by Amberly Wrubleski | Mar 6, 2024 | Blog
“Three Reasons Police Officers (first responders or public service personnel) Stay Away From Mental Health Professionals… And How to Change That”
- Courtesy of Jason Childers PhD.
For various – and some very legitimate – reasons, the overwhelming majority of officers (first responders or PSP) will not seek treatment from a mental health professional. Most officers (first responders or PSP) choose to live with their symptoms rather than admit and confront the internal challenges they face. However, the failure to recognize and address mental health problems within law enforcement (first responders or PSP) has led to the sad statistic that more die of suicide than from gunfire and traffic accidents combined.
The first and foremost reason officers (first responders or PSP) don’t seek out help is the same reason many others within society keep their difficulties to themselves: the stigma surrounding mental health. Unlike typical medical treatment for a physical disease or condition, there is a perception of “there is something wrong with you” that goes along with mental health treatment. Something such as a musculoskeletal injury or diabetes is considered to be external in a sense that it has happened to a person, while mental health problems are viewed as something internally wrong with someone and as a part of who that person is as a human being.
Of particular concern for police officers (first responders or PSP) living with PTSD is how this stigma affects their career, including promotional opportunities and job assignments, courtroom testimony, and worrying about being placed on desk duty or even being fired by administrators or other officials who have little to no understanding of mental health issues.
However, the large number of officers (first responders or PSP) who continue to work and function within their departments despite their symptoms is a testament to the fact that police officers are highly capable of performing their duties even when they meet the criteria to be diagnosed with PTSD.
This is not to say that there are not certain severe and debilitating cases that warrant light duty or even termination or resignation, but overall, police officers (first responders or PSP) are mentally capable and competent to handle the demands placed upon them, even when they may be struggling to control their symptoms.
On top of issues surrounding mental health stigma is the culture of stoicism, which can be defined as the endurance of pain or hardship without a display of feelings and without complaint. Digging further into it, Wikipedia (n.d.) provides the following information:
Stoicism is a school of Hellenistic philosophy that flourished throughout the Roman and Greek world until the 3rd century AD… According to its teachings, as social beings, the path to happiness for humans is found in accepting that which we have been given in life, by not allowing ourselves to be controlled by our desire for pleasure or our fear of pain, by using our minds to understand the world around us and to do our part in nature’s plan, and by working together and treating others in a fair and just manner.
To a point, this philosophy is necessary in police (first responder or PSP) work. Separating one’s feelings and emotions from the trauma and stress of the immediate scene is about the only way to see an incident through to its conclusion. They would be unable to do their jobs otherwise. But to completely and permanently separate yourself from your feelings and emotions is to lose your humanity. Those emotions have to be processed at some point, or they remain bottled up inside. That is where the second part of stoicism comes in
… by using our minds to understand the world around us and to do our part in nature’s plan…
Police officers (first responder or PSP) play a vital role in maintaining civilization. The problem is, it can be difficult to truly understand the world in which they operate, even for officers. Though they all come from various backgrounds, their life experiences are generally “normal” before they are thrust into an abnormal world of violence, trauma and human misery. Almost immediately, they are exposed to an abnormal world in which people kill or savagely maim other human beings; in which monsters molest children; and in which people are seriously injured or killed through accidents, assaults, and suicides. And perhaps most abnormal of all is for someone to go to work every day and face the very real threat of violence being inflicted upon them by another person. Even though cops are prepared through training to confront all of these things, the images, sounds, smells, and emotions are not things the psyche can easily process over and over throughout one’s career.
The world of police works leads to the third reason police officers (first responders or PSP) don’t seek out mental health treatment – their distrust of mental health professionals (and just about everyone else who isn’t a cop). Police officers live within a very closed society, having very few friends outside of their jobs. Though there are other factors involved, one of the main reasons is they get tired of trying to explain their work to people who can’t and often won’t understand. Of all people who should understand are mental health professionals, but even then, it isn’t guaranteed. Once officers have reached a point where they may need to reach out for mental health treatment, they’ve also reached a point of self-imposed isolation and distrust of much of the rest of society.
So they go to work, day in and day out, many living with untreated symptoms of PTSD. Their personal and work relationships suffer, they become stressed and burnt-out, and some self-medicate with alcohol.
