The police – why and how we should care

When you see or hear a tragic news story, you perhaps experience an emotional and empathic response. You consider the victims, bystanders, families and wider public distress. As psychologists, perhaps we also appreciate the issues for psychological services needing to respond to disasters and tragedy. But for me, it's not just empathy for of the victim, the public or the services. It's for those running towards the disaster.

Those behind the uniform who juggle families, commitments, who have already worked a full shift, not eaten properly, they need to do the school run in half an hour but now can't.

Those who are uploaded to social media, or publicly criticised, yet are expected to be there for everyone in any event.

Those who often choose not to disclose their occupation to people for fear of judgement.

Those who choose to help but receive no thanks.

Those whose necessary actions to safeguard can be seen as an inconvenience.

Those who experience physical threat and trauma daily.

Those who experience obstacles getting the required support.

Those with a hidden higher suicide rate than the average public.

Those deemed key workers but not Covid-vulnerable despite being spat at regularly.

Those also facing austerity measures and poor resourcing, but with no right to strike.

Those whose annual leave is always open to cancellation in times of national need.

Those whose profession is so widely dramatised and televised.

Those who are never off duty… even when off duty.

Those who are police officers.

My journey

Throughout all of my clinical practice, psychology degree and other post-graduate training, I have preferred working with those some may deem 'more challenging' groups – forensic/offenders, street workers, drug and alcohol services, safeguarding, asylum seekers and refugees to name a few. I have worked in various settings; primary, secondary and third sector providers. Working with specific populations has always required adaptation and appreciation for that lived experience and societal context. It has not only provided me with some understanding of the interface and presenting needs of those involved with multi-agency working, but also some insight into the impacts that can have on the professionals.

Privately, I am a police spouse. This involves juggling work and a young family amongst what can be an unpredictable and unsociable working pattern. This isn't just living with a shift worker, it's knowing that altered shifts means something unthinkable has happened and there is good chance they are dealing with a risk-based situation. In 2022, according to Gov.uk figures, there were over 41,000 recorded assaults on police officers in England and Wales. In the same year, Police Scotland reported over 7000 assaults in the line of duty and last month the Police Service Northern Ireland PSNI reported 43 assaults within a seven-day period.

Personally, it can be unnerving when a serious incident is unfolding from the news and knowing he is in the thick of it. I have first-hand experience of the workplace rules, demands and quirks a serving police officer faces, and how their very way of doing life adjusts and alters in response to their occupation. These traits may be irksome but are necessary to be a safe, skilled officer.

The first police officers I worked with therapeutically had come to the attention of secondary services due to their acute risk presentations. Their stories and ways of engaging cannot be compared with the general public, nor are they to be put in the same category as military personnel (although this is a common, understandable comparison). These individuals came with significant levels of illness, compounded by delayed help-seeking and the effects of their roles and incidents they had attended.

In contrast to the military, there are fewer bespoke support services for police. Their needs are often considered 'too much' for the Improving Access to Psychological Therapies approach, and 'not enough' for secondary or specialist services. There are hopes of a 'health covenant', and that services for emergency workers will be brought in line with those for our armed services; there is hard work going on in these arenas.

There are three residential settings for police officers nationwide. I was incredibly lucky to work in one for the best part of six years. It was a real privilege to be a (small) part of an officer's journey, witnessing the challenges of policing across the UK, and also how being an officer affects dealing with normal life challenges. It also inspired my PhD into police mental health and facilitated my data collection. There are, however, no police specific services for Posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD), despite Police Care UK funding research by Prof. Chris Brewin, Dr Jess Miller and others on PTSD and CPTSD in UK police officers, published in Psychological Medicine in 2018, suggesting that prevalence sits at 8 per cent and 12 per cent respectively.

This all fuelled my interest in joining Police Care UK – a national charity whose charitable activities centre around 'harm caused by policing'.

Harm caused by policing

It is widely documented that policing carries psychological risks. Figures from the Police Federation of England and Wales show that in 2020, 10,000 Police Officers were off work due to stress, depression, anxiety and post-traumatic stress disorder. 80% of Police Officers admitted to struggling with their mental wellbeing. In the same year, 70% of Scottish Officers had their rest days cancelled due to work demand and around a third regularly went to work despite feeling mentally unwell – on average 19 times in six months. The Police Service in Northern Ireland lost 21,702 working days due to psychological illness between April and December 2021. UK police suicide prevalence is thought to be 2-3 times that of the general public.

Why? Well, according to author John Sutherland when he spoke to the Police Federation in 2021, an Officer could see 400-600 (criterion A) traumatic events during an average career, contrasted with the 3-4 serious events typically thought to be experienced by civilians. On top of the usual life stressors, this accumulation of trauma can take its toll: a dripping tap of experiences with catastrophic cumulative impact. More than half of police officers report they don't have the opportunity to process difficult experiences before moving on to the next – a significant precursor to impairment from trauma impact.

Every police department carries its own trauma vulnerability. Police officers can never be protected from difficult material. It is omnipresent; there's direct, indirect and vicarious exposure.

