Chapter 1

Law Enforcement Mental Health and 

Wellness Act

Report to Congress

Chapter i

Law Enforcement Mental Health and 

Wellness Act

Report to Congress March 2019
Recommended citation: Spence, Deborah L., Melissa Fox, Gilbert C. Moore, Sarah Estill, and Nazmia E.A. 

Comrie. 2019. Law Enforcement Mental Health and Wellness Act: Report to Congress. Washington, DC: U.S. 

Department of Justice. 

The Internet references cited in this publication were valid as of the date of publication. Given that URLs and 

websites are in constant flux, neither the author(s), the contributor(s), nor the COPS Office can vouch for their 

current validity.

The U.S. Department of Justice reserves a royalty-free, nonexclusive, and irrevocable license to reproduce, 

publish, or otherwise use the work for Federal Government purposes and to authorize others to do so. This 

resource may be freely distributed and used for noncommercial and educational purposes only.
Contents

Introduction1

Overview of the Law Enforcement Mental Health and Wellness Act 2

Methods 3

U.S. Department of Justice Support for Law Enforcement Mental Health and Wellness 5

Mental Health and Wellness Programs for Military Professionals and Veterans 7

Is the military a model for law enforcement? 8

Public information and wellness promotion campaigns 9

Embedded mental health professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Family readiness and mental health and wellness 12

Expanding support in transition 13

Suicide prevention policy 14

The DoD Suicide Event Report 16

Crisis Hotlines 19

Findings and limitations: The available data 19

Veterans Crisis Line and Military Crisis Line 20

Crisis lines for law enforcement

21

Mental Health Checks 25

Approaches 27

Suggestions for furthering mental health checks in law enforcement 30

Peer Mentoring Programs 31

Current practice 31

Obstacles to adoption 33

Additional Recommendations to Support the Mental 

Health and Wellness of Federal, State, Local, and Tribal Law Enforcement Officers 35

Privacy considerations are key to the success of peer-led programs 35

Building resilient officers begins, but does not end, in the academy 37
i v LAW ENFORCEMENT MENTAL HEALTH AND WELLNESS ACT

Civilian staff must not be forgotten39

Whole health programs are the goal, but there is no single approach 

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that will succeed everywhere . . . . . . . . . . . . . . . . . . . . . . . . 39

Conclusion 41

Appendix A. Recommendations 43

Appendix B. Abbreviations, Acronyms, and Initialisms 45

Notes 47

Introduction 47

U.S. Department of Justice Support for Law Enforcement Mental Health and Wellness 47

Mental Health and Wellness Programs for Military Professionals and Veterans 47

Crisis Hotlines 48

Mental Health Checks 48

Peer Mentoring Programs 48

Additional Recommendations 49

Conclusion 49
 

Introduction
 

Good mental and psychological health is just 

as essential as good physical health for law 

enforcement officers* to be effective in keeping 

our country and our communities safe from crime 

and violence. An officer’s mental state affects his 

or her behavior in a variety of situations and can 

influence decision-making and judgment. However, 

the current state of support for officer wellness 

nationally is disjointed and faces both cultural and 

logistical obstacles. 

The daily realities of the job can affect officers’ 

health and wellness. They face a constant need to 

be vigilant, long hours and shift work, exposure to 

the daily tragedies of life, and regular interaction 

with people who are in crisis or hostile toward 

them. Patrol officers face a national undercurrent 

of heightened public scrutiny of the profession that 

overshadows the legitimacy of their individual efforts. 

Corrections officers can expect to encounter verbal 

abuse and physical assaults from prisoners and 

exposure to hazardous materials and blood-borne 

pathogens.1 All of these things added to the ordinary 

hassles of the workplace and their personal lives can 

lead to cumulative stress and burnout. 

Officers anticipate and accept the unique dangers 

and pressures of their chosen profession. However, 

people under stress find it harder than people not 

experiencing stress to connect with others and 

regulate their own emotions. They experience 

narrowed perception, increased anxiety and 

fearfulness, and degraded cognitive abilities.2

 This 

can be part of a healthy fight-or-flight response, but 

it can also lead to significantly greater probabilities 

of errors in judgment, compromised performance, 

and injuries.3

 Failing to address the mental health 

and wellness of officers can ultimately undermine 

community support for law enforcement and result 

in officers being less safe on the job. 

Psychological stress may also have serious 

consequences for the individual officer’s health.4 

In particular, traumatic law enforcement work has 

been shown to increase officers’ risk of developing 

post-traumatic stress disorder (PTSD) symptoms.5 

PTSD is associated with major depression, panic 

attacks, phobias, mania, substance abuse, and 

increased risk of suicide.6

 PTSD can increase the 

risk of cardiovascular disease, hypertension, heart 

disease, and possibly stroke as well.7 

With a professional suicide rate estimated at 

28.2/100,000 for men and 12.2/100,000 for 

women, officer mental health and wellness needs 

to be discussed openly and honestly by the law 

enforcement field.8 In releasing his foundation’s report 

on first responder suicide in April 2018, Jay Ruderman 

said, “We need to end the silence that surrounds the 

issue of first responder mental health.”9

 This echoes 

what we have been hearing from growing numbers 

of leaders in the field. With the Law Enforcement 

Mental Health and Wellness Act, we believe 

Congress has taken an important step in making the 

end of that silence a reality. Supporting the expansion 

of and access to mental health and wellness services 

will help our nation’s more than 800,000 federal, 

state, local, and tribal law enforcement officers 

identify issues early and get the help they need. And, 

most importantly, it will save lives. 

* Throughout this report we refer to law enforcement officers, or “officers,” to be inclusive of sheriffs’ deputies, marshals, special agents, and all the 

other individuals who are granted responsibilities for enforcing federal, state, local, or tribal laws and generally engage in the broad range of activities 

classified as policing even if the word “officer” does not appear in their job title. 
2 LAW ENFORCEMENT MENTAL H E A LT H A N D W E L L N E S S A C T

Overview of the Law Enforcement 

Mental Health and Wellness Act

The Law Enforcement Mental Health and Wellness 

Act (LEMHWA) was passed in Congress in 2017 

and signed into law in January 2018. The fact that 

it passed both chambers unanimously and without 

amendment shows that its purpose and intended 

effects are uncontroversial among policymakers: 

Law enforcement agencies need and deserve 

support in their ongoing efforts to protect the mental 

health and well-being of their employees. But the 

timing of the act and this opportunity to respond 

to its provisions is important. A damaging national 

narrative has emerged in which law enforcement 

officers—whether federal, state, local, or tribal—

are seen not as protectors of communities but as 

oppressors. Even though there are approximately 

800,000 individuals who wear badges in this 

country, and they engage in millions of honorable, 

positive, and uncontroversial interactions with the 

community every day, officers today can find that 

their actions are constantly questioned and viewed 

suspiciously. The public trust in law enforcement 

inherent to successful crime prevention, 

suppression, and prosecution can be damaged by 

assumptions and misunderstandings as much as 

by deliberate challenges and provocations. In this 

environment, where an inherently stressful job is 

made more so by a constant undercurrent of distrust 

and negative public opinion, the risks to officer 

wellness are exacerbated.

To aid in addressing these risks, LEMHWA called 

for the U.S. Department of Justice (DOJ) to submit 

(1) a report to Congress on mental health practices 

and services in the U.S. Departments of Defense 

(DoD) and Veterans Affairs (VA) that could be 

adopted by federal, state, local, or tribal law 

enforcement agencies as well as (2) a report 

containing recommendations to Congress on

• effectiveness of crisis lines for law enforcement 

officers;

• efficacy of annual mental health checks for law 

enforcement officers;

• expansion of peer mentoring programs;

• ensuring privacy considerations for these types 

of programs.

LEMHWA specified that this work should 

include identifying and reviewing research as 

well as consulting with state, local, and tribal 

law enforcement agencies; the U.S. Department 

of Homeland Security (DHS); and other federal 

agencies that employ law enforcement officers.

The DOJ is pleased to respond to the act as officer 

safety, health, and wellness is a longstanding 

priority of the agency. This report addresses these 

specific requests of the act in a single document. 

The act also specified that the Director of the 

Office of Community Oriented Policing Services 

(COPS Office) would submit a report to Congress 

that “focuses on case studies of programs 

designed primarily to address officer psychological 

health and well-being.” That report, entitled 

Law Enforcement Mental Health and Wellness 

Programs: Eleven Case Studies, is periodically 

referenced throughout this report, as the case 

studies provide examples for many of the points 

and recommendations discussed here.
Introduction 3

Methods

Recognizing the potential linkages between 

recommendations for improving officer mental 

health and wellness and the case studies of 

promising practices in that area, the DOJ tasked 

the COPS Office with preparing this report. In 

addition to working closely with the authors of 

the case studies report to make the best use of 

their site visit experiences, the COPS Office team 

also reviewed the available literature on mental 

health in police officers, crisis lines, peer support 

and mentoring, and mental health checks. Publicly 

available program information was reviewed from 

the DoD, the VA, and a variety of law enforcement 

agencies to identify examples and understand 

operational context. Contacts within other federal 

agencies, national law enforcement stakeholder 

organizations, and recognized experts in different 

aspects of mental health in law enforcement 

agreed to consultation interviews providing their 

perspectives and examples. Recommendations 

and examples were then presented and discussed 

with subject matter experts and knowledgeable 

practitioners to ensure their reasonableness 

and feasibility.

The end result is that this report first summarizes 

some of the existing efforts supported by the 

DOJ aimed at promoting mental health and 

wellness in law enforcement. It then reviews 

some of the programs and efforts of the DoD and 

the VA that appear to have the most appeal and 

applicability to law enforcement. This is followed by 

discussions of crisis lines, mental health checks, 

and peer mentoring programs. Recommendations 

concerning all these areas are presented 

throughout the report as well as summarized in 

appendix A to this report.

This report concludes with additional 

recommendations that are more global to the 

mental health and wellness issue than the 

specifically named approaches but that we 

believe are important to the design and delivery 

of effective services for the men and women who 

serve in our nation’s law enforcement agencies 

whether at the federal, state, local, or tribal level. 

There are differences to be found in some of the 

existing services available to members of different 

types of departments, and some of the stressors 

can be different for federal agents as compared 

to tribal officers, city-based officers, sheriffs’ 

deputies, or state patrol and investigative officers. 

But overwhelmingly we found that the similarities 

far outweighed the differences. People we spoke 

to in agencies with peer support programs 

felt there was always room for expansion and 

improvement and worried about other agencies 

where programs did not exist. The challenges of 

trust, system navigation, insurance limitations, 

and confidentiality were also cross-cutting. The 

lack of geographically proximate behavioral health 

professionals is equally significant for employees 

of rural sheriffs’ offices and tribal departments as 

it is for federal agents assigned in remote field 

offices. Suicide threatens officers at all types of 

agencies. Consequently, initial plans to specify 

recommendations by the type of agency (i.e., 

federal, state, local, or tribal) eventually were set 

aside in favor of recommendations that speak to 

all of law enforcement. The levels and mechanisms 

of support needed to implement these 

recommendations may vary depending on the size 

and type and location of an agency, but the mental 

health and wellness needs of law enforcement 

officers—and the types of programs most likely to 

meet those needs—do not.

