Police brutality and unmet need for mental health care.

OBJECTIVE: National movements have raised awareness of the adverse mental health effects of police brutality. This study examines the relationship between perceived police brutality and unmet need for mental health care. DATA SOURCES: We used the 2018 Survey of the Health of Urban Residents (N = 4338), a quota sample survey of adults in urban areas in the contiguous United States. STUDY DESIGN: Multivariate regressions were used to understand the association between police brutality and unmet need for mental health care. Unmet need was regressed on police brutality (the independent variable), controlling for sociodemographic and health status characteristics of respondents and access to care. We then stratified the sample by experiences of police brutality (no negative encounters with the police, encounters that were perceived as necessary, and encounters that were considered unnecessary) and described how medical mistrust and perceived respect within health care settings were associated with odds of unmet need for each subsample. DATA COLLECTION: Data were collected online. PRINCIPAL FINDINGS: Negative police encounters perceived as necessary were associated with greater odds of unmet need compared to no negative police encounters (odds ratio [OR] = 1.98, confidence interval [CI] = 1.30-2.65). Odds of unmet need were also higher among persons with negative and unnecessary police encounters (OR = 1.28, CI = 1.05-1.56). Greater respect was associated with lower odds of unmet need among persons who reported negative unnecessary encounters with the police (OR = 0.88, CI = 0.72-0.97). Medical mistrust was associated with greater odds of unmet need among those with negative unnecessary police encounters (OR = 1.52, CI = 1.12-1.93). CONCLUSIONS: Persons who are exposed to police brutality are also likely to be those who experience unmet need for mental health care. Ensuring that they feel respected within medical settings and establishing conditions that build trust in medical institutions are important for eliminating unmet need for mental health care.

US law enforcement policy predictors of race-specific police fatalities during 2015-16.

Mounting evidence suggests that law enforcement organizational factors contribute to higher incidence and racial disparities in police killings. To determine whether agency policies contribute to race-specific civilian fatalities, this exploratory study compared fatality rates among agencies with and without selected policies expected to reduce killings. A cross-section of 1085 fatalities in the 2015-2016 The Counted public-use database were matched to 481 agencies in the 2013 Law Enforcement Management and Administrative Statistics (LEMAS) database. Negative binomial regression estimated incidence rate ratios (IRR) adjusted for agency type, number of officers, percent female personnel, median income, percent with a bachelor's degree, violent crime rate, and population size, with inference using robust standard errors. Agencies with greater proportions of full-time personnel (range 43-100%) had lower rates of all (IRR = 0.85; 95% confidence interval [CI] = 0.77-0.93) and non-White civilian killings (IRR = 0.85; CI = 0.73-0.99). Mission statements predicted lower rates of all (IRR = 0.70; CI = 0.58-0.84) and White killings (IRR = 0.60; CI = 0.40-0.90). Community evaluation and more types of personnel incentives predicted lower rates of White (IRR = 0.82; CI = 0.68-0.99) and non-White killings (IRR = 0.94; CI = 0.89-1.00), respectively. Increasing video use predicted higher rates of White killings (IRR = 1.13; CI = 1.01-1.28). No policies were significantly associated with Black civilian killings. Law enforcement policies that help reduce police killings may vary across racial groups with the least benefit for Black civilians. Impact evaluations and meta-analyses of initiatives aimed to mitigate fatalities should be explored, particularly policies to address anti-Black bias. A national registry tracking all police killings and agency policies is urgently needed to inform law enforcement policies aimed to mitigate civilian fatalities.

Standing by: The spatial organization of coercive institutions in China.

