be asking, wait a minute, why at 10 o’clock in the morning did this officer crash his car and is drunk? Why? Not what's wrong with him but what's happened to get us to this point? The big thing with substance abuse is that there's such a stigma associated with it and in getting treatment but that's not even the worst of it. We don't have the facilities or we don't have the knowledge of where to go when we need to get help. There's a great example of an officer that came to me. Well, we went to his house at about 3:00 in the morning because crisis never happens at noon. It's always like 3:00 in the morning. We sent him to a facility. A nationally recognized facility. Our insurance covered all but $500 a day. And so 20- 21-, 28- 45- or 90-day stay, an officer is looking to come out-of-pocket anywhere between $10,000 to $50,000.

Now here's the other side of it. We need to have facilities that are first-responder savvy. Now imagine sitting in a group because when you go in to inpatient work, you'll be doing group work and you'll be doing individual counseling. So imagine sitting next to somebody and they're like, "All right what's going on with you?" "Well, I grew up being abused by my mother. I wound up stabbing my stepfather in the face. I started drinking to cover it up and next thing you know, by the way, I'm getting ready to serve 18 years if I don't complete this program and my roommate woke me up and I thought it was my mom, so I stabbed him." "Okay. Well, thank you. What's your name?" "Hi, I'm Chris. I'm a cop." Yeah, that's going to be the best most awkward setting. In order to get healthy, in order to become sober to get through the recovery process, you have to be honest and no cop is going to be honest sitting next to somebody who they find themselves more adversarial.

HOWARD SPIVAK: Other comments?

JOHN VIOLANTI: That's funny that, in terms of research, stress and alcohol abuse are co-morbid. They occur a lot quick. In one of our research projects, we looked at that and what the effect was on suicide ideation and if you had high levels of stress and you had high alcohol use, you had a tenfold risk of suicide ideation. So all of those things are kind of a nasty triad that people involved in alcohol are at higher risk for suicide as well.

HOWARD SPIVAK: So from what I'm hearing, it sounds like we need to deal with the substance abuse in a bigger context and not just focus on the substance abuse itself?

CHRISTOPHER SCALLON: Yeah, the substance abuse is a result of some underlying trauma or cumulative trauma or whatever it is. If all we're working on is to get to somebody to stop drinking, we're missing the boat completely. We need to fix it and the best way I'd describe it to folks is it's that we have a cup that starts empty and then we put trauma in it. And it starts getting filled up a little bit, maybe a big splash. And eventually it starts overflowing. Well, the overflowing is the suicidal ideations. The overflowing is the DUI. You're trying to self-medicate through whatever whether it be pharmaceuticals which I've experienced. So if you just pour it out, yeah, sure, your cup is not overflowing but how long is it going to take for that cup to get filled up again? So what that involves with the academic side of it and the mental health side of it is dumping that cup out. That means addressing the underlying trauma. It's unique for where we are in specific parts of the agency. In other words, there's a pretty coincidental thing that happens. A lot of like sexual assault investigators have a history. Understanding that maybe they need to address that before they start going over the top or falling over.

HOWARD SPIVAK: Great. Thanks. 

STEVE BISHOPP: All right. . Okay. So I have a couple of comments and suggestions particularly that deal with research. And then a question for John Violanti. My name is Dr. Steve Bishopp. I'm a Sergeant with the Dallas Police Department. I've been there right at 29 years and I’ve been involved in quite a bit of research of my own in officer mental health and use of force so that's where these questions are coming from. Anyway, so I'll start with Dan. When you were talking about mindfulness and some of the programs that are going on, I was also going to just let you know or make you aware that the University of Texas of Dallas brain centers, brain sciences is also doing a lot of work in that area and doing programs with the Dallas Police Department and some other agencies. That might be a resource or somebody to reach out to see what they've done as well. I don't know if you're aware of that. You can't always be aware of everything going on but I was just going to tell you that.

But I wanted to address a little bit about the resiliency part and this is for Chris as well, I think resiliency starts at recruiting. So if we have recruiting measures where we're finding people that are already emotionally healthy. Are they married? Are their relationships going well? What past have they experienced in college, victims of serious violent crime. I'm not talking about these, mixing them out. But this would start the resiliency issue and having people resilient coming into the job in the first place.

