FEBRUARY 1990 CRITICAL INCIDENT STRESS DEBRIEFING By Capt. Richard J. Conroy, M.S. Assistant Chief of Police Saint Cloud, FL Police Department * As the first responder to an early morning pedestrian accident, a police officer comes across a severed leg protruding from a shoe lying in the middle of the highway prior to locating the victim. * While stopping his car, a "back-up" officer responding to a domestic distur- bance call sees a fellow officer take a shotgun blast to the stomach just as the front door to the residence opens without warning. * An 18-month-old child is pulled from the family's backyard pool by the first responding police officer, only to have the child pro- nounced dead at the hospital emergency room. These accounts typify the wide-range of emotionally traumatic incidents that law enforcement officers may encounter. As first responders on the scene, they must act without delay, often without the support or backup of other emergency services personnel. Research conducted by Dr. Jeffrey T. Mitchell (1) of the University of Maryland suggests that almost 90 percent of all emergency services personnel are affected at least once by critical incident stress during their careers. In the past 2 decades, much emphasis has been placed on the effects of critical incident stress on the emergency services worker who is not a law enforcement officer. Unfortunately, the law enforcement community has been rather slow to accept the fact that critical incident stress can also be a potentially debilitating syndrome that seriously affects both the job performance and personal lives of police officers. (2) CRITICAL INCIDENT STRESS Critical incident stress can be brought on by any action that causes extraordinary emotion and overwhelms and impacts on an individual's normal ability to cope, either immediately following the incident or in the future. Police officers' human coping mechanisms are no different than those of others, just because they carry a badge and a gun. And the myth that police officers always have total emotional control in all situations is just that a myth, not a reality. Any incident that results in deep emotional impact has the potential to overwhelm an officer's ability to cope. Oftentimes, it makes the officer come face to face with his or her vulnerability or sense of mortality, such as in an officer-involved shooting, the death or serious injury of a co-worker, prolonged or extraordinary rescue operations, or life-threatening, dangerous, or ``close'' calls. For the most part, society expects law enforcement officers to handle whatever comes their way, to turn emotions on and off at will. But, is it reasonable to expect police officers to be all things to all people? And what happens if they can't live up to the expectations society places on them? Are there solutions to the problem? THE DEBRIEFING PROCESS The Critical Incident Stress Debriefing (CISD) process has been developed in an effort to make law enforcement officers and emergency service workers understand that they are normal people, having normal reactions to abnormal events or situations. These debriefings are not the operational critiques that law enforcement administrators traditionally schedule after a major incident. Instead, they are gatherings led by a trained mental health professional with the assistance of supportive peer personnel. The concept behind these debriefings is to encourage free expression of thoughts, fears, and concerns in a supportive group environment without losing status among one's peers. In fact, debriefings are much more successful and the feedback more positive when peer support personnel are more active. (3) The debriefing process allows individuals to gain insight and reframe the event in a different perspective. As short-term initial intervention, it often aids in preventing some of the long-term cumulative effects caused by traumatic incidents. Some departments require personnel to attend a debriefing session after being involved in a critical stress incident, while others make attendance a personal choice. All debriefings are confidential and provide an opportunity for educating officers on stress responses, as well as letting those involved know that they are not alone in their thoughts and feelings. Successful law enforcement debriefings have been conducted after the Winnetka, IL, school shooting, the Palm Bay, FL, shopping center shooting, and the Cerritos, CA, air disaster. DEBRIEFING TEAMS Debriefing teams are support groups composed of volunteer trained mental health professionals and emergency workers who learn to talk with others about job-related stress. The team counsels others on dealing with the emotional toll of their professions. Team members undergo 16 hours of training before they can conduct a counseling session, which is usually scheduled within 48 hours after emergency workers have been involved in a critical incident. During the training, these volunteers are taught to identify critical incidents and the physical and emotional symptoms resulting from them, as well as delayed stress reactions. Team members must also become familiar with a debriefing model. Basically, this model covers how to get people to identify what happened, their role in the incident, and what impact the incident had on them. If additional assistance is needed after the debriefing session, the individual is given a list of referrals to contact for one-on-one counseling. Almost 100 CISD teams across the country operate on national, statewide, regional, and local levels. These teams have conducted in excess of 4,500 debriefings for law enforcement, as well as other emergency services workers since 1983. A number of larger police agencies have formed their own departmental teams and have trained peer debriefers, written operational procedures, and gathered administrative support for the CISD concept. Other police agencies have networked their members into county and regional teams where multidisciplinary resources from police, fire, emergency medical, hospital, chaplaincy, and mental health are pooled and shared as the need arises. LAW ENFORCEMENT CONCERNS The many administrative misconceptions about police involvement with mental health professionals are changing. The philosophies like ``we can handle anything'' and ``it all comes with the job, take it or leave it'' are becoming archaic. Police managers who have witnessed officers suffering from a vast array of emotional, physical, and behavioral symptoms are beginning to recognize that these conditions can be the resulting effects of critical incident stress. Employee turnover, sick leave abuse, an increase in alcohol consumption, extreme aggressiveness, and substance abuse are just a few of the outward signs that an officer may need help from the department and peers. Training and education in the area of stress management have become somewhat common practices in the police profession. Within the past few years, any law enforcement conference, workshop, or seminar would not be complete without a segment or speaker on stress management, stress symptoms and their effects. But, there is still a long road to travel. Agency administrators need to realize that training programs will be more effective if they cover more than just the basics of stress education. Programs should encourage the dissemination of information specific to critical incident stress and the associated debriefing process. CONCLUSION Providing critical incident stress debriefing services to law enforcement officers should be no different than giving officers the proper tools and equipment to perform their jobs correctly. Agency administrators owe it to their communities to assist in dealing with the effects of critical incident stress. The well-being of their departments, officers, and the citizens they serve depend on it. FOOTNOTES (1) Jeffrey T. Mitchell, Roles, Stressors and Supports for Emergency Workers, National Institute of Mental Health, U.S. Department of Health and Human Services, 1985. (2) Thomas Pierson, ``Critical Incident Stress: A Serious Law Enforcement Problem,'' The Police Chief, vol. 66, No. 2, pp. 32-33. (3) Jeffrey T. Mitchell, Critical Incident Stress Debriefing Training Seminar, Orlando, FL, April 1989.