How do authoritarian states organize their coercive institutions over space? We argue that autocrats maximize the utility of their limited coercive resources by clustering them with perceived threats in society, i.e., segments of the population that are ideologically distant and have mobilizational potential. We test this proposition using a dataset that covers the universe of police stations (N = 147,428) and religious sites (N = 115,394) in China. We find that police stations are more likely to be located within walking distance of foreign religious sites (churches) than other sites (temples), even after controlling for the estimated population within 1 km of each site and a set of key site attributes. This finding is robust to using alternative model specifications, different variable measurements, and multiple data sources. Moving beyond the clustering pattern, we also address the temporal order issue and show that the Chinese state has allocated more new coercive resources around existing foreign religious sites than native sites, i.e., after these sites are already in place. This study enriches our understanding of how autocrats rule and further opens up an emerging new methodological avenue for research on authoritarian politics.

Patterns of occupational stress in police contact and dispatch personnel: implications for physical and psychological health.

PURPOSE: Occupational stress in police call handlers is researched less frequently than in operational or frontline police, despite the role's unique challenges. Occupational stress is potentially manageable, thus improved understanding of its contributors and consequences is important for effective intervention. We aimed to compare levels and sources of organisational stress in police contact and dispatch personnel with UK benchmarks. Second, to test whether different typologies of stress were associated with physical health, mental health and substance use. Finally, to examine whether non-organisational factors (socio-demographic factors and family interference with work (FIW)) predicted organisational stress typologies. METHODS: A sample (n = 720) of police and civilian staff in a UK police call and dispatch centre were surveyed. RESULTS: The strongest sources of stress were competing and high demands, low control, insufficient managerial support and ambiguity surrounding workplace change-all of which indicated need for 'urgent action' according to UK benchmarks. Substance use and particularly mental health difficulties were higher than published norms. A latent profile analysis grouped respondents into a low-stress group and two high-stress profiles. As stress increased across profiles, this corresponded with worse physical and mental health and higher substance use. FIW predicted membership of both high-stress profiles. CONCLUSION: Despite non-operational roles, police contact and despatch personnel can experience high occupational stress which is associated with physical and mental health difficulties and substance use. Organisational-level interventions which address lack of control, conflicting role demands as well as enhance management support and communication around change might be most effective in this group.

Police demilitarization and violent crime.

Policymakers and advocates make contradictory claims about the effects of providing military equipment to local law enforcement, but this intervention is not well understood because of severe data limitations and inferential challenges. I use 3.8 million archived inventory records to estimate the magnitude of sources of bias in existing studies of the 1033 Program. I show that most variation in militarization comes from previously unobserved sources, which implies that studies that show crime-reduction benefits are unreliable. I then leverage recent policy changes to evaluate the effect of military equipment: the Obama Administration recalled property under Executive Order 13688, which resulted in a forced demilitarization of several hundred departments. Difference-in-difference estimates of agencies that retained similar equipment show negligible or undetectable impacts on violent crime or officer safety. These findings do not suggest that similar scale federal reforms designed to demilitarize police would have the downside risks proposed by proponents of military transfers.

Sources and severity of stress in a Southwestern police department.

BACKGROUND: Policing is a stressful occupation. Most research examining police stress focuses solely on patrol officers, and often focuses on black and white officers only. Further, organizational sources of stress tend to be more important for police officers generally. AIMS: To explore sources and severity of stress in a predominately Hispanic, mid-sized, Southwestern police department. METHODS: A cross-sectional study of 147 police officers of all ranks was conducted. A modified version of the Police Stress Survey (PSS) was administered during daily briefings. Logistical regression models were utilized to examine predictors of stress based on gender, race/ethnicity, rank and tenure. RESULTS: Overall, occupational stressors proved more prominent than organizational stressors, contrary to previous research. Additionally, race/ethnicity was predictive of both total stress and occupational stress; rank was predictive of organizational stress; and tenure in law enforcement was predictive of occupational stress. CONCLUSIONS: The sources of stress that impact police officers may be shifting as the climate surrounding law enforcement changes. What is stressful for officers depends on the race/ethnicity, rank and tenure of the officer within the organizational structure. Potential interventions designed to alleviate stress should be mindful of the variety of needs within any given department.

The development of the Police Practices Scale: Understanding policing approaches towards street-based female sex workers in a U.S. City.

