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Health/Wellness

Mitigating post-OIS trauma

Dr. Cherylynn Lee Published July 16, 2023 @ 6:00 am PDT

iStock.com/SDI Productions

One of the most profound truths — and fallacies — in law enforcement is the old adage “If it’s predictable, it’s preventable.” You are trained to assess for pre-assault indicators; however, those indicators aren’t always present before an attack. You are given information about the call you are responding to, but that information may not be accurate or may change by the time you arrive on scene. There is much we cannot control in this profession, and that’s OK (it has to be; what choice do we have?). But what can we control? What is both predictable and preventable?

The majority of officer-involved shootings (OISes) are neither predictable nor preventable. After the incident, you have your department’s protocols and procedures. Interviews. Investigations. Admin leave. Predictable logistical pieces of the process, not preventable. In the aftermath of the OIS, not only will there be overt departmental procedures, but there will be also internal physiological processes. I’m referencing what the brain and body go through in the immediate aftermath of a critical incident like an OIS — and in the months to follow. Much of the body’s physical and psychological response is predictable, and therefore, some of the suffering that ensues after an incident (clinical depression, alcohol abuse, post-traumatic stress injury) is preventable. 

As a police psychologist, I get a front-row seat to the aftermath of such incidents. In the last several years, I have debriefed dozens of OISes, MCIs, TCs and kid calls. I have had many dispatchers and officers sit in my private office going through it. I work with several agencies, directly and indirectly, advising them on how to support their personnel and what procedures would be advantageous to put in place following an OIS. What I have learned over the years is that no two agencies are the same — no two people are the same — but the human condition demands that when you drink too much water, you have to pee. If drinking water is your job, it’s the responsibility of your employer to provide a bathroom. If dealing with trauma is your job, it’s the responsibility of your agency to provide the tools to deal with it. Period. The good news for administrators and wellness champions (I see you; don’t give up) is that you don’t need to reinvent the wheel. There are best practices that exist to help mitigate stress, mitigate the trauma response, keep your cadre healthy and keep your workforce strong. Many of these practices are low-hanging fruit, meaning it’s not going to take a budget season, full moon and act of God to get them off the ground.

The rest of this article is going to provide a brief on best practices: what they are, how they are utilized, and the benefit to the person and the agency. We will cover peer support; Rest, Information and Transition Services (RITS); debriefings; and anniversaries.

Peer support

Peer support is defined as a group of sworn and civilian employees who are specially trained to provide emotional, psychological and tangible support to their peers. The purpose of having a peer support team (PST) is to provide this service to agency personnel during both professional and personal crises. PSTs do not include therapists or psychologists but may work under the advisement of one to help with training, guidance and problem-solving. Well-established PSTs are trained to provide day-to-day support as well as to participate in critical incident response.

Some examples of applicable duties for PSTs after an OIS include:

    1. Responding to the scene and providing tangible and emotional support to the officers
      1. Bringing water, food and warm clothing 
      2. Contacting the family of the officer
      3. Being present and supportive of department personal who are affected
    2. Providing support during the procedural necessities
      1. Being present with the officer before and after their interview
      2. Driving the officer back to the station, home, etc.
      3. Advocating to command staff what the needs of the officers might be
    3. Mopping up
      1. Connecting with dispatch and answering questions, resolving the unknowns of the call
      2. Starting the process of standing up a critical incident stress debrief
      3. Driving the shooter(s) to the fitness for duty appointment
      4. Checking in periodically — taking the officer to coffee, lunch, etc., during admin leave and after

It should be noted that no peer support procedures your agency develops should contradict OIS policies, nor should they put the officer or agency in a position of increased liability by operating outside of the bounds of their training. As an example, most PSTs are trained to not talk about the facts of the OIS, especially prior to the officer’s interview. Some states have legal protections for the conversations between PSTs and other department members. These procedures ought to be written down to help hold peer teams accountable as well as provide the information to supervisors and administration.

Rest, Information and Transition Services (RITS) 

RITS is a process run by PST members only; no clinician is required. Generally speaking, a RITS lasts between 10 and 30 minutes and provides an opportunity for peers to explain and educate officers about what to expect, physiologically and psychologically, after an OIS. For example, the PST member might talk about sleep, flashbacks and anger, along with other normal stress reactions, and then provide some suggestions on how to control these responses. This normalizes what department members experience after an OIS. Additionally, during a RITS the PST members ought to provide available resources (chaplain, culturally competent clinicians, etc.) that will help the individuals affected. A RITS will be done before department members go home, sometimes before leaving the scene. Some light refreshments and water or coffee ought to be provided.

Debriefings

A critical incident stress debriefing (CISD) is a formal, structured intervention where a clinician and PST member are required. 

Why: The goal of the CISD is to provide psychological support to the group that encountered the experience. A CISD is not therapy, but is designed to mitigate the impact of the stress response, assist in the affected individuals’ ability to go back to work and identify those who may need added support. 

