We’ve dug back into familiar ground recently, addressing officer wellness as it relates to mental health. Promoting a “Stigma Free” understanding of mental illness is something we’ve both committed to, for those who suffer and for whom law enforcement is often the first line of intervention, and also for police officers who themselves struggle. Our two most recent articles looked into recognizing and understanding that even cops are not immune to the more serious and debilitating mental illnesses, how to recognize them, and the importance of intervention. Their point-of-view was largely external – for the healthy officer/supervisor considering a colleague/subordinate who is or might be slipping out of control.
Today we’re talking to officers who may be experiencing concerns for themselves, about usually less disabling but still very serious – deadly even – issues that are likely to impact a much larger percentage of us with potentially devastating consequences, the mood disorders. The most common of these are major depression, dysthymic disorder, adjustment disorder with depressed mood, and bipolar disorder. Mood disorders are simple to diagnose for experienced mental health professionals. It's a basic question-and-answer interview that identifies symptoms, as set by the DSM V.
Instead of going into detailed descriptions of their symptoms, theories of disease etiology, and treatments for each, we thought it better to present a version of the interview format I (Althea) use during the first session to diagnose my patients and to see what level of intervention is warranted. Asking the same questions of yourself – and answering them honestly! – is an easy and powerful self-assessment of whether you may benefit from speaking with a professional. I ask:
- What brings you here today?
- With everything that is going on, how are you sleeping? Do you find it hard to fall or stay asleep? Do you wake up too early or have trouble getting out of bed?
- Do you generally feel tired most of the day or do you have enough energy?
- Any changes in how you are eating, or have you experienced any unintentional weight loss or gain?
- Do you ever feel hopeless, like you are living in a black hole with the darkness heavy or never-ending?
- How do you feel about yourself and how you fit into this world? Do you feel like you have value and worth, or do you feel like you have little worth?
- Do you ever have thoughts of not wanting to live or “escaping”? If yes, how often do you think about it? What would you do to hurt yourself? Have you ever tried to hurt yourself in the past? Have you ever been hospitalized for psychiatric issues?
- Do you ever think about wanting to hurt other people? If so, how and who?
- Any changes in how you focus or concentrate? Are you able to finish tasks?
- Are you more irritable? Do little things get under your skin? How often do you yell at other people?
- At work and in the home, have there been in changes in productivity?
- What do you do for fun? When was the last time you did that?
- When making decisions are you able to make them, do you question yourself, or do you waiver between choices?
- What do you worry about?
- Do you pay bills on time, and are you having any financial difficulties?
- Any changes in your life in the past five years (such as job changes, moves, death(s) or other loss of loved ones, or changes in your relationships)?
- Who are the people you feel close to emotionally? Do you spend time with them or do you prefer to be alone?
- When was the last time you felt happy and life just felt good? Do you generally feel happy, frustrated, angry, stressed, worried or sad?
How do the answers make you feel? What do they reveal about you, your moods, your self-esteem and sense of self? If you find them troubling, or they seem to reveal or confirm what you’ve known or suspected about your mood and wellness, consider following up with a mental health professional.
Treatment
Based on this and other information gathered in the interview, I can form an initial diagnosis and treatment plan. If potentially life threatening depression is revealed, putting the client or someone else at risk, quick and intense intervention is needed and may require hospitalization to quickly stabilize a patient on their medications. Most forms of depression, however, are not nearly so serious and can be treated in some form of outpatient care, such as office visits.
Many LEO’s will not seek treatment for depression, especially if they’re having thoughts of death, because they fear hospitalization. Those are the ones most in need of treatment! Such thoughts aren’t necessarily an indicator for inpatient care unless you are in imminent risk of hurting yourself or someone else. Depression is highly curable (90% +) and, with the proper treatment interventions, those thoughts can go away. Eating your gun is never an option; treatment always is.
I can also determine whether or not someone will benefit or is a candidate for medication. The benefit of psychotropics are that they treat the brain’s neurotransmitters. How I explain this to my patients is that when the brain is not releasing enough serotonin into the blood stream, people become depressed. We all have mood swings during the day and speed bumps. When a depressed person hits a speed bump, their mood goes low and stays there. When a non-depressed person hits a speed bump during their day, they go low, problem-solve the solution and then the mood comes back up. Medication helps the lows to not stay low. But medication is not a complete answer to the depression, as it treats about 60–80% of the mood with the other 40–60% coming from participating in therapy together with a qualified counselor. If medication is warranted and the patient is agreeable, I then make a referral to a psychiatrist who is a medical doctor that specializes in the treatment of mental disorders.
Talk therapy is a key component in the treatment of depression. The most widely used approach is cognitive behavioral therapy (CBT). CBT combines both cognitive and behavioral therapies to solve problems concerning dysfunctional emotions, behaviors, and cognitions through a goal-oriented, systematic approach. It is a dynamic approach, engaging both emotions and the intellect, and well-suited for police officers. Depending on the intensity of the depression and the motivation of the patient, talk therapy can last from three sessions to six months to several years. It depends on what each person needs.
Cops experience depression via mood disorders like anyone else, with the events you encounter during a career policing putting you at risk. If you’ve been feeling unlike yourself for a while and it’s affecting your happiness, relationships, or performance on the job, make an appointment to talk to a licensed mental-health professional. Mood disorders are very treatable conditions, and you deserve to be well.
