Understanding the mental health and wellbeing needs of police officers and staff in Scotland.

Police work can be stressful and demanding and can impact on employee wellbeing. This study aimed to understand mental health (MH) issues and risk factors for poor MH in officers and staff of the Police Service of Scotland (PSoS); and gather their ideas of workplace wellbeing interventions that are suitable for this workforce. Face-to-face/telephone interviews were conducted with 30 Superintendents and eight stakeholders, recruited throughout PSoS. Interview topics included: MH issues; health/health behaviours; employment; and potentially beneficial workplace interventions. A thematic analysis approach was adopted. High levels of occupational stress and anxiety, currently or in the past, were reported, as were experiences of PTSD, anxiety and depression. The main stressors reported were working hours, workload, culture, leadership and organisational change. Officers and staff recognised progress towards promoting and managing MH in the service but identified interventions, including training, counselling, and environmental workplace changes as needed to address mental health issues within police cultures.

Introduction

Police officers’ roles and responsibilities place them in challenging and stressful situations that can significantly impact on their mental wellbeing and possibly even performance (Garbarino et al., 2013). Evidence suggests that the ways in which mental health (MH) challenges manifest or are dealt with in police forces differ from other occupational groups (Garbarino et al., 2013; He et al., 2002; Kapade-Nikam & Shaikh, 2014; Kumarasamy et al., 2016; McCarty et al., 2007; Tewksbury & Copenhaver, 2016). Research on the mental health (MH) problems police face, reports a range of issues, including depression (Garbarino et al., 2013), stress (Goodman, 1990; Kumarasamy et al., 2016), PTSD (Violanti et al., 2007), somatization (He et al., 2002), burnout (Garbarino et al., 2013), anxiety (Garbarino et al., 2013), and family problems (Kapade-Nikam & Shaikh, 2014). A range of risk factors contribute to the stress and distress experienced by police officers; these are often divided into two categories: operational and organisational stressors (Alexander et al., 1993; Evans & Coman, 1993; Purba & Demou, 2019). Organizational stressors have been identified as more likely to cause adverse psychological distress than operational stressors (Brown & Campbell, 1990; Brown et al., 1999; Kop & Euwema, 2001; Tyagi & Dhar, 2014). Our recent systematic review demonstrated strong evidence of associations between organisational stressors and occupational stress, psychiatric symptoms/psychological distress, emotional exhaustion and personal accomplishment (Purba & Demou, 2019). The main work-related stressors impacting on the mental health of this key group of employees were long working hours and heavy workload, police culture and organisational change (Purba & Demou, 2019). In another study on police stress interventions, Amaranto et al. observed that prominent sources of direct stress included: ‘(a) being “second-guessed” in field work, (b) punishment for “minor” infractions, (c) lack of rewards for jobs well done, (d) fear of being “de-gunned” (official removal of an officer’s service revolver as well as any personal weapons) for stress or personal problems, and (e) low morale’ (Amaranto et al., 2003). Acute stress has been demonstrated to cause PTSD among other outcomes, contributing to poor health even after officers retire (Violanti et al., 2007). High-job demands placed on this occupational group are often associated with burnout, resulting in knock-on effects on sickness absence levels, greater use of force and poor interactions with the public, health issues, strained relationships and lower quality of work (Manzoni & Eisner, 2006; Richardsen & Burke, 2007). In addition, organisational structures and cultures influence beliefs, attitudes, identities, and cognitions and can affect employees’ ability to undertake their roles or their response to stressors (Garbarino et al., 2013; He et al., 2002; Kapade-Nikam & Shaikh, 2014).

