The Fatal Five: Off-Duty Threats to Law Enforcement
By Olivia Johnson, D.M., Konstantinos Papazoglou, Ph.D., John Violanti, Ph.D., and Joseph Pascarella, Ph.D., M.P.H.
Analysis of data collected from 2017 to 2019 on law enforcement suicide deaths revealed 10 risk factors present in many cases. Of these, five were noted as significant among police and corrections officers: interpersonal relationships, substance abuse and addiction, sleep and related disorders, physical and mental health, and access to firearms.1
Careful examination of these issues will help reduce negative outcomes. Additionally, changing the paradigm from prevention and intervention to a proactive approach will assist those who experience suicidal ideations and display risk-taking behaviors.
Various factors can impact police officers’ intimate relationships. For example, their work entails shifts, including night hours, which might differ from their spouse’s. Discrepancy in a couple’s schedule may create distance and lead to issues if communication is absent or minimal. In such cases, quality — rather than quantity — of time can prove beneficial.
Further, officers must cope effectively with negative feelings (e.g., anger, frustration, disappointment) resulting from the challenges of police work. When most return home from a shift, they cannot de-escalate their unpleasant emotions. Thus, they may express rage or other intense feelings toward their partner, adversely affecting their relationship.
Officers must also connect emotionally with their spouse and safely express negative feelings experienced during their shift. Even partners not affiliated with law enforcement can connect and share their emotional reactions to difficult situations.
Moreover, lack of communication and intimacy in relationships may lead to separation or divorce, which can overwhelmingly impact officers’ lives. If the split is toxic, this may negatively affect officers’ health, wellness, and job performance. Many cases of suicide were influenced by relationship issues.2
Substance Abuse and Addiction
Millions of Americans, including some first responders, struggle with addiction. Opiate use is a factor in approximately 20% of all suicide deaths in the United States, and alcohol intoxication (at or above the legal limit) occurs at a similar rate.3
First responders, particularly those in law enforcement, commonly use alcohol.4 This not only lowers inhibitions but also intensifies depression, making it a catalyst for suicide. From 2017 to 2019, about 19% of suicide cases noted alcohol intoxication — at least 1 to 2 times higher than the legal limit — at or near the time of death. Rates are presumably much higher because of the unavailability of toxicology results for many cases.5
Most agencies have clear policies on illicit drugs. For example, according to Law Enforcement Management and Administrative Statistics, 90% have a screening program.6 However, screening of alcohol and prescription drug abuse is inconsistent. Given the potential for substance abuse based on previous post-traumatic stress disorder (PTSD) and sleep deprivation incurred in the profession, law enforcement agencies must review policies considering potential treatment options rather than ambiguous ones and those focusing on termination.7
Sleep and Related Disorders
People spend nearly one-third of their life sleeping.8 However, insufficient sleep is a public health epidemic.9 Issues can result from hectic lifestyles, heavy and chaotic workloads, medical conditions like insomnia and sleep apnea,10 alcohol consumption, and use of illicit and prescription drugs.11
Inadequate sleep among first responders is dangerous and can lead to injuries and fatalities. Sleep is an essential component for an individual’s overall well-being. Research has shown that the effects of sleep deprivation are similar to those that occur while under the influence of alcohol.12 Additionally, deficits cannot be addressed by simply sleeping longer. Negative effects of poor sleep patterns can include injury and illness, increased anxiety, depression, and even suicide.13
Dr. Johnson, a former police officer and military veteran, conducts training, consultation, and needs assessments for law enforcement agencies nationwide regarding health, wellness, and safety.
Dr. Papazoglou, a clinical, police, and forensic psychologist and principal founder of the POWER Project, a nonprofit public service corporation in California, recently completed his postdoctoral appointment at Yale School of Medicine in New Haven, Connecticut.
Dr. Violanti, a veteran New York State trooper, is a full-time research professor at the University at Buffalo in New York.
Dr. Pascarella, a retired captain from the New York City Police Department, is an associate professor of criminal justice at Saint Joseph’s College in Brooklyn, New York.
Physical and Mental Health
Although there is literature on PTSD and initial screening of candidates,14 little research exists on how to sustain the mental health of highly functioning, long-term officers. According to a recent study, nearly 26% of 434 surveyed police officers reported symptoms of mental illness. Additionally, the officers consistently noted that they would seek treatment if confidentiality was guaranteed.15
Law enforcement agencies must recognize the association between the physical and emotional/psychological consequences of the job. Further, management must implement a system that can confidentially screen tenured officers for mental health issues and change the existing perspective that physical and mental health are unrelated. These assessments should continue throughout officers’ careers.