This needs to change. Especially if one wants experienced and capable officers to provide high levels of quality service throughout an entire career without becoming mentally and emotionally spent.
If you’re a cop reading this, I encourage you to take some action to help yourself and your fellow officers. Increase awareness of stress and PTSD within your department. Teach a class on stress management, or bring someone in to put it on if you don’t have the expertise. Talk about it as an issue that needs to be addressed and extend empathy and understanding to co-workers who may be going through a rough time. Reach out to local mental health professionals to establish a working relationship and educate them on police work before they’re needed. If you’re an administrator, put something in place for your officers! Make it clear to them through policy and your actions that their jobs will not be placed in jeopardy for seeking professional help. If you cared enough to rise up through the ranks, the wellness and health of your officers should be at the top of your mind.
If you’re a mental health professional reading this, reach out to your local police agencies (first responder or PSP). Give them a free course on mental health issues and get to know the officers on a first name basis. Having a familiar face and a name to reach out to when they need help will break down some of the barriers. Help eliminate the stigma of mental illness, both within police agencies (first responder or PSP) and your community. Not only will local officers benefit, but so will the communities they serve. Educate officers on the differences between seeing a licensed counsellor, a psychologist, a psychiatrist, or a typical medical doctor, how these differences play out in medical records, and how these records are protected.
by Amberly Wrubleski | Mar 6, 2024 | Blog
Steve Rose, PHD
As you navigate the intricate journey of recovery, understanding the stages of relapse allows you to spot the signs of a relapse before it happens. Relapses typically unfold in stages that subtly transition from emotional unease to mental conflict, and, without intervention, may culminate in physical relapse.
In the initial stage, you might find yourself grappling with emotions and behaviors that quietly undermine your recovery foundation. You may not be thinking about using again, but your feelings of anxiety, isolation, or neglect of self-care are like quiet whispers, hinting at the possibility of relapse without directly acknowledging it.
As you move into the mental relapse stage, the whispers become a conversation—a battle, even—between the part of you that cherishes your progress and the part that yearns for escape. It’s here that the idea of using begins to take a more definite shape, tempting you with memories of use that gloss over the pain and struggle that followed.
If this inner turmoil goes unaddressed, you may find yourself stepping into the realm of physical relapse, where you act on your thoughts of using. It might start with a decision that seems inconsequential but can quickly spiral back into the cycle of addiction.
This article aims to illuminate these stages, offering you the insights and tools to recognize and counteract them. By understanding the nuanced progression of relapse, you empower yourself and your support network to act decisively, reinforcing your journey toward lasting recovery.
Emotional Relapse: The Silent Prelude
Understanding Emotional Relapse
Emotional relapse is the first and most deceptive stage in the relapse process. During this phase, you’re not consciously thinking about returning to substance use, but your emotions and behaviors may be silently laying the groundwork for a potential relapse. It’s characterized by feelings and actions that erode your emotional stability and recovery resilience, often without your direct awareness.
Recognizing the Signs
The signs of emotional relapse are subtle, yet recognizing them is crucial for maintaining your recovery journey. They include:
- Increased Anxiety: You might feel more anxious than usual, with a persistent sense of unease that’s hard to shake off.
- Intolerance and Anger: Small irritations become major issues. You may find yourself quick to anger and hard to please.
- Mood Swings: Your emotional state may fluctuate widely, feeling fine one moment and overwhelmingly negative the next.
- Isolation: Pulling away from friends, family, and support groups, you might start skipping recovery meetings or avoiding calls.
- Not Asking for Help: Even when you know you need it, there’s a tendency to internalize your struggles rather than reaching out.
- Neglecting Self-Care: Poor eating and sleeping habits start to creep in, along with neglecting your hygiene and personal well-being.
Navigating Through Emotional Relapse
Recognizing these signs is the first step toward averting the progression to further relapse stages. Here are strategies to help you navigate through emotional relapse:
- Stress Management: Engage in activities that reduce stress. Yoga, meditation, exercise, and hobbies can offer relief and a positive outlet for your emotions.
- Build Your Support System: Lean on friends, family, and recovery groups. Share your feelings and experiences, even if you don’t feel like it. The act of sharing can lighten your emotional load.
