Mental Health and Suicide of First Responders

The Ruderman White Paper Update on

Mental Health and Suicide of First Responders Hanna Shaul Bar Nissim, PhD Jeff Dill, MA, NBCC Robert Douglas, DCC Olivia Johnson, DM Caitlyn Folino, MBA

may 2022

Authors Hanna Shaul Bar Nissim, PhD, Deputy Director U.S., Ruderman Family Foundation

Dr. Hanna Shaul Bar Nissim is Deputy Director U.S. at the Ruderman Family Foundation. Hanna completed her PhD at the School of Social Work and Social Welfare at the Hebrew University of Jerusalem, with a focus on philanthropic studies. She joined the Ruderman Family Foundation after completing a two-year postdoctoral fellowship at Brandeis University. Hanna has been acknowledged worldwide as the expert on American Jewish philanthropy. Her work has been supported by several universities and research institutes, and by local and international foundations. She authors scholarly peer reviewed articles, media publications, and professional reports, and is frequently quoted in national and international media outlets. Hanna is a Visiting Scholar at the Lilly Family School of Philanthropy, Indiana University–Purdue University Indianapolis and a member of the Faith & Giving Task Force of the Generosity Commission.

Jeff Dill, MA, NBCC, Founder and CEO, Firefighter Behavioral Health Alliance

Jeff Dill, MA, NBCC, Founder and CEO, Firefighter Behavioral Health Alliance. In 2010, Jeff Dill founded Firefighter Behavioral Health Alliance (FBHA). Jeff travels across the US and Canada holding workshops to educate firefighters and EMS about behavioral health awareness and suicide prevention. In 2010, FBHA began tracking and validating data on all FF, EMS, and dispatcher suicides in the US. FBHA also offers seven workshops for counselors, chaplains, family members, and those preparing for retirement.

Jeff Dill holds a Master’s Degree in Counseling. He is a retired Fire Captain at Palatine Rural Fire Protection District in Inverness, Illinois. On July 1st, 2021 Jeff was appointed the new Behavioral Health Administrator for Las Vegas Fire & Rescue.

Robert Douglas, DCC, Founder and CEO, National Police Suicide Foundation

Robert is Executive Director and Founder of the National Police Suicide Foundation, Inc., in Winter Haven, Florida. The Foundation provides educational training seminars for emergency responders on the issue of suicide/mental health. In I

July 1994, Robert retired as an agent, after serving 20 years with the Baltimore City Police Department and 5 years as a patrol officer with the Temple Terrace Police Department in Temple Terrace, Florida. He holds a BS degree in criminal justice from the University of South Florida and an MS degree in criminal justice management from the University of Baltimore. Robert also holds a master’s degree in theology from St. Mary’s Seminary and University and a DCC in Christian counseling from Kingsway University and Theological Seminary in Norwalk, Iowa. He lectures at the FBI National Academy on mental health/suicide prevention for law enforcement personnel. He retired in 2009 as the senior pastor at Jenkins Memorial Church in Riviera Beach, Maryland, where he has served for 24 years. Robert also served as police chaplain for FOP Lodge #3 in Baltimore City from 1988 to 2002, and as chaplain for Alcohol, Tobacco, and Firearms in Washington, DC. Bob also founded the Compassionate Shepherd Ministries in Laurel, Delaware, in 2012, and served as senior pastor until 2019. He is the author of four books: Death with no Valor, Beyond the Badge, Healing for Hero’s Heart, and The Art of Being You.

Olivia Johnson, DM, Blue Wall Institute

Dr. Olivia Johnson is founder of the Blue Wall Institute, an Air Force veteran, and a former police officer. Dr. Johnson is a subject expert in police suicide and prevention, and holds a Law Enforcement Psychological Autopsy Certification from the American Association of Suicidology. She holds a master’s degree in criminology and criminal justice from the University of Missouri, St. Louis, and a doctorate in organizational leadership management from the University of Phoenix.

Dr. Johnson served as an Advisory Board member for VALOR Officer Safety and Wellness Program regarding curriculum review for de-escalation training and techniques, and previously worked as a senior research associate for the Institute for Intergovernmental Research as a lead instructor for the VALOR Officer Safety Program. She was program advisor and lead instructor for the Suicide Awareness for Law Enforcement Officers (SAFLEO) program.