U.S. Department of Justice Support for Law Enforcement 

Mental Health and Wellness

The health and safety of all law enforcement 

officers, including their mental health and 

wellness, is an important priority of the DOJ. 

Law enforcement officers do difficult work in 

unforgiving conditions; even if most days in 

the working life of most patrol officers do not 

involve high-speed car chases, ambush by armed 

vigilantes, struggles with people made belligerent 

by drug use, or other risks to their lives, the fact 

remains that any day could involve any of those 

dangers or one of many others—and even less 

sensational aspects of the job can nevertheless be 

stressful and have long-term negative effects on 

officers’ mental well-being.

The DOJ recognizes that law enforcement officers 

perform uniquely dangerous tasks. It has long 

undertaken efforts to promote officer safety, officer 

morale, and public respect for their work and has 

several programs that translate this support into 

action. In 2011, the COPS Office and the Bureau 

of Justice Assistance (BJA) formed the national 

Officer Safety and Wellness (OSW) Group to 

bring attention to the safety and wellness needs 

of law enforcement officers following a number 

of high-profile ambushes on police. The OSW 

Group convenes regularly and brings together law 

enforcement practitioners, researchers, and subject 

matter experts to help amplify new and existing 

efforts to improve officer safety and wellness in the 

field. The third of four main themes into which the 

OSW Group’s priority areas are organized is mental 

and physical health and wellness; the priority areas 

under that theme are physical health (e.g., fatigue, 

alcohol, weight, and nutrition), maintaining good 

health, former military in law enforcement, and—

importantly—psychological health. The OSW Group 

meetings in October 2016, October 2017, and April 

2018 all dealt with aspects of officers’ mental 

health, with the October 2016 meeting focusing on 

resilience (specifically in response to mass casualty 

events and other major crises) and the October 

2017 and April 2018 meetings including in-depth 

discussion of emotional health and officer suicide. 

The reports on all three of those meetings provide 

recommendations of ways agencies can support 

their officers’ mental health.10

In addition to cosponsoring the OSW Group, 

the COPS Office publishes reports written by 

its award recipients whose work involves law 

enforcement mental health and wellness. This 

library of resources includes reviews of the 2016 

Pulse nightclub shooting in Orlando, Florida, and 

the ambush of two officers in Las Vegas, Nevada, 

in 2014 as well as other events in which the 

demands of the job have had the potential to cause 

long-standing mental effects on officers.11 After 

the massacre at Sandy Hook Elementary School in 

2012, the COPS Office partnered with the National 

Alliance on Mental Illness to produce a guide for 

law enforcement leadership to help equip their 

departments for the long-term emotional effects of 

such critical incidents.12

Similarly, the BJA’s efforts extend beyond the OSW 

Group. The Officer Robert Wilson III Preventing 

Violence Against Law Enforcement Officers and 

Ensuring Officer Resilience and Survivability 

(VALOR) Initiative is a collection of programs 

providing training, research, partnerships, and other 

resources to benefit law enforcement officers’ shortand long-term safety, wellness, and resilience. The 

suite of programs in the VALOR Initiative includes 

training and technical assistance programs on deescalation strategies and tactics, crisis intervention 

training, and other physical safety concepts, as well 

as research and programs on resilience and other 
6 LAW ENFORCEMENT MENTAL H E A LT H A N D W E L L N E S S A C T

mental health and wellness concepts.13 In 2018, BJA 

also launched the National Officer Safety Initiative 

in support of the President’s February 9, 2017, 

officer safety–focused executive order. This BJA 

National Officer Safety Initiatives program is funding 

innovative approaches to augment law enforcement 

safety in three key areas: (1) law enforcement 

suicide, (2) traffic safety, and (3) a national public 

awareness and education campaign.

For many years the BJA has administered two 

programs important to officer safety and wellness: 

(1) the Public Safety Officers’ Benefits (PSOB) 

program and (2) the Bulletproof Vest Partnership 

(BVP). The PSOB program provides a death benefit 

to the eligible survivors of federal, state, or local 

public safety officers. It also provides a disability 

benefit to eligible public safety officers who have 

been permanently and totally disabled as the direct 

result of a catastrophic personal injury sustained 

in the line of duty.14 Since its inception in 1976, 

the PSOB program has provided more than $1.8 

billion in these death and disability benefits to law 

enforcement officers, first responders, and their 

families. The BVP has assisted state and local 

agencies in purchasing more than one million vests 

since it was created in 1998.15

Other components provide mental health support 

and services to law enforcement officers as 

well. The Office for Victims of Crime’s online 

resource, the Vicarious Trauma Toolkit, “was 

developed on the premise that exposure to 

the traumatic experiences of other people”—

survivors of terrorism and mass violence, as 

well as their families; people who have been 

physically or sexually abused or subject to 

human trafficking; even first responders—“is an 

inevitable occupational challenge for the fields 

of victim services, emergency medical services, 

fire services, law enforcement, and other allied 

professionals.”16 The toolkit offers guidance in 

assessing agencies’ readiness to cope with 

vicarious trauma; prioritizing needs, making 

plans, and identifying resources to help agencies 

become trauma-informed; and developing policies, 

procedures, and programs to strengthen agencies’ 

response to vicarious trauma.

The National Institute of Justice funds dozens of 

projects on officer safety—as of September 5, 2018, 

there are 23 open awards accounting for close to 

$12 million, of which about one-third of the awards 

(and more than half the funds—eight awards worth 

more than $6 million) specifically focus on officer 

stress, resilience, or mental well-being and a ninth 

almost million-dollar award is a multilevel study on 

officer safety and wellness in general.17

But even with these programs and projects in 

place, gaps still remain—which is why Congress 

has charged the DOJ with investigating other ways 

to make stronger government support for law 

enforcement mental health and wellness a reality. 
Mental Health and Wellness Programs for Military 

Professionals and Veterans

Section 1(a) of LEMHWA requires that this report 

examine DoD and VA mental health practices 

and services that could be adopted by federal, 

state, local, or tribal law enforcement agencies. 

The precedent for looking to the armed services 

for examples of programs to serve the law 

enforcement professions is well established; there 

are similarities in the structure of organizations, 

in the round-the-clock functions, in the exposure 

to life and death situations, and in the cultural 

intertwining of personal and professional identity. 

Both military and law enforcement professionals 

hold ranks, carry weapons, and are trained to use 

deadly force. We expect them all to run toward 

danger, not away from it, to face some of the 

most horrific circumstances imaginable while 

remaining calm and rational, and to work to restore 

order from chaos. Courage, valor, honor—these 

are important words in both professional worlds, 

telling us as much about the values they hold for 

themselves as about those we hold them to. 

But while the paramilitary nature of law 

enforcement agencies and the hypervigilant 

environment in which they work are no doubt 

some of the primary reasons why parallels are 

often drawn between the two professions, the 

composition of the respective workforces is also an 

important consideration when looking for ways to 

promote and preserve the mental wellness of the 

law enforcement organization.

According to the Bureau of Labor Statistics, 

the overall labor force in the United States is 

approximately 53 percent male with an average 

age of 42. Law Enforcement Management and 

Statistics data from the Bureau of Justice Statistics 

show that the composition differs in local law 

enforcement, where about 87 percent of those 

employed in the industry are men, and the average 

age is 39. DoD statistics show that the active duty 

and reserve workforce is more similar to that of 

law enforcement than the general population, with 

men accounting for approximately 83 percent of 

the workforce and an overall average age of 34.

Why might these demographics matter? Consider 

suicide rates: Men are 3.5 times more likely to 

commit suicide than women, and one of the 

highest suicide rates is for middle-aged men.18

Policing and the military professions are both 

reported to experience suicide at rates higher than 

the general population. Whether the higher suicide 

rate is due to the fact that these professions 

employ significantly higher percentages of 

men or whether middle-aged men are at higher 

risk of suicide because they are more likely to 

work in these types of high stress and high risk 

professions is not for this report to determine. 

But the commonality of male-majority workforces 

is significant because to the extent they are 

interested in promoting wellness and help-seeking 

behaviors among employees, they will face some 

gender-related challenges. A number of studies 

over the years have found that men pursue 

preventive screenings, maintain a regular source 

of care, and get timely medical interventions much 

less often than women.19

This tendency is not because men are somehow 

programmed to avoid seeking help. But some 

research has suggested that “men who score 

higher on measures assessing dimensions of 

masculinity norms generally have less favorable 
8 LAW ENFORCEMENT MENTA L H E A LT H A N D W E L L N E S S A C T

help-seeking attitude, seek help for psychological 

problems less often, and in some cases fail to 

obtain routine health examinations.”20 While the 

reasons behind this gender difference are not 

fully understood, research indicates that men 

who more strongly identify with masculine norms 

tend to show poorer mental health and less 

psychological help seeking.21 In addition, studies 

have found that a prominent socially accepted 

role for men includes the notion that need for 

help and perceived weakness are not congruent 

with masculinity.22 Put another way, cultural 

expectations of male behavior, often valued by both 

the military and law enforcement professions, can 

be among the main barriers to ensuring not only 

that there are programs and services to address 

the unique health and wellness needs of a largely 

male workforce but also that those programs and 

services are accessed and used by that workforce. 

An additional concern, unique to this population, is 

that seeking assistance can jeopardize an officer’s 

career—that they may be taken off the street or 

forced to turn in their weapon—which is another 

important challenge to help-seeking behavior in law 

enforcement. 

While both professions are predominantly male, 

there are growing numbers of women serving both 

in the military and in law enforcement. Research 

supports the need for greater awareness of sexspecific mental health needs as well as more 

definitive studies to further address these needs in 

the context of sex-specific treatment approaches.†

†

 More research is needed regarding the impact of increasing workforce diversity and gender balance on wellness, help-seeking behaviors, and 

treatment and intervention effects in law enforcement work environments.

Is the military a model for law 

enforcement?

There are reasons why so many people in the law 

enforcement arena may look to the military for ideas, 

models, and programs to improve officer mental 

health and wellness. To the extent that the DoD and 

the VA have identified ways to encourage helpseeking behavior and provide services that recognize 

the unique challenges facing the workforce, the 

law enforcement community should absolutely 

look to learn from those efforts. But it should do so 

recognizing that the DoD and the VA working across 

the nation with their public and private partners still 

have room to improve their own efforts to support 

service member and veteran mental health and 

wellness—as evidenced by a suicide rate higher 

than the general population’s—and that not every 

program they have implemented has been proven 

effective. Every death by suicide is a tragedy, and 

as long as there are deaths by suicide, efforts to 

prevent suicide must continue.