Policing is a diverse and rewarding occupation. It's not just responding to emergencies: it's proactive investigations, juggling multiple cases and heavy workloads, supporting victims, compiling case files, intelligence, reviewing (often upsetting) material and evidence, public order and physical threat (assault and/or exposure to biohazards).

It's classifying offensive images, collecting body parts, witnessing raw atrocity and depravity yet showing professionalism and human care to even the most disturbing of offenders.

Police work is being a highly trained, split-second decision maker who will always face consequences, whether that be media exposure or the review of investigations.

It's being deeply disappointed by an officer bringing the profession into disrepute and wanting to shout 'we're not all like that', but fearing the public's perception and potential for personal and professional backlash. The officer publicly buying a coffee is often met with criticism. No other profession experiences this.

Policing is a culmination of shift work, irregular dietary intake, irregular toilet access, stress, persistent autonomic nervous system arousal and disturbed sleep.

It's families juggling life; passing pyjama-clad kids between each other in supermarket or police station carparks, booking annual leave 14 months in advance to (try) to be at a family event. It's making plans and having to cancel them at short notice. Being a police spouse/child/dependant can be bearing witness to a loved one returning home, drained, sometimes silent and visibly shaken by their shift.

And then showing up to the next job… and the next… for up to 30 years' service.

Police Care UK

Hopefully I have offered some insight into the challenges and support requests Police Care UK, receive on a daily basis. My working day varies, but generally starts with our referral meeting with the welfare team. It also means allocating and undertaking complex assessments to identify the best starting space for trauma therapy. I liaise with the welfare team and wider teams within and associated with the charity to oversee the therapeutic journey.

This was the first UK evaluation of a PSYTREC model in a residential setting, and the first intervention specifically targeting C/PTSD in a policing population worldwide. The results are very promising so far, with 93 per cent of officers returning to work, and 84 per cent losing their diagnosis as of January 2023. But the evaluation remains in progress, with a longitudinal design; publication is envisaged later this year.

I love the freedom and support to be able to deliver new things and help forge a therapeutic service fitting to policing need. Working for a specialist national police charity means a fabulous team, with many retired police or those affiliated with the police. We recognise the needs of the whole police family; serving and veteran police officers and staff, volunteers, and their families who have suffered any physical or psychological harm as a result of policing. The charity's therapy need rose 900% in the first year of going live; last year we delivered 5.5K hours of therapy, and we continue to grow.

Challenges remain, including those presenting outside our remit of 'harm caused by policing'. There are 'postcode lotteries' of support nationwide, and sometimes an officer's occupation health or force are not supportive or under resourced. We need to tackle signposting limitations, including a lack of understanding, delayed help seeking and negative press.

Tips for psychologists interested in working with police officers

Working with police officers requires an acceptance and understanding of 'a job like no other'. Understandably, police can present cautiously to professionals and disengage if the support is not fitting. There can be a working culture of hierarchy, and we sometimes need to work to override initial reactions based on a sense of duty and camaraderie. I find I need to keep pace, keep my humour, expect to be personally tested, and bring out my best 'poker face'.

Policing is a multisensory experience and requires a robust therapeutic container (and strong stomach!). It often involves hearing explicit and highly challenging information. The higher-than-average mortality rate (health and suicide related) can cause sadness that ripples out, a 'thinning blue line'. The therapy process can sometimes jar an officer's own expectations of being infallible, so it's vital to build enough trust so that the rescuer allows themselves to be vulnerable, heard and helped. We need to understand that stigma around help seeking is heightened for help givers, and they worry about burdening us and wish to protect us from their horrors.

Yet working with police officers is also very rewarding, and an absolute privilege. It is being trusted with their personal accounts and letting them come out from behind the uniformed persona. Police Officers are not used to being ill and most are highly motivated to make change. They are generally keen to learn – intra-session homework is not something I have struggled with in this field!

I'll end with some Do's and Don'ts for engaging with this population.

Do:

Do see the person behind the uniform, and consider their families.

Be trauma aware, and if not trained to do a robust trauma-focused intervention, hold the space, be clear and refer on.

Appreciate that them even sitting with you, considering sharing, is for most a big deal.

Offer flexible appointments, juggling shifts is hard enough.

Be open to learn.

Expect to hear something unpredictable and potentially horrific.

Accept that sometimes humour is a form of communicating something painful.

Bring yourself to the session and build up trust.

Be prepared to be asked questions; police officers are continually assessing situations and need to feel safe.

Be kind.

Do what you say. Consistency and integrity are core policing qualities; they go a very long way.

Don't:

Don't assume it's the 'big job' that caused the problems, it could've been the smaller things that had personal relevance.

Don't assume it will always be work material; police have private and early life experiences too.

Don't expect to have the full details: there are often things they officially can't tell you.

Don't pretend to understand acronyms or processes: enquire and look to understand.

Don't compare to TV programmes, or ask unnecessary questions.

Don't forget your clinical supervision.

Don't underestimate the positive impact you can have.

And, more broadly as a member of the public, the next time a road is closed, don't be cross at the officer at the cordon. You don't know what they are protecting you from, or what and who they have had to deal with that day.

We can all do our bit to create what policing needs – a safe space, one that truly holds.