- Maintain a Healthy Lifestyle: Prioritize sleep, nutrition, and physical activity. A healthy body supports a healthy mind, making you more resilient to emotional turmoil.
- Practice Mindfulness: Mindfulness and meditation can help you stay grounded in the present, making it easier to manage negative emotions and stress.
- Seek Professional Help: If you find it challenging to manage your emotions or notice a significant impact on your daily life, consider seeking help from a counselor or therapist specialized in addiction recovery.
Emotional relapse doesn’t have to lead to substance use. By acknowledging your emotions and taking proactive steps to manage them, you can reinforce your foundation in recovery and continue moving forward on your journey.
Mental Relapse: The Inner Conflict
Understanding Mental Relapse
In the stage of mental relapse, the inner conflict between wanting to use and wanting to remain in recovery becomes pronounced. This stage is characterized by a mental tug-of-war: part of you may start reminiscing about the days of substance use, while another part remembers the reasons you chose sobriety. Mental relapse is marked by an increased struggle with thoughts about using, making it a critical time to employ strategies that can steer you back towards recovery.
Recognizing the Signs
Identifying the signs of mental relapse is essential for preventing a return to substance use. These signs include:
- Glamorizing Past Use: You might catch yourself fondly remembering the times you used substances, conveniently forgetting the negative consequences that followed.
- Lying: Small lies to yourself or others about where you’ve been or what you’ve been doing can signal a shift towards old behaviors.
- Hanging Out with Old Using Friends: Reconnecting with friends who use can increase temptation and rationalize your thoughts about relapsing.
- Fantasizing About Using: You may find yourself daydreaming about using, imagining scenarios where you indulge in substance use.
- Planning Relapse: The thought process might shift to planning how to use again, possibly scheming to use around others’ schedules to avoid detection.
Navigating Through Mental Relapse
Engaging in proactive strategies is crucial to combat the mental urges and keep relapse at bay. Here are some effective ways to navigate through this challenging stage:
- Play The Movie Until The End: When having thoughts of using, you’re only seeing the metaphorical highlight reel, not the full movie. Take a step back and watch the full move, hour by hour, until the end.
- Talk About It: Sharing your thoughts with someone you trust can significantly lessen their power over you. Whether it’s a friend, family member, or therapist, talking can provide perspective and support.
- Engage in Healthy Activities: Fill your time with activities that bring you joy and satisfaction without substance use. Hobbies, exercise, and volunteering can redirect your focus and energy.
- Avoid Triggers: Stay away from people, places, and situations that trigger your desire to use. Creating a safe environment is key to maintaining your recovery path.
- Use Delay Tactics: When thoughts of using become overwhelming, tell yourself to wait for 30 minutes or an hour. Often, the urge will pass or become more manageable within that time.
Seek Professional Help
If mental relapse signs persist or your struggle intensifies, seeking professional help is a critical step. A therapist specialized in addiction recovery can provide the tools and strategies to navigate through this stage, reinforcing your commitment to recovery and helping you maintain sobriety.
Mental relapse is a challenging stage, but it’s also a test of your resilience and commitment to recovery. By recognizing the signs and employing effective strategies, you can navigate through this stage and continue on your path to long-term recovery.
Physical Relapse: Crossing the Threshold
Understanding Physical Relapse
Physical relapse is the stage where the mental debates and emotional unrest culminate in the act of substance use. It represents a critical juncture where the theoretical risk of relapse becomes a reality. This stage signifies a moment of action that reverses the progress made in recovery, highlighting the importance of immediate intervention to return to the path of sobriety.
Recognizing the Signs
Physical relapse may not always start with a conscious decision to return to substance use. It can be triggered by a series of seemingly minor decisions that lead to a situation where the temptation to use becomes overwhelming. Recognizing the early signs of emotional and mental relapse is crucial to preventing physical relapse. However, once physical relapse occurs, it’s essential to acknowledge it quickly and seek support.
Navigating Through Physical Relapse
If physical relapse occurs, it’s vital to treat it as a setback rather than a failure. Here are steps to navigate back to recovery:
- Immediate Acknowledgment: Recognize the relapse as soon as it happens. Denial can lead to prolonged substance use and delay the return to recovery.
