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“There Was No Plan in Place to Get Us Help”: Strategies for Improving Mental Health Service Utilization Among Law Enforcement

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Abstract

Police experience a documented, elevated need for mental health (MH) care due to the significant chronic stressors and acute traumatic experiences that characterize police work. Yet, many barriers prevent officers from accessing and engaging fully in MH treatment. The purpose of this study is to understand the idiosyncratic officer-perceived barriers and facilitators to MH service utilization to generate strategies for increasing the accessibility of MH resources. Heeding the call for more qualitative work in this line of inquiry, we used thematic analysis of in-depth, semi-structured interviews with a sample of 48 U.S. police officers to examine how officers came to initiate MH services, why they chose to engage or not engage such resources, and what organizational and supervisory factors promoted service utilization. Officers’ narratives show that police leadership should strive to (1) alleviate fear of negative professional consequences by addressing structural stigma, (2) improve agency culture and social norms around mental health care by focusing on prevention and resilience, and (3) emphasize the development of relevant and trustworthy MH care. To address structural barriers, officers described the urgent need for police leadership to clarify and make transparent organizational MH policies and processes, systematize departmental MH responses, and leverage mandated counseling. Additionally, officers perceived the need for a cultural shift emphasizing comprehensive, incentivized, preventative MH services. Finally, officers’ concerns regarding the quality of MH care encompassed the need for confidential, trustworthy services grounded in the realities of police work. Implications for research and practice are discussed.

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Notes

  1. The principal investigator originally aimed for a sample of approximately 35 participants, exceeding the recommended sample size of Creswell (2007) based on the study’s design. The goal of participant selection in qualitative research is to achieve saturation (i.e., informational redundance) by gathering sufficient depth of information to fully understand the range of perceptions and experiences that describe the issue under examination (Fossey et al. 2002; Gaskell 2000). As such, we allowed for some flexibility related to a subjective sense of whether new information about the constructs under examination was discussed by participants, which ultimately increased the sample to 48.

  2. Within our general sampling framework, we prioritized demographic diversity among the sample in an effort to be responsive to the increasing diversity of the U.S. police force (Hyland and Davis 2019) and collect sufficient data to understand the experiences of groups typically underrepresented in law enforcement.

  3. Officers were asked broadly how they process the stressors of police work (i.e., “What do you think helps you deal with the impact of your job?”) and then, specifically, if they have received mental health counseling (i.e., “Have you ever gone to counseling to deal with the challenges of this job?”). If they had not accessed counseling, they were asked if they had concerns about doing so (i.e., “Would you have any concerns about going to counseling if you felt that you wanted to?”) and were prompted to elaborate on their answer (e.g., “Tell me more about why you’d be concerned to seek counseling?”).

  4. When discussing high-stress events, the participant gave a general description of the event and, broadly, what their agency’s response was to the incident. As appropriate, the interviewer asked if and who they spoke to about the event, including medical or mental health care providers (i.e., “Did you talk to anyone about what happened? What about medical or mental health care providers?”). As needed, the interviewer followed up to inquire whether counseling services would have been helpful and if they would have had any concerns about accessing them.

  5. We consider the possibility that our recruitment strategy may have resulted in a sample particularly engaged or concerned with mental health in our discussion section.

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Acknowledgements

We wish to extend our deepest appreciation to the research participants of this study.

Funding

This study was funded by internal grants to the first author from the University of Virginia (no grant number applicable).

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Authors and Affiliations

  1. Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 3071, Durham, NC, 27710, USA

    Meret S. Hofer

  2. Wilson Center for Science and Justice, Duke University School of Law, Durham, NC, USA

    Meret S. Hofer

  3. Department of Psychology, University of Virginia, Charlottesville, VA, USA

    Shannon M. Savell

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  1. Meret S. Hofer
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Correspondence to Meret S. Hofer.

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Hofer, M.S., Savell, S.M. “There Was No Plan in Place to Get Us Help”: Strategies for Improving Mental Health Service Utilization Among Law Enforcement. J Police Crim Psych 36, 543–557 (2021). https://doi.org/10.1007/s11896-021-09451-0

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