Police officers can be especially vulnerable to poor MH if they do not have support systems (family, friends, peers, trust from colleagues and supervisors), or if they lack personal qualities that enable them to cope (Loriol, 2016). Organisational cultures and fear of stigmatisation are other critical factors affecting officers’ MH (Bell & Eski, 2016; Garbarino et al., 2013). Gabarino et al. suggested that ‘[i]nvestigating stress in police officers is particularly difficult because they are afraid of being identified as individuals who have been compromised by stress’ (Garbarino et al., 2013). Officers are encouraged to display physical and emotional courage and a lack of emotional control can be deemed a weakness (Garbarino et al., 2013), potentially leading police officers to suppress their emotions (Bell & Eski, 2016; Bonifacio, 1991). The current culture in police forces and amongst other emergency personnel, can make it difficult for individuals to disclose and discuss mental health issues and this ultimately poses a barrier to receiving support (Bell & Eski, 2016; Berg et al., 2006). Disclosing mental health problems has been described as ‘career destroying’(Bell & Eski, 2016). This is further supported by Bell and Esky who suggested that the inherent cynicism, lack of empathy, and macho culture that have been associated with policing cultures, deter discussions around mental health issues and access to support (Bell & Eski, 2016). The implications of this stigma can be far-reaching, leaving those experiencing MH issues feeling isolated and marginalized (Bell & Eski, 2016). Power and gender dynamics also contribute to constructions of police culture (Morabito et al., 2011). McCarty (2013) suggests that in broad terms, masculine culture has pervaded law enforcement organisations, resulting in an environment in which female officers may feel uncomfortable.

Work-related mental health problems have several socioeconomic consequences due to factors such as sickness absence, presenteeism, leaveism, loss of productivity and ill-health retirement. In addition to economic costs, personal costs to the individual and their families include lower self-esteem, somatization and a negative impact on family and social relationships. The workplace is one of the most important settings for mental health promotion and behaviour change. Workplace interventions aimed at mental health protection are implemented mainly at the organisational level, targeting working conditions and policies, or at the individual level through programmes on stress management and skills training to provide employees with the tools and resources to cope with the impact of work-related problems.

Numerous studies examine interventions developed or tailored for the police, as well as generic workplace interventions implemented within police workforces (Acquadro Maran et al., 2018; Arokoski et al., 2002; Backman et al., 1997; Doctor et al., 1994; Carlier et al., 2000; Carlier et al., 1998; MacMillan et al., 2017; Norris et al., 1990; Patterson et al., 2014; Penalba et al., 2008; Richmond et al., 1999; Shipley & Baranski, 2002; Tolin & Foa, 1999; Verbeek et al., 2018; Wilson et al., 2001). Most of these interventions report varying success and study limitations, such small sample sizes. A systematic review examining manualised psychosocial interventions to prevent psychological disorders in law enforcement included: cognitive-behavioural-theory interventions; supportive therapies; psychodynamic and physical-activity therapies and non-pharmacological strategies (Penalba et al., 2008). Two studies have examined the impact of debriefing as an intervention following critical incidences (Carlier et al., 2000; Carlier et al., 1998). Both studies showed no difference in psychological morbidity or post-traumatic stress symptomology following debriefing. However, at follow-up subjects in the intervention group (debriefed) exhibited more PTSD symptomatology than non-debriefed subjects (Carlier et al., 2000; Carlier et al., 1998). While the outcomes did not show effectiveness for this type of intervention, there was a high level of satisfaction from the intervention subjects (Carlier et al., 2000; Carlier et al., 1998). Group counselling demonstrated no significant changes in general health or sickness absence, although the sessions were valued by police officers (Doctor et al., 1994). Conversely, an intervention using training in psychological and technical techniques to reduce anxiety and enhance operational performance in US police officers, demonstrated positive findings that were sustained two years post-implementation (Arnetz et al., 2013). Another study found that physical activity and wellness courses resulted in decreased perceived stress and increased wellbeing (Acquadro Maran et al., 2018).

Many recent studies highlight the range of mental health issues experienced by people working in police organisations across the world and evidence suggests that the ways in which mental health challenges manifest in police workforces differ from other organisations. However, to date, little research has been conducted in the UK on MH issues in the police forces (Bell & Eski, 2016; Houdmont et al., 2018; Johnson et al., 2005). Recent Police Service of Scotland (PSoS) staff surveys have identified that MH issues, such as anxiety and depression, are a concern, as are a number of organisational risk factors which impact on MH, wellbeing and family life (Association of Scottish Police Superintendents, 2015). Our study aim was to conduct an exploratory study within the PSoS to: understand the MH issues officers and staff face and the perceived risk factors for poor MH; and assess what policies, practices and interventions police officers and staff think are appropriate and can be effective in their organisation. Understanding the mental health issues and their key risk factors for police forces has immense potential for the wider study of the long-term health of a key front-line service.