Caitlyn Folino, MBA, Program Associate, Ruderman Family Foundation

Caitlyn Folino graduated from Bentley University in 2019 with a degree in management. She went on to complete her MBA degree at Bentley University in 2020. Caitlyn joined the Ruderman Family Foundation in 2019 as an advocacy intern and progressed to program associate in 2021.

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Our Mission The Ruderman Family Foundation is an internationally recognized organization that works to end the stigma associated with mental health. The Foundation does this by identifying gaps in mental health resources and programs in high school and higher education, and by organizing other local and national programs and initiatives that raise awareness about the stigma.

The Ruderman Family Foundation believes that inclusion and understanding of all people is essential to a fair and flourishing community and promotes these values through its leadership in mental health initiatives and funding policies. For more information, please visit www.rudermanfoundation.org.

The Ruderman Family Foundation The Ruderman Family Foundation is dedicated to raising public awareness of issues related to inclusion and mental health. We believe that full inclusion of people with mental health issues is not a matter of charity but a civil right. Mental health and suicide of first responders needs to be explicitly and frequently exposed by media outlets, policy makers, first responders, and members of the public.

Mental health issues and high rates of suicide of first responders present a complex and pressing problem, the importance of which cannot be overstated. As this update shows, since 2018, we have not witnessed a change in the rates of suicide of first responders, and the programs and policies targeted to address these issues remain insufficient.

This update of our White Paper published in 2018 is intended to keep the issue of mental health of first responders in the focus of public attention and facilitate access to services, programs, and resources for all members of this group Jay Ruderman President and Chair of the Board of Trustees Ruderman Family Foundation

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Table of Contents Executive summary

1

Introduction

4

COVID-19

5

Civil unrest

6

Statistics on first responders’ suicides Police officers

7 7

Law Enforcement Suicide Mortality Database

7

Suicide statistics

9

Federal support for the mental health of law enforcement personnel

10

Firefighters and Emergency Medical Technicians

12

Firefighter Behavioral Health Alliance

12

Suicide statistics

12

Methods of suicide

14

Measures of suicide prevention

15

Media coverage and reporting

15

Suicide awareness programs

15

Research and analysis

17

Strides in research about first responder mental health

18

Conclusions

20

References

22

Executive Summary Overview

In April 2018, The Ruderman Family Foundation published a white paper on the subject of mental health and suicide rates of first responders. In the more than three years since that report came out, the severity of mental health challenges, and the tragic prevalence of suicide among first responders has not changed unfortunately. Indeed, the situation has been exacerbated by the COVID-19 pandemic along with increased public scrutiny and media coverage driven by police shootings. These front-line workers have faced mounting stress and isolation.

Together these factors have led to a wave of resignations and retirements from law enforcement agencies (MacFarquhar, 2021).

This report presents updated data for 2020 and 20211 and seeks to raise awareness of the fact that problems and gaps in service exposed in our 2018 report have not received effective treatment and continue to affect the mental health of first responders. While suicides for the general population have decreased during the pandemic (Johnson, 2022), this update reports that there has been moderate to no decrease in suicides for all types of first responders in the year 2020. Although there has been a decrease in suicide in the general population, the trend among first responders remained unchanged. If COVID-19 follows the pattern of similar tragedies, such as Hurricane Katrina, there could be a rise in suicide in the future (Ehlman et al., 2022).

We saw a slight decrease in first responder suicides from 2017 to 2020. Though this is in line with trends from the general public, the numbers are only growing as more cases become verified. In addition, following the pattern of similar tragedies there could be a rise in suicides in the future (Ehlman et al., 2022).

1 Data for 2021 is still being updated. The verification of if a death is considered suicide can be a long process, and this number might increase over time as more information comes available.

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Key findings » As before, police officers and firefighters are more likely to die by suicide than in the line of duty. This is true for all reasons except coronavirus, which was by far the most prolific killer and largest problem facing all law enforcement officers. In 2020, 116 police officers died by suicide, compared with 140 in 2017. The number is lower, but cases can take time to uncover, and it can take months to verify these deaths by a medical examiner or coroner. » Suicide remains more common than death in the line of duty, but a less frequent cause of death than COVID-19. In 2020, there were 182 COVID-19 fatalities, 116 confirmed suicides, and 113 deaths in the line of duty. » 61.7% of all police officer deaths in 2020 were due to the coronavirus. » Although 2020 has been a time of extensive changes, the number of reported firefighter and EMS suicides was not reduced and stands at 127, slightly higher than the 126 confirmed cases in 2017.

