STIGMA - THE HUMAN STAIN

A Study of Police Suicide in 2008-2016
Police Suicide - What It ISN'T
Master Police Coaches - Building a Better Cop
PTSD - The "Hidden Injury"
Police Suicide - Making a Difference
The Importance of Therapy
Police Suicide - the SOLUTIONS
Interview with the BOL Chairman
So-Called "Helpers"
A MATTER OF PUBLIC TRUST
2016 Police Suicide Study
Annual Mental Health Checks
Stigma - The Human Stain
2016 Police Suicides: the NSOPS Study
Police Stress vs Trauma--a difference?
Does PTSD Cause Violence? from the Badge of Life
A New Police Suicide Prevention Program for the 21st Century
Police Suicide, Just a Bad Choice?
Chiefs Lead the Way
"Bring a Buddy"

by Marla Friedman, Psy.D, PC
Police Psychologist, Badge of Life

S-T-I-G-M-A, These 6 powerful letters stop our officers from getting the help they need.  In fact it stops a lot of people from seeking mental health treatment.  Somehow we leapt into the 21 Century, but brought our 20th Century ignorance and misconceptions with us--like holding on to the idea that the world is flat or that smoking is good for you.  Some people believe that seeking help to maintain and build resilience through mental health treatment is a character flaw or personality weakness. It is not.  It is a strength.  It takes guts to ask for help and then follow through on seeing a mental health professional.

Humans are not built for continual assault and punishment without it having a long lasting influence.  Cumulative trauma is etched in the hearts, minds and bodies of our first responders like a stain that spreads to engulf all of the good around them.  If you have any doubts about this, just ask the parents, spouses and children of law enforcement officers.  They see their loved ones through a special lens.  Sometimes they can’t label what is wrong, but they can feel it.  Go ahead ask the first responder in your life. Watch them deny any problems. “I’m just tired.”  “I just want to have a few drinks and relax.” “I don’t want to talk about work at home.” If you ask them to get help they will most likely refuse because they are afraid of the stigma.  What will my peers, chief or friends say if they found out?  “Who will trust me on the job?”

 

The fact is no one can handle seeing a dead or injured child and walk away without that face living inside them forever.  Add to that the daily stress required by dealing with a hostile public year in and year out.  The violence, hatred and neglect that is experienced on many shifts makes a small cut each time.  Like a surgeon, they learn to stuff down their feelings so they can do their job.

 

Stigma is the number one reason law enforcement officers forgo mental health checks and suffer in silence instead.  This is always to their detriment.  No amount of pretending it doesn’t hurt or doesn’t have a negative effect on the mind and body to see human destruction of the most unimaginable kind makes it true.  In fact, vey few go unscathed. 

 

If officers can fight criminals they can surely learn to fight stigma.

 

Recently I participated in a discussion about the Guardian versus Warrior model for police officers.  Some suggested that officers used to be trained to be peace officers, but now that has changed and they are expected to model military style behavior. What remains the same, regardless of which side of the discussion you fall on, is the concept of accepting that the mind and body are one. We are affected on all levels by traumatic experiences.

 

The release of stress hormones accompanied by the visual memory of past encounters as well as the minds propensity to imagine future assaults can cause anticipatory anxiety, panic attacks, clinical depression, psychological numbness, withdrawal, distracted cognition, avoidance and rage.  Feelings of depersonalization and derealization are also common.  Additionally, the officer will become hypervigilant and suspicious. These reactions, which result in an understandable and defensible survival mode response, may cause behavioral manifestations which are overreaction to minor events, aggressive actions toward the public, peers and family members and in extreme cases the person becomes overwhelmed with these ongoing feelings and resorts to suicide. While suicide is statistically rare it still represents a devastating outcome to a treatable phenomenon.  The result of this ongoing assault is well documented yet stigma, still, unfortunately trumps science when it comes to seeking appropriate diagnosis and required mental health care.

 

The decision to avoid treatment due specifically to the concept of stigma has been tested using three statistically valid measures.  These assessment tools were originally used to assess the attitudes and behavior of an elderly population living in rural settings. The independent variables were: 1. Isolated rural subjects. 2. Adjacent rural subjects. and 3. Urban subjects. The dependent variables were the scores on the specific measures. However these tests could be used with a law enforcement population during the pre-employment evaluation to determine the subjects’ mental elasticity and attitudes toward maintaining health regardless of perceived stigma from internal and external influences and belief systems.

 

The goal would be to narrow the selection process to specific candidates who demonstrated mental flexibility and the willingness to undergo ongoing mental health checks and /or treatment to maintain and develop personally and professionally, without regard to the stigma of engaging in therapy as needed.