There are also ways in which the two professions 

are not so neatly comparable, particularly when 

it comes to their ability to implement wellness 

programs. The military ultimately has a single 

employer. All health services both for active duty and 

retired service members are centralized. While the 

individual experience of ease of access and quality 

can vary, the development and implementation of 

wellness programs can be rolled out on a national 

scale to all employees and retirees. The Defense 

Health Agency (DHA) is the joint, integrated 

Combat Support Agency that “supports the 

delivery of integrated, affordable, and high quality 

health services to Military Health System (MHS) 

beneficiaries and is responsible for driving greater 

integration of clinical and business processes across 

the MHS.”23 DHA directs the execution of multiple 

shared services across the service branches 

including pharmacy, health information technology, 

education and training, and public health. DHA 

also administers the TRICARE Health Plan, which 

provides medical, dental, and pharmacy programs to 

more than 9.4 million uniformed service members, 

retirees, and their families.

In policing, there are more than 17,000 agencies in 

the United States with a wide variety of benefits 

plans and providers, a variety of affinity groups and 

labor organizations, and no agency exists to 
Mental Health and Wellness Programs for Military Professionals and Veterans 9

serve the unique health and wellness needs of law 

enforcement retirees. Furthermore, nearly half of 

those law enforcement agencies employ fewer 

than 10 full-time sworn officers.24 Although most of 

the approximately 800,000 officers in this country 

work for larger agencies—63 percent of officers 

work for one of the 5 percent of agencies that 

employ more than 100 sworn25—even a large police 

department in this country is small when thinking 

of them as organizations providing a complex series 

of training and services to their employees. Only 

43 local police departments in the Unites States 

have more than 1,000 sworn employees. The total 

number of military personnel (active duty and 

reserve) is nearly 3.5 million. The DoD and the VA 

have the ability to support and deploy large-scale, 

multifaceted, health and wellness programs in a 

way that most law enforcement agencies do not.

With this basic understanding of why DoD programs 

may hold promise as models for addressing the 

unique needs of law enforcement personnel but 

nevertheless not be plug-and-play replicable, we can 

look at some DoD and VA resources and programs. 

The focus in this report is not to comprehensively 

catalog everything they have to offer in terms 

of mental health and wellness, but to focus on 

approaches that seem to offer not just the most 

applicability to the law enforcement context, 

but also the potential for replicability in a highly 

decentralized professional environment. 

We therefore attempt to stay away from programs 

and services that are the most integrated with 

the structure of the DoD as a centralized health 

care provider with enforceable fitness-for-duty 

standards because the inability to replicate across 

50 states and thousands of cities and counties 

with different health care provider networks and 

collective bargaining agreements would likely 

make replication unsuccessful. For example, policy 

updates to TRICARE ended limits on the number 

of annual visits covered individuals could use for 

various mental health services. Insurance limits 

on mental health services is often reported as a 

major barrier to accessing services or completing 

treatment plans by law enforcement officers. 

For another example, this report will later look at 

the idea of annual mental health checks in law 

enforcement—but if we simplistically present 

the DoD’s predeployment readiness screens 

as potential models for law enforcement, we 

overlook the importance of the DHA infrastructure 

in the design and administration of the program 

as well as overlooking the important differences 

between daily police work and sustained military 

deployments to duty stations far removed from 

home and civilian life.

Public information and wellness 

promotion campaigns

Spend any time looking at Military OneSource, or 

the Defense Suicide Prevention Office website, 

or the MHS site, or Crisis Line pages, or many 

of defense community news sites for service 

members and their families, and it becomes 

apparent just how much public information 

the DoD promotes to encourage help seeking 

behavior. Promotional campaigns, resource guides, 

social media feeds, news stories, all work to 

destigmatize and demystify mental health services 

and ensure service members that providers in 

their communities are familiar with the challenges 

of military life. Promotional efforts are expanded 

when they can build on other national-level 

initiatives, such as during National Mental Health 

Month or National Suicide Prevention Week, 

amplifying the broader public health efforts around 

mental wellness with military specific information.

For example, the MHS runs Operation Live 

Well. First launched in 2013, it takes a holistic 

approach to helping military families live their 

best. It provides information and resources in 

integrative wellness, mental wellness, nutrition, 

physical activity, sleep, and tobacco-free living. 
1 0 LAW ENFORCEMENT M E N TA L H E A LT H A N D W E L L N E S S A C T

Its information is designed to make healthy living 

an easier option for service members by being 

informed by the service member experience. 

At the time the multiyear, multiphase effort was 

launched, the DoD estimated that in a single year, 

the military discharged more than 1,200 firstterm enlistees before their contracts were up 

because of weight problems and that TRICARE 

was spending more than $1 billion per year on 

obesity-related medical costs.26 Its whole health, 

whole family approach recognizes that our physical 

and mental well-being are interrelated, that our 

environments can make it easier or harder to be 

healthy, and that good information on health and 

fitness needs to be presented to communities 

in ways that recognize the complexities of their 

lives—particularly when dealing with the unique 

aspects of life in the military community.

Comprehensive mental health promotion may be 

similarly beneficial. One interview subject spoke 

about work he had read by Dr. Michael Matthews, 

Professor of Engineering Psychology at the United 

States Military Academy, that had influenced 

his thinking in recent years. In his 2014 book, 

Head Strong: How Psychology is Revolutionizing 

War,

27 Dr. Matthews explores how a change in 

perspective—going from a reactive, disease-based 

health care model to a proactive, preventionbased health and wellness model—can make an 

immediate difference in operational readiness. And 

that training in prevention is not just for building 

a stronger and more ready military but also the 

route to improving the operational readiness of 

all first responders. The interviewee believed that 

there should also be a corresponding savings in 

health care cost related to reducing or eliminating 

chronic health problems associated with the 

daily exposure to stress—such as PTSD, anxiety, 

hypertension, and other metabolic diseases—in 

the emergency services.

DoD and VA resources include easy-to-find 

materials on what to expect at a first appointment 

with a behavioral health provider, how to talk to a 

medical provider about mental wellness concerns, 

and how to recognize risks in family members and 

peers and what to do when you see them. They 

also provide smartphone apps for self-care like 

Virtual Hope Box (VHB), which is modeled on a 

cognitive behavioral therapy technique that uses a 

physical box containing things that remind patients 

of positive experiences, reasons for living, people 

who care about them, or coping resources. A 

recent study found that the smartphone app was 

more effective than print materials at improving 

veterans’ ability to cope with unpleasant emotions 

and thoughts. The authors of the study concluded 

that the VHB may be an important way to improve 

patient coping by making an existing cognitive 

behavioral therapy technique more convenient 

and accessible.28

And they produce resources aimed at helping the 

civilian clinician community better understand the 

unique needs of service members and veterans. 

For example, the VA produced a Community 

Provider Toolkit on suicide prevention with 

information on assessment, safety planning, VA 

resources, education, and other tools a communitybased care provider might need to know to help a 

client at risk who is a veteran. 

Recommendation 1. Support the creation of a public 

service campaign around law enforcement officer 

mental health and wellness in conjunction with National 

Mental Health Month.

The law enforcement community is only just 

beginning to talk about mental health and wellness. 

Support is needed to develop national campaigns 

about the risks and opportunities to officer mental 

health that can be deployed in conjunction with key 

national public health initiatives. One of the biggest 

barriers to seeking help is fear of the unknown or a 

sense that there is no one who can help. Reinforcing 

the already existing public message that there is 

help with law enforcement–specific messages that 

acknowledge the community’s unique needs can 
Mental Health and Wellness Programs for Military Professionals and Veterans 11 

help officers and agencies talk about those needs. 

National campaign material can then be customized 

by agencies with wellness programs to include 

resources on programs and services they offer. 

Recommendation 2. Support the development of 

resources for community-based clinicians who interact 

with law enforcement and their families to help them 

better understand some of the unique risks facing their 

clients and what resources may be available to them as 

members of the first responder community. 

Encouraging officers to seek help is only half 

the equation. No public campaign will succeed 

if they cannot access quality clinical support that 

understands the profession. Evidence-based web 

and electronic toolkits of resources and safety plan 

quick guides that introduce clinicians to some of 

the unique realities of law enforcement should 

be developed. Congress already recognized this 

need in part in section 3 of LEMHWA when it 

directed the Attorney General and the Secretary 

of Health and Human Services to partner in 

producing law enforcement–specific resources 

for clinicians and behavioral health providers. But 

the development of clinician training and toolkits 

of provider resources—including the identification 

of referral networks, family support options, and 

locality-specific information in connection with 

support for growing the network of embedded 

professionals—would help further extend the reach 

of informed clinicians, particularly in more rural 

or isolated parts of the country where there may 

not be an extensive clinical network of providers. 

Existing comprehensive wellness programs in law 

enforcement agencies, like those profiled in the 

wellness case studies report, as well as clinicians 

who have direct law enforcement experience and 

the community of police psychologists could all 

be tapped to build a national-level evidence-based 

toolkit in cooperation with the DOJ. 

Embedded mental health professionals 

It can be difficult to convince anyone in need of help 

to make the effort to seek it. Finding mental health 

professionals who can be trusted and are perceived 

as beneficial can be tough for anyone, not just 

service members or law enforcement officers. So 

finding ways to make access easy and convenient 

is important. The DoD runs a variety of efforts 

to expand access and use, including producing 

extensive resources on how to find a provider that 

will work for you and what to expect when calling 

a crisis line or meeting with a behavioral health 

professional through the TRICARE network. 

One of the ways the DoD is attempting to improve 

access is by embedding services and providers 

with the service members. Madigan Army Medical 

Center, which is located on Joint Base LewisMcChord just outside Lakewood, Washington, 

offers all behavioral health service line programs 

in-house. Outpatient and inpatient care, substance 

abuse treatment, family advocacy, child and family 

care, support for traumatic brain injuries—all are 

available through what they are calling embedded 

behavioral health (EBH) teams. 

EBH teams are in the unit areas. Service 

members therefore spend less time travelling to 

appointments; also, the teams’ being embedded in 

operational units helps remove some of the stigma 

around their use. The teams also work to build a 

working relationship with unit commanders so that 

they can be informed on generalized trends across 

units, like with sleep or leadership stressors. In 

an article published early in 2018, the lieutenant 

colonel who serves as the chief of behavioral 

health at Madigan observed that with the EBH 

teams in place, soldiers “are willing to come in and 

get care . . . they realize they can go get care and 

not be treated as broken.”29 
12 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T 

The integration of clinicians with the unit also helps 

in explaining to soldiers that seeking care is highly 

unlikely to impact their careers. There are very few 

diagnoses that are career limiting, and command is 

seldom aware of who is receiving care. 

Recommendation 3. Support programs to embed 

mental health professionals in law enforcement 

agencies. 