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» Since the start of the pandemic, there have been at least 181 firefighters and 78 emergency medical care providers who have died of COVID-19-related complications. » Marital/relationship issues stemming from trauma or mental health challenges have led the known reasons for firefighter and EMS suicides.

Marital/relationship issues could include having a spouse that doesn’t know how to best support the trauma first responders are experiencing or the first responder is unable to maintain a healthy relationship due to the mental health challenges brought on by their experiences. » The most prevalent method of suicide for both male and female firefighters and EMS personnel was firearms. Nearly 60%, or 1,005 out of 1,716 cases confirmed by the FBHA indicated the use of firearms from 1880 to present. » Mental health problems of first responders who retire from the force and “fall off the radar” often remain untreated. » Most first responder suicides are not covered by the mainstream media, and the public learns about these unfortunate events irregularly, through alternative channels. » Shame and stigma, which are often associated with the suicide of first responders, lead to secrecy and silence surrounding the event, preventing appropriate processing of it by colleagues of the deceased. » Programs aimed at promoting awareness of first responders’ mental health and at preventing suicide have not borne sufficient fruit so far. » There is an urgent need to improve the registration and research of first responder suicides.

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Introduction In April 2018, The Ruderman Family Foundation published a white paper on the subject of mental health and suicide rates of first responders. In the more than three years since that report came out, the severity of mental health challenges, and the tragic prevalence of suicide among first responders has not changed unfortunately. Indeed, the situation has been exacerbated by the COVID-19 pandemic along with increased public scrutiny and media coverage driven by police shootings. These front-line workers have faced mounting stress and isolation.

Together these factors have led to a wave of resignations and retirements from law enforcement agencies (MacFarquhar, 2021).

Since the publication of the white paper, several developments led to a significant increase in first responders’ stress and workload. Law enforcement agencies were affected by the ever-looming immigration crisis at the southern borders of the US, social and human rights protests, mass shootings in schools and places of worship, and civil unrest and protests. First responders had to deal with the consequences of storms and hurricanes, wildfires in California that destroyed everything in their path, and extreme temperatures that led to loss of human life.

The after-effects and the toll of such stress on the lives and mental health of first responders remains to be studied and will be felt for many years to come.

In our 2018 White Paper, we compared the numbers of law enforcement officers, firefighters, and Emergency Medical Technicians (EMTs) who died by suicide and of those who died in the line of duty in 2017. We found that in 2017, both police officers and firefighters were more likely to die by suicide than in the line of duty (Ruderman White Paper, 2018). In updating this study three years later, as we compare these numbers again for the years 2020 and 2021, we also need to take into consideration the implications of the coronavirus pandemic for the mental health of first responders. The COVID-19 pandemic changed life as we know it starting in March of 2020 and created new challenges that all first responders are continually facing.

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covid-19

In late 2019, an infectious disease caused by the SARS-CoV-2 virus, known as coronavirus disease or COVID-19,was detected in China, and by January 2020, also in the US (WHO, 2021). Those who became infected were required to quarantine, and many others opted for isolation out of fear. Yet, many essential workers were not given the choice to isolate or stay home. At the same time, isolation and lack of interaction have been detrimental to the wellbeing of millions. As of April 1st, 2022, the pandemic has claimed over 970,000 lives in the United States (CDC, 2022).

Figure 1: Trends in Total Deaths in the United States Reported to CDC Source: Center for Disease Control (2022) Cumulative Deaths 1M 800k 600k 400k 200k 0 Jan 23, ‘20

Jun 7, ‘20

Oct 21, ‘20

Mar 6, ‘21

Jul 20, ‘21

Dec 3, ‘21

Apr 17, 22

The COVID-19 pandemic affected the mental health of entire populations.

