Over the last two years, researchers, including myself, have examined officers who died by suicide and the possible comorbidity of PTSD, anxiety, depression, sleep disturbances, impulsivity, rage and “hypervigilance,” often described as “paranoia” by many in the mental health field, along with head impacts/injuries. After over 35 years as a clinician working almost exclusively with law enforcement officers in the suicide prevention and mental health space, I truly believe this comorbidity is the missing piece in suicide prevention.

In the New York Times article “Pentagon Data Shows High Suicide Rates Among Troops Exposed to Blasts,” Dave Philipps addresses how explosive ordnance disposal (EOD) team members, who disable roadside bombs and routinely train and work around very large blasts, had the highest suicide rate: 34.77 deaths per 100,000 people per year. Followed by infantry and special operations forces, armor crews and artillery troops, whose rates are closer to 30 deaths per 100,000. The national average is 14 deaths per 100,000 per year. The article went on to discuss how blast waves surging repeatedly through the brain can destroy cells, fray connections and lead to a tangle of mental health problems that are often not recognized as being caused by brain injury, including nightmares, insomnia, depression, anxiety, substance abuse and social isolation. Many service members who receive diagnoses of post-traumatic stress disorder may actually have brain injuries that produce similar symptoms, scientists say.^[1]Philipps, D. (2024, July 31). Pentagon Data Shows High Suicide Rates Among Troops Exposed to Blasts. The New York Times. nytimes.com/2024/07/31/us/military-suicide-rates-report.html This will no doubt hold true for the law enforcement community as well.

In another New York Times article by Phillips, “Pattern of Brain Damage Is Pervasive in Navy SEALs Who Died by Suicide,” the same conclusions were found. This article also addressed that blast waves may kill brain cells without causing any immediately noticeable symptoms, according to Dr. Daniel Daneshvar, chief of brain injury rehabilitation at Harvard Medical School. “People may be getting injured without even realizing it,” Daneshvar said. “But over time, it can add up.” People’s brains can often compensate until injuries accumulate to a critical level, he added; then, “people kind of fall off a cliff.” The article went on to talk about the SEALs who died by suicide and point to a troubling pattern in the elite force. What struck me like an anvil was that the average age of a SEAL who died by suicide was 43. The article went on to say that around the age of 40, nearly all of them started to struggle with insomnia and headaches, memory and coordination problems, depression, confusion and, sometimes, rage.^[2]Philipps, D. (2024, June 30). Pattern of Brain Damage Is Pervasive in Navy SEALs Who Died by Suicide. The New York Times. nytimes.com/2024/06/30/us/navy-seals-brain-damage-suicide.html It cannot be a coincidence that according to First H.E.L.P., 31% of all law enforcement suicides were those aged 40 to 49, which was 9% higher than the closest other age ranges.^[3]Lawrence, D. S., Dockstader, J., Solomon, K., Schlosser, L. Z., & Willis, J. (2024, March). Law Enforcement Deaths by Suicide. CNA Corporation. … Continue reading

Let’s think about this: Our law enforcement officers, especially those on SWAT teams, are exposed to flashbangs on a regular basis. These are actually known as “concussion grenades.” Police officers are commonly exposed to blasts from breaching operations such as forcibly opening secured doors and clearing blocked entrances using explosive charges in close proximity.^[4]Carr, W., Polejaeva, E., Grome, A., Crandall, B., LaValle, C., Eonta, S. E., & Young, L. A. (2015). Relation of Repeated Low-Level Blast Exposure With Symptomology Similar to Concussion. The … Continue reading^[5]Kamimori, G. H., Reilly, L. A., LaValle, C. R., & Olaghere Da Silva, U. B. (2017). Occupational Overpressure Exposure of Breachers and Military Personnel. Shock Waves, 27(6), 837-847 In a study investigating the health impacts of low-level blast exposure, breachers reported more post-concussive symptoms compared to non-breachers. They rated these symptoms as more severe and noted that they interfered with their daily lives more significantly.^[6]Carr et. al., 2015 This exposure to low-level blasts can increase the chance of being diagnosed with PTSD. In fact, “Several studies in animals suggest that low-level blast exposure can induce PTSD-related behavioral traits in the absence of a psychological stressor. Indeed, if blast injury can induce PTSD-like symptoms without a psychological stressor, then human cases that are presently being labeled PTSD may in fact be part of the spectrum of blast-related brain injury.”^[7]Elder, G. A., Stone, J. R., & Ahlers, S. T. (2014). Effects of Low-Level Blast Exposure on the Nervous System: Is There Really a Controversy? Frontiers in Neurology, 5, 104813

