Improving Mental Health Care for Police Officers

This article examines how therapists’ sociopolitical bias against law enforcement officers affects mental health care and synthesizes existing literature on anti-police rhetoric within mental health professions and its influence on therapeutic relationships. Cultural and organizational factors are reviewed regarding their effect on officers’ willingness to seek care, and evidence-based interventions and training approaches for therapists are identified. Findings indicate that negative narratives about police within mental health institutions can erode trust and discourage officers from accessing services. Recommended interventions include motivational interviewing, mentalization-based therapy, group therapy, cognitive-behavioral approaches, and family counseling.

Therapist training in police culture, trauma-informed care, and resilience-building is essential for fostering cultural competence and trust. Mental health professionals and their organizations must reject ideological approaches toward law enforcement and adopt balanced, fact-based perspectives. Implementing specialized training and culturally competent practices can enhance therapeutic alliances and improve mental health outcomes for police officers.

Keywords: Police, law enforcement, therapists, sociopolitical bias, mental health

“Therapists are not your friend and really could care less about you as a person. Never ever talk to them. They are liberal scumbags, or they wouldn’t be in that career.”¹

This police officer’s overgeneralization reveals a sentiment with more than a grain of truth: Many therapists have unsympathetic or even hostile views of the police. Recognizing this potential bias, this essay argues for developing and implementing effective strategies to address these negative views and promote effective mental health treatments for law enforcement officers.

There is widespread anti-police rhetoric across the different professions involved in the mental health field. Typically, this rhetoric makes sweeping negative generalizations about police officers, fails to note evidence that contradicts these claims, and ignores the positive and challenging work police do for their communities. The result is language that makes many police officers feel misunderstood, attacked, or demonized. Examples of this are:

• Many social work academics argue that the police are tools of “social control and White supremacy”² and perpetrate “structural violence.”³ They add that social workers should cease to collaborate with these agents “enforcing racial dominance.”⁴

• A subfield within social work focuses on the complete abolition of the police.⁵

• In 2022, the American Psychological Association adopted a resolution⁶ related to racism in policing, in which it officially endorses many claims of anti-police activists.

• The Journal for the American Academy of Child and Adolescent Psychiatry has declared itself to be an “anti-racist journal,”⁷ thus linking itself to myriad contentious ideologies within anti-racist” thought (some of which advocate for defunding the police).⁸

Police officers’ overly negative portrayal, whether from academia or the media, often reflects a larger societal context that has adopted a social justice narrative about policing. Three simplistic ideas are popular in mental health organizations⁹ and academia:¹⁰

1. Traditional power structures are mostly harmful to society.

2. Discrimination is the fundamental cause of all unequal outcomes.

3. Problems should be seen primarily through the lens of race or gender or other markers of identity.

This language, which is now common in mental health institutions, professional bodies, and therapy services, could easily influence therapists to:

• view police as agents of oppression rather than unique individuals;

• conceive of law enforcement officers with simplistic, false narratives; and

• have reduced empathy toward officers.

What does this mean for police officers themselves? This rhetoric could likely undermine police officers’ general trust in mental health professionals and discourage their use of services. Reasonably, police will monitor therapists for signals as to whether they hold views hostile toward the police. Conversely, expressions of gratitude and support for the police could meaningfully reduce these concerns.

The appropriate view from the mental health community should recognize that every law enforcement officer is an individual, requiring a personalized approach that reflects their needs, stressors, and treatment goals.

Therapists working with officers should consider the stresses of police work: trauma exposures, shift work, organizational stress, and disturbed sleep cycles. Law enforcement officers often interact with people at their worst. Police are scrutinized by the media and public and are easily criticized on social media. There is a reputational asymmetry; citizens and journalists can, and do, attack officers’ reputations by portraying their actions as misconduct. Yet officers have few opportunities to explain their perspective, and exoneration often takes years and does not make headlines.^11,12 Police may have good benefits and adequate salaries, but they are certainly not rich.¹³ Judging by the mass exodus from police work and the lack of recruits, being a police officer seems a less desirable job than ever.¹⁴

Law enforcement officers may witness terrible traumas, and their work leads to increased rates of emotional distress when compared to the public at large. Officers often suffer from compassion fatigue, emotional numbing, and cynicism.¹⁵

Most officers handle even traumatic events well, but some develop severe trauma reactions such as posttraumatic stress disorder¹⁶ along with work stress-related mental health disorders, such as depression and anxiety. Shift work is also hard on families. The public needs police around the clock, including holidays, meaning officers’ schedules often conflict with family routines and special gatherings.