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In many ways, for first responders this disease added more work to their already stressful and difficult load. A recent study on the stigma on first responders during COVID-19 pointed to an increased sense of isolation, stigmatization, and lack of support they experienced. The same study also found that people working in jobs involving higher risk of exposure to coronavirus reported a decrease in social interactions, accompanied by an increase in refusal by others to socialize with them; they also reported feeling dirty or infected (Zolnikov & Furio, 2020). During a time of increased stress, losing social support and interaction further deprived these men and women of vital assistance in their time of need.

Throughout 2020, first responders were also worried about transmitting the disease to their loved ones and felt pressured to maintain physical distance from friends and family. This unique and troubling experience put excessive pressure on first responders. It has been shown that isolation has been linked to anxiety, restlessness, emptiness, marginalization, decreased sleep, decreased immunity and inflammatory control, and higher morbidity rates (Cacioppo, Hawkley, Norman, & Berntson, 2011). In addition to the anxiety and isolation caused by the pandemic, first responders were faced with tumultuous times of civil unrest in 2020.

civil unrest

When analyzing suicide deaths of law enforcement officers over time, it is important to examine the events that took place during the same period.

Several such events involved law enforcement in 2020, including the shooting deaths of George Floyd, Breonna Taylor, and Duante Wright, which exacerbated racial and civil unrest nationwide. This unrest resulted in protests and destructive riots (Carnegie Empowerment for International Peace, 2020), in millions of dollars in property and other damage, lives lost, and assaults on thousands of officers (FBI, 2019-20). In the wake of the unrest, officers were pushed to the limit, both physically and emotionally. The antipolice sentiment and backlash led to record numbers of retirements and resignations (Sutton, 2021).

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Statistics on first responders' suicides police officers

Law Enforcement Suicide Mortality Database

Since 2017, the Blue Wall Institute and National Law Enforcement Suicide Mortality Database™ (LE-SMD) have collected extensive data on law enforcement and correctional officers’ suicides, non-fatal attempts, and overdose deaths. Every case included in the LE-SMD undergoes a stringent verification process that includes the use of at least one of the following: police reports, autopsy and toxicology records, agency press releases, next of kin notification, etc. Dozens of cases await verification because of the need for further investigation or other circumstances. The COVID-19 pandemic and workforce shortages have contributed to a slowdown in the processing of records, causing a lag in reporting and verification by the LE-SMD.2

2 Note that cases can be confidentially submitted to the LE-SMD at https://form.jotform.com/nlesmd/761/NLE-suicide-mortality-database-form

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The LE-SMD is a one-of-a-kind database that serves as a confidential repository for cases involving current, sworn, retired, and former officers. Cases are included as far back as can be verified, with nearly 600 cases currently registered.

The data revealed comorbidities and what Johnson termed the 10 Fatal Factors (Johnson, 2020):

Interpersonal relationship issues

Substance abuse/ addiction

Medical issues

Cumulative stress and trauma

Sleep disturbance

Firearm access Being under investigation

Mental health concerns Pending/ nearing retirement

Other major life events/ situations

These identifiable factors can help in the future development of extensive risk assessment tool to assist managing those most at risk (Johnson & Krawczyn, personal communication, 2022). According to Olivia Johnson (2021), Founder of the Blue Wall Institute and of the LE-SMD, a comprehensive in-depth examination and analysis of the accumulated data revealed correlations and commonalities between the cases. Future research can provide a thorough understanding of each of these factors that can potentially assist in reducing suicide deaths.

Identifying correlations and commonalities in the data has the potential to help recognize early indicators of suicidal ideation and risk-taking behaviors before 8

an attempt is made. This systematic approach views the ten risk factors as an integrated operational system. From this perspective, the prevention-intervention method provides an analytical approach to addressing potential risk factors before they materialize. The suicide prevention protocol of the Blue Wall Institute is built on the medical health (eustress) model (J. Krawczyn, personal communication, 2022). The protocol is operationalized by identifying and assessing healthy personality traits and behaviors during the recruitment process of first responders, which have been documented during the background investigation, and reinforcing them through the teaching of healthy coping skills at the police academy, with observable application of these skills in the FTO (Field Training Officer). Use of the protocol is expected to help officers address, process, and avoid the 10 Fatal Factors that can result in suicidal ideation or suicide.

