First Responder and Law Enforcement Mental Health and Wellness Research Development

Concerns about the physical health, mental health, and safety of first responders and law enforcement officers (LEOs) have been increasing for some time. In recent years, the public has become more aware of the overall toll law enforcement bears and the tragic consequences of poor mental health (Choi and Seipel, 2021; Nanavaty, 2015; Violanti, 2018). At the same time, the public perception of law enforcement, including officers at the U.S. Department of Homeland Security (DHS), has been polarized. Ensuring that officers' mental health and wellness are continuously protected is integral to the DHS strategic plan's priority of championing the DHS workforce.

Previous research suggests that the stress that police officers endure results in “higher rates of heart disease, divorce, sick days taken, alcohol abuse, and major psychological illnesses such as acute stress disorder, PTSD [posttraumatic stress disorder], depression, and anxiety disorders” (U.S. House of Representatives Committee on the Judiciary, 2017). Evidence also suggests that the suicide rate estimated for law enforcement professionals is higher than that of the general population for both men and women (Violanti and Steege, 2021). However, there is a dearth of evidence about the effectiveness of law enforcement mental health programs, which affects knowing what works.

With approximately 80,000 federal LEOs, intelligence analysts, and other staff in its agencies, DHS is uniquely positioned to take positive steps to change the professional culture to a model that prioritizes safety, health, and wellness. The goal of this research was to synthesize evidence from the growing literature on mental health and wellness programs of law enforcement and first responder populations to help DHS in identifying and strengthening programs and policies and to conduct an evaluability assessment (EA) to provide direction for future research.

This study presents findings from multiple research tasks, including a review of domestic and international literature on first responder wellness programs and interviews with key stakeholders in DHS about existing DHS wellness programs and their implementation and subsequent challenges. We conducted an EA of programs identified as potentially ready for evaluation in the stakeholder interviews. Findings from these tasks were used to develop a research agenda for future DHS wellness research efforts.

Methods

The methods for this research included a rigorous literature review to characterize the current state of mental health and wellness research through an analysis of peer-reviewed and gray literature published from 2015 to 2023 on the actual or perceived effectiveness of wellness-related programs for law enforcement and first responders. We identified the following ten types of interventions:

• mindfulness programs
• scenario-based stress response training
• psychotherapy
• group prevention skills and knowledge training
• physical fitness and physical health programs
• mobile health applications
• peer support, mentoring, and chaplain programs
• critical incident response programs
• other stress reduction programs
• suicide prevention training.

We also identified and met with wellness experts from DHS and local law enforcement agencies to receive input on the research that the individuals or their agencies were involved in and what they think are the most pressing topics related to law enforcement wellness. For the EA, we conducted follow-up interviews with key staff from five programs. The data collected from these methods were used to identify research questions, study designs, and research challenges for the research agenda.

Key Findings

We identified key findings that we have organized around four key areas: program evidence, DHS-related challenges, future work, and barriers.

Program Evidence

• According to the literature within the scope of our parameters, the most studied wellness programs for law enforcement and first responders were group prevention skills and knowledge training, psychotherapy, physical fitness, and mindfulness training.
• The findings were generally positive for psychotherapy and mindfulness training in terms of the reduction in mental health symptoms.
• Physical fitness studies also preliminarily demonstrated beneficial results in a variety of areas.
• However, most of the studies assessed were not methodologically rigorous, making it difficult to draw conclusions about program effectiveness.
• In addition, there were relatively few studies for some program types—such as suicide prevention training; mobile health applications; and peer support, mentoring, and chaplain programs—which limits our conclusions.
• This literature review focused on law enforcement and first responder populations; there is additional literature with other populations, such as workers in other high-stress jobs, that needs to be reviewed and have its lessons learned incorporated.
• According to our interviews, certain program types, such as suicide prevention training, physical fitness programs, mindfulness training, and mandatory postvention efforts, were generally described as effective.
• Our EA found that four of the five programs we assessed met two or fewer readiness criteria. The U.S. Customs and Border Protection suicide prevention program was most ready to engage in a formal evaluation, though several key evaluability areas required improvement.

Future Research

• Overall, more research is needed with larger samples, rigorous designs, and outcomes other than knowledge change.
• There is concern about using programs that have not been previously evaluated, though lack of program standardization makes research and implementation difficult.

U.S. Department of Homeland Security–Related Challenges

• Some interviewees recommended adopting robust, evidence-informed, non-DHS programs and adapting them for DHS's population, with the related concern of the uniqueness of the department and the applicability of programs designed for different populations.
• Interviewees expressed concerns about the size of the department and the ability to tailor programs by component or mission.
• There are logistical challenges associated with conducting research on DHS wellness initiatives, including the need to ensure confidentiality and the possible need for support from labor unions to conduct research with DHS employee participants.
• Given the wellness programs that have been implemented thus far, DHS as a department appears to be taking mental health and wellness seriously. As components work to design and strengthen existing programs, they should consider what already exists across DHS.
• Implementing some types of evidence-based programs, such as short-term, intensive residential programs and group psychotherapy, are less applicable for DHS.

Barriers

• Stigma in seeking and receiving services is a critical barrier but, according to interviewees, might be improving. Most interviewees agreed that mental health stigma was slowly declining, especially as more young professionals join the workforce.
• Some general barriers to use of wellness programs include a workplace culture that discourages help-seeking and fear of losing one's security clearance or approval to carry a firearm.
• Organizational barriers to participation include (1) a lack of resources to fund programs and/or on-site mental health clinicians, (2) employees feeling that they do not have sufficient time to seek out support (especially employees who have very demanding roles), (3) employee concerns around confidentiality, (4) insufficient leadership support, and (5) a lack of awareness about the resources available to employees.
• Most of the programs included in our EA were not ready to be part of a rigorous impact evaluation. Lack of time, resources, leadership support, and existing data-collection efforts were identified as barriers to evaluation.

More research is needed with larger samples, rigorous designs, and outcomes other than knowledge change, such as mental health and wellness outcomes. Although literature review findings were generally promising, methodological weaknesses limit the conclusions that can be drawn. The comparability and generalizability of the studies are limited because of the use of different outcome measures, evaluation designs that were less rigorous because they are secondary to the overall training goals of the program, and low participation and response rates.

Although we were able to review evaluations done on mental health and wellness programs, because of our criteria, the evaluations were all conducted with first responder personnel. Additional literature on other populations should be reviewed and might provide additional insight into workplace wellness programs.