Identifying Context Specific Risk Among Trauma-exposed PSNI Personnel

Abstract

Background: The risks associated with police work can have a significant impact on the mental health of police officers and staff. The extant literature primarily highlights the impacts of organisational and operational risks for the development of adverse mental health outcomes for police populations, with more recent research identifying the significant risks associated with organisational stress. However, within the policing context there is a paucity of research that (i) evaluates mental health outcomes across the various domains of risk, including individual, operational, and organisational, (ii) considers the broader socio-environmental context within which the police operates, both as an organisation and within the wider community which they police, and (iii) uses participatory approaches to help translate knowledge of various risk factors for adverse mental health outcomes into improved policy and risk-mitigation strategies. The present study addresses these gaps in the literature and investigates adverse mental health outcomes for police within the post-conflict context of the Northern Ireland.

Objectives: (1) To identify those who, in policing, are most at risk of developing adverse mental health outcomes; (2) to identify potential risk and protective factors associated with adverse mental health outcomes that are unique to policing in the context of Northern Ireland; (3) to identify the individual, organisational, and operational risk factors associated with adverse mental health outcomes within the PSNI; (4) to develop a risk management strategy for the organisation in an attempt to reduce rates of adverse mental health consequences.

Methods: The aforementioned gaps within the literature were addressed using a multi-method, implementation research approach across four research phases. In phase one, a systematic literature review was conducted to examine and synthesise existing research investigating risk factors for the development of adverse mental health outcomes for police. In the second phase key informant interviews were conducted with PSNI personnel to gain knowledge of the context-specific stressors that they encounter both as a result of working for the PSNI as an organisation, as well as policing in a post-conflict setting. The first two phases were then used to inform the selection of the various measures of risk for the third phase, which consisted of a PSNI personnel survey of over (N=1,834) police officers and staff. Hierarchical regression was used to identify the individual, organisational and operational risk factors associated with adverse mental health outcomes. The findings from the first three phases of this study were then used to inform recommendations for the PSNI, which were subsequently presented for feedback in a focus group discussion, as the final phase of the study. The focus group discussion was held with the Senior Management Team of the PSNI?s Occupational Health and Wellness service where the proposed recommendations were reviewed for suitability, and feedback was obtained regarding potential barriers towards implementation. Ways to increase mental health service uptake within the organisation was also discussed.

Results: In the first phase, 414 articles were screened using title and abstracts, 57 articles were full-text reviewed and a final 20 articles were included in the systematic literature review. Seven of the articles included outcome measures for depression, three for anxiety, 12 for PTSD and seven for burnout. Each of these articles included at least one set of risk factor across individual, organisational or operational domains. The findings of the review revealed that there were significant risk factors across each of the different domains of stress on mental health outcomes. Very few of the studies however, included risks across each of the domains of stress, and instead focused on a single domain for the analysis. Consequently, a multifactorial and multidimensional approach to understanding police mental health is necessary whereby individual, organisational and operational risks should all be included in the analysis to fully understand the impact of these risks.

In phase two, interviews were conducted with five officers and staff. Several context-specific stressors for police within the PSNI were identified, which included six key areas of stress: 1) austerity, 2) workload, 3) problems with management, 4) feeling of underappreciation or being unimportant to the organisation, 5) exposure to interpersonal trauma, and 6) the unique stressors associated with the post-conflict setting of Northern Ireland. Many of the stressors associated with working for the PSNI appear to be a result of under-resourcing and participants highlighted that the impacts of working for the PSNI are further exacerbated by the ongoing threat from dissident groups in Northern Ireland.

The results of the survey found that 34.4% of the participants met the diagnostic cut-off score for anxiety, 36.6% for depression, 9.8% for PTSD, 12.3% for Complex PTSD (CPTSD), 2.2% for burnout and 1.6% for secondary traumatic stress. The multiple hierarchical regression found that individual risk factors, namely personality and coping style, were the strongest predictors of anxiety, depression, PTSD and CPTSD. Organisational stressors also played an important role in predicting all mental health outcomes, and operational risks were significant for PTSD, CPTSD and STS.

Results from the focus group discussion resulted in the finalisation of six trauma risk management recommendations. The potential challenges identified by the focus group included lack of resourcing, potential non-compliance from officers and staff, and the various unintended consequences to the organisation as a result of implementing the recommendations. These potential barriers to implementation led to the adjustment of the recommendations in order to facilitate their uptake within the organisation.

Conclusion: The results of this study highlight that police mental health is a complexed issue with many contextual factors contributing to adverse mental health outcomes. Results imply that individual factors are highly relevant in understanding the mental health of police officers and staff and that the various domains of risk (individual, organisational and operational) are multifaceted and dynamic. Findings also highlight the significance of context, both within the organisation and the wider community, on psychological outcomes. Understanding the specific factors that contribute to risk for the development of adverse mental health of police officers and staff was important from the position of the PSNI, but this also raises questions with regards to national responsibilities for both the police service and other first responders.

This study advances our current knowledge on the topic of police mental health through a synthesis of findings from a systematic literature review on the various individual, organisational, and operational risks contributing to mental health, a set of qualitative interviews which provided context-sensitive data on policing in Northern Ireland, advanced quantitative analysis on the rates of adverse mental health outcomes and their various psychological risk factors, and finally a focus group discussion that provided information from key stake holders about the barriers and facilitators of implementing recommendations towards a risk management strategy for the organisation. The implications of these findings for theory, policy, and practice are discussed.