Suicide statistics

Currently, the LE-SMD has 116 verified cases of suicide in 2020 and 61 cases in 2021 (Johnson, 2020-21). In 2017, we found that 140 police officers died by suicide, compared with 129 who died in the line of duty (Ruderman White Paper, 2018). In 2020, 295 police officer fatalities were reported by the National Law

Table 1. National Law Enforcement Suicide Mortality Database (2017-2021).

Year

Occupation

Number

Active

Retired

Former

2020

LE

95

73

14

8

CO Total

21 116

19

1

1

92

15

9

LE

51

45

2

4

CO Total

10 61

8

1

1

53

3

5

2021

*Only cases that have been verified (by autopsy, police report, agency notification, family, etc.) are included in the data. Dozens of cases that are pending verification are not included.

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Enforcement Memorial Fund; 182 of these fatalities were COVID-19 deaths (113 other cases included: 45 by gunfire, 42 in traffic, and 26 other) (NLEMM, 2021).

This means that 61.7% of all officer deaths in 2020 were due to the coronavirus, making the disease the most prolific killer and largest problem facing law enforcement officers. The coronavirus has surpassed suicide as the leading cause of death for law enforcement officers. Aside from deaths due to the coronavirus, suicide remains more common than death in line of duty, with 182 COVID-19 fatalities, 116 confirmed suicides, and 113 deaths in the line of duty in 2020 (Table 1).

One of the most prevalent mental health issues in the US is depression. Although law enforcement personnel are often subject to personal and professional stress and trauma, the rate of depression in this occupational group is not known. It is likely to be double that in the civilian population (Hartley et al., 2012; Reeves et al., 2011). In the LE-SMD, depression characterized 32% of cases of suicide during 2017-2019 (Johnson, 2021; Violanti, 2021). This included cases in which depression was confirmed by a clinical diagnosis, but also those in which there was no clinical diagnosis, but family members had noted the depressed mood or despondency of the deceased in the months, weeks, and days preceding the suicide.

Federal support for the mental health of law enforcement personnel

In November of 2017, Congress passed a bill called the Law Enforcement Mental Health and Wellness Act of 2017. The bill expanded the allowable use of grant funds under the Community Oriented Policing Services program to include establishing peer mentoring mental health and wellness pilot programs in state, local, and tribal law enforcement agencies. It also required the Department of Justice to work with the Department of Health and Human Services to develop educational resources for mental health providers regarding the culture of law enforcement agencies. The bill also mandated reviewing existing crisis hotlines and researching annual mental health checks with first responders (S. 867 - 115th Congress (2017-2018): Law Enforcement Mental Health and Wellness Act of 2017, 2017).

In 2019, following the initial request to prioritize law enforcement mental health at the federal level, COPS, Office of Community Oriented Policing Services within the US Department of justice, published the “Law Enforcement Mental Health and Wellness Act: Report to Congress,” which included 22 recommendations for Congress on ways to improve the mental health of law enforcement officers in the US.

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The list included: » creating a national crisis line for law enforcement » supporting the creation of a law enforcement suicide event report surveillance system » supporting programs that embed mental health professionals in law enforcement agencies » supporting the expansion of peer support programs to ensure that all officers have access to this service (Spence et al., 2019)

The bill also led to the creation of the Law Enforcement Mental Health and Wellness Act Program. It was developed by the Office of Community Oriented Policing Services, which is part of the US Department of Justice, and which allocated funds to be used to improve the access of law enforcement personnel to mental health and wellness services (COPS, 2021) through the implementation of peer support, training, family resources, suicide prevention, and other wellness program practices.

Recently, in 2021, 65 new awards of two-year grants, totaling over $7 million, were given to law enforcement agencies across the US (COPS, 2021). From 1994 to October 2021, the COPS office has invested $14 billion in community policing, including granting awards to more than 13,000 state, local, and tribal law enforcement agencies to fund the hiring and redeployment of more than 134,000 officers (United States Department of Justice, 2021).