- Seek Support: Reach out to a trusted friend, family member, or sponsor in your recovery network. Honesty about the relapse can open doors to support and guidance.
- Revisit Your Recovery Plan: Review and adjust your recovery plan with the help of a professional. Understand what led to the relapse and how to address those triggers moving forward.
- Re-engage with Treatment: Whether it’s returning to therapy, attending support group meetings, or considering inpatient treatment, re-engaging with professional help is crucial.
- Practice Self-Compassion: Relapse can bring feelings of guilt, shame, and failure. It’s essential to practice self-compassion, recognizing that recovery is a journey with potential setbacks.
Prevention Strategies
Preventing physical relapse starts early in the recovery process by addressing the emotional and mental stages of relapse:
- Early Intervention: Engaging in prevention strategies during the emotional and mental relapse stages can halt the progression to physical relapse.
- Emergency Action Plan: Have a plan for moments of strong temptation, including people to call and safe places to go.
- Continuous Self-Care: Maintaining a routine of self-care, including healthy eating, exercise, and mindfulness practices, supports emotional and mental health.
- Education: Understanding the nature of addiction and the process of recovery can empower you to navigate through difficult times with awareness and resilience.
Physical relapse is not the end of the recovery journey but a part of the learning process. It offers an opportunity to deepen your understanding of your triggers, enhance your coping strategies, and strengthen your commitment to sobriety. With immediate action, support, and a compassionate approach to self, returning to the path of recovery is not just possible—it’s a pivotal step toward lasting change.
Reaching Out for Support: A Pathway to Resilience
As you navigate the complex and deeply personal journey of recovery, it’s crucial to remember that you are not alone. Each step you take, whether it feels like progress or a setback, is a part of your path toward healing. If you find yourself struggling with the stages of relapse or feeling overwhelmed by the challenges of recovery, I invite you to reach out for support.
The Power of Connection
In moments of doubt or difficulty, the support of others who understand your journey can be incredibly empowering. Whether it’s sharing your experiences, listening to others, or simply being in the presence of those who empathize without judgment, connection is a powerful tool for recovery.
Professional Support
As an addiction counselor, I offer a safe space to explore your thoughts, feelings, and behaviors associated with substance use and recovery. Together, we can develop strategies to manage the stages of relapse, address underlying issues, and build a resilient foundation for your recovery journey. Seeking professional support can provide you with personalized guidance and tools to navigate the complexities of addiction and recovery.
Peer Support
Support groups and peer-led meetings offer a sense of community and understanding that is unique to shared experience. Engaging with others who are on similar paths can provide comfort, insight, and the motivation to continue forward. These connections remind you that you’re not alone in your struggles or your achievements.
Family and Friends
The support of family and friends can be an invaluable resource during recovery. Open communication about your needs, boundaries, and experiences can strengthen these relationships and provide you with a network of care and encouragement.
Taking the Step
Reaching out for support is a sign of strength and an important step in your recovery. It’s an acknowledgment that you are committed to your well-being and willing to take action to sustain your journey toward health. Whether you’re facing the early signs of relapse or simply seeking to strengthen your recovery, support is available to you.
Remember, recovery is not a journey to be walked alone. It is a path best navigated with the support of others—professionals, peers, family, and friends—who can offer guidance, understanding, and encouragement every step of the way. If you’re feeling ready to reach out for support or have questions about the recovery process, I am here to help. Together, we can work towards a future defined by hope, resilience, and lasting recovery.
by Tim Kerney | Apr 27, 2022 | Blog
by Diana Festejo | Dec 13, 2019 | Blog
In light of the difficult subject of suicide, consider taking a moment of going through the attached document sent to us anonymously. While it’s noted from a parent’s perspective, consider colleague, co-worker, brother, sister, neighbor as minimally additional ways to look at it. Please reach out. When there is Hope, there can be recovery, and there can be resiliency. See our article…Will you be a friend or an aquaintance
by Diana Festejo | Jun 9, 2019 | Blog
If I could forget what my eyes have seen
- I would stop the years of tragedy from replaying in my head, while trying to sleep at night.
- I would no longer see the face of the young child I couldn’t save from drowning.
- I would no longer see the lifeless bodies lying on the highway at the countless fatality car accidents I’ve worked.