Policing is an important structural determinant of HIV and other health risks faced by vulnerable populations, including people who sell sex and use drugs, though the role of routine police encounters is not well understood. Given the influence of policing on the risk environment of these groups, methods of measuring the aggregate impact of routine policing practices are urgently required. We developed and validated a novel, brief scale to measure police patrol practices (Police Practices Scale, PPS) among 250 street-based female sex workers (FSW) in Baltimore, Maryland, an urban setting with high levels of illegal drug activity. PPS items were developed from existing theory and ethnography with police and their encounters with FSW, and measured frequency of recent (past 3 months) police encounters. The 6-item scale was developed using exploratory factor analysis after examining the properties of the original 11 items. Confirmatory factor analysis was used to model the factor structure. A 2-factor model emerged, with law enforcement PPS items and police assistance PPS items loading on separate factors. Linear regression models were used to explore the relative distribution of these police encounters among FSW by modeling association with key socio-demographic and behavioral characteristics of the sample. Higher exposure to policing was observed among FSW who were homeless (ß = 0.71, p = 0.037), in daily sex work (ß = 1.32, p = 0.026), arrested in the past 12 months (ß = 1.44, p<0.001) or injecting drugs in the past 3 months (ß = 1.04, p<0.001). The PPS provides an important and novel contribution in measuring aggregate exposure to routine policing, though further validation is required. This scale could be used to evaluate the impact of policing on vulnerable populations' health outcomes, including HIV risk.

"Most [False Reports] Involve Teens": Officer Attitudes Toward Teenage Sexual Assault Complainants-A Qualitative Analysis.

Scholars, advocates, and victims have repeatedly criticized the police treatment of sexual assault (SA) complainants. Apathetic attitudes and hostile behavior on the part of the police have likely resulted from socialization into a culture that condones the use of force and violence and blames SA victims for their victimization. Using data from in-depth semistructured interviews with 52 Los Angeles Police Department sex crimes detectives, we examine officer attitudes toward teenage complainants of SA. Notably, almost three fourths of the respondents (n = 38; 73%) mentioned that teenagers lie about SA. Practical implications, theoretical advancements, and directions for future research are discussed.

Stress Management Competency Framework in English policing.

BACKGROUND: The UK Health and Safety Executive's Stress Management Competency Framework and associated questionnaire, the Stress Management Competency Indicator Tool (SMCIT), address line managers' behaviours across four competency areas. The application in policing remains unexplored. AIMS: This study profiled English police officers' perception of their line managers' competencies in the framework areas. The odds of experiencing poor mental wellbeing and work attitudes associated with having a line manager with a development need on each competency area were tested. METHODS: Two hundred and sixty-three police officers completed a survey comprising the SMCIT and measures of psychological distress, resilience and work engagement. Bivariate correlations were calculated to identify patterns of relationships between variables. Binary logistic regression analyses tested the odds of psychological distress caseness, low resilience and low work engagement being associated with officers' perception of their line manager having a development need on the SMCIT criteria. RESULTS: Approximately half the participants reported their line manager had a development need on the 'Managing and Communicating Existing and Future Work', 'Managing the Individual Within the Team' and 'Reasoning and Managing Difficult Situations' competencies, and one quarter on the 'Respectful and Responsible: Managing Emotions and Having Integrity' competency. Officers' rating of their line manager having a development need on the four competency areas was associated with up to four-fold elevated odds of each undesirable state. CONCLUSIONS: The framework competency areas are relevant to English policing and offer a basis for stress reduction interventions targeted at line managers' behaviours.

Experiences among firefighters and police officers of responding to out-of-hospital cardiac arrest in a dual dispatch programme in Sweden: an interview study.