Next, I think Wendy, we talked about this before that sergeants are probably the most important people when it comes to officer resilience. I've been a sergeant for 19 years, so I'm particularly focused in this area. But I believe sergeants have probably the biggest impact on whether the officers come to work and want to work, feel like they're supported by supervision. We find that that variable consistently in the mental health research of stress-related issues with officers that their relationship with their supervisors is one of the biggest organizational stressors that they're going to come across.

But anyway, I wanted to make just some points about resiliency and the mindfulness training which officers who go to it—even if they are reluctant to go to it—they're coming out of it saying, “Hey, that was some good stuff. I can use that. I wish I had had that before.” So I'm just repeating your call to that because I think you're right. I guess back to John. One of the things I wanted to ask you to do, if you could talk just a little bit about your study on the life expectancy study— the one I emailed back and forth with you about awhile back—because I think that more than anything else really hammers home the physiological impact of stress on police officers in the life expectancy of police. I'll cut it off there. I had a bunch of notes but I'll leave it go at that. But I would like to hear about that and see what you had to say.

JOHN VIOLANTI: Thank you, Steve. Well, the news isn't good. I mean, look at our Buffalo sample. I'll start with that and then talk more about what we did with that. We did a police mortality cohort, which is a study of a group of police officers from 1950 to 2015. We looked what officers died from and so forth and so on. The lifespan for that particular cohort was 68.2 years. Now the average lifespan for white males, by the way, in the United States is probably around 78, 79—somewhere in that area. So they're dying at a much earlier age and they're dying more, as I mentioned before, from heart disease- and cardiovascular disease-related deaths. The other part of the study compared that sample with the national sample of life expectancy in the United States. What we found that at various ages, police officers were always at greater risk for dying than was the general population. An example between the ages of 15 and 55, they had a 40% greater chance of dying than did the average citizen in the United States. As they got older, of course, they had a greater chance of dying.

But the really interesting thing about that is that the younger officers had an increase of dying over people in the general population and dying of cardiovascular disease. So what causes a young person to have a heart attack or having some sort of a cardiovascular malfunction? Well, again, lifestyle, stress, police officers putting up with this stuff, what they put up with every day. Now the stress in policing is only one factor, what does that affect? It affects your diet. It affects your health. It affects your sleep. It affects your life. So all of these things together decrease the life expectancy of police officers. How do you stop that? Well again, wellness issues are important. Getting people well, getting officers well. Training them to be well. How to sleep, how to eat, how to deal with stress, use mindfulness, use yoga. Use what you want. But my gosh, take care of it. But yeah, it's unfortunate that they die at an earlier age than the general population.

CAITLIN THOMPSON: Hi. Caitlin Thompson with Cohen Veterans Network and prior to my work there, I oversaw the suicide prevention program for the Department of Veterans Affairs. I'm really interested in hearing Major Stiver about your experience in terms of being a veteran as well as just what research is being done for our veterans who are also going into law enforcement. I know that there are so many similarities, the sleep deprivation, the family difficulties, the substance abuse, et cetera, et cetera. So what is being done right now to better understand that and just overall what are your thoughts in terms of the overlaps? Thank you.

WENDY STIVER: I was in the Army in the '90s before a lot of the changes happened after 9/11 that led to increases in deployments and things like that in the military. And a lot of my friends who were still in the military have been deployed five, six, seven times or just even being deployed once when I was in the military was rare.

In some of my exploration here, what I found is when we talked about family support, the military already had kind of some of those concepts built in in terms of taking care of soldiers and their families or airmen and their families. As a kid growing up in the Air Force, we were very well-cared for. My dad deployed, my dad went on unaccompanied assignments and was gone. So we had great support networks that were already there back in the '70s to give away my age.

Then kind of about five years after the invasion of Iraq, the military really started looking hard at resiliency and how to build more resilient workforces because suicide numbers were going up and they were noticing the need to improve on the systems that were already there. I think that's what we're seeing in police now, and I think some of it is coming over and we're learning, or we have the ability to learn from some of the things that the military has done to build. There's a whole Air Force office of resiliency. They've got a whole group of people that are working on this. So the challenge is going to be building that into the operational structures of police departments at a time when we're struggling to recruit, we're struggling to meet our operational commitments. And I can tell you that when it comes to doing research and bringing that back into our agencies, one of the biggest challenges is that nobody has the capacity because any kind of project is viewed as a threat to operational resources. So we take a police officer away from policing to work on a project that might help us out in the long run, but we're taking a police officer away from policing. I think that's one of the big challenges.