Methods

The setting of our research project is the Scottish Police Authority/The Police Service of Scotland (PSoS). This is an organisation of over 23,000 employees (Police Officers, staff and Special Constables). In-depth semi-structured interviews were conducted with PSoS employees and stakeholders (line managers, management/human resource personnel, trade union representatives, others involved in workforce wellbeing), either face-to-face or by telephone. Our PSoS employee target population was the Superintendent rank who, as a group: are exposed to many traumatic incidents; have experience of the demands and risk factors in the lower police ranks, experience high levels of demands; and are likely to line-manage more junior staff. Currently there are approximately 160 Superintendents in the PSoS. The majority are between 46 and 50 years of age and approximately 70% have been in this rank for 1–5 years. Therefore, they can both reflect on their own experiences and opinions as officers and provide insights into work-related issues for lower ranks of the workforce. We aimed to conduct up to 40 c.60-minute interviews with Superintendents and 10 ‘stakeholder’ interviews. We sought interviews with people with personal experience of MH issues themselves or of managing people with MH issues at work. Interviews with Superintendents covered topics including: MH-related issues (both work and non-work related); general health, wellbeing and health behaviours; employment; opinions and ideas on what workplace interventions for MH issues work/do not work. Interviews with stakeholders explored similar issues, and additionally: how MH-related issues differ for officers and staff; mechanisms in place to identify and manage MH conditions; perceptions on whether current support was effective; and perceived facilitators and barriers to offering new workplace MH interventions.

Participants were recruited from locations throughout the PSoS. The study was advertised using posters and a brief notice distributed via the PSoS. The researchers offered to answer any questions before participants gave permission to take part and were asked to sign a consent form or provide recorded verbal consent over the telephone. Interviews were audio-recorded using an encrypted dictaphone with participant consent. Two members of the research team conducted the interviews, one undertaking interviews only with the Superintendents and the other with the stakeholders.

Two researchers (HH and ED) independently read a sample of anonymised transcripts to develop an analytical framework and identify key themes. Transcripts were then read repeatedly and coded for analysis using QSR NVivo12. A thematic analysis approach was adopted (Braun & Clarke, 2006); data were coded and indexed into six primary categories: perceptions of MH, personal experiences of MH, MH stressors, police cultures, MH policies/practices, and MH interventions. All participants gave their permission for anonymised quotes to be used. Quotations attributed to Superintendents are denoted by P and stakeholders by S. The numbers used only differentiate participants and are randomly allocated with no links to the order in which interviews took place, job title, gender, etc. We use ‘s/he’ and ‘him’/her’ throughout as an additional measure to protect against (presumed) deductive disclosure of participants’ identities.

Results

Thirty Superintendents were interviewed (n = 20 men, n = 10 women). Twenty-five worked mainly in urban environments, three in rural areas and two had worked in both contexts. Participants had 18 to 29 years of service with the police and the majority had 5 years or less years of service before their planned retirement. The eight stakeholders interviewed (n = 6 women, n = 2 men) had a wide range of experience within the PSoS and covered strategic roles, including in policy development and implementation, wellbeing remit and management.

When asked about their perceptions of good and poor MH and personal experiences of MH issues, participants felt that, although there was still room for improvement, police officers’ understandings of MH issues had improved considerably. Their perceptions of the concept of MH varied: some framed MH as the (in)ability to cope with stress and several referred to ‘struggling’, ‘stress’, ‘mental ill-health’, and ‘crisis-situations’ (see officer participant quotes below). The definition of MH was also linked with ‘happiness’.

As seen in their following quotes, stakeholder perceptions of what MH meant to them appeared to centre more around overall wellbeing and feelings of happiness, or to an officer’s personal response to traumatic operational situations:

All participants appeared open and candid when asked about their experiences of MH. Many expressed concerns about the MH of the PSoS workforce; and highlighted challenges relating to depression, stress, anxiety and PTSD, as seen in the quotes describing lived experiences of mental health issues below from officers and stakeholders.