OBJECTIVES: The objective of this study was to explore firefighters' and police officers' experiences of responding to out-of-hospital cardiac arrest (OHCA) in a dual dispatch programme. DESIGN: A qualitative interview study with semi-structured, open-ended questions where critical incident technique (CIT) was used to collect recalled cardiac arrest situations from the participants' narratives. The interviews where transcribed verbatim and analysed with inductive content analysis. SETTING: The County of Stockholm, Sweden. PARTICIPANTS: Police officers (n=10) and firefighters (n=12) participating in a dual dispatch programme with emergency medical services in case of suspected OHCA of cardiac or non-cardiac origin. RESULTS: Analysis of 60 critical incidents was performed resulting in three consecutive time sequences (preparedness, managing the scene and the aftermath) with related categories, where first responders described the complexity of the cardiac arrest situation. Detailed information about the case and the location was crucial for the preparedness, and information deficits created stress, frustration and incorrect perceptions about the victim. The technical challenges of performing cardiopulmonary resuscitation and managing the airway was prominent and the need of regular team training and education in first aid was highlighted. CONCLUSIONS: Participating in dual dispatch in case of suspected OHCA was described as a complex technical and emotional process by first responders. Providing case discussions and opportunities to give, and receive feedback about the case is a main task for the leadership in the organisations to diminish stress among personnel and to improve future OHCA missions.

Mental health in the criminal justice system: A pathways approach to service and research design.

BACKGROUND: Care pathway approaches were introduced into health care in the 1980s and have become standard international practice. They are now being introduced more specifically for health care in the criminal justice system. Care pathway delivery has the theoretical advantage of encouraging a whole-systems approach for health and social care within the criminal justice system, but how well is it supported by empirical evidence? AIMS: The aim of this study is to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000. METHOD: We used an exploratory narrative method to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000. The available literature was reviewed using a keyword search approach with three databases: PubMed, Medline, and Google Scholar. FINDINGS: Research in this field has covered police custody, courts, prisons, and the wider community, but there is little that follows the entire career through all these elements of offender placement. Main themes in the research to date, regardless of where the research was conducted, have been counting the disorder or the need, development and evaluation of screening tools, and evaluation of clinical intervention styles. Most evidence to date is simply observational, although the possibility of conducting randomised controlled trials of interventions within parts of the criminal justice system, especially prisons, is now well established. CONCLUSIONS: Access to health care while passing through the criminal justice system is essential because of the disproportionately high rates of mental disorder among offenders, and the concept of structured pathways to ensure this theoretically satisfying, but as yet empirically unsupported. Further, substantial cuts in services, generally following government economies, are largely unresearched. Considerable investment in new possibilities, driven by both pressure groups and government, tend to be informed by good will and theory rather than hard evidence and are often not evaluated even after introduction. This must change.

Identifying the Key Risk Factors for Adverse Psychological Outcomes Among Police Officers: A Systematic Literature Review.