It is clear from a variety of DoD programs that it is 

important to military personnel that programs and 

services be culturally competent to the military 

experience. This is the experience in first responder 

communities as well—law enforcement officers 

want the people they talk to to understand the job 

and the unique stresses it can place on them. While 

some people will enter a career in behavioral health 

after spending time as a sworn law enforcement 

officer, there will never be enough to provide care to 

all the law enforcement officers in the country. Also, 

ease of access is important to encouraging use. 

But a program that embeds behavioral health 

practitioners into law enforcement agencies even 

part time could not only reduce barriers to use 

but could also help expand the understanding 

of mental health professionals in terms of the 

unique risks and experiences of law enforcement. 

Examples of this already exist in a number of 

police departments with physicians who act as 

medical directors, often attached to specialty 

units like special weapons and tactics (SWAT). In 

some agencies licensed physicians are also sworn 

reserve officers, bringing them into the culture and 

climate of the department where they get to know 

the officers alongside whom they serve. Even if 

primary medical care is not their job purpose in the 

department, they can be a resource for officers 

with questions, help demystify the system of 

medical care locally, and assist departments in 

vetting the services of other medical specialists for 

the ability to work with the unique population and 

in a unique environment. 

Mental health professionals could also be 

integrated into agencies through reserve officer 

programs or through memoranda of understanding, 

retainers, or other flexible arrangements. While 

not every agency can support its own exclusive 

police physician, there may be ways to support 

the expansion of police physician programs on a 

regional sharing basis and similarly encourage the 

building of programs to embed police behavioral 

health providers into departments as well. 

Family readiness and mental health and 

wellness 

For anyone, either the home can be the place where 

they find the strength to manage the stress of their 

job or it can be the source of stress that makes the 

job more challenging. This is particularly true for 

service members and law enforcement officers. In 

many respects, military families also serve—not just 

the uniformed individual. There are unique stresses 

to being the family of a service member, and the 

DoD has built extensive programs over the years to 

assist families. Helping the family be healthy and well 

is part of making sure the service member is also. 

Family readiness programs are built on the premise 

that knowing that a spouse will have the support they 

need while the service member is deployed will help 

the service member stay mission-focused. 

Family readiness groups (FRG) are the longstanding focal point of family readiness in the U.S. 

Army and Navy. In the Air Force, it is known as the 

Key Spouse program; the Marine Corps has the 

Family Readiness Program; and the Coast Guard 

has the Work-Life Program. But what all these 

programs do is keep spouses and families informed 

and supported during a service member’s time with 

a unit, especially during that unit’s deployment. 

The FRGs all operate slightly differently by branch 

of service, but they are key sources of information 

to unit families and strive to make family members 

feel as resilient and connected to the broader 

support community as possible. 
Mental Health and Wellness Programs for Military Professionals and Veterans 1 3

The DoD also supports broader programs aimed 

at spouse and family member resiliency, not just 

during deployments but also when they return 

and are managing the day-to-day realities of 

military life like periodic moves, which can make 

it challenging for spouses to maintain careers 

and lead to children struggling with changing 

schools. Research has shown that military 

spouses and children experience higher levels 

of depression and anxiety than the general 

population.30 Extensive resources for parents are 

available through Military OneSource. 

Recommendation 4. Support programs for law 

enforcement family readiness at the federal, state, and 

local level.

When law enforcement officers are asked about 

the major stressors in their lives, family worries 

are always near the top of the list. They know 

their families fear for them on the job, and that 

can make it hard for them to fully share their 

experiences with their families in ways that 

might benefit their own mental wellness. The 

24/7 nature of the job, shift work, exposure to 

traumas that they wish to protect their own loved 

ones from—all of these things can make it hard 

for law enforcement families to understand and 

support their officers. Furthermore, unlike service 

members on deployment, law enforcement officers 

are “deployed” in their own communities. In 

natural disasters or civic emergencies, the stress 

of ensuring their own families’ safety can be an 

additional emotional burden that affects their ability 

to stay mission-focused. In short, law enforcement 

families also serve, just as military families do, and 

it is important to provide them with both education 

and counseling services to help the whole family.

Some agencies and organizations have begun to 

spend more time on supporting the whole officer 

family, but the effort is nascent. Most family support 

programs, whether local or national, primarily focus 

on the survivors of fallen officers. The COPS Office 

is taking a first step toward better informing future 

expansion efforts with a project it funded in FY 

2018 for the International Association of Chiefs of 

Police to develop resources on supporting officer 

families, including a guidebook on integrating familyfriendly policies into a department, blog posts, a 

podcast series, and a brochure on starting family 

support groups. To shed more light on this important 

resiliency factor, support is needed in three key 

areas: (1) to more fully explore the stressors that 

law enforcement families experience; (2) to create 

educational programs that help families recognize 

and acknowledge when they may need professional 

assistance and where and how to get that 

assistance; and (3) to build more comprehensive 

family readiness programs, whether through national 

organizations or at the individual agency level.

Expanding support in transition

The coordination of DHA and VA programs and 

services is one of the ways the DoD is able 

to provide care to many transitioning service 

members and retirees in a way that would be 

beyond the capability of law enforcement agencies. 

But even then the system is not a complete 

guarantee. In January 2018, President Trump signed 

an executive order, “Supporting Our Veterans 

During their Transition From Uniformed Service to 

Civilian Life,” which directed the DoD, the VA, and 

the DHS to develop a joint action plan ensuring 

that the new veterans who did not qualify for VA 

healthcare would receive treatment and access 

to services for mental health care for one year 

following their separation from service. 

At the time the executive order was signed, it was 

noted by the U.S. Secretary of Veterans Affairs that 

service members in transition to veteran status 

face higher risks of suicide and mental health 

issues than active-duty members. In addition to 

working to expand mental health programs to 

new veterans and eliminating prior time limits, the 
1 4 LAW ENFORCEMENT MENTAL HEALTH AND WELLNESS ACT

three departments also announced plans to extend 

Military OneSource to veterans in the first year 

following separation.

Military OneSource offers a wide range of 

individualized consultations, coaching, and 

counseling for many aspects of military life. 

Its programs are available at no cost to service 

members whether active duty, reserve, or National 

Guard; their families and survivors; and the recently 

separated. The services are all encompassing, from 

nonmedical counseling to assistance with elder 

care, adoption, education, spousal employment, 

relocation tools, and even tax preparation 

services. It also gives users confidence that all the 

information it provides through its web portal and 

call center have been vetted by the DoD.

Recommendation 5. Encourage departments to 

allow retired law enforcement officers to make use of 

departmental peer support programs for a select period 

of time post-retirement or separation.

The memories of traumatic incidents and the 

impacts of a career composed of high-level stress 

do not automatically dissipate when officers leave 

the job.

Taking a page out of the recent executive order 

expanding the use of Military OneSource to recent 

separations, law enforcement agencies with peer 

support programs could make those services 

available to recently retired officers for a period of 

time. The transition to retirement can be a critical 

time for law enforcement, particularly considering 

that they often retire many years ahead of their 

non–law enforcement peers. A sudden separation 

from the peer networks that help make the job 

manageable puts retirees at risk for depression, 

and given research that shows officers on average 

live significantly shorter lives than non-officers,31

more needs to be done to support the transition 

to retirement.

In fact, many peer support programs in law 

enforcement agencies are run and staffed by retirees. 

In the wellness case studies report, the authors 

found that those staff and volunteers value the 

chance to give back to the profession and to continue 

to serve other officers. But for those new retirees 

who are not looking for volunteer service, being able 

to access their agency’s wellness networks and 

services that helped them while they were on the 

job could be an important benefit to extend into the 

transition to retirement or second careers.

Suicide prevention policy

Mental health and wellness is more than 

just suicide prevention, but given the higher 

suicide rates found in both the military and law 

enforcement environments than in the general 

population, it is important to note that the DoD has 

made substantial investments in the area of suicide 

prevention. The investment in recognizing the 

extent of the problem places them ahead of the 

law enforcement profession in prevention efforts. 

In November 2017, the Office of the Under 

Secretary of Defense for Personnel and Readiness 

issued DoD Instruction 6490.16,32 which 

established policies and assigned responsibilities 

for the Defense Suicide Prevention Program, 

incorporating earlier directives into a single 

issuance. It begins with an overview of DoD policy 

regarding suicide prevention:

“It is DoD policy that the DoD:

a. Make substantial efforts to reduce suicide.
Mental Health and Wellness Programs for Military Professionals and Veterans 1 5

b. Foster a command climate that:

(1) Encourages personnel to seek help and 

build resilience.

(2) Increases awareness about behavioral 

healthcare and reduces the stigma 

for personnel who seek behavioral 

healthcare, in accordance with DoD 

Instruction (DoDI) 6490.08.

(3) Protects the privacy of personnel 

seeking or receiving treatment relating 

to suicidal behavior, consistent with 

applicable standards, including DoD 

5400.11-R, DoD 6025.18-R, and DoDI 

6490.08. This includes data collected 

over the course of suicide prevention, 

intervention, and postvention activities.

c. Provide personnel continuous access to 

quality behavioral healthcare and other 

supportive services, including crisis 

services; foster collaboration of DoD 

suicide prevention efforts; and services to 

strengthen readiness and resilience of DoD 

personnel and their dependents.

d. Provide DoD Components with a training 

competency framework on suicide 

prevention.

e. Develop program standards and critical 

procedures for suicide prevention, 

intervention, and postvention that reflect a 

holistic approach.

f. Collect and consolidate surveillance data of 

suicides and suicide attempts for reporting 

and analysis for members of Active 

Component and SELRES, and for suicides 

by Service members’ dependents using 

consistent collection, reporting, and analysis 

of suicides and suicide attempts. This 

includes suicide-related behaviors data from 

the Department of Defense Suicide Event 

Report (DoDSER) submitted by the DoD 

Components in a timely manner to support 

suicide prevention efforts.

g. Promote lethal means access measures 

for suicide prevention, in accordance with 

Section 3 of this issuance.

h. Encourage unit memorial ceremonies and 

services when a Service member dies by 

suicide.

i. Implement the Department of Defense 

Strategy for Suicide Prevention (DSSP), 

which is modeled after the National Strategy 

for Suicide Prevention and encompasses 

the comprehensive policy on prevention 

of suicide among Service members, as 

required by Section 582 of PL 112-239.

j. Foster collaboration, cooperation, and 

coordination among stakeholders, including 

other federal agencies; appropriate public, 

private, and international entities; and 

appropriate institutions of higher education 

to support suicide prevention policies and 

programs in accordance with Section 591 of 

PL 114-92.”33

Recommendation 6. Support the development of 

model policies and implementation guidance for law 

enforcement agencies to make substantial efforts to 

reduce suicide.

Policy on its own, of course, does not mean anything 

without practical implementation. But policy is an 

important starting place. Policies not only tell us 

the operational standards of agencies but also are 

statements on what is important and valued. 