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firefighters and emergency medical technicians3 Firefighter Behavioral Health Alliance

The Firefighter Behavioral Health Alliance (FBHA) collects data on firefighter and EMT suicides across the US. The following data are tracked and validated on incidences of suicide: year, age, gender, rank, disposition (active, retired, fired, resigned, suspended, “on-duty injury”), name, department, method, reason, confidential notes, military, wild land, volunteer, career, in addition to the name of the person who confirmed the report. The information is collected for EMTs, dispatchers, and firefighters. The database is inclusive, without discrimination based on age, rank, or gender between the three categories of responders, nor on any of the parameters above (career or volunteer, city, suburban, or rural, etc.).

The historic study of firefighter and EMS suicides started in recent years. The FBHA has intensively researched news articles and medical examiner reports, and discovered numerous cases of firefighter suicides that date as far back as 1880. Yet, 95% of the collected data refer to cases between 2000 and the present day, which suggests that increase in suicides is a relatively recent phenomenon.

Suicide statistics

Our 2018 study found that in 2017, 103 firefighters and EMS personnel died by suicide and 93 died in the line of duty. In the three years since the report was published, the number of suicides of firefighters and EMS workers in 2017 was updated to 126 (FBHA, 2018, 2021). The increase over time is due to new information discovered confirming losses to be suicides. Still, this number is believed to be only about 65% of all losses (FBHA, 2021), as more data may be lacking about volunteer firefighters and EMS personnel across the US. There are an estimated two million firefighters and EMS workers in the US. Since our last report, the percentage of volunteer firefighters has increased from approximately 50% to 70% (FBHA, 2021), and tracking the deaths of volunteer firefighters and EMTs is more difficult.

Although 2020 has been a time of extensive changes, it did not drastically reduce or increase the number of reported firefighter and EMS suicides, which stands at

3 Disclaimer. Firefighter Behavioral Health Alliance data are updated, at times, daily. For current data, please contact Jeff Dill at jdill@ffbha.org or visit their website at www.ffbha.org.

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127, compared to 126 confirmed suicides in 2017 at the time that our last white paper was released. Unfortunately, similarly to the data about police officers, we do not find a reduction in the number of firefighter and EMS suicides. New mental health policies and awareness promoted in the last few years are not reflected in a significant reduction of first responders’ suicides (FBHA, 2021).

As shown in Table 2, in 2021, there have been 97 confirmed suicides of firefighters and EMS workers (FBHA, 2021). These losses likely serve to increase the stress of all first responders. With the rising death toll, exposure to the coronavirus is a constant source of legitimate fear. Since the start of the pandemic, there have been at least 181 firefighters and 78 emergency medical care providers who have died because of COVID-19-related complications (Choi, 2021).

Table 2. Confirmed suicides of Firefighters and EMS workers Year

2021

Number of 97 confirmed suicides

2020 127

2019 144

2018 118

2017 126

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Among the known reasons of firefighter and EMS suicides are (Figure 3):

Figure 3. Reasons for EMS suicides

6% 19%

Medical/ physical issues

7%

Post-Traumatic Stress Disorder

Other reasons, including legal, financial, or combinations of various issues

7%

Addictions

15%

Depression

25%

Unknown

21%

Marital/family relationships

Methods of suicide

In the general population, the most common method of suicide is firearms for males and pills/overdose for females (FBHA, 2021). Yet, the most prevalent method for both male and female firefighters and EMS personnel is firearms (FBHA, 2021). Since 2011, FBHA has been using the term “cultural brainwashing” to help explain this phenomenon. In the context of self-perception, cultural brainwashing means that when first responders put on their uniform, they are ex14

pected to act in a professional manner. This includes courage, strength, showing no weakness, and handling all issues on their own. Because the fire service is a male-dominated profession, it is possible that female firefighters act in the same manner as their male counterparts, often carrying out suicide by firearms. Nearly 60% (1005 of 1716) of suicide cases confirmed by the FBHA were carried out by the use of firearms (2021).