The law enforcement and mental health community, including psychiatrists, have too often assigned a mental health diagnoses without asking about their patients’ history of repetitive head impacts (RHI) or the number of concussions they sustained over their lifetime. Most officers will say they’ve never had a concussion, but when asked how many times they’ve had their bell rung, the answer is almost always “more times than I can count.” What people don’t understand is those are concussions; the brain keeps score, and it has since birth. Add that to the fact that many law enforcement officers grew up in violent homes or areas, and have a history of playing sports, and the die is cast long before they ever enter the job. In fact, in two studies surveying law enforcement officers, 92% reported a history of playing a sport, with the majority having participated in contact sports.^[8]Carr et. al., 2015^[9]Walsh, M. (2020). Mild Traumatic Brain Injury and Chronic Traumatic Encephalopathy; The Potential Long-Term Effects on Law Enforcement. [Master’s thesis, Florida State University] This is significant because football and soccer have the highest concussion rates, and contact sports have higher concussion rates than non-contact sports.^[10]Conder, R. L., & Conder, A. A. (2015). Sports-Related Concussions. NC Med J, 76(2), 89-95

Risk factors for prolonged recovery include repeated concussions over time, injuries close together in time and psychosocial stress.^[11]Conder & Conder, 2015 In my private practice, over 87% of all officers diagnosed with PTSD, depression and/or anxiety had sustained head impacts and injuries and were referred to a neurologist or neuropsychologist. These numbers were confirmed in a pilot survey done in Texas in 2023.

Understanding that not all mental health issues stem from psychological trauma is important. Articles like this are needed to help expand thinking. It is also essential to address this at law enforcement and first responder conferences, in-service training and officer wellness programs, including peer support. The mental health and law enforcement communities must join forces and demand best practices and procedures after various incidents or exposure. Training such as, but not limited to, defensive tactics, EVOC, pugil stick, ASP, PR24, ground fighting, boxing, grappling and mobile field force need to be viewed through a different lens. Protocols after falling from horseback, ATVs or MVA/TCs need to be put in place and followed, starting in the police academy. Requiring baseline neuropsychological testing after being hired with re-evaluations every five years for all officers would be appropriate. Officers should also be evaluated at the time of entering a specialty unit like SWAT and every 24 months while in the unit. An exit evaluation should be done when they leave the specialty unit, then they should return to the normal protocol of every five years.

I am proud to write that after much advocacy, the UNITE Brain Bank in Boston, which is the largest brain bank in the world, changed their inclusion category to include law enforcement and other first responders, and the Concussion Legacy Foundation (CLF) did a breakout website for those individuals as well. This allows researchers to study law enforcement officers’ brains, gain insights into potential causality and mitigate risks both on and off the job.

CopLine (1-800-267-5463) is the only hotline in the country, and possibly the world, that has been addressing the possible role head impacts and injuries play in the mental health of officers. Being able to have additional tools to help callers has been incredibly rewarding for both our callers and our volunteers. Thanks to CopLine’s collaborative efforts with CLF, we are able to refer our callers to doctors who deal with the neurological effects they are experiencing. Combined with our extensive network of culturally competent mental health clinicians, CopLine remains a one-of-a-kind resource. CopLine has proven to be an invaluable confidential service for all active and retired officers, as well as their families.

If we want to truly reduce suicide rates, we will need to look at the role that head impacts and injuries play in an officer’s mental health. We need to effect change through legislation and departmental policies. If we don’t, I’m afraid we will be writing the same articles on psychological trauma that we have been doing for decades without seeing suicide rates reduced. The most important thing to know is that there is hope and that head trauma is treatable.