Depression was linked to work organisation, exposure to critical incidents, and to a lack of ‘feeling valued’. A large majority of officers experienced stress and conveyed both personal and work challenges and associated impacts on job performance and home life. Concurrently, many remarked that they had not informed anyone within the police force of this. Anxiety was a prominent concern and issue for a significant number of participating officers and staff and its prevalence was thought to be vastly underestimated, as expressed by P15 below:

While some officers explicitly stated they had suffered from PTSD symptoms, others recounted experiences or described symptomatology typical of PTSD but these were often normalised and accepted as simply ‘part of their job’. Relaying memories of past traumatic operational incidents still evoked emotional responses, which at times surprised participants, as seen in the participant quotes below.

Operational experiences where fellow officers were directly affected or even killed, were especially challenging. Stakeholders thought that experiences of PTSD and PTSD symptomatology among officers were very common. Participants relayed how their job and their MH impacted on family life and raised concerns around how difficult it is to achieve and maintain a good work-life balance, as participant P28 states below. We explore this in more detail in a follow-up paper.

The operational and organisational stressors considered most common among officers and staff, were: traumatic operational incidents; the fast reaction times needed when handling challenging incidents and how this can be taken for granted; job role (including rank, lack of role clarity and appraisal, ineffective handovers); workload (including staffing, resources, public perceptions); working hours (including long-working hours, on-call, short notice shift changes); police cultures (including stigma, help-seeking behaviours, confidentiality, ‘masculine’ culture, ‘cupboarding’, bullying); and organisational structures and change (including increased scrutiny, performance, media pressures, leadership, management, lack of training), with emphasis given to the merging of different forces to create Police Scotland in 2013. Stakeholders considered operational stressors to be most challenging for officers, while officers maintained that organisational stressors presented the greater challenge to their MH. Some of these risks to their mental health were described in the following quotes:

Police officers know that support for their wellbeing is available but described how the stigma associated with MH issues in the police prevents them from seeking help and being open about their difficulties, as described in their quotes below. Participants acknowledged that MH stigma was still present but not as strong as previously.

Some maintained that the ‘male-dominated’ culture and representations of ‘masculinity’ prevent organisational MH interventions being successful and the negative experiences of officers that disclose personal difficulties is a deterrent to normalising and encouraging help-seeking for MH issues.

While several aspects of police cultures were deemed negative, others were considered positive and protective for wellbeing, including camaraderie, humour, and team dynamics that ‘galvanise’ people, cultivate a sense of belonging and serve a multitude of vocational purposes (see quotes below). This ‘sense of belonging’ was raised by both officers and stakeholders, but one stakeholder (S3) maintained that police staff (non-officers) do not experience the same team dynamics as police officers.

Current sources of support within the PSoS, including the ‘Your Wellbeing Matters’, ‘Your Time Matters’ and the Trauma Risk Management (TRiM) initiatives, among others, were deemed helpful and positive developments, but limitations to these approaches were also highlighted. ‘Your Wellbeing Matters’ aims to raise awareness of wellbeing issues and address the stigma around MH and included training 200 wellbeing champions, whose role is to signpost those who need support to relevant services. ‘Your Time Matters’ aims to record Superintendents’ working hours so that an informed case could be put forward to address the challenges of long-working hours. While this is obligatory, it is not taken up universally as officers said that ‘no-one checks it anyway’, and referred to it as ‘time consuming’ and ‘clunky’. The Trauma Risk Management (TRiM) process aims to identify risks and provide support for police staff and officers when they are directly involved in potentially traumatic incidents. Participants differed in their understanding of exactly what was involved in TRiM, but overall it was considered constructive and serving a good purpose. The extent to which police officers expressed they might seek support from their families varied; some suggested officers are now more likely to use family support to help prevent or address MH difficulties, while others preferred not to seek support from their family.

Efforts to address wellbeing and MH issues for police officers and staff were praised and acknowledged, but officers and stakeholders still felt more can be done, as stated by participant P19:

A variety of ideas about potential interventions to address MH and wellbeing issues were proposed. A common thread was the importance and agency of leadership, leading by example, and training to address stigma. Having ‘pioneers’, officers with experience of MH difficulties, coming forward and being open about their experiences, was suggested as a means of decreasing stigma, increasing dialogue and improving MH issues.

Another suggestion was a complete change in mindset in terms of the representations of the hierarchical workforce structure to improve wellbeing. Participants suggested several environmental changes as a pathway to healthier lifestyles and enhanced wellbeing, including better provision of workplace gyms and canteens, and policies around practical issues (e.g., limiting/prohibiting work-related smartphone use when off-duty, improving flexible working provision). They also highlighted a need for increased messaging and communication around MH issues.