 

The first test is called, Self Stigma of Seeking Help (SSOSH).  It is a self-reporting measure where the subject anticipates their own reactions in the face of considering seeking help for emotional reasons.  It taps into the subjects’ level of intelligence, the effect on their self-esteem and personal sense of psychological adequacy. This short form has the candidate rate their agreement on a list of statements using a series of ten statements using a 5-point scale. 1 (strongly agree) to 5 (strongly disagree). Scores range from 10-50 with higher scores indicating greater self –stigma. “The SSOSH showed good convergent validity with the anticipated benefits subscale of the Disclosure Expectations Scale and Intentions to Seek Counseling Inventory. Internal consistency was adequate in the current sample ( = .75)” As a result, our psychologists who specialize in assessment could utilize this measure to help predict which officers would be likely to seek help if needed and this would be an additional variable to use during the initial selection process.

 

The next measure is the Perception by Others for Seeking Psychological Help (PSOSH).  “The PSOSH consists of 21 items that follow the statement, ‘Imagine you had a problem that needed to be treated by a mental health professional.  If you sought mental health services, to what degree do you believe that the people you interact with would …”Participants rated their agreement with a series of statements (e.g., think of you in a less favorable way) using a 5 point scale that ranges from 1 (not at all) to 5 (a great deal.) Scores range from 0 to 84, with higher scores indicating levels of public stigma.  The scores also related positively to the scores on the Stigma of Seeking Psychological Health Scale.r = .31, p < .001) and the (SSOSH, r = .37, p < .01)


The PSOSH was found similar to other measures of stigma and also demonstrates validity for individuals experiencing stress, indicating high internal validity and consistency.  Internal validity for the PSOSH was excellent in the current sample ( = .98) This measure with its superior performance would further identify officers that would be immune to the reactions of others upon hearing that they were pursuing mental health treatment.  These officers would be more likely to utilize therapy with the result being better overall health as well as an increase in family harmony and an improved work life.  These officers might also demonstrate better overall resilience across the board.

 

The third test is the Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS).  It “measures an individuals likelihood of seeking psychological health from mental health professionals and assesses perceptions of social contacts, including how one thinks family members, close friends, significant others, coworkers and others would react if the person completing the survey were to receive psychological help.” The three factors measured are: psychological openness, help seeking propensity and indifference to stigma.  “Participants rated their agreement with a series of statements using a 5-point scale that ranged from 0 (disagree) to 4 (agree)”The current sample produced internal consistencies of (’s = .74-.83). This would also be a good measure to use to support the information gathered from the other tests, as multiple measures are always indicated when making high level decisions related to public health and safety.

 

Neurological, psychological, physical and situational trauma damages the whole person.  Stigma is just a word. Confront it and give yourself a chance at normal relationships. Flexibility and openness in regards to maintaining good mental and physical health allows for a long -term career that is satisfying and pride producing.  It also allows for gratification and pleasure in the officers personal life. The two build on each other and it’s a risk worth taking.

 

                                          References

 

Fischer, E.H. & Turner, J.L.  (1970).  Orientations to seeking professional help:  Development and research utility of an attitude scale.  Journal of Consulting and Clinical Psychology, 35, 79-90.  http://dx.doi.org/10.1037/0029636

 

Komiya,N., Good, G.E., & Sherrod, N.B.  (2000).  Emotional openness as a predictor of college students’ attitudes toward seeking psychological help.  Journal of Counseling Psychology, 47, 138-143.  http://dx.doi.org/10.1037/0022-0167.47.1.138

 

MacKenzie, C. S., Knox, J.  V., Gekoski, W. L.  (2004).  An adaptation and extension of the attitudes toward seeking professional psychological help scale.  Journal of Applied Social Psychology, 34, 2410-2433.  http://dx.doi.org/10.1111/j.1559-1816.2004.tb01984.x

 

Vogel, D. L., Wade, N.G., & Ascherman, P. L.  (2009). Measuring perceptions of stigmatization by others for seeking psychological help: Reliability and validity of a new stigma scale with college students.  Journal of Counseling Psychology, 56, 301-308.  http://dx.doi.org/10.1037/a0014903

 

Vogel, D. L., Wade, N. G., & Haake, S.  (2006).  Measuring the self-stigma associated with seeking psychological help.  Journal ofCounseling Psychology,53, 325-337.  http://dx.doi.org/10.1037/0022-0167.53.3.325

 

Vogel, D. L., Wade, N.G., & Hackler, S. (2007).  Perceived public stigma and the willingness to seek counseling:  The mediating role of self-stigma and attitudes toward counseling.  Journal of Counseling Psychology, 54, 40-50.  http://dx.doi.org/10.1037/0022-0167.54.1.40

 


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