PTWE 5 Storyboard - Mental Health and Resilience Tools Final Copy PDF

PTWE #2: MENTAL HEALTH & RESILIENCE TOOLS The objectives of this session are to: - Understand the prevalence of mental health disorders in Canadian police. Identify sources of job-related police stress. Recognize the impact police culture has on mental health within organizations. Recognize signs &...

PTWE #2: MENTAL HEALTH & RESILIENCE TOOLS The objectives of this session are to: - Understand the prevalence of mental health disorders in Canadian police. Identify sources of job-related police stress. Recognize the impact police culture has on mental health within organizations. Recognize signs & symptoms of mental health and emotional disorders common in police. Develop understanding of evidence-based resilience tools that can be used to proactively manage mental health or function as healing tools. State of Mental Health in Canadian Police Officers In 2018, the Canadian Association of Mental Health released a discussion paper which revealed some alarming statistics regarding the state of mental health in Canadian law enforcement. The report showed that Canadian police officers are disproportionately affected by mental illness. While it was alarming at the time, the recommendations from the report have initiated positive change in the right direction. It showed that: • • • 36.7% of municipal/provincial police currently had symptoms of mental illness 50.2% of RCMP currently had symptoms of mental illness ~10% of the general population currently had symptoms of mental illness In addition, a study of two urban Canadian police departments found that mental health problems and illnesses were frequently cited by officers: • 52% reported moderate to severe stress (11% extremely severe); • 88% reported moderate to severe anxiety (12% extremely severe); • 87% reported moderate to severe depression (13% extremely severe); and • 29% were in the clinical diagnostic range for Post-Traumatic Stress Disorder (PTSD). The lifetime prevalence rate of PTSD for all Canadians is about 9%. Keep in mind these statistics are reflective of a generation who did not take a proactive approach to mental health due for various reasons: lack of education/tools/resources, lack government funding towards programs and research and being influenced by leadership and an organizational culture that minimized its importance. Police Suicide in Canada In 2012 Ombudsman conducted an internal investigation on the state of police mental health within OPP. OPP is often studied in these situations because it is an internationally recognized police organization. The report revealed statistics indicating that police are more likely to engage in suicidal behaviors than the general public. In fact, police are statistically more likely to die by suicide by their own gun than a violent interaction with a criminal. It is speculated that the statistics regarding police suicide are underreported for several reasons: there are currently no regulations that require services to track police suicide, and some of these incidents may happen post-retirement making it difficult to track. The good news is that the ministry accepted and implemented the majority of recommendations to improve mental health supports for police however, rather than having a standardized approach for all services, funding largely varies by service and consequently the supports that are available to officers and their families are not the same for all officers. Sources of Police Stress The two major sources of police stress are Operational Stress and Organizational Stress. Operational Stress is stress and trauma that officers encounter in the course of their work. Exposure to traumatic situations such as car accidents, murder scenes, child abuse, sexual assault and violence can leave officers vulnerable to Operational Stress Injuries (OSI). Organizational Stress is generally recognized as the tension resulting from characteristics of the workplace. Organizational stressors such ineffective leadership, problematic working conditions and promotions processes, understaffing, lack of resources and organizational culture can cause serious challenges for police officers. In fact, police tend to rank organizational stressors higher than operational stressors as a source of their anxiety. Organizational culture “While operational and organizational stressors impact all first responders, organizational culture can be particularly impactful on police. The shared actions, attitudes, beliefs and values of police organizations are unique due to the nature of the work and the emphasis on authority and control. While police culture can encourage supportiveness and team work and compel police to hold themselves to high standards….It can also translate into toughness, cynicism and extreme loyalty. Officers who do not conform can experience harassment and barriers to career mobility. Harassment from peers and superiors can lead to anxiety, depression, PTSD and other mental health problems in police. While many aspects of police culture are universal, organizational culture can differ across police services depending on the Chief’s (or Commissioner’s) style and the philosophy of others in leadership positions. Organizational culture can impact how police respond to signs of mental illness in themselves and others…mental illness can be perceived as a weakness. Officers with mental illness may face bullying and ostracism. Witnessing such behaviors can prevent other officers from coming forward with their own mental health struggles for fear it will have negative consequences on their careers. It can also