- I would no longer see that person take their last breath who was caught in gang crossfire.
- I would forget the look on a parent’s face, when I told them their child was dead and never coming home.
- I would no longer see the lifeless bodies of every homicide victim I’ve seen over the years.
- I would not remember what a decomposed body looks like, even worse, what one smells like.
- I would forget the look of fear and pain on every domestic violence victim’s face, who endured abuse from someone they loved.
- I would erase the images of child abuse, sex trafficking, and child porn, I was forced to see throughout my career.
If I could forget what my eyes have seen
- my heart would be softer, my trust more attainable, and my guard not always up.
- I’d be less skeptical, less cynical, and remember that kindness in humanity still exists.
- I would no longer break down and cry unexpectedly, like a dam of emotion breaking for reasons unknown.
- I would sleep without issues, cold sweats, and repetitive dreams of being killed, would be a thing of the past.
- I would not have to sit with my back against the wall when out in public, forever on alert, just in case evil were to show up.
- I’d be forever free from the truth that evil is real, it’s out there, I know, because I’ve looked into its eyes.
If I could forget what my eyes have seen, I would not be a police officer.
These are the burdens we carry, the price we pay, to keep you safe.
This is the truth behind our badge.
by Diana Festejo | Apr 16, 2019 | Blog
THE CULTURE OF I’LL SLEEP WHEN I’M DEAD IS, IN FACT, KILLING FIREFIGHTERS (AND FIRST RESPONDERS)
The burgeoning discussion within the fire service regarding mental health and wellness needs to stop making claims about causes behind mental health problems and wake up to the dark, concrete truth beneath it: sleep loss is taking firefighter lives. Through mourning the loss of my husband’s partner on the job, my family knows all too well the reality of this topic.
At a round table discussion with firefighters involved in peer support, we examined the matter that is gaining national attention within the fire service: suicide through the lens of sleep deprivation. One member from across the room replied cautiously, “You’re going to have a hard time to get guys to buy into the idea that sleep loss causes suicide.” But nothing in me has interest or concern for the art of persuasion; this is not a speculation or feeling. These are facts. Stone cold. Sleep loss is killing firefighters, period.
Suicide is the line of duty death that isn’t considered such. It’s time to face this type of LODD that no one wants to talk about, with a scientifically new understanding. Sadly, those who fall victim to it also fall short of the hero’s honors and recognition the profession extends to any other death in the fire service. There is now research that lends evidence to suicide as a complex result of physiological processes resulting from the impact of chronic sleep disruption over a career.
Researchers from the Stanford University School of Medicine published a 10-year study which found a relationship between suicide in adults and sleep disruption. Of 420 participants, 20 individuals with chronic sleep disturbances committed suicide during the investigation. This is just a small window into the dark underworld of firefighting: sleep deprivation. Let’s take a closer look at what happens physiologically and psychologically when you regularly experience interrupted sleep. Here are three reasons why sleep loss contributes to suicidal ideation and completion.
•LACK OF SLEEP – STRIPPING THE BALANCE
You may have heard of the brain-gut connection. Serotonin, mostly produced in the gut, is a neurotransmitter linked to feeling good, and greatly impacted by sleep patterns. Researchers at the Department of Molecular Neurobiology at the University of Groningen, Netherlands, found that chronic sleep restriction leads to gradual and persistent desensitization of serotonin receptors, lowering its’ ability to boost our mood, resulting in depression. To make matters worse, this neurotransmitter is 80%-90% produced the gastrointestinal tract, and when the body experiences the stress of sleep disruption, the sympathetic response halts activity in the gut, impairing the production of this chemical that makes us feel positive. Deficient levels of serotonin are found in the brains and cerebral spinal fluid in the bodies of person’s who have committed suicide.
Another special neurotransmitter, dopamine, is a brain chemical that influences how we experience pleasure and pain. But dopamine is only functional if it has substantive receptor sites. Research suggests that lack of sleep may reduce the number of dopamine receptors. According to the Journal of Neuroscience, this chemical effect explains changes in behavior that occur alongside sleep deprivation. These changes include increases in risk-taking behavior, irrational thoughts, impulsive choices, and drug relapse. This type of behavior increases in correlation to how sleep deprived an individual is, giving us a glimpse into why people may complete the act of suicide. When dopamine levels are low, one may experience complete lack of motivation, apathy, debilitating fatigue, foggy brain, addictive behavior, shifty moods, and memory impairment. Dopamine function plays a vital role in how you feel, levels of motivation and how interpersonal relationships play out.