It is well established that police work is highly stressful; however, a paucity of evidence limits our knowledge and understanding of the factors that may lead to, compromise, and/or compound psychological distress for this unique population. To address this lack, the current systematic review was conducted to reveal the individual, organizational, and operational risk factors that have been identified in the research literature to date and their associations with depression, anxiety, posttraumatic stress disorder (PTSD), and burnout. We performed searches on literature published between January 2008 and January 2018 and identified a total of 20 studies that met our inclusion criteria. The results indicated that individual factors, including high levels of neuroticism, low social support, and engaging in passive or avoidant coping strategies, were associated with adverse psychological outcomes. This review identified low social support from colleagues as the most common risk factor linked to adverse psychological outcomes. Other organizational risk factors associated with such outcomes included high work demands, low resources, and low reward. This article demonstrates that individual, organizational, and operational factors all impact the negative psychological outcomes of police officers to some degree. In particular, the current review suggests that certain negative psychological outcomes are likely a result of a combination of risk factors across the three domains of risk, highlighting the necessity to observe psychological risk of police in a more comprehensive way.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Identificando los factores de riesgo claves para las consecuencias psicológicas adversas en la población policial: Una revisión sistemática de la literatura. REVISIÓN DE FACTORES DE RIESGO PSICOLÓGICO PARA LA POLICÍA Está bien establecido que el trabajo policial es altamente estresante; sin embargo, la escasez de evidencia limita nuestro conocimiento y comprensión de los factores que pueden conducir, comprometer, y/o constituir el malestar psicológico en esta población única. Para abordar esta escasez, se condujo esta revisión sistemática para revelar los factores de riesgo individuales, organizacionales y operativos que han sido identificados hasta la fecha en la literatura científica y sus asociaciones con depresión, ansiedad, trastorno de estrés postraumático (TEPT) y burnout. Realizamos una búsqueda de los artículos publicados entre Enero de 2008 a Enero de 2018 y se identificaron un total de 20 estudios que cumplían nuestros criterios de inclusión. Los resultados indicaron que los factores de riesgo individuales, incluyendo altos niveles de neuroticismo, bajo apoyo social, y engancharse en estrategias de afrontamiento pasivas o evitativas, estuvieron asociadas con resultados psicológicos adversos. Esta revisión identificó el bajo apoyo social de los colegas como el factor de riesgo más común relacionado a los resultados psicológicos adversos. Otros factores de riesgo organizacional asociados a tales resultados incluyeron alta demanda laboral, pocos recursos y baja gratificación. Este artículo demuestra que los factores individuales, organizacionales y operacionales impactan los resultados psicológicos negativos de los oficiales de policía en algún grado. En particular, la revisión actual sugiere que ciertos resultados psicológicos negativos son probablemente el resultado de una combinación de factores de riesgo en los tres dominios de riesgo, enfatizando la necesidad de observar el riesgo psicológico de los policías en una forma más integral.

Management of crime scene units by Quebec police senior managers: Insight on forensic knowledge and understanding of key stakeholders.

What do policing leaders think and know of forensic science? Beyond crime scene investigators or detectives, how do police senior managers perceive the role, utility and limitations of forensic science? Very few empirical studies have addressed the issue. Forensic scientsts should be concerned about the perception that law enforcement senior managers have of their discipline for two reasons. First, strategic and financial decision-makers are obviously key players in the overall administration and provision of forensic science, either as a supervisor, money provider or as a customer. Second, literature has highlighted that other actors involved in forensic science underestimate the scope and possibilities offered by forensic science, hence limiting its exploitation and potential. Following interviews with 18 police senior managers from Quebec (Canada), this study shows that they generally restrict forensic science to a reactive discipline whose role and utility is to identify offenders and support the Court. This understanding of forensic science, like that of many others including a significant share of forensic scientists, differs from the perception of other police activities in modern law enforcement agencies where proactive action is sought. Considering these findings and the growing body of literature which calls for forensic science to connect more tightly with policing and security, we advocate a more extensive education of police leaders regarding the scope of forensic science.

The City of Brockton's "Champion Plan": The Role of Police Departments in Facilitating Access to Treatment.

The City of Brockton (Massachusetts) initiated The Champion Plan (TCP) in February 2016 as part of a community-wide effort to redefine the public safety sector's approach to policing the drug crisis. TCP program model allows those suffering from addiction to walk into a police station and ask for treatment. Early evidence suggests substantial successes for this approach to addressing addiction. Data show 523 individuals walked into the Brockton Police Department 818 times looking for help during the first 24 months of operation. Program staff were able to secure placement beds, on average, within 90 minutes of making contact with clients. Program clients report high levels of satisfaction with the program model, and early data indicate that a substantial number of clients retain engagement with services beyond intake. Findings from this study indicate police-centered treatment-on-demand programs may be viable strategies for getting those suffering from the disease of addiction into treatment.

The Promise Initiative: Promoting a trauma-informed police response to sexual assault in a mid-size Southern community.