MH training – even mandatory training – was suggested as being beneficial. Mandatory counselling and health checks encompassing a mental, as well as physical, wellbeing focus were suggested to: reduce the stigma of consulting for MH issues; directly benefit individuals; make financial savings for the organisation (e.g., reducing sickness absence); and alleviate the pressures absences put on other staff.

Discussion

Our analysis of these interviews with PSoS Superintendents and stakeholders demonstrates a complex series of issues around the MH of police officers and staff. Participants discussed high levels of occupational stress and anxiety, either currently or in the past, consistent with previous studies (Arial et al., 2010; Chitra & Karunanidhi, 2018; Gershon et al., 2009; Goodman, 1990; Kroes, 1985; Kumarasamy et al., 2016; LaMontagne et al., 2016; Reiser, 1974). Underreporting of MH issues was considered widespread and experiences of perceived PTSD, anxiety and depression were reported. Participants who conveyed that they had experienced depression, connected their depression with occupational stressors. A lack of feeling valued played a notable role in depression; others made a direct link between operational trauma and perceived PTSD, even when symptoms did not overtly manifest themselves until triggered by circumstances long after an event. Stakeholders’ impression of how common PTSD is amongst officers appeared to diverge from that of the officers themselves, who tended to ‘play down’ PTSD experiences.

The main work-related stressors perceived to contribute to MH issues were job role, working hours/workload and organisational culture. Participants’ own experience, personal qualities and background impacted on their reactions to and experiences of operational stressors. Aligned with recent literature, organisational, as opposed to operational, stressors were reported by officers and staff to be the key stressors (Purba & Demou, 2019). The impact of significant organisational change (i.e. PSoS merged into a single police force in 2013) and the ways in which this change was applied still were seen to be the cause of a number of organisational stressors.

Stigma associated with MH in the workplace still prevents officers from being open about the challenges they are experiencing, although the stigma was not perceived to be as extreme as it once was. Bell and Eski (2016) reported a tendency for officers to be reluctant to seek support for MH issues for fear of being stigmatised, which could further exacerbate MH issues (Bell & Eski, 2016). Moreover, the masculine dynamics of police cultures and how these discourage officers from coming forward, as seen in previous research (Agocs et al., 2015; McCarty, 2013; McCarty et al., 2007), and being more open about MH difficulties, were also evident.

Overall, the results reflected a view that any future intervention strategy needs to acknowledge the importance of police cultures. This has been emphasized in literature which maintains that police identity and practice is constructed through police organisational culture (Tewksbury & Copenhaver, 2016). Such constructions ‘normalise’ emotional responses to the experiences and events police are likely to encounter and can have direct implications for any interventions that attempt to address stressors unique to police personnel (Carlier et al., 2000; Richardsen & Burke, 2007; Tewksbury & Copenhaver, 2016). Taking account of the broader organisation, culture is essential to a better understanding of the impact of changes within the organisation. Understanding the organisation and its structures is important to ensure interventions/intervention components can address existing barriers to help-seeking and engagement and capitalise on the opportunities to improve MH and wellbeing within the police. Going forward, calls were made for better provision of counselling, training and leadership and even suggestions for mandatory counselling. Police officers of all ranks need to be better informed about factors that can both provoke the development of or exacerbate mental health issues specifically within police organisations (Bell & Eski, 2015). Counselling provision for officers experiencing depression has been suggested previously, highlighting that such counselling should be made available without the potential for punitive implications of using such a service (Tewksbury & Copenhaver, 2016). Similar to previous research (Tewksbury & Copenhaver, 2016), our study participants were ambivalent about using counselling services as they found it difficult to be confident that doing so would not impede their career progression or trajectory. However, they maintained that a counselling programme could play a constructive role specifically through supporting attempts to find a better balance between one’s work and home life. Early screening, extra resources, workplace interventions and health promotion campaigns have been identified as potentially useful for improving adverse health-related behaviours and health issues (Penalba et al., 2008). Other intervention ideas to address mental health and wellbeing issues in the police workforce were suggested by participants. Early recognition of PTSD symptoms, for example, is essential in making the diagnosis of post-traumatic stress in high-risk occupational cohorts such as police forces (Austin-Ketch et al., 2012). The importance of training to address and effectively manage MH issues was a common thread. This included training aimed at line managers, to provide them with the tools to identify and manage MH difficulties and minimize exclusion within the workplace. Other studies have also suggested that if knowledge is improved upon, the detrimental impact of mental health difficulties can be circumvented for the police workforce and possibly even for the communities that the police organisation serves (Bell & Eski, 2015; Mitchell et al., 2001). Participants also spoke about the importance of leadership and in particular, leading by example with regards to mental health issues in the police force. One participant maintained that what is needed is individuals across ranks to be more open about the mental health difficulties they are experiencing, despite the vulnerable position this would put them in. Encouraging officers and their spouses to enter confidential counselling, altering training and hiring practices, making peer counsellors available, establishing administrative changes, adding diversity programs and critical incident training with the aim to minimize the risk of work stress among police officers are other suggestions reported in the literature (5).