Behavioral health training has been on the increase in the fire service, EMS, and dispatch centers, but many organizations, especially volunteer organizations, are limited in the training they offer. Within the fire service, almost 70% of firefighters are volunteers. Increased federal funding is needed to assist departments in creating a behavioral health program. According to FBHA, behavioral health programs should cover 12 points, beginning with educational training through retirement. For more information about how to create a program, contact FBHA at www.ffbha.org. They offer free guidelines and policies.

measures of suicide prevention Media coverage and reporting

Most suicides involving first responders are not covered by mainstream media, partially because of shame and stigma surrounding such deaths. At times, however, the public is made aware of suicides through agency press releases, social media posts, and news reports. This is more often the case if the deceased is a respected member of the agency, and if the suicide occurred on-duty or within the framework of an investigation of criminal activity or of pending criminal charges. Though publications regarding first responders’ mental health are a popular topic, with over 400 articles mentioning our last white paper in 2018, there is not an increase in transparency regarding the circumstances surrounding the deaths.

After the suicide of an officer, a ripple effect may produce long-lasting consequences for colleagues. Often many of them are forced to grieve privately over the loss of a fellow officer and try to process it in some meaningful way without appropriate help, because the tragic event has been shrouded in secrecy. More should be done by policy makers and decision makers about mandatory reporting of law enforcement officers’ suicide deaths, on- and off-duty (Olivia Johnson, 2021).

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Suicide awareness programs

Robert Douglas, founder of the National Police Suicide Foundation, stated that in 2018 only about 3%-5% of law enforcement agencies had any type of police suicide awareness program in place. Today, Robert Douglas (personal communication, 2021) believes that these numbers have increased marginally, but not at the rate necessary to curb suicide deaths of members of law enforcement agencies.

Douglas further explains that suicide has been and remains a leading cause of mortality in first responder populations, yet agencies have failed to address this threat properly and in a timely manner, and the implementation of suicide prevention programs has yet to curtail the trend of growth in suicides of first responders.

Douglas (personal communication, 2021) believes the agencies should consider the following measures:

» Adopt mental health policies that recognize suicide as a significant health problem. » Acknowledge the connection between on-the-job stress and suicide; identify and keep accurate statistical data on suicide deaths. » Adopt a comprehensive crisis response model as a practical framework for understanding and addressing the entire range of suicide-related issues involved in police work. » Include basic intervention skills for handling mental health/suicide situations in training programs for recruits and enlisted law enforcement officers.

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» Develop peer support/critical incident stress management (CISM) protocols that include debriefing opportunities for officers affected by the suicide of a colleague. » Provide bereavement support services to family members and peers of the officer who committed suicide. » Develop a spouse/partner/significant other awareness program that should: • Include a step-down CISM awareness element • Implement suicide awareness training

Research and analysis

Law enforcement is a public service, yet developments in recent years prompted calls by the public to defund law enforcement agencies. According to Dr. Jorey Krawczyn (personal communication, 2021), trainer and consultant for the Blue Wall Institute, negativity resulting from social pressure and media coverage has led to increased withdrawal of law enforcement personnel from service and the profession. Remaining officers who are not yet eligible for full retirement benefits experience this negativity daily, which takes a toll on their mental health. Officers who resign and leave the service take these mental health problems with them and are lost to follow-up. Moreover, new recruits brought into service to replace those who retired may bring with them their own issues. Krawczyn explained that for law enforcement recruits who have experienced trauma early in life, fear response can become a learned behavior that affects their decision making, judgment, perceptions, and reactions. When expressed in the career environment, these may manifest as cognitive and behavioral risk factors (e.g., excessive use of 17

force, substance use and addictions, discord in family relationships, and suicide).

According to Szyf, Tang, Hill, and Musci (2016), this process is preventable and reversible if such manifestations are properly identified through the assessment of first responders during their hiring and training. Additional research and historical analysis of past law enforcement officers’ suicides can help in this process.

Strides in research about first responder mental health

A new way of addressing first responder mental health that has had significant success in recent years is brain balancing. This new procedure, performed by Vitanya Brain Performance, involves clients attending 10-15-minute neurofeedback and 10-minute biofeedback sessions twice a week for 12 weeks, then once a week for 12 weeks. The first step in the process is mapping the brain to find areas that are over- or under-communicating. Next, researchers work to find the frequencies needed to make changes and improve the communication between the brain and the body. This stage takes approximately one month, after which the clients can work with a biofeedback headset that uses light and sound to make changes. This headset uses bilateral stimulation, which is the same mechanism that REM sleep uses to flush out trauma. Usually, during REM sleep, information from the day before is filed into long-term and short-term memory.