AIMS: A mixed-methods study details a multidisciplinary team's efforts to assess and transform police response to sexual assault in a mid-size community. METHOD: A police department-wide survey (n = 331) determined baseline levels of officer exposure to trauma-informed training, rape myth acceptance, and awareness of community and nationwide sexual assault movements to understand officer attitudes towards factors influencing sexual assault investigations. These data, in conjunction with SAMHSA's (2012) trauma-informed assumptions, were leveraged to develop and adopt trauma-informed policies that would enhance the police department's response to sexual assault. RESULTS: At baseline, few officers reported receiving trauma-informed interviewing training (21.8%) or having knowledge of local SAK, #MeToo, or #TimesUp movements (10.0%, 7.2%, 3.9%, respectively). Chi-square analyses suggested officer knowledge of community SAK movement, personal investment in learning about sexual assault, and understanding of trauma were higher in officers with versus without training; of concern, officers with more sexual assaults on their caseload were more likely to endorse rape myths. Training understanding was related to lower rape myth acceptance. CONCLUSIONS: Policy changes, including adding trauma-informed training to the Police Academy, were implemented by the MDT to promote a system-wide trauma-informed approach to sexual assault and ensure community safety.

Factors of Trust in Immediate Leaders: An Empirical Study in Police Service Environment.

The study has two objectives-first, to examine the dimensionality of police service employees' job satisfaction and their assessment of the enablers from the Common Assessment Framework, analyzing these facets at different organizational levels, and second, to identify the impact of selected facets of job satisfaction on trust in one's immediate leader. The study is based on a comprehensive on-line questionnaire where 1209 responses from police service employees were acquired, and for the data analysis, factor analysis was first used to formulate the factors of job satisfaction facets and of the Common Assessment Framework enablers. Second, structural equation modelling was performed to identify the correlations of the studied variables. The Common Assessment Framework enabler Strategy/Leadership was significantly correlated with the enabler Processes and had an indirect impact on Trust through direct impacts on Leadership style in the organizational unit and Autonomy/Tasks. Both of the latter determinants had a significant influence on Trust in one's immediate leader. The confirmed the impact of determinants from different hierarchical levels indicates the importance of efforts by managers at all organizational levels should the police management intend to achieve and maintain high levels of trust in one's immediate leader in police service work environment.

When Domains Spill Over: The Relationships of Work-Family Conflict With Indian Police Affective and Continuance Commitment.

Policing is a stressful occupation that may give rise to work-family conflict (WFC). WFC arises when the work domain encroaches into the family domain, or vice versa, causing officers to become less attached to their job and the police organization. Using survey data collected from a sample of police officers in India, we examined the relationship between four dimensions of WFC (time-based, strain-based, behavior-based, and family-based WFC) and two dimensions of organizational commitment (continuance and affective). Family-based WFC was found to reduce continuance commitment, while strain-based WFC reduced affective commitment. Time-based, strain-based, and behavior-based WFC increased continuance commitment. We examined the implications of these findings for police policy makers and administrators. In addition, we also discussed our findings in the context of cross-cultural comparisons.

Implementation, Uptake, and Culture Change: Results of a Key Informant Study of a Workplace Mental Health Training Program in Police Organizations in Canada.

BACKGROUND: Organizational characteristics and attributes are critical issues to consider when implementing and evaluating workplace training. This study was a qualitative examination of the organizational context as it pertained to the implementation of a workplace mental health program called Road to Mental Readiness (R2MR) in police organizations in Canada. METHODS: We conducted a qualitative key informant study in 9 different policing organizations in Canada. RESULTS: The central theme of "successful cultural uptake" emerged as key to R2MR's implementation and the ability to facilitate broader culture change. Successful cultural uptake was enabled by several contextual factors, including organizational readiness, strong leadership support, ensuring good group dynamics, credibility of the trainers, implementing widely and thoroughly, and implementing R2MR as one piece of a larger puzzle. Successful cultural uptake was also described as enabling R2MR's impact for broader cultural change within the organization. This enablement occurred through enhanced dialogue about mental health and the introduction of a common language, a supportive workplace culture, increased help seeking, and organizational momentum for additional mental health programming and policy initiatives. CONCLUSION: Successful uptake of R2MR has the potential to lead to promote change within policing organizations. The model derived from our research may function as a tool or roadmap to help guide other organizations in the process of or planning to implement R2MR or a similar intervention.