prevent them from getting the care and supports that they need.” (CAMH 2018) The good news is that transformational leadership is starting to have a positive impact on police culture, but it takes considerable time to motivate and influence the majority to change their ways. Spotlight on Northern and Indigenous Policing Police in Northern and Indigenous communities are exposed to many of the same stressors as their fellow officers, but additional challenges can further impact their mental health and well-being. Research shows that police in small-town and rural settings experience significantly high levels of stress, and consequently higher levels of mental health disorders. Some of the additional stressors faced by officers in these locations include: • • • • • • • • • Isolation (lack of social connection tells nervous system we are threatened) Extreme environmental conditions Long distances to travel Lack of back-up Lack of health and social services Communities with high rates of crime and victimization Communities with high rates of poverty, mental illness, substance misuse and family disruption Broader role expectations Lack of respect for authoritarian approach of policing: Prior to colonization, Indigenous societies had their own forms of social control…Indigenous approaches to justice were grounded in healing, educating, reconciling and collectivity (CAMH 2018). Operational Stress Injuries (OSI) OSI are psychological issues such as that directly result from activities performed in the line of duty. While not a medical diagnosis, the term was coined by the military to more accurately reflect the range of symptoms and conditions that can result from occupational stress and trauma. There are 4 classifications of OSI: 1. 2. 3. 4. Anxiety Depression PTSD Substance Use Disorders For the purpose of this lesson, we will focus on PTSD since most people have a general understanding of the other OSI’s. PTSD According to the DSM-V, PTSD is a stress related disorder following exposure to trauma including actual or threatened death, serious injury or sexual violence by: - Directly experiencing trauma Witnessing trauma done to others Hearing about trauma that occurred to a close family member or friend Repeated exposure to details of traumatic events. *Does not apply to electronic media exposure unless work-related. The main classifications of PTSD symptoms are: 1) Intrusive symptoms (one or more of following): a. Recurrent, involuntary distressing memories b. Recurrent distressing dreams about trauma c. Flashbacks d. Prolonged psychological stress resulting from cues that symbolize aspect of trauma e. Physiological reactions resulting from cues that symbolize aspect of trauma 2) Avoidance of stimuli (at least one of the following): a. Avoiding distressing memories, thoughts, feelings about trauma b. Avoiding external reminders of trauma (people, places, activities, conversations, objects) 3) Negative alterations in cognitions and mood (2 or more of following): a. Inability to remember details of trauma (dissociative amnesia) b. Negative beliefs or expectations about self c. Persistent distorted cognitions ie. Self blame d. Diminished interest or participation in significant activities e. Feelings of detachment or estrangement from others f. Persistent inability to experience positive emotions 4) Alterations in arousal and reactivity (2 or more of following): a. Irritable and angry outbursts b. Reckless, self-destructive behaviour c. Hypervigilance d. Exaggerated startle response e. Problems concentrating f. Sleep disturbance In addition, symptoms may appear directly after the event, or may have a delayed expression and not present until years afterwards. It can be triggered by one or more events. Symptoms need to be present for 1 month to achieve a clinical diagnosis and cause clinically significant distress and impaired social, or occupational functioning. It is possible to overcome PTSD – Cognitive behaviour therapy is currently the most effective treatment for PTSD. Compassion Fatigue Burnout and compassion fatigue are often used interchangeably. Burnout symptoms were addressed in our Wellness, Stress Management & Resilience lesson. To clarify the difference between the two, burnout results from repeated occupational stress and being overworked, while compassion fatigue originates from secondary trauma or repeated dealing with victims of trauma. Compassion fatigue is defined as an overexposure to secondary suffering and pain that can cause personal stress and a reduced ability to be empathetic. It is important to note that Compassion fatigue is not a specific diagnosis, it is often referred to as ‘the cost of caring’, and is common in helping professions such as social workers, nurses, doctors, mental health clinicians, caregivers and first responders. About 23% of officers fall victim to compassion fatigue, which is a precursor to burnout. While the signs and symptoms of compassion fatigue mirror PTSD, the defining characteristic is a reduced sense of empathy and possible angry outbursts or neglect towards loved ones. While symptoms of burnout tend to present only at work, symptoms of compassion fatigue are evident in work AND home. Burnout is characterized by chronic workplace stress that can be reduced by taking time off work. Burnout develops gradually, but takes a long time to recover. Compassion fatigue may have a quick onset, but early recognition and managing compassion fatigue early can help prevent burnout. Hypervigilance Rollercoaster Hypervigilance is the body’s way of protecting you from threatening situations. It is a chronic state of stress that heightens your