But when trauma occurs, instead of this process, the information is filed away and is sorted differently into the brain. Therefore, those experiencing PTSD or living with trauma can be triggered by similar experiences, because the brain has not processed the information correctly. Brain balancing can allow people to refile the information properly, enabling them to separate themselves from the experience, so that the brain can file it the way it originally would have (S. Smith, personal communication, 2022). The headset also uses binaural beats, in which the ears receive two different frequencies, as a result of which the brain creates a third frequency that helps build new connections during every session. This can

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repair the irregularities in the communication patterns of the brain.

Ponder and Smith (2021) examined the effect of therapy on veterans’ and first responders’ mental health and suicide. At the end of the 24-week period, they found an 11% increase in resilience, 13% increase in relationship satisfaction, 33% decrease in depression symptoms, 68% decrease in anxiety, 18% decrease in suicidality, and 64% decrease in symptoms of PTSD. These results remain to be replicated on a larger scale for law enforcement officers, firefighters, and EMS workers across the US in a broader peer reviewed experiment.

Expanding this method to more agencies, as well as to firefighters and EMS workers, could reduce the number of first responders who die by suicide. The FBHA research has found that marital/relationship issues are the leading cause of suicides for firefighters. This is an important understanding that highlights the importance of relationship satisfaction for the mental health of first responders (FBHA, 2021; S. Smith, personal communication, 2022). Depression was the second and PTSD the fifth leading cause of suicide for firefighters (FBHA, 2021). This approach has been successful in reducing the symptoms participants are experiencing for both mental illnesses (S. Smith, personal communication, 2022). This method of reducing mental health symptoms in first responders could be successful in helping prevent suicide, as well as decreasing symptoms for all first responders.

Using the brain mapping technique on a large scale could serve as a preventive method for first responders to mitigate this crisis in our society.

Similarly, there are other types of brain mapping before intervention, including audio/visual stimulation, brain/computer interaction devices, High Performance Neurofeedback Ultra Low Power Neurofeedback and Coherence Training that are developing techniques to map and reach the brain to improve irregularities in the brain patterns. All of these techniques could make a difference in the mental health of first responders in the coming years, if government offices and law enforcement agencies invest in them and prioritize taking these new steps to protect the mental health of their first responders.

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Conclusions Mental health issues and high rates of suicide of first responders are not a new phenomenon, but are a complex and pressing problem. Since the publication of our previous white paper, we have not witnessed a decrease in the rates of suicide of first responders, and the programs and policies targeted to address these issues remain inadequate.

Programs that promote awareness of first responder mental health must be improved and expanded. Additional measures need to be taken, such as monitoring of the mental health of retired first responders and assessment of the mental health of newly hired personnel. This may include the use of risk assessment and preventive procedures to help reduce or eliminate the negative effects of exposure to traumatic incidents. Having fair and inclusive media coverage can

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also help remove the stigma surrounding first responder suicides and assist in reducing the grief of affected families and colleagues.

Additionally, mandated reporting of suicide deaths and non-fatal attempts is needed. Currently, no government organization requires mandated reporting of such deaths or attempts. Mandated reporting is important for understanding the multidimensional phenomenon of suicide and to better understand trends, patterns, and relationships in the data. Reducing suicide deaths and non-fatal attempts involves a multi-faceted approach with collaborative efforts. Lastly, officers are at greatest risk in the 12 hours they are off-duty (Johnson, 2019). Therefore, an action plan should be implemented as a prevention effort. According to Johnson, Papazoglou, Violanti, and Pascarella (2022): ...[a]n effective action plan should encompass officers, officers’ families, police managers, police health professionals, policy makers, and even political figures.

The action plan should also occur in multiple perspectives in the form of raising awareness through small groups discussions and workshops, available hotlines, psychoeducational materials, and available support and services that can be provided to officers and their families maintaining their privacy and confidentiality. As well, periodic preventative assessments conducted by mental health professionals are imperative to prevent any emerging form of psychopathology or other mental health challenges that can increase the risk of self-harm (p. 270).

Behind the numbers presented in this update are the faces and names of first responders who have died prematurely, and of countless family members, friends, and colleagues left behind. We must value and protect the wellbeing of those who take upon themselves to serve the public with courage and dedication in difficult and stressful roles.

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