The introductory language of the DoD instruction 

on suicide prevention offers a starting point 

because a law enforcement agency of any size 

could establish a policy that fosters a climate 

that encourages personnel to seek help, builds 
1 6 LAW ENFORCEMENT MENTAL HEALTH AND WELLNESS ACT

resilience, and reduces stigma around behavioral 

healthcare. In fact, the statement of intent captured 

in policy could play an important role in changing 

the climate within an agency by demonstrating that 

the mental health of its personnel and help-seeking 

behavior is valued. 

Other sections of the DoD guidance may also 

offer potential models for basic law enforcement 

policy development at the agency level, including 

on the protection of privacy for individuals making 

use of intervention and support services. Also the 

case studies on law enforcement mental health 

and wellness conducted under the auspices of the 

LEMHWA offer some examples of agencies with 

established programs that have incorporated some 

aspects of operations into departmental policy, 

most often around information privacy. 

But a systematic effort to develop model policies 

and implementation guidance could include a more 

comprehensive review of what currently exists, how 

pieces from different experiences could fit together, 

and how it could vary from federal law enforcement 

agencies to smaller local and tribal departments. 

It could also include other suicide prevention 

experts in the discussion, particularly those who 

have worked with first responders and military 

personnel. Model policy development should also 

look at issues regarding data collection, retention, 

and privacy and what agencies can protect versus 

what they must share with the public about suicide 

prevention and other wellness efforts. Consideration 

must also be given to how agencies memorialize 

employees who die by suicide.34

The DoD Suicide Event Report

The annual DoD Suicide Event Report (DoDSER), 

first published in 2007, is the principal suicide 

surveillance tool of the DoD and an important 

data point in the DoD’s efforts to prevent future 

suicides. Without accurate, detailed, and timely 

information on suicides and suicide attempts, 

prevention and postvention programs are less 

likely to be effective and any evaluation of program 

effectiveness is impossible. 

The DoDSER reports on the contextual factors 

of suicides and attempts by service members, 

including event circumstances, medical and 

behavioral health factors, job-related factors, 

lifestyle stressors, and demographics. In all more 

than 500 data elements are a part of the survey. 

This type of detailed information, even with all 

personally identifiable information redacted, is 

invaluable to those in the organization charged 

with designing and evaluating the DoD’s suicide 

prevention programs, policies, and strategies. 

As was stated in a forum of police leaders on 

the topic of law enforcement suicide several 

years ago, “we cannot prevent that which we do 

not acknowledge.”35 In addition to transparently 

acknowledging the problem of service member 

suicide, the DoDSER provides a relatively 

comprehensive picture of the problem across 

the service branches and allows the DoD to 

look for common risk factors and patterns that 

may be mitigatable.

The 2016 report was released in June of 2018. 

In light of the earlier discussion on how men are 

less likely to engage in help-seeking behaviors, 

it is interesting to note that one of their findings 

was that “communication of suicidal thoughts and 

feelings [was] either not made or [not] recognized 

in 64.9 percent of suicide cases.”36 Another 

important finding is that “firearms were the 

method of injury most often identified in suicide 

cases (62.2 percent). The majority (94.6 percent) of 

the firearms used were personal possessions, with 

only 3.8 percent of firearm deaths resulting from 

self-directed use of a military-issued weapon.”37

Other findings include the fact that nearly half of 

those who died by suicide had at least one current 

or past behavioral health diagnosis, and substance 

abuse and anxiety were among the most common. 
Mental Health and Wellness Programs for Military Professionals and Veterans 1 7

Also interesting is that for both suicides and suicide 

attempts, a majority of the individuals had had 

contact with the MHS in the 90 days prior to 

the incident. 

These are examples of the types of contextual 

information that is critically important to 

organizational efforts to improve wellness and 

prevent suicides. If a high percentage of the cases 

involved near-term contact with the health system 

prior to the incident, were there opportunities to 

intervene? If in two-thirds of cases there were no 

identifiable help-seeking behaviors noted, is that 

because the individual really hid it well or because 

the wider community lacks training and awareness 

on the signs of suicide and what to do if you see 

those signs in someone you know? 

The Veterans Crisis Line (VCL, discussed further 

in Crisis Hotlines beginning on page 19) provides 

information on warning signs of suicide that 

everyone should be aware of including the 

following:

• Anxiety, agitation, sleeplessness, or mood 

swings

• Feeling excessive guilt, shame, or sense of 

failure

• Engaging in risky activities without thinking

• Increasing alcohol or drug misuse

• Neglecting personal welfare

• Deteriorating physical appearance

• Withdrawing from family and friends

• Showing violent behavior, like punching a hole in 

the wall or getting into fights

• Giving away prized possessions38

Recommendation 7. Support the creation of a 

Law Enforcement Suicide Event Report surveillance 

system, possibly beginning with a focus on federal law 

enforcement agencies.

Since the DOJ established the National OSW 

Group in 2011, the issue of law enforcement 

suicide has repeatedly come up in discussions, 

always noting that we in fact know very little about 

the circumstances of law enforcement suicide 

or even the number that take place each year. 

A number of reasons why this is the case have 

been discussed in law enforcement circles over 

the years, and although general cultural reluctance 

to acknowledge suicides is a part of it, efforts to 

protect the survivors also become a factor—death 

by suicide can lead to a loss of survivor benefits or 

the denial of funeral honors. Agencies that do not 

want to hurt the survivors further can therefore be 

incentivized to remain silent about suicides.

But even for agencies that acknowledge suicides, 

an unintentional misclassification as an accidental 

or undetermined death is still possible, and we 

understand very little of the causes. There is 

no widespread, systematic effort to look at law 

enforcement suicides and their circumstances the 

way there is about line-of-duty deaths through the 

FBI’s LEOKA (Law Enforcement Officers Killed 

and Assaulted) program and the National Law 

Enforcement Officers Memorial Fund’s (NLEOMF) 

analysis efforts. Two small nonprofits, the Badge 

of Life and Blue HELP, provide some of the best 

estimates we have of the number of suicides in 

law enforcement each year, and they consistently 

show them exceeding line-of-duty deaths. 

Furthermore, we have seen recently that suicides 

are not always isolated events, and once there is 

one suicide in an agency others may follow. For 

example, at the time of this writing, the Chicago 

Police Department had experienced four suicides 
1 8 LAW ENFORCEMENT MENTA L H E A LT H A N D W E L L N E S S A C T

in four months.39 Questions about whether 

these stories are tragic coincidences or clusters 

of evidence of systemic risk factors cannot be 

answered without more rigorous data collection 

and research efforts. 

The creation of a law enforcement suicide event 

report surveillance system modeled on the DoDSER 

is critically needed to understand suicide in law 

enforcement. Any data collected must also be 

analyzed to inform prevention, training, and practice. 

Are there officer job assignments that are riskier 

than others? Discernable patterns in age, tenure, or 

experience? Guessing what the risks and barriers 

are is no substitute for rigorous research. Research 

partnerships with public health or academic 

organizations may provide the analytic capabilities 

needed to support the data collection efforts. 

In recognition of the complexity of collecting, 

managing, and analyzing these data, as of 2018 

Badge of Life is no longer making their statistics 

public and is instead “promoting the mandatory 

reporting of all suicides by chief law enforcement 

executives into a national repository.”40

Recognizing that collecting sufficiently detailed 

information across thousands of agencies would 

be an incredibly challenging task, one way to 

begin would be with the creation of a federal law 

enforcement suicide event report, bringing together 

data on suicides and suicide attempts from the 

DOJ, the DHS, and other federal agencies with 

sworn officers. Although federal law enforcement 

work is recognizably different than that of much 

state and local work, the problem of suicide in the 

workforce is known to be there as well. In addition 

to providing valuable information to the federal law 

enforcement agencies on how to better protect 

their own officers, a multiyear surveillance of the 

federal agency experience could provide insights 

into risks in state, local, and tribal agencies.
Crisis Hotlines

There is no large-scale academic evidence for 

the efficacy of crisis lines‡

 for the mental health 

and wellness of law enforcement personnel. In 

addition, the efficacy of crisis hotlines in preventing 

suicides has not yet been empirically proven for 

the general population. However, it is the opinion 

of our interviewees that, in spite of the need for 

deeper research, crisis lines are an important tool 

for addressing mental health generally and suicide 

specifically for law enforcement officers. It is 

important to note that while crisis lines address 

any number of mental health scenarios, most 

of the research centers on suicide and suicidal 

ideation and so this discussion will also necessarily 

center on suicide. Our interviewees stressed 

that while suicide prevention is of paramount 

importance, it is critical to ensure that officers have 

access to services far before reaching the point of 

suicidal ideation. As one interviewee said, “If they 

are already at that point, just keep them away from 

a weapon.” Crisis lines may be a uniquely effective 

tool at one point of intervention, but mental health 

services ought to be comprehensive and ongoing. 

“We need to provide mental health care as primary 

care,” said one federal interviewee, “not simply 

reactive care.”

‡ This report uses “crisis lines” broadly to refer to any type of always-available service people feeling troubled can contact for advice and referral, 

including what may be called hotlines, helplines, live chat, text, suicide prevention lines, and so on.

Findings and limitations: 

The available data

Proving that a suicide has been prevented is 

difficult to measure in an academically rigorous 

fashion, partly because it is nearly impossible to 

create a randomized trial and partly because privacy 

concerns can inhibit follow-up calls or pre- or posttesting. Furthermore, there may be a population 

self-selection problem: Those who reach out to 

a crisis line may be less disposed to self-harm or 

may be more desirous of being talked down from 

suicidal ideation. It is even more difficult to prove 

efficacy for prevention of self-harm or harm that 

does not reach the threshold for suicidal ideation. 

While any comprehensive attempt to address 

officer mental health and wellness must be far 

broader in scope than suicide prevention, most 

research on crisis lines involves suicidal ideation 

and includes metrics concerning suicide. It remains 

unclear if law enforcement employees are at special 

risk for suicide, but we do know that the success 

rate for suicide by firearm is the highest of any 

suicide method (82.5 percent of suicides attempted 

with a firearm are successful).41 Because officers 

have ready access to firearms, the risk of success 

is potentially much higher. Therefore, officers must 

have equally ready access to crisis counselors at all 

times. Crisis hotlines offer an opportune solution to 

the acute crisis of suicidal ideation.

The available research shows that responders at 

crisis lines can reduce distress over the course 

of a call for both suicidal42 and nonsuicidal crisis 

callers.43 A study of a national general population 

crisis line found that half of callers reported seeking 

additional care after reaching out to a crisis line in 

follow-up calls.44 Similarly, the VA’s suicide hotline 

has demonstrated success in engaging veterans 

in crisis and connecting them with services.45

Crisis lines are a promising addition to the suite of 

services needed to support officer mental health 

and wellness. 
2 0 LAW ENFORCEMENT M E N TA L H E A LT H A N D W E L L N E S S A C T

Recommendation 8. Support rigorous research that 

can evaluate the efficacy of crisis lines and, if supported, 

provide data toward considering them an evidencebased practice.