Police officers require determination and toughness, values that sometimes conflict with asking for help. Officers must decide whether, over time, their symptoms will decline or whether they would benefit from professional mental health care. Fortunately, the law enforcement community has made a laudable effort to erode the stigma¹⁷ that portrays those seeking mental health care as lazy or weak. Yet, due to the critical nature of law enforcement, police administrators have procedures for removing officers who may pose a risk to themselves or the public. As a result, officers may worry that seeking help may signal an inability to handle their job, thereby risking their removal from active duty.

Adding to this complexity, there is wide variation among police departments in their administrative guidelines, support systems, and culture regarding mental health. Many departments devote considerable resources to making psychotherapy available and to encouraging officers’ participation. Some departments even mandate a yearly mental health check-in. However, other police departments maintain a skeptical culture toward psychotherapeutic approaches and may actively stigmatize engaging in mental health treatment. These differences necessitate that therapists become familiar with the local administrative structure and culture and adapt their clinical approach accordingly.

Given the specific needs of police officers seeking help, we can identify potential interventions. To start with, innovative programs can combine technology with anonymous surveys to identify officers most likely to benefit from these services and help them access them.¹⁸ Police officers’ mix of physical and emotional stressors¹⁹ suggests that physical wellness programs are desirable to encourage healthy lifestyles and vigorous physical conditioning and reduce substance abuse.

The following approaches could be helpful in the clinical setting:

• Motivational strategies aid by prioritizing goal setting and addressing barriers to change²⁰

• Mentalization, the ability to notice, access, and reflect on mental states in oneself and others, is an important skill for police and may be an important focus of training for both interfacing with the public and as a focus in individual therapy.²¹

• Group therapies, whether online or in person, show promise for destigmatizing and efficiently spreading mental health treatment while utilizing the benefits of the group process.

• Cognitive behavior therapy approaches have been applied to police,²² as have solution-focused therapies.²³

• Family and marriage counseling may be especially beneficial for law enforcement personnel.²⁴

• Favoring directness over ambiguity, especially regarding confidentiality and transparency about the therapist’s process, helps to promote trust.

However, none of the above approaches is likely to work if police officers do not trust their therapists. Police counseling referral networks need to create a supportive, collaborative, and confidential environment. It is important to ensure that therapists are equipped to collaborate effectively with police officers. Therefore, specialized training programs and workshops should be developed to address the unique challenges and stressors faced by law enforcement personnel. This training should include:

• building skills in trauma-informed care, resilience-building techniques, and evidence-based approaches tailored for the police community;

• contributions from approaches across a range of psychotherapy modalities;

• a comprehensive understanding of police culture and experiences; and

• incorporating peer consultations, a ride-along with current officers, or training from former officers to provide therapists with practical insights into the experience of law enforcement.

These practices should enable therapists to use specific, actionable steps to signal cultural competence, including knowing common acronyms such as “arrested person” (AP) and “field training officer” (FTO), as well as knowledge of terms such as “brass” (used for command-level staff or high-ranking officials who are no longer on the street.

Therapists should demonstrate knowledge of the basic daily challenges of law enforcement, including heavy paperwork loads and the stressors associated with high-stakes interactions with the public. They should signal that they understand that police work may, for better or worse, engender tight-knit camaraderie and allegiance to other officers but could also lead to tribalism and wariness toward outsiders. Police may also develop hypervigilance, which can be problematic, but also serves as a functional adaptation and survival trait.

To better prepare for this work, mental health professionals can access a wide range of books, including Gilmartin’s well-regarded text, Emotional Survival for Law Enforcement,²⁵ among others.^26,27,28 Likewise, several documentaries, series, and movies provide windows into some aspects of police work. For instance, the series “Southland”²⁹ is cited as an accurate portrayal of off-duty life, whereas “The Wire”³⁰ is a representative portrayal of jurisdictional squabbles, manipulation of crime statistics, and the tedium of investigative work. The movie “End of Watch”³¹ is known for its portrayal of the camaraderie between partners and the daily transition from high-intensity calls to the mundane. While engaging with popular media may seem like an unconventional form of clinical preparation, doing so can provide therapists with a richer, more nuanced understanding of the law enforcement world and, ultimately, enhance the quality of care they provide.

Some mental health professionals promote negative views of police officers and morally elevate, promote, and apply police-hostile theories through aforementioned policy statements, training programs, and scholarly journals. Mental health professional organizations must condemn anti-police rhetoric arising from within their own ranks. Therapists must replace anti-therapeutic ideologies for intellectual humility and an open exchange of ideas and focus on helping individuals.

Mental health professionals, and the organizations that represent them, should espouse balanced, fact-based views toward law enforcement, including noting research that raises questions about pervasive racism and acknowledging positive trends in policing and the criminal justice system.^32,33,34

There is no evidence that American police are especially racist, callous, or corrupt.³³ The police did not create, nor can they solve, all of society’s problems. It is troubling that ideological approaches, under the banner of mental health, have undermined trust with the law enforcement community. Those in mental health need to acknowledge and correct these problems.