But I have seen where the VA and the military have been looking very closely at and studying suicide and the impact on both active military members and veterans. That's a huge part of our recruiting pool. We're bringing in a lot of people from the military into policing so the better work that you're doing in the VA and the better work they're doing in the military may have some impacts on what we see in policing as we move forward.

DAN GRUPE: Just on a related note, a quick follow up. One of the teachers who teaches our mindfulness class, Chris, does a lot of teaching and coaching inside the VA too and made me aware of this whole health initiative that the VA has been rolling out, which is really a philosophical shift that puts the individual and health promotion at the center of healthcare as opposed to disease management, and is a personalized approach that integrates a lot of things we've been talking about, mindfulness, sleep, hygiene, nutrition, relationships, spirituality. But it's really person-centered and asks the veteran what matters most to you and how can we develop an individualized plan of health to promote those things that matter to them. So, I think it's something for law enforcement if they're not already looking at it, to take a look at this model.

HOWARD SPIVAK: Right.

JOHN VIOLANTI: Okay. I just wanted to add that I think one of the important things to consider is the reintegration of people coming back from war, from Afghanistan, into police work. If they were officers when they left and they went to war, and they came back, there's quite an adjustment coming back to the job of being a cop again. Things are different in the streets in Baghdad than they are in the streets of Detroit. Well, it's close but, [laugher] they're different. And different modes of dealing with people so there needs to be a reintegration process and I think most departments are doing that, a re-training, a lot having to do with driving and shooting, and everything. It has to be kind of be learned all over again. Because the military way of doing things in combat is quite different.

DR. LESTER ANDRIST: Great. Thank you for this panel. It's been really informative and excellent. I'm Dr. Lester Andrist, Director of The Public Safety Leadership Administration Program, Professional Masters Program at the University of Maryland. We have this focus on leadership for law enforcement, and other public safety officials. I just wanted to ask from any or all of you if you had one suggestion for changing organizational culture, just one implementation, something that we can implement. I think that's a huge question but I think it's a really important one. Other than just sort of rounding up people in a classroom and saying, “This is important.” Is there something that you thought about that could make that change?

CHRISTOPHER SCALLON: I do a lot of speaking at different universities. And it's always interesting when you come across a criminal justice major or something like that, who knows everything. I think the best thing you could do and what helps any organization or people learning about it, is to be honest. Here's the bad part, being honest about what we do isn't always pretty. There's a picture. Everybody wants to be a lion until it's time to do lion stuff, and then it gets pretty ugly.

I spoke with a friend of mine, a doctor who's over here at Old Dominion University, and we used to repeatedly go there. And I would tell them about the struggles. I would tell him about how hard it was to deal with certain things that I saw and how that stress affected me in doing investigations. We talk about how many children can you see physically, sexually molested to the point where they need hospitalization? I mean, how many times can you see that before you're starting to get this distaste for what humanity does to you? And again, it's just cumulative on top. That's just one thing on top of 13 others. If we allow ourselves to be real and understand that, “Hey, we have problems on our end.” Until we start recognizing that, we're not going to change anything.

You go to any agency, I always ask, "Hey, how many drunks do you have in your agency?" And they're like, "We have a couple." No, you don't. No, you don't. ”How many of your folks have thought about suicide?” "Well, not that many." “No. It's a lot. I'm here to tell you.” We have to be okay with saying it, I think ultimately.

WENDY STIVER: Yeah. I think when you talk about changing the culture, that's a really, really huge order. But there are a couple of things there. One is, I had the privilege to go down to Columbia, South Carolina and meet with some folks at the Richland County Sheriff's Office. And Sheriff Leon Lott there has done some pretty impressive things with changing the perception of that agency when it comes to the stigma of PTSD, and the things that his people have encountered. He let me sit in a room with these folks and just listen to their stories all day, and they were very patient and kind, and giving in that way. But they made it very clear we talk about this, and we talk about this openly with everybody in the agency when they come in the front door. So that's kind of helped to change the way they perceive it.