The current insufficiency of data in this area is not 

due to the services provided by crisis lines but 

rather to a lack of dedicated research. Research on 

crisis lines generally and the usefulness of crisis 

lines to law enforcement specifically would allow 

services to be tailored to the law enforcement 

population based on need rather than supposition. 

Research is needed to establish the skills needed by 

counselors, the best practices on a call, and the best 

means of service referral and privacy maintenance. 

Crisis lines can also provide invaluable data on law 

enforcement suicide. This type of research can be 

carried out within existing programs while incurring 

a limited time or financial burden. Experts should 

be consulted on how best to collect, protect, and 

use the data already collected by crisis lines to 

help create an accurate understanding of mental 

health crises amongst law enforcement officers. In 

the end, evidence-based research, not anecdotal 

reports, should govern which programs are 

promoted and funded.

Veterans Crisis Line and 

Military Crisis Line

The VCL was launched in 2007 and allows either 

veterans in crisis or their loved ones to call, text, 

or chat online confidentially with a qualified VA 

responder. Its call takers are backed up by a referral 

network of professional service providers located 

in each of the VA medical centers around the 

country. As of late 2018, the VA states that since 

its creation, the VCL has answered more than 3.5 

million calls and dispatched emergency services to 

callers in crisis nearly 100,000 times. The program’s 

anonymous chat service, introduced in 2009, has 

engaged in more than 413,000 chats, and the textmessaging service has responded to nearly 98,000 

texts. All together the call line, chat, and text 

services provide veterans with single point of entry 

access to confidential, round-the-clock support. 

The Military Crisis Line (MCL) is a joint resource 

of the DoD and the VA. Promoted to active service 

members in crisis and their families, it connects 

them to the professionals at the VCL through 

its own brand identity. The ultimate referrals for 

service may be routed differently for active service 

members than for those covered by the VA, but the 

system and toll-free number are the same. What is 

important to callers in crisis is not only that is the 

call confidential but also that the person answering 

the phone is someone who can identify with the 

military culture and experience and will know how 

to refer callers to service providers with similar 

knowledge. And one seemingly small but key 

aspect of the VCL/MCL program is that it provides 

public information on what to expect when making 

the call, including the exact language a caller will 

hear when the phone is answered (or the chat or 

text response for those contact methods). Given 

that fear of the unknown can be a significant 

barrier to help-seeking behavior, providing military 

personnel, veterans, and their loved ones with 

clear, easy-to-find and -understand information 

about what exactly will happen when they place 

the call is an important demystifying step.

Another component of the program is the Veterans 

Self-Check Quiz.46 Created in conjunction with 

the American Foundation for Suicide Prevention, 

it offers a safe, easy way for an individual to learn 

whether stress and depression might be affecting 

them. The quiz takes less than 10 minutes to 

complete, and it is reviewed by a chat responder 

who will then leave a personal response offering 

options for follow-up in a secure website, usually 
Crisis Hotlines 2 1

within 10–15 minutes. The individual who 

completed the quiz then decides what to do next. 

They can continue talking with a responder through 

the chat without identifying themselves, get a 

referral to see someone in person, or decide to do 

nothing further at that time. 

The MCL itself is actually serviced by the National 

Suicide Prevention Lifeline, with military or veteran 

callers told to press 1 when they call to reach 

someone who will understand their unique needs 

and the service networks they have access to. The 

U.S. Substance Abuse and Mental Health Services 

Administration launched the Suicide Prevention 

Lifeline on January 1, 2005. Vibrant Emotional 

Health, the administrator of the grant, works with 

its partners—the National Association of State 

Mental Health Program Directors, National 

Council for Behavioral Health, and others—to 

manage the project along with Living Works, Inc., 

an internationally respected organization specializing 

in suicide intervention skills training. And its work 

is independently evaluated by a federally funded 

investigation team from Columbia University’s 

Research Foundation for Mental Hygiene.47

Crisis lines for law enforcement

In our interviews, we received specific and useful 

feedback regarding the specific needs of the law 

enforcement community. There are obstacles to 

using services that are unique to law enforcement, 

both culturally and structurally, and any expansion 

or support of crisis lines for law enforcement 

personnel should take these into account.

A recurring theme in our interviews was the 

pressure that shift work places on normal access to 

services. For example, an officer working the night 

shift may not be able to get to a doctor’s office in 

normal working hours for preventive care check-ups. 

If the officer has a co-parent who works during 

normal working hours, it can be extremely difficult 

for either parent to take a child to the doctor. 

Multiple interviewees remarked on the importance 

of access to health and mental health services 

24 hours a day; crisis lines can operate 24 hours 

a day. In addition, they are location-independent. 

This means that an officer can access a crisis line 

without being physically present and ensure total 

anonymity for callers.

Many of our interviewees were from larger 

agencies. When asked what resources they 

needed to ensure officer mental health and 

wellness, we received a surprising and nearunanimous response: Focus on smaller agencies. 

A representative from a national organization 

said, “Every large agency is connected to crisis 

services.” A chief from a major city department 

said, “Honestly, the large agencies can take care 

of their own. If Congress is going to take action, 

we’d advocate that resources focus on smaller 

agencies that can’t afford their own programs.” An 

urban district sheriff said, “I’m more worried about 

the doughnut districts, frankly. We’re fine, but the 

surrounding counties don’t have the resources or 

the manpower.”

Firefighters and emergency medical technicians 

(EMT) have a dedicated national crisis line48

supported by the National Volunteer Fire Council. 

Rigorous data are collected on firefighter and 

EMT suicides by the Firefighter Behavioral 

Health Alliance.49 The centralized services and 

data collection help to provide the most useful 

interventions. The disaggregated nature of state 

and local law enforcement more closely mirrors 

that of the fire service but as practiced puts the 

onus on each department to provide services and 

many are simply without the resources to do so.
2 2 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T

Interviewees repeatedly made the point that it is

difficult for an officer to open up to someone who

might not “get it.” Working in law enforcement

exposes officers to very specific stressors, and

while a well-intentioned councilor can sympathize,

he or she may not be able to empathize.

Anecdotally, we were told that officers are more

likely to reach out to peers, especially if there

was a good departmental culture around mental

health and wellness. However, the anonymity

of a crisis line may be appealing to an officer

who is personally concerned about speaking

about mental health within the workplace. Crisis

lines staffed by law enforcement or former law

enforcement officers could be an optimal entry

point for officers experiencing a mental health

crisis. There are currently two operational crisis

lines focused exclusively on law enforcement:

Cop2Cop and Copline.

Cop2Cop, which is featured in the case studies 

report, was launched in 1998 as a joint effort 

between the State of New Jersey Department of 

Human Services Division of Mental Health and the 

University Behavioral Health Care unit at Rutgers 

University.

50 It was the first program of its kind. 

The hotline is always open, staffed by retired law 

enforcement officers, and available to officers and 

their families. The program was later expanded to 

include all first responders.

Copline was started in 2006 to take the core 

concept of Cop2Cop national. Copline is similar 

to Cop2Cop: It is operational 24 hours a day, 

seven days a week; it is staffed by retired law 

enforcement personnel; and it is confidential. 

Unlike Cop2Cop, which is publicly funded, Copline 

is a registered nonprofit. It has attained an 

international presence.

Recommendation 9. Support the expansion 

of crisis lines for law enforcement that are staffed 

with call-takers and counselors with a law 

enforcement background.

Interviews and anecdotal reports suggest that 

law enforcement officers may be more willing to 

engage with counselors who have also worked in 

law enforcement. We suggest that crisis lines for 

law enforcement be staffed, to the highest degree 

possible, with counselors who come from a law 

enforcement background. Specialized training will 

be required for counselors with and without law 

enforcement experience.

Counselors with law enforcement experience will 

require training in mental health crisis response. 

While some law enforcement officers receive 

a good deal of training in mental health crises, 

this training is from a public safety standpoint. 

They will need to retrain as counselors, and 

appropriate trainings need to be identified. 

Research demonstrates that crisis line workers are 

more effective when they have more experience. 

A large-scale study from Canada and the United 

States demonstrated that there was no significant 

difference in call outcomes between paid 

professional counselors and volunteer counselors. 

Instead, counselors who had more than 140 

hours of call experience had significantly better 

outcomes on calls.51 Furthermore, counselors 

who demonstrated empathy and respect had 

better call outcomes. 

Counselors without law enforcement experiences 

may be necessary and useful. Whether serving 

as specialists or general responders, civilian 

counselors will need to retrain on their specific 

population. Possible opportunities include ride-
Crisis Hotlines 2 3

alongs, time spent embedded in a department, 

specialized trainings, or other options entirely. 

Experts should be engaged to design and test 

effective trainings for civilian counselors.

Recommendation 10. Consider support for a national 

crisis line for law enforcement.

If Congress chooses to support crisis lines as 

an intervention for law enforcement mental 

health crises, support should be provided for a 

national crisis line. The deference shown to the 

needs of small, rural, and geographically diverse 

departments by all of the interviewees indicates 

that any measures to expand crisis lines should 

include and in fact be designed around the needs 

of underresourced departments. Therefore, any 

crisis line expansion should be national in scope, 

as should data collection efforts. All state and 

local law enforcement agencies should have 

access to lines. Department leadership should 

be briefed on what the lines offer and how they 

can support departments. 

Critically, the crisis line should offer not only 

crisis counseling but also referrals to vetted local 

providers. One of the great successes of the VCL 

is the national scope that allows its counselors 

and specialists to make direct referrals to vetted 

local suicide prevention coordinators so clients and 

callers ready to engage with services can connect 

with appropriate and available care. Removing 

obstacles to engaging with care increases the 

likelihood of engaging with care. In the same study 

that studied volunteers, only 42 percent of callers 

who committed to seeking care followed through.52

If crisis line counselors can refer to vetted local 

service providers, those referrals may save lives. 

Whether that means expanding the VA’s model of 

piggybacking on the infrastructure of the National 

Suicide Prevention Lifeline, or creating a parallel 

service, or expanding statewide programs like 

Cop2Cop to all states and territories, enabling 

counselors to refer callers to local services is of 

critical importance to expanding crisis line access.

Mental Health Checks

The general public has been taught to believe 

that regular well-patient visits with a doctor are 

important not just for early detection of potentially 

serious physical issues but also for simple routine 

maintenance of health. Similarly, semiannual 

prophylactic dental cleanings are understood to 

keep teeth healthier and safer than they would be 

if the dentist only saw the patient when something 

was observably wrong. Likewise, research 

demonstrates the usefulness of check-ups and 

check-ins to screen for unhealthy behaviors such 

as substance abuse.53 The idea behind recurring 

mental health check programs that have been 

adopted by some law enforcement agencies is 

similar: Practice routine observation to improve early 

detection or even prevent serious mental issues.