•BRAIN HIJACK
Sleep deprivation activates the body’s fight or flight response. This response primes the body with essential hormones to gear up to combat or flee imminent danger. However, the high frequency that firefighter’s bodies remain in this state due to daily occurrences on the job has grave consequences for their health. While this response is necessary for survival in certain extreme circumstances, the long-term impact causes overwhelming detriment and long-term damage to regions of the brain.
Sleep deprivation or repetitive circadian disruption causes the amygdala, or “stress center” of the brain to activate. When this happens, the amygdala hijacks the rational brain. The prefrontal cortex, which is normally responsible for executive decision making and moderating social behavior, is no longer in control. What results is a propensity for behavior that is out of character, irrational, and impulsive. According to the Department of Neurobiology at Yale, “Even quite mild acute uncontrollable stress can cause a rapid and dramatic loss of prefrontal cognitive abilities, and more prolonged stress exposure causes architectural changes in prefrontal dendrites.” Stress from sleep deprivation structurally shrinks essential areas of the brain, such as the prefrontal cortex and the hippocampus, which are critical for decision making, processing, and emotional regulation. One of the main factors to blame for brain shrinkage is cortisol: the stress hormone pumped out by the adrenal glands when the body is forced to wake up and run a call. Excess cortisol injures and kills cells in the hippocampus. It is a common denominator for individuals who suffer from depression.
•REM SLEEP
The loss of the REM stage of the sleep cycle may be the most significant contributing factor to suicidal ideation for the sleep-deprived firefighter. During the REM stage, the final portion of the 90-minute sleep cycle, critical psychological processing occurs. It is during this phase that the mind processes emotional responses and events of the day. Undergoing this period multiple times per night is absolutely crucial in maintaining emotional stability. When your sleep is interrupted, your body is forced to restart the sleep cycle from the beginning, regardless of how short the interruption might have been. In other words, if you work at a station that runs 3-4 times per night, or one every 45-60 minutes, it is possible that you may rarely or never enter into REM sleep. This is the reason that many people will experience depression and irritability after a night with disrupted sleep. Your body physically never processed the events of the preceding day.
Science once theorized that depression and psychological disorders caused sleep problems, but now research shows the opposite: the less sleep a person receives, the more likely the individual is to have mental issues that could ultimately result in death. Have you ever noticed that the majority of suicides are committed during the late hours of the night and into early morning? There is something to be said about feeling alone in the dark turning over thoughts when there is nothing found in the light to distract you. The conscious, awake mind is not capable of processing emotions in the way REM sleep does, especially when the amygdala is in the driver’s seat. Research by Michael Perlis, Ph.D., Professor, and Director of the Pennsylvania Behavioral Sleep Medicine Program finds that completed suicides are far more likely to occur at night between the hours of midnight and 4:00 a.m. He states, “Sleep disturbance has consistently been found to be a risk factor for suicidal ideation and behavior,” and explains that “it is likely that being awake at night, when one is biologically prepared to be asleep, may be a risk factor in and of itself. The risk is that at this phase of the 24-hour day we all may be particularly vulnerable to catastrophic thinking and low impulse control.”
The research is proven, and the science is concrete, the time for buy-in is over. What we need now is for leaders in the fire service to step up and take charge of challenging a culture in this industry that has turned its’ back on the need for and the importance of sleep. There are ways to mitigate the effect of sleep deprivation, but before any of these practices are implemented, leaders in the fire service, both formal and informal, need to transform the tone and culture around sleep. There must be a shift in the attitude in the firehouse away from “I’ll sleep when I’m dead” towards an understanding that sleep is valuable, and every aspect of our lives- and others- depend on it.
This article has been written to help spread awareness of the very real and immediate dangers of sleep deprivation. In honor and respect of the late Denver Firefighter Michael Jeffries who sadly succumbed to suicide in 2016.
Written by Jacqueline Toomey, Founder, First Responder Sleep Recovery Program