senses. Hypervigilance is the necessary manner of viewing the world from a threat-based perspective, having the mindset to see the events unfolding as potentially hazardous. While effective on duty, chronic hypervigilance can accompany many different mental illnesses – for example anxiety is linked to long-term hypervigilance. Widespread among first responders, the hypervigilance cycle is characterized by a sharp transition between two states: “on-duty and off-duty.” The nature of their jobs in emergency services necessitates heightened awareness. This state of extreme attention leads to the hypervigilance cycle. While experiencing hypervigilance, they feel alert, energetic, funny, ALIVE. However, hypervigilance is accompanied by a state of higher anxiety, causing exhaustion. Applying the third law of motion by Sir Isaac Newton, “for every action, there is an equal and opposite reaction,” those in full-blown hypervigilance will “crash and burn” hours after the shift ends. At the end of the shift, they cannot just “turn off” the hypervigilance switch. It will take a few hours for the body to recover as it tries to reestablish balance by returning stress hormones to baseline levels. Just by spending several hours in the hypervigilance state, even though it may have been a slow shift, the body is exhausted. Instead of returning to normal, the body goes into an extreme rest mode, leaving them feeling tired, detached, emotionless, ANGRY. Over time those feelings turn them into an off-duty “couch potato. (Gilmartin, 2018). It is important to note that personal relationships may be negatively affected by the emotional withdrawal that tends to happen off duty. Not wanting to engage with loved ones or make simple decisions like what you’re having for dinner is a sign an officer is falling victim to this. It’s important to educate your spouse on the effect the job can have on physiology and emotions, so they don’t take this personally, but also so you can be on the same page with how to cope together. We highly recommend everyone reads Emotional Survival for Law Enforcement by Kevin Gilmartin. Gilmartin, a retired officer warns officers to pay attention if they fall victim to “I used to” syndrome. “I used to play sports with friends…I used to golf to relieve stress…I used to make time to cook healthy meals…I used to work out regularly”. It is big indicator that you are falling victim to this. Continue to stay connected to friends and family and engage in activities you once enjoyed – remember that according to the Polyvagal Theory, this social connection piece tells our nervous system we are safe and secure. PART 2: Resilience Tools for Police Compassion fatigue, hypervigilance, burnout are often precursors to some of the larger mental health disorders like anxiety, depression, PTSTD and addictions. In order to minimize the risk of falling victim to these conditions, officers must take a proactive approach to mental health, but also recognize when to seek professional help. Consistently using positive coping strategies that promote physical, emotional and cognitive resilience in conjunction with stress management tools will improve an officers ability to self-regulate their response to stress but also improve their capacity to handle repeated exposure to stress and trauma. The rest of this lesson focuses on evidence-based resilience tools. Please note, while Mindfulness practices are proven resilience tools – we have allotted a full session to this topic in person and hence will refrain from touching on this in this particular lesson. Similarly, The BIG 4 (Visualization, Box Breathing, Goal Setting and Positive Self-Talk) will be covered in R2MR Training. Growth Mindset Research shows that people with a growth mindset have a lower prevalence of mental health disorders but also a reduced prevalence of burnout. In addition, they tend to achieve more, have higher motivation and fewer behavioral problems. They have improved self-esteem, feel more positive and an overall greater resilience. Approach Coping People with a tendency to use approach coping regularly over avoidance coping in the face of stress, trauma or adversity and in everyday life have a lower prevalence of mental health disorders. • • • • APPROACH COPING AVOIDANCE COPING Directly facing the stress or challenge. Reduces distress! Not facing the stress or challenge. Increases distress! Talking through problems Reframing situation to recognize positives (cognitive reappraisal) Goal setting or breaking problem into smaller goals to overcome challenge Seeking support or guidance • • • • • Procrastination Rumination (repeated negative thoughts) Refusing to discuss Avoiding feelings around stress/challenge Negative behaviours to numb or distract (ie. Excessive drinking or drug use) On an interesting note, perfectionists tend to have avoidance coping tendencies – because they want to succeed in everything they do, they tend to avoid challenges they don’t feel comfortable excelling at. Perfectionists have high rates of mental health disorders. In policing, officers may be tempted to suppress feelings around stress or trauma they have experienced on any level. We now know through science that suppressing negative emotions elevates the stress response in the body. To overcome emotional distress, we must allow ourself to feel the emotions. We will discuss several emotional regulation strategies next. Self Compassion Kristin Neff, PhD has spearheaded much of the research on self-compassion as a resilience tool. The research-proven benefits of self-compassion include: • • • • • • • • • • • Lower prevalence of mental health disorders (anxiety, depression) Reduced perceived stress levels Lower risk of coronary heart disease More empathy towards others (ie. Better leadership, improved public relations) More likely to learn from mistakes Heightened emotional intelligence Better emotional regulation Improved sleep Feel happier Improved overall resilience Improved sense of wellbeing Self-compassion is an emotionally positive self-attitude that protects us against the negative consequences of self-judgement, isolation and rumination. Remember self-compassion is a practice that is continuously developed. The three pillars of self-compassion are as follows: a In the face of stress or adversity, we need first be mindful enough to recognize a moment of emotional distress. Secondly, in that moment we must exercise kindness towards ourselves rather than defaulting to being harsh or self-critical. Choose to speak to yourself positively and demonstrate empathy towards yourself - like you would talk to a friend experiencing distress. Finally, the last pillar is connectedness – after practicing self-kindness, rather than telling our nervous system we are unsafe and elevating the stress response by self-isolating or casting judgement towards ourselves for having those negative emotions - we are going to connect ourselves back to humanity through thought alone and tell ourselves for example “every officer has these negative feelings periodically.” By consciously choosing that thought pattern, we get a dump of oxytocin in the bloodstream which down regulates the stress response and tells our nervous system we are safe and secure. Self-compassion is an extremely powerful resilience tool. Emotional Freedom Technique (EFT) Emotional freedom technique is an evidence-based form of self-stress-relief therapy that combines principles of Chinese acupressure with modern psychology. Many forward-thinking wellness companies are using EFT as a proactive way to manage employee wellbeing. Many clinical psychologists are using EFT in combination with CBT to treat a variety of conditions. While it’s a relatively newer technique, research in over 10 countries and over 100 studies show its effectiveness in treating: • • • • • • Everyday Stress Anxiety PTSD Phobias Pain Sleep issues In fact, a study with var veterans who had severe PTSD, over an 8 week tapping program 50% of them were able to completely rid themselves of all symptoms. How does EFT work? EFT is thought to release energetic blockages caused by repressed emotions from stress or trauma. By tapping specific meridian points or ‘energetic hotspots’ on the body while simultaneously saying negative statements about our feelings around a stress/challenge, the amygdala begins to fire. From there, a tapping session usually will incorporate statements of self-compassion to get the oxytocin dump into the bloodstream and calm the nervous system, control thinking etc. After that, we continue tapping the meridians while saying positive statements around how we WANT TO THINK about that stress or challenge…and what’s happening is the brain is creating new neural connections that help us reframe how we think and feel about that stress or trauma. To be clear, one is not miraculously cured from major mental health disorders after one tapping session – always consult with your doctor for a treatment plan. While it might seem a little out there - this is simply another tool for the toolkit that you can use to proactively self-manage stress, or help your recovery. A great way to do this is search up Brad Yates on Youtube – he has many follow along videos. Cognitive Behaviour Therapy CBT is an evidence-based effective treatment for many psychological conditions. These include: • • • • • • • • • Mood disorders, such as depression and bipolar disorder Anxiety disorders, including specific phobias Generalized anxiety disorder Obsessive-compulsive disorder PTSD Substance use disorders Insomnia Chronic fatigue Sexual and relationship problems CBT is an intensive, short-term (6 to 20 sessions), problem-oriented approach designed to be quick, practical and goal-oriented and to provide people with long-term skills to keep them healthy. In CBT, you learn to identify, question and change the thoughts, attitudes, beliefs and assumptions related to your problematic emotional and behavioural reactions to certain kinds of situations. By monitoring and recording your thoughts during situations that lead to emotional upset, you learn that the way you think can contribute to emotional problems such as depression and anxiety. In CBT, you learn to reduce these emotional problems by: • Identifying distortions in your thinking • Seeing thoughts as ideas about what is going on rather than as facts • “Standing back” from your thinking to consider situations from different viewpoints. For CBT to be effective, you must be open and willing to discuss your thoughts, beliefs, behaviours and participate in exercises during sessions. For best results, you must also be willing to do homework between sessions. Childhood experiences and events, while not the focus of CBT, may also be reviewed. This review can help people to understand and address emotional upset that emerged early in life, and to learn how these experiences may influence current responses to events. According to CBT, the way people feel is linked to the way they think about a situation and not simply to the nature of the situation itself. CBT principle is that by altering our thoughts, we direct our feelings & behaviours, giving us more control over our life. As you embark upon a policing career, proactive therapy is recommended to get a baseline assessment. It