Research does not conclusively support 

comprehensive routine physical exams for 

asymptomatic adults. As far back as 1981 the 

American College of Physicians noted that 

“present data are not adequate evidence justifying 

annual complete examination of the asymptomatic 

patient at low medical risk.”54 And as recently as 

2013 in a metaanalysis of 14 randomized trials 

comparing health checks to no health checks, 

researchers found that the health checks did not 

reduce morbidity or mortality whether overall, 

cardiovascular, or cancer-related.55 And for mental 

health checks for the otherwise asymptomatic 

adult, the evidence is simply not known. It 

may seem intuitive to some that preventive 

mental health care is likely to be helpful,56 and 

there appears to be increasing acceptance of 

mental health checks as an effective approach 

for mitigating the emotional rigors of a career 

in policing. However, in-depth research on the 

benefits of such care and the most effective 

methods for implementing mental health check 

programs remains to be conducted. 

At the same time, the stress of police work 

is well known. Speak with any veteran police 

officer and they will be able to share work-related 

experiences that are incomparable to those in 

most other professions, that had a significant 

psychological impact on them, and for which they 

never received counseling or professional support. 

Anecdotally, there is broad understanding within 

the field that alcohol abuse, divorce, hypertension, 

and depression are occupational hazards that 

equal or surpass threats of violent encounters 

posed by patrolling and fighting crime. The data 

also support this reality. In 2017, 46 officers were 

fatally shot in the line of duty while more than 

three times as many died by suicide.57 So law 

enforcement officers may not universally qualify 

as asymptomatic patients at low risk; they may 

therefore benefit from proactive screening.

Despite intense demands on their psyches, law 

enforcement officers’ mental health needs are 

often overlooked until a response is necessitated 

by negative behavior or a significant event. Even 

when resources are available, many officers will 

not seek help voluntarily—either because they do 

not recognize their need for emotional support or 

because of the strong stigma in American policing 

associated with seeking emotional support. 

“In police culture, a major obstacle that 

impedes the maintenance of psychological 

health is the stigma attached to asking for help. 

Law enforcement culture values strength, selfreliance, controlled emotions, and competency 

in handling personal problems. These values 

discourage help-seeking behavior, and there 

is a sense of having lost control by asking 

someone else to help fix the problem. If these 

values are held too rigidly, an officer can feel 

weak, embarrassed, and like a failure for 

seeking help from others. One study found 
2 6 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T

that stigma and help-seeking attitudes were 

inversely related. In other words, a person 

facing a higher level of stigma for seeking 

help was less likely to have a help-seeking 

attitude. This generates concern for officers 

who unconditionally conform to the traditional 

values of law enforcement culture—they will 

be more likely to avoid seeking help, even 

when distressed, and potentially pay the price 

of detrimental health effects.”58

This situation is slowly improving, but there is 

still a long way to go. One expert interviewed 

said, “There are obstacles to officers seeking the 

help they need. Number one is stigma—the fear 

in seeking help. The field has done a lot better 

recently at getting away from its culture that 

stigmatized needing any kind of help. But we now 

need to help officers understand that needing help 

is not a weakness and that getting help does not 

put their future assignments in jeopardy.”

Officers can be fearful of being considered weak 

or untrustworthy; concerned that seeking help 

will lead to sanctions or loss of professional 

opportunities; or wary of other perceptions. In 

these instances, officers are often unlikely to seek 

help even privately—doubting their treatment will 

remain confidential or be understood.

Their fears may not be without merit; some 

departments have policies requiring mental health 

treatment be reported, especially if it involves 

medication. Even when that is not the case, the 

small and communal nature of many departments, 

along with regressive attitudes about emotional 

health, can render stigmatization a real threat.

When stigma does not prevent an officer from 

seeking support, self-recognition and access 

to services can also present challenges. While 

effective in some situations, a reliance on voluntary 

referral causes some officers to fall through the 

cracks. The result: Law enforcement supervisors, 

mental health providers, fellow officers, and family 

members are often unable to identify the need for 

emotional support or services before a debilitating 

effect on the officer is evident.

There is no large-scale or sufficiently rigorous 

research on the efficacy (or lack thereof) of mental 

health checks—at any regular interval—for law 

enforcement professionals. It has been suggested 

that even without evidence of their efficacy, 

proactive mental health checks have become a 

growing practice among first responders. In the 

2017 employee assistance program (EAP) manual 

for employees of Barnes–Jewish Children’s 

Hospital in Boston, Cynthia Hovis writes, “First 

responders, police, fire departments, military 

personnel, and medical staff started the practice [of 

annual mental health check-ups] in recent years.”59

The National Surveillance of Police Suicides study 

conducted by the Badge of Life Police Mental 

Health Foundation “tentatively attributes [an 

11-percent drop in police suicides in a four-year 

period] to . . . ‘the increased willingness of officers, 

many of them younger, to seek professional 

assistance’–not only when they have a problem 

but also through preventive measures such as 

annual mental health checkups.”60 But these 

discussions do not point to particular programs or 

to organizations that use them. There is no formal 

indication of how many U.S. law enforcement 

agencies have implemented mental health checks 

or even a clear picture of just what such checks 

entail, but among law enforcement executives 

and clinicians who specialize in supporting law 

enforcement officers, they are a slowly increasing 

approach to prophylactically mitigating the inherent 

stress of the profession rather than waiting for 

problematic symptoms to appear. 

LEMHWA specifically referred to annual checks, 

but some interviewees noted that even less-thanannual periodic checks that take into account key 

career transition points may be just as effective; 

the support for this concept in the field is based on 
Mental Health Checks 2 7

a desire to assess mental and emotional wellness 

regularly, not just at a hiring screen and then in 

reactive checks following critical incidents. 

Mental health checks are typically conceived as a 

mandatory process of having officers meet with 

a clinician, members of an internal peer support 

team, or supervisors to discuss aspects of the 

officer’s work that need emotional navigation. 

The approach used varies by department, with 

some focusing on operational debriefings while 

others look to preventive screenings. For example, 

in Mundelein, Illinois, a new wellness program 

implemented in late 2018 requires police officers 

to meet with a psychologist annually in addition 

to their physical fitness exam.61 But mental 

health checks are distinct from pre-employment 

screening, fitness-for-duty evaluations, or 

structured psychological counseling. “’It’s not 

meant to be a fit for duty examination or a head 

check,’ [Police Chief Eric] Guenther said. ‘It’s really 

meant to be an outlet and a conversation and a 

source for coping mechanisms.’”62

There is also an increasing belief in the potential 

need to expand mental health checks to civilian 

staff, given the recognition that the stress 

of working on police-related matters and the 

aftermath of critical incidents also impacts 

dispatchers, crime scene technicians, and victim 

advocates, and other nonsworn staff.

Advocates of implementing mental health checks 

believe they can be beneficial in several ways. 

When they are a requirement for all officers, they 

can significantly reduce stigma associated with 

engaging in discussions about stressful aspects of 

the job. Chief Guenther of the Mundelein Police 

Department noted that voluntary check-ins with 

a police psychologist were ineffective because 

nonrequired check-ins seldom took place at all. 

“There’s too much pride in this profession. You 

have to be the big tough cop, right? And you 

can’t be seen as being weak.”63 In departments 

that make mental health checks mandatory for all 

officers or for specific units, engaging in discussion 

about stressors is less likely to be perceived as 

the exclusive domain of officers unable to cope 

with the demands of the profession or who are 

considered to be at risk. Moreover, the challenge 

of having officers independently recognize when 

they may need to seek support is reduced. Mental 

health checks may essentially infuse nonclinical 

services into the department and help identify 

those in need of structured treatment.

When conducted in group settings, mental 

health checks are often viewed and positioned as 

group “rap sessions” rather than a one-on-one 

opportunity for officers to share any individual 

concerns in a safe, nontreatment setting. Group 

sessions are believed by some to have positive 

benefits. They can enable positive peer influences 

and create understanding by officers that the 

challenges they face are not unique and do not 

stem from individual shortcomings. Group mental 

health checks can also encourage ongoing positive 

peer exchange and normalize the understanding 

that stress requiring attention is an inherent part of 

the profession.

Approaches

Some law enforcement agencies have mental 

health checks exclusively following stressful 

incidents when there is a perceived need to 

assess or respond to the emotional state of 

officers, and others implement regularly scheduled 

mental health checks as an ongoing approach for 

supporting officers or identifying those who may 

benefit from structured treatment. Mental health 

checks are sometimes implemented for patrol 

units, specialized units (e.g., SWAT, Violent Crimes 

Task Force, child welfare, sex crimes, etc.), or for all 

sworn officers within a department. The approach 

used varies by department. 
2 8 LAW ENFORCEMENT M E N TA L H E A LT H A N D W E L L N E S S A C T

Immediate post-incident mental 

health checks

One of the more reactive approaches for 

conducting a mental health check program often 

borne out of incident-driven necessity, or one 

aspect of a more comprehensive mental health 

program, is a post-incident mental health check. 

This form of a mental health check process or 

program is often viewed as a type of psychological 

first aid. The goal of this approach is to ensure 

that an officer’s emotional state is observed and 

considered immediately following a critical incident 

and that an officer’s need for support does not 

compromise the department’s level of service.

Departments typically assign a mental health 

incident commander to oversee officer mental 

health. This individual may serve in this role for 

only a few days while a more extensive mental 

health response is organized. Alternatively, they 

may be the only person dedicated to supporting 

officers following an incident. The person is 

usually a trusted police psychologist, a licensed 

mental health professional, a licensed employee 

assistance provider, a member of the department’s 

command staff, a departmental chaplain, or the 

appropriate officer from a neighboring department. 

The mental health incident commander’s 

responsibilities typically include the following:

• Monitoring officers’ behavior and verbalizations 

on scene to determine if anyone needs 

immediate assistance

• Ensuring that a mental health provider or 

supervisor checks in with all officers involved 

before the end of shift

• Being available to consult with the chief and 

command staff as appropriate and permissible 

by policy

• Sharing information about available 

mental health resources with officers 

and connecting with officers’ family members 

if needed

Recurring mental health checks

Recurring mental health checks are typically 

scheduled at regular intervals to provide officers 

and civilian staff with an opportunity to speak to a 

trusted and qualified professional with whom they 

can share any concerns. It is most common that 

the individual conducting the mental health check 

be a licensed psychologist who can identify officers 

in need of counseling and has the ability to provide 

informal psychological support for minor challenges 

that an officer may be experiencing. 