Access to Firearms
Easy access to firearms increases suicide risk. Research revealed that 95% of police officers who died by suicide used a gun, compared with 59% of military personnel.16
One study examined the Israeli Defense Forces’ policy on firearms. Soldiers were prohibited from taking them home, which reduced suicides by 50%.17 U.S. police agencies may find this strategy effective as most officer suicides occur away from the workplace.18 However, implementing such a policy may be problematic because many police departments and unions stipulate that officers should be armed 24 hours a day.
The predominant strategy in cases of potential police suicide is to remove the firearm from the officer. There are two opposing schools of thought on the safest possible strategy.
First, some studies support the removal of guns, including one that suggests restricting access and reducing their ownership can decrease the risk of firearm suicides.19 A meta-analysis found that the odds of completed suicide are three times greater among persons with access to firearms.20 Additionally, more suicides were carried out by handgun owners than non-owners.21 Finally, decreases in firearm suicides are associated with laws and regulations that limit access to guns.22
Second, an argument can be made against removing firearms. Police officers symbolically identify with them. Without guns, they may feel subject to ridicule and scapegoating. According to psychologists, removing an officer’s firearm could exacerbate their depression.23 Studies suggest that emphasizing that firearm limits are temporary might facilitate adherence to clinician advice.24 Thus, any removal should be accentuated as such.
One study found that highlighting the temporariness of firearm loss communicates to an officer that gun safety interventions are not aimed at permanently confiscating them.25 Further, measures can be taken to make the home environment safe — for instance, locking the firearm in a timed safe for several hours post-crisis or having a loved one remove ammunition and store it in a separate, unknown location.
“From data regarding law enforcement suicides, five significant themes emerged that can result in negative outcomes.”
Safety Planning Intervention is a brief, six-step measure that provides officers with a written personalized safety plan should a crisis develop.
- Look for warning signs in oneself (e.g., suicidal thoughts, alcohol use, high stress).
- Develop internal coping strategies (e.g., exercise, movie).
- Utilize social situations and people to avoid suicidal thoughts (e.g., close friends, meetings).
- Note people to ask for help if needed (e.g., spouse, parents, colleagues).
- Identify mental health professionals or other available help (e.g., department psychologist, Employee Assistance Program (EAP), police peer support, suicide hotline).
- Create a safe environment.26
There is no single solution to limit firearm access in potential suicide cases. Leaders should consider cases individually and confer with psychologists and EAP personnel to find the best path forward. This difficult decision requires extensive planning, and it must consider the officer and family’s safety.
From data regarding law enforcement suicides, five significant themes emerged that can result in negative outcomes. Risk factors noted in many of the cases of completed suicide require an in-depth examination. This not only reduces suicide deaths among these populations but also proactively protects officers against the occupation’s negative repercussions and the consequences of not properly addressing negative life events. Proactive assessment of these factors can alert those closest to the officer if there are signs of suicidal ideation and risk-taking behaviors.
“[C]hanging the paradigm from prevention and intervention to a proactive approach will assist those who experience suicidal ideations and display risk-taking behaviors.”
Dr. Johnson can be reached at firstname.lastname@example.org, Dr. Papazoglou at email@example.com, Dr. Violanti at firstname.lastname@example.org, and Dr. Pascarella at email@example.com.
1 Blue Wall Institute, https://www.bw-institute.com/, analyzed unpublished raw data it had collected for the years 2017-2019 on the demographics of police suicides.
3 U.S. Department of Health and Human Services, Substance Use and Suicide: A Nexus Requiring a Public Health Approach (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2016), https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4935.pdf.
4 Paul Brunault et al., “Posttraumatic Stress Disorder Is a Risk Factor for Multiple Addictions in Police Officers Hospitalized for Alcohol,” European Addiction Research 25, no. 4 (2019): 198-206, https://doi.org/10.1159/000499936.
5 Ibid.; and Blue Wall Institute.
6 U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, Law Enforcement Management and Administrative Statistics (LEMAS) (Ann Arbor, MI: Inter-University Consortium for Political and Social Research, 2020), https://doi.org/10.3886/ICPSR37323.v1.
7 U.S. Department of Justice, National Institute of Justice, “Impact of Sleep Deprivation on Police Performance,” last modified January 5, 2009, https://nij.ojp.gov/topics/articles/impact-sleep-deprivation-police-performance; and John Violanti, “PTSD Among Police Officers: Impact on Critical Decision Making,” Dispatch 11, no. 5 (May 2018), https://cops.usdoj.gov/html/dispatch/05-2018/PTSD.html.
8 National Institutes of Health, National Institute of Neurological Disorders and Stroke, “Brain Basics: Understanding Sleep,” accessed September 13, 2022, https://www.ninds.nih.gov/health-information/patient-caregiver-education/brain-basics-understanding-sleep.