When: Debriefs can last between one and three hours, and ideally they are conducted within 72 hours of the incident and may involve the shooter(s). It may make sense to delay the debrief if the unit is going on days off, interviews are delayed, etc. What is of the utmost importance is everyone who needs to be there is there, and that they are paid for their time. (Yes, I said that. No, I’m not taking it back.)

Where: This intervention should be off-site, if possible — a church, auditorium or someplace safe and confidential. The last thing we want is for the IA sergeant or chief to walk by the room. People will be less inclined to talk.

Who: The debrief should only include those directly affected by the incident. If only two out of four on a squad were on scene, you only invite the two who were present. No one above the rank of sergeant should be in the room as a general rule, though there are some exceptions. There ought to be separate debriefs held for command staff at a different time if indicated.

What: There are six steps involved in the Debrief process: 

  1. Fact phase
  2. Thought phase
  3. Reaction phase
  4. Symptom phase
  5. Teaching phase
  6. Re-entry phase

During the fact phase, everyone who touched the incident recounts, in order, what they saw and what they did. Because of how trauma affects the brain, often the memory of the event leaves us with an incomplete picture of what happened. This phase makes the picture complete. The thought and reaction phases ask the participants to recount what was their most prominent thought during the incident, as well as how they felt. The symptom phase goes over what the physical and psychological effects of the incident are on the individuals affected. The teaching phase normalizes what was brought up in the symptom phase, explaining the participants’ reactions and providing stress management information. Finally, the re-entry phase allows for final explanations, actionable directives and resources.

During each phase, the participant will be asked to speak; however, they are gifted the option of saying “Pass” should they wish to do so. Food and refreshments ought to be provided (something other than instant coffee and doughnuts). 

Anniversaries

Just the word itself gives me anxiety (thank you, marriage). Within this context, it is important to remember that it is common in our culture to honor those we’ve lost over time. Those directly affected by an OIS are likely to experience an uptick in stress symptoms as the anniversaries approach (often the first, third and fifth are the hardest). This is normal —
however, so many within our culture suffer in silence that many don’t know how normal this is. It may be wise for the PST to send out emails and go to briefings reminding folks of what resources are available, as well as making themselves available. 

Tips on implementation

If the above information looks tempting to initiate, or redesign, within your department, good. This article is not meant to be training or legal advice, but is a profoundly brief overview of some best practices. Here are some final thoughts and considerations: 

  1. Consider putting these interventions and processes into the OIS ops plan. That way, when your department endures this type of incident, there is no question your personnel will be supported effectively and efficiently, and the process is not dependent on the will of the command staff, who are likely going to be too busy with other things. These events are emotionally charged, and it’s good to have something tangible — and black-and-white — to default to.
  2. Have a one-pager for officers about what to expect after an OIS. They may not know what to expect regarding the interview process, when they can call family, etc. If they know what to expect, you reduce the anxiety and anger that may be directed toward the department at a later time. 
  3. Have a culturally competent clinician be involved in the development of your procedures. While it’s the administrators’ job to protect the agency, it’s a clinician’s job to protect the person. Having a clinician who understands the effects of an OIS will go a long way when the officer needs to sit down to talk through some of the stress response. Your fitness for duty or pre-employment clinician should never be involved in treatment — those boundaries ought to be very clear. That’s a whole other article.

When department members feel cared for and appreciated, they are more likely to show up, perform their duties and bring forth their best. When there are evidence-based interventions put in place, officers are more likely to feel cared for, more likely to heal with minimal scarring and more likely to return to work stronger and with even more to offer their department and community. The physiological and psychological aftermath of an OIS is real and part of what makes us human. And remember, the human condition demands that if we drink too much water, we must pee. Good thing we as a culture don’t have to argue the value of toilets during city council meetings. The human condition also demands that after an OIS we think and feel. Imagine a world where we didn’t have to argue the value of providing the funding for peer teams, culturally competent clinical support and, ultimately, doing the right thing. It is woven into the fabric of our being, as law enforcement professionals, to always do the right thing, especially if it’s the hard thing. It’s go time.

Dr. Cherylynn Lee

Dr. Cherylynn Lee

Dr. Cherylynn Lee is a police psychologist and works full-time for the Santa Barbara Sheriff’s Office as the Behavioral Sciences manager, overseeing the mental health co-response teams, CIT training and Wellness Unit, including Peer Support. As part of her duties, Dr. Lee is a member of the county’s threat management team and serves on the crisis negotiation response teams for both the Santa Barbara Sheriff’s Office and the Santa Barbara Police Department. Dr. Lee has a private practice in the Santa Ynez Valley where she sees first responders exclusively, specializing in trauma, post-traumatic stress, mindfulness and job performance improvement. She can be reached at crl5034@sbsheriff.org.

View articles by Dr. Cherylynn Lee

As seen in the July 2023 issue of American Police Beat magazine.
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