Our study has a number of strengths and limitations. As the topic of MH remains sensitive, a key strength of this research is that independent university researchers conducted the participant interviews and analysis, providing an added layer of privacy protection and strong reassurance of participant confidentiality. Overall, participants were keen to provide their perspectives on the MH issues which they perceived to be prevalent or problematic within their workforce. This is despite participants recognising a widespread fear that such information could be ‘used against them’ if there was any risk that their views and experiences were expressed to peers and line managers.

Having the PSoS Superintendents as the target group for our sample, allowed us to gain insights into how mental health issues may manifest themselves in a group that are exposed to a large number of traumatic incidents, whose role places high levels on demand on them, who have come through the ranks and are likely to also be involved in line-managing more junior staff. While we cannot be certain of the generalisability of our results across the PSoS, recruiting almost a fifth of all PSoS Superintendetns (30 Superintendents; 2:1 male: female ratio) ensured we have a wide coverage of experiences and perceptions across this rank. It is also important to acknowledge limitations. Thus, only sampling within the Superintendent ranks, a decision which was in part determined by the resources available for the study, could be seen as a limitation, as we are not capturing current personal experiences of officers of other ranks, only those recalled by the superintendents when they were at earlier stages of their career. Inevitably, this may not provide an accurate representation of all of the mental health challenges experienced currently by more junior ranks, either because of issues related to retrospective recall or due to the changing nature of mental health stressors. A further limitation is that the number that we were able to interview within the Superintendent rank has not allowed us to examine perceived differences in gender, ethnicity, job title and geography, because of potential risks to (presumed) deductive disclosure where there are small numbers of people with particular combinations of these characteristics within PSoS. Thus, as the data we gathered are very rich, often describing very personal experiences, subgroup analysis could potentially compromise participants’ anonymity.

Conclusions

This partnership project was initiated by Police Scotland, as part of their ongoing work to promote and manage the health and wellbeing of their. Recognition of the importance of good MH and the challenges associated with raising MH issues in police workforces (and indeed many other occupational groups) highlighted the need for a study to assess and understand MH needs within Police Scotland; and identify new ideas for interventions that would be acceptable for better management of MH issues. In line with studies across other police forces, the main perceived stressors reported by our participants were: long working hours, workload, culture, leadership and organisational change. Officers and staff recognised that there had been progress towards promoting and managing MH in the service but identified further potential for interventions, including training, counselling, and environmental workplace changes which could further address continuing mental health issues within police cultures. Whilst results from published studies report some positive results, pointing to the potential effectiveness of some interventions, they also highlight the need for more research to understand the interventions and/or intervention components that are required for the prevention and management of MH issues in this workforce. It is essential that these are feasible to implement, acceptable for the workforce and the organisation, and effective and cost-effective in improving mental health in police officers and staff (Penalba et al., 2008). Future larger studies with police officers and staff across forces, and particularly studies which can examine perceived differences in mental health issues by gender, age, rank, and ethnicity, are warranted to better understand the needs of the changing workforce. Our findings can serve as the groundwork to inform workplace interventions for promoting good MH and managing mental illness in the workplace, tailored to the needs of PSoS and its workforce while taking into consideration organisational specific opportunities and barriers.