is important to note that you may need to try multiple therapists before finding one that you connect with. In addition, it is probably a good idea to find a therapist with experience working with police to ensure they understand the culture, challenges and realities of the profession. Gratitude Daily gratitude practice is the single best thing you can do daily to enhance your perceived sense of wellbeing. The benefits of regular gratitude practice include: • • • • • • • • • • • • Lower levels of mental health disorders (ie anxiety, depression) Reduction in perceived stress Lower levels of CHD Stronger immune system Less perceived pain Improved sleep Improved mood Feel happier Enhanced sense of well-being Improved self-esteem Improved empathy Better relationship satisfaction When we practice gratitude, our brain releases dopamine and serotonin, two neurotransmitters that regulate our mood and tend to be low in people with mental health disorders. People with anxiety tend to be focused thoughts regarding the future and people with depression tend to be focused on thoughts in the past. While it’s normal to do this periodically, it can be troublesome of it’s a consistent pattern. Gratitude grounds our thoughts in the present moment – and by doing so helps alleviate the illusion of suffering. By consciously choosing to focus on the positive, it silences the voice of our inner critc. In addition, one of the biggest reasons people are unhappy is social comparison. By focusing on the positive things in our life in the present moment, gratitude helps eliminate the opportunity for the mind to default to social comparison. The simple act of saying 3 things you are grateful for daily is a great place to start. But regular gratitude practice really is a lifestyle that has a whole effect on our cognitive, physical and emotional resilience, not to mention health and well-being. Check your Understanding 1. Operational Stress Injuries may include: a. Anxiety, depression, PTSD b. Anxiety, depression, PTSD, substance use disorders c. Slips trips and falls d. Vicarious trauma 2. 23% of police officers fall victim to compassion fatigue. The key defining characteristic of compassion fatigue is: a. Feeling tired all the time b. Not being able to show compassion for yourself c. Reduced empathy towards public on duty and in personal relationships at home d. Wanting to withdrawal at home 3. Police are statistically more likely to die by suicide from their own gun as opposed to a violent interaction with a criminal. a. True b. False 4. While hypervigilance is important for officer safety, long-term hypervigilance is associated with anxiety. Symptoms that officers are falling victim to the hypervigilance roller coaster include: a. Withdrawing from friends and family b. Feeling energetic and humorous mostly at work c. Neglecting hobbies you once enjoyed d. All of the above 5. According to the 2018 CAMH discussion paper on police mental health, municipal and provincial police officers are over 3 times as likely to be affected by mental health disorders compared to the general population. a. True b. False 6. 29% of police experience PTSD, while the general population prevalence is 10%. In order to get a clinical diagnosis for PTSD: a. Symptoms must be present for at least a month b. You have intrusive symptoms (ie flashbacks or dreams) c. Avoid stimuli that remind you of stress or trauma d. Trauma has negatively impacted your thinking or mood e. All of above 7. The three pillars of self-compassion are: a. Kindness, compassion and mindfulness b. Mindfulness, self-kindness and connectedness c. Suffering, mindfulness, kindness d. Suffering, mindfulness, connectedness 8. Avoidance coping to deal with a threat or challenge increases the stress response and makes us more susceptible to mental health disorders when habitual. Which of the following would be examples of avoidance coping in policing: a. Drinking excessively after work to numb negative emotions b. Refusing to speak about things you witnessed at work despite signs of stress c. Scrolling social media aimlessly to distract yourself d. Promising yourself you’ll connect with a therapist ‘another day’ e. All of the above 9. Although it’s slowly changing for the better, the culture of policing prevents many officers from seeking mental health supports. a. True b. False 10. CBT is a clinical-psychology based therapy capable of treating: a. Insomnia b. Substance use disorders c. Mental Health disorders d. Relationship problems e. All of the above 11. Police report operational stress as the biggest source of stress in policing. a. True b. False 12. Additional stressors faced by officers policing northern or indigenous communities may include: a. Social isolation b. Lack of backup c. Mistrust between police and indigenous communities d. Lack of available health services e. All of the above 13. Emotional Freedom Technique works by: a. Combining principles of acupuncture with modern psychology to release energetic blockages associated with repressed emotions. b. Tapping meridians on the body while saying both positive and negative statements around stress and trauma to create new neural networks in the brain c. Incorporating statements of self-compassion d. All of the above 14. What are the benefits of regular gratitude practice? a. Reduced anxiety, depression b. Improved sleep c. Enhanced mood and wellbeing d. Greater immunity & lower risk of heart disease e. All of the above 15. Compassion fatigue, hypervigilance, burnout are often precursors to some of the larger mental health disorders like anxiety, depression, PTSTD and addictions. a. True b. False