I think the other thing and the other big thing is diversifying our agencies and not just bringing in people of different cultures and backgrounds and races, and expecting them to conform to the organizational culture, but allowing them to bring their own culture into the agency. My agency just graduated from the academy, one of our first African immigrant officers. It was a big day for us and it was a big day for him. He's from Burundi. He brings a whole different culture and different ideas to the agency. I think we don't just expect him to conform but celebrate what he brings to the table. In the United States, we're looking at an average of about 12 ½ percent women in police agencies, right? We know that women bring different cultural perspectives into this job that can help change the way we think about things. So, I think that's really, really important. We've been working on it for a while, just in broad terms of diversifying our agencies, and it needs a lot more work because there's not a whole lot of research on how to do it better and what works and what doesn't.

HOWARD SPIVAK: Thanks. We're running out of time and I want to give the last few people a chance to ask questions, so...

ELIZABETH MUMFORD: Hi. My name is Elizabeth Mumford. I'm with NORC at the University of Chicago based here in Maryland. I want to just take this opportunity to thank NIJ and some people in the room who supported a national-level study of agencies and officers in terms of safety and wellness. So we have collected the agency level data. We've closed the cross sectional first wave of the officer data, and we got additional NIJ funding to follow up. We're really hoping to expand the sample.  We have the right statisticians so we have really good weights and stuff like that, but it's a challenge to get agencies and officers to participate in these studies, where we're asking a lot of sensitive questions at the national level. But we're specifically doing this to bring this data to the table to raise awareness in administrative meetings and municipal funding conversations about what the extent of PTSD is, what the extent of resilience is in the officer population, how many of them are coming from the military and what are they dealing with in their personal lives. So, I wanted to put that out there and to ask if anybody is interested to please reach out to me because we certainly would welcome inputs.

On my own, I've also studied a lot of trauma-informed care in the last five years. I will stand up like I'm at an AA meeting. I come from a history of suicidality so I'm really sensitive to these topics and making sure that we all feel comfortable talking about it. I was on a panel with CNA about three months ago, and what was raised was the issue of the stigma if you have something like this on your record, you can't retire with your weapon. And I wondered if anybody wanted to comment on this because I hadn't heard of this before and this really shocks me that we're facing this insoluble situation of somebody feeling a need to retire with a weapon but fearing that putting it on their record is going to stop that.

CHRISTOPHER SCALLON: Yeah.

WENDY STIVER: Yeah, I know.

CHRISTOPHER SCALLON: Yeah. Yeah. That's a big issue. As far as retiring with your weapon, that's a new one. This is where the problem is from the top down. If I reach out for help and I say I have an issue. I'm drinking. I can't control it. I need help. Most agencies are fairly small. We're not dealing with large agencies. But I'm not getting transferred to any specialty assignment because I'm a drunk, right? There is no concept of somebody being in recovery. And when somebody's in recovery and they slip, relapse, that's part of the recovery process, they're penalized for it. They're penalized for it. —“Listen, we want to help our officers. That guy will never work in traffic.” They're talking out of the side out of their mouths, right? So, that's why you get a lot of people doing that. And as far as the gun thing, what I've seen happen is that somebody voluntarily go to get help. And then while they're receiving help, it becomes involuntary. And depending on what state you're in, for example Virginia. If you're involuntarily held at a facility, you can't have a gun anymore. So, it's not about even having a job anymore. It's done. It's over. But different states have different things.

HOWARD SPIVAK: All right. I'm sorry, but I just got a sign that we have to wrap up so I think we're going to have to close off questions. I was asked to do a wrap up on this and I have to say there's far too much that's been talked about for me to do that. But what I will do in closing is reference for all of you the fact that NIJ has on its website a strategic research plan for safety and wellness in this area. I think a fair amount of what we talked about today is covered in that. I think there are some holes that were pointed out today which are interesting that we'll have to think about. But I encourage you to look at that and we're certainly open to feedback from any of you if you review it and have any thoughts about it. So on that note, I want to thank our panelists. They're totally wonderful. Thank you.