One in five police officers are at risk of PTSD – here's how we need to respond

Policing is undoubtedly a stressful occupation, with officers often facing potentially traumatic situations. They may be exposed to disaster, hostage situations, sexual and physical assaults, shootings, mutilations and death, or face threats to their life.

As a result, police and emergency services workers have elevated rates of post-traumatic stress disorder (PTSD), depression and suicidal thoughts and actions.

Last night the ABC’s Four Corners program Insult to Injury highlighted how police officers' claims for compensation and psychiatric treatment for PTSD are being met with scepticism, resistance and lengthy delays.

Perceived stigma, failure to seek help and policing organisations' failures to support help-seeking have created a melting pot of despair for some officers.

How common is PTSD?

PTSD rates are directly impacted by “dose”, or number of exposures to potentially traumatic events. Routine and repeated exposure during police work means the risk of PTSD in Australian police is as high as 20% – far beyond the 1-3% prevalence expected in the general population.

PTSD is a serious mental health condition that may develop following potentially traumatic experiences. Symptoms include hyperarousal or hypervigilance, numbing or depression, intrusions (typically “flashbacks” or nightmares) and avoidance or withdrawal.

In some professions, such as policing, PTSD is characteristically accompanied by rage and alcohol abuse.

For any person on the road to recovery from trauma exposure, the key factors are stability and safety. With timely treatment, PTSD is a temporary and manageable condition.

Adding insult to injury

Last night’s Four Corners examined cases in which insurance companies impeded injured police officers' recovery by allegedly prolonging the claims process with unjustified delays and failing to act on psychiatrist recommendations, even when the claimant was clearly suicidal.

Each individual interviewed reported multiple exposures to suicides, homicides, mutilation, dismembered body parts, family homicides and corpses of children and infants. The ex-officers were visibly distressed, even when recounting incidents from more than a decade ago.

It can be difficult to discern where the responsibility for mental health sits. All parties involved in the Four Corners case studies, from the individuals to the policing organisations and the insurance companies, failed to seek or provide adequate support and created circumstances that made the problem worse.

Research shows people who seek compensation for PTSD are more likely to have a poorer prognosis, more severe symptoms and longer recovery time than those who haven’t sought compensation.

There are three plausible reasons for this pattern:

• people seeking compensation are doing so because their psychological injury is more severe

• people seeking compensation exaggerate or prolong their symptoms (a practice known as malingering) to maximise their payout

• the claims process is prolonged, triggers further stress and exacerbates symptoms or otherwise hinders recovery.

It is the job of insurance companies to protect their own interests and to detect those who fall into the second category.

However, an ethical compensation system must deliver timely and warranted assessment and outcomes for claims in a way that protects those who are distressed and psychologically unwell.

Changing attitudes to seeking help

We would like to think wider cultural shifts within Australia have been permeating our law-enforcement agencies, with a move towards “are you OK?” and away from “toughen up, princess”. But that’s not the case. Individuals officers' attitudes can prevent them from seeking help.

The common features of each case highlighted by Four Corners were an awareness there was a problem, lack of support for treatment from the organisation, but also a lack of independent treatment seeking or personal responsibility for health and well-being.

Reducing stigma and removing individual barriers to seeking treatment is crucial for early intervention, treatment and ultimately recovery and health. People who are proactive about seeking timely treatment have far better outcomes than those who hide symptoms and self-medicate for years or decades.

The first step towards reducing barriers to seeking treatment and instigating cultural change is a multi-level, organisation-wide program of education for law-enforcement agencies.

This requires a supportive framework in which officers are instructed, from recruit school and throughout their careers, about chronic stress, mental health and how to be robust officers. This should include PTSD-prevention strategies, as well as those to normalise the practice of seeking treatment.

Such programs have been trialled in recruit schools at the Department of Fire and Emergency Services in Western Australia and the Queensland Police Service, with promising results.

Pretending “she’ll be right” and that mental health issues do not exist in policing has been the strategy for decades. Clearly, it’s not working. Open discussion of stress, resilience and mental strength from day one in a high-risk profession, as well as struggles and avenues for support, is a clear pathway to cultural change.

For crisis or suicide prevention support, please call Lifeline on 13 11 14 or visit www.lifeline.org.au/gethelp