9 L.R. McKnight-Eily et al., “Perceived Insufficient Rest or Sleep Among Adults — United States, 2008,” Morbidity and Mortality Weekly Report 58, no. 42 (October 2009): 1175-1179, https://www.researchgate.net/publication/278027485_Perceived_insufficient_rest_or_sleep_among_adults_-_United_States_2008.
10 National Highway Traffic Safety Administration and National Institutes of Health, National Center on Sleep Disorders Research, Drowsy Driving and Automobile Crashes: Report and Recommendations (Washington, D.C.: National Highway Traffic Safety Administration, April 1998), https://www.nhlbi.nih.gov/files/docs/resources/sleep/drsy_drv.pdf.
11 Gustavo A. Angarita et al., “Sleep Abnormalities Associated with Alcohol, Cannabis, Cocaine, and Opiate Use: A Comprehensive Review,” Addiction Science & Clinical Practice 11, no. 9 (2016), https://doi.org/10.1186/s13722-016-0056-7; and Annie Britton, Linda Ng Fat, and Aidan Neligan, “The Association Between Alcohol Consumption and Sleep Disorders Among Older People in the General Population,” Scientific Reports 10, no. 5275 (2020), https://doi.org/10.1038/s41598-020-62227-0.
12 A.M. Williamson and Anne-Marie Feyer, “Moderate Sleep Deprivation Produces Impairments in Cognitive and Motor Performance Equivalent to Legally Prescribed Levels of Alcohol Intoxication,” Occupational and Environmental Medicine 57, no. 10 (October 2000): 649-655, https://doi.org/10.1136/oem.57.10.649.
13 Police Executive Research Forum, An Occupational Risk: What Every Police Agency Should Do to Prevent Suicide Among Its Officers (Washington, D.C.: Police Executive Research Forum, 2019), accessed September 14, 2022, https://www.policeforum.org/assets/PreventOfficerSuicide.pdf.
14 Violanti, “PTSD Among Police Officers.”
15 Katelyn K. Jetelina et al., “Prevalence of Mental Illness and Mental Health Care Use Among Police Officers,” JAMA Network Open 3, no. 10 (2020), https://doi.org/10.1001/jamanetworkopen.2020.19658.
16 John Violanti, Occupation Under Siege: Resolving Mental Health Crises in Police Work (Springfield, IL: Charles C Thomas, 2021).
17 Leah Shelef et al., “A Military Suicide Prevention Program in the Israeli Defense Force: A Review of an Important Military Medical Procedure,” Disaster and Military Medicine 1, no. 16 (2015), https://doi.org/10.1186/s40696-015-0007-y.
18 Violanti, Occupation Under Siege.
19 Police Executive Research Forum; and Elinore J. Kaufman et al., “State Firearm Laws and Interstate Firearm Deaths from Homicide and Suicide in the United States: A Cross-Sectional Analysis of Data by County,” JAMA Internal Medicine 178, no. 5 (2018): 692-700, https://doi.org/10.1001/jamainternmed.2018.0190.
20 Andrew Anglemyer, Tara Horvath, and George Rutherford, “The Accessibility of Firearms and Risk for Suicide and Homicide Victimization Among Household Members: A Systematic Review and Meta-Analysis,” Annals of Internal Medicine 160, no. 2 (2014): 101-110, https://doi.org/10.7326/M13-1301.
21 Kaufman et al.
22 J. John Mann and Christina A. Michel, “Prevention of Firearm Suicide in the United States: What Works and What Is Possible,” American Journal of Psychiatry 173, no. 10 (October 2016): 969-979, https://doi.org/10.1176/appi.ajp.2016.16010069; and Police Executive Research Forum.
23 Police Executive Research Forum.
24 Ian H. Stanley et al., “Discussing Firearm Ownership and Access as Part of Suicide Risk Assessment and Prevention: ‘Means Safety’ Versus ‘Means Restriction,’” Archives of Suicide Research 21, no. 2 (2017): 237-253, https://doi.org/10.1080/13811118.2016.1175395.
26 Barbara Stanley and Gregory K. Brown, “Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk,” Cognitive and Behavioral Practice 19, no. 2 (2012): 256-264, https://doi.org/10.1016/j.cbpra.2011.01.001; and Barbara Stanley at al., “Comparison of the Safety Planning Intervention with Follow-Up vs. Usual Care of Suicidal Patients Treated in the Emergency Department,” JAMA Psychiatry 75, no. 9 (2018): 894-900, https://doi.org/10.1001/jamapsychiatry.2018.1776.