There is evidence of regular mental health checks 

being mandated as often as each quarter and 

as seldom as annually. Some departments also 

structure their program by scheduling regular hours 

each month that a mental health service provider 

is available on premises and allowing officers to 

voluntarily check in. Other departments’ mental 

health checks are conducted in group settings 

rather than one on one. Mental health checks 

typically last between 30 and 90 minutes and 

provide officers an opportunity to address any 

issues the officer chooses while not requiring 

disclosure of concerns. Regardless of the 

approach, there are some common expectations of 

recurring mental health check programs:

• Providing officers with readily available access 

to a professional who is able to support minor 

challenges they are confronting
Mental Health Checks 2 9

• Identifying officers who may be in need of 

structured counseling or support and working 

with those officers to provide them with 

appropriate resources

• Reducing the stigma associated with counseling 

and accessing services and encouraging officers 

to focus on their emotional wellness

• Familiarizing officers with a mental health 

professional so if the need for structured 

services arises an officer is more likely to 

engage with that familiar professional

• Helping the practitioner develop a working 

understanding of the department culture and 

officers so they are best prepared to provide 

culturally competent support when the need 

inevitably arises in the future

• Fostering a culture of emotional wellness 

within the department and advancing the 

understanding that high levels of stress are an 

inextricable part of the profession and are best 

navigated proactively 

U.S. Department of Defense remote mental 

health check

In an effort to ensure the mental health readiness 

of military service members preparing to deploy, 

the DoD, as prescribed by the National Defense 

Authorization Act of 2010 (Public Law 111-84, 

28 Oct 2009, Title VII Health Care Provisions, 

Section 708), mandates the provision of a 

“person-to-person” mental health assessment for 

each member of the Armed Forces deployed in 

connection with a contingency operation (hostilities 

against the United States). 

For reserve units and their members who do not 

have readily available access to military healthcare 

providers before they are called to active duty 

for deployment, the DoD has implemented 

the Reserve Health Readiness Mental Health 

Assessment Program. This mental health check 

program can be conducted remotely but still 

ensures a face-to-face mental health assessment. 

The process includes three stages and is 

concluded only upon the deploying reservist 

interacting directly with a trained 

service provider. This interaction can occur 

face to face, telephonically, or via a DoD 

Telehealth videolink. 

The first stage is a self-report survey that 

screens for post-traumatic stress disorder 

(PTSD), depression, stress, alcohol abuse, 

suicidality, and problematic family relationships 

and is submitted to remote assessors. If the first 

stage does not show any areas of concern upon 

assessment, reservists bypass the second 

stage and proceed to the third stage, which 

is the in-person assessment.

The second stage is required only if a reservist’s 

initial self-assessment shows potential areas of 

concern. This stage is a follow-up self-report survey 

that further queries the reservist about PTSD and 

depression symptoms and establishes a more 

informed evaluation by the trained provider during 

the third stage.

During the third stage, as part of the in-person 

assessment, the provider reviews and clarifies 

the reservist’s responses, identifies areas of 

concern, and refers the reservist for specialty 

care as appropriate.

While there are aspects of this approach to a 

mental health check that could be replicated for 

departments that have limited resources or face 

other factors that prevent the implementation of 

an in-house program, there is no guarantee that 

this approach will fit law enforcement. Preparing 

reservists for extended deployments away from 

their jobs, homes, and the protective factors of 
3 0 LAW ENFORCEMENT MENTA L H E A LT H A N D W E L L N E S S A C T

their families and communities is a different goal 

than ensuring the continued wellness of law 

enforcement officers in the course of their career. 

Suggestions for furthering mental 

health checks in law enforcement

Recommendation 11. Support research to 

determine the efficacy of mental health checks, 

establish which approaches are most effective, and 

provide resources that move law enforcement toward 

best practices.

The acceptance and support for recurring mental 

health checks as an integral part of a comprehensive 

mental health program is based largely on the 

vision of law enforcement executives and expertise 

of the clinical professionals with whom they 

collaborate. The result of these efforts has been 

the emergence of a call for a proactive method for 

bringing meaningful support resources to officers 

in a manner that reduces stigma and helps embed 

a focus on emotional wellness. However, it is 

important to ensure the process is defined and 

understood by everyone involved. One former chief 

we spoke to noted that in his last department, “our 

psychologist did periodic evaluations”—i.e., mental 

or emotional assessments at regular intervals—“for 

officers in vice, narcotics, [and] SWAT and for people 

in long-term specialty assignments, but I wouldn’t 

characterize those as . . . mental health checks.” 

(Emphasis added.) Providing clarity about what 

works and how federal, state, and local agencies 

can implement effective programs is a substantial 

need. It is equally if not more important to identify 

the most effective methods for conducting a mental 

health check program and ensure that 

any intervention is not unintentionally harmful 

to officers. Formal research and guidance for 

the field would ensure that limited resources 

are spent responsibly and effectively. Even a modest 

investment in pilot sites could provide critically 

needed data before large-scale implementation 

funding is committed to programs of questionable 

efficacy. This is also true for the initial hiring 

screening process, where, as one interviewee 

noted, universal and clear clinical guidelines based 

in research are needed to determine a person’s 

ability to safely perform the essential functions of 

law enforcement work. People applying for law 

enforcement jobs are not blank slates—they bring 

with them their past experiences and, in some 

cases, diagnosable conditions—but those need 

not always be disqualifying. 

Recommendation 12. Consider methods for 

establishing remote access or regional mental health 

check programs at the state or federal level.

Once research has identified promising models 

for mental health checks, there will inevitably 

be many law enforcement agencies that will not 

have the capacity or local access to the necessary 

professionals to implement an effective program 

(whether preventively or post-incident). In these 

instances, having access to a program that allows 

for remote assessment and engagement with 

mental health professionals has potential. When 

the appropriate mental health professionals are 

not available for an underresourced, rural, or very 

small department—or simply to gain scales of 

economy—remote access and regionally oriented 

programs that serve multiple jurisdictions may 

be of benefit. 

However, for such a program to develop resources, 

incubation and a collective focus is required. 

Entities that work at the federal, state, or possibly 

regional level are best positioned to advance this 

concept and convene the level of support needed 

to be effective. 
Peer Mentoring Programs

The benefit of the peer in the facilitation of 

counseling has been well documented for many 

years in a variety of settings. As long ago as the 

late 1960s, the mental health profession saw an 

advantage in peer counseling when C. Eisdorfer 

and S.E. Golann advanced guidelines for the use 

of peer counselors in the mental health field.64

Research has shown that paraprofessionals, which 

is what a trained peer mentor is relative to a 

behavioral health practitioner, “frequently achieve 

clinical outcomes equal to or better than those 

obtained by professionals.”65 Peer counseling has 

also been shown to have an effect in the treatment 

of addictive behavior such as alcoholism. 

Peer support and mentoring programs in law 

enforcement agencies are also not new. Some 

agencies began making use of peer support in 

the early 1970s, earning recognition as models 

for crisis incident management. For example, L.N. 

Blum has described how in in 1974, the Portland 

(Oregon) Bureau of Police began a program called 

the Traumatic Incident Corps. It was established 

when the department observed that some officers 

who had been involved in traumatic incidents were 

still suffering the results of the trauma experienced 

during those incidents. They saw behaviors such 

as alcohol and drug abuse, violations of law and 

departmental policy, and insubordination. Looking 

to improve how the department dealt with these 

officers, the bureau turned to other officers who 

had themselves been involved in trauma.66 The 

Boston Police Department also started a critical 

incident stress peer support program in 1974. 

Initially similar to what was taking place in Portland, 

as the program became more effective its scope 

was expanded to include addressing stress that 

resulted from employees’ financial situations, 

marital problems, department layoffs, and 

administrative policy changes.67

Current practice

Today, peer-led critical incident stress debriefing 

(CISD) is widely used in law enforcement agencies 

in the aftermath of traumatic incidents. Caring for 

other human beings in a crisis can be incredibly 

challenging and lead to secondary traumatic stress, 

so agencies’ efforts to help officers process their 

own emotional reactions are important. However, 

the evidence to support critical incident debriefing 

programs as part of preventing secondary 

traumatic stress is subject to the implementation 

model used. A 2002 metaanalysis published in 

the Lancet found that Critical Incident Stress 

Management (CISM)—the most common program 

model implemented in a variety of first responder 

fields—was no more effective than no intervention 

at all in preventing the development of PTSD.68 This 

does not mean all CISD practices are ineffective 

but that it is important for agencies to understand 

there are different models and protocols for CISD 

and the choice of protocol matters.

There are also many peer programs that provide 

support for broader purposes, helping officers 

struggling with any aspect of their lives that may 

affect or be affected by the job or even being used 

to promote healthy lifestyles to all officers. This 

variety of uses can be seen in a number of the 

case studies that accompany this report. This use 

of peer programs to improve overall wellness is 

also backed by evaluation research: Peer-led health 

and safety trainings have been shown to have a 

positive effect on the targeted lifestyle behaviors.69

Where peer support programs exist in law 

enforcement agencies, they succeed because the 

peer volunteers understand the job of those they 

seek to support. They do the same job, or they 

did earlier in their careers. They have also been 

there, in the same place as the officer in need 
3 2 LAW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T

of support. This makes them usually much more 

accessible than a behavioral health professional. 

“This availability, coupled with a greater ease of 

interaction, may give the peer the edge needed 

to do extremely effective intervention in times of 

crisis. Peers are equals. They would be confidants 

even if they were not crisis interveners.”70 This is 

also why peer support programs may exist even 

when agencies have other EAPs. An EAP may offer 

many of the same services, but it might not be 

located where the officer is, or available 24 hours 

a day, or be staffed with people with direct law 

enforcement experience.

This is not to dismiss the EAP as a valuable tool in 

a holistic and multimodal approach to wellness and 

resiliency. As one individual noted in an interview 

for this report, while there may be poor EAPs out 

there, in general they likely have an undeservedly 

negative reputation and one that is most likely 

perpetuated by people who have never made any 

use of an EAP. But he added, “I like to tell people 

that [in my experience] you cannot raise three 

teenaged daughters and not use [the] EAP.”

Peer support programs are sometimes under the 

auspices of chaplaincy programs, which some 

interviews noted can help reassure officers that 

their engagement with the program will be kept 

confidential. And chaplaincy programs are an 

important piece of wellness support in agencies 

even when they are not connected to peer 

support programs. But even when programs are 

housed elsewhere, clear confidentiality rules are 

important to their success. The team that worked 

on the mental wellness case studies found that 

an occasional downside of efforts to ensure 

confidentiality is that these important programs 

don’t always keep the types of statistics that 

can help demonstrate performance success that 

can be necessary to securing ongoing funding. 

Another challenge one individual noted was that 

“there can be perceptions [among command staff] 

of peer mentoring programs not holding people 

accountable.” He went on to note that there are 

questions about how much do you invest in a 

person who may ultimately be disciplined as a 

result of their actions, but that “I think you can 

take a general approach of separating the person 

from the employee and balance confidentiality and 

assistance with accountability by considering the 

egregiousness of behavior.” And the more clear 

policies are up front, particularly in terms of what 

lines cannot be crossed no matter what, the better.

Recommendation 13. Support the expansion of peer 

support programs to ensure all officers have access to 

this important wellness service.

Whether as the entry point to professional 

psychological services or as the end point 

for career and life advice, it is clear that law 

enforcement officers value peer support 

programs and that they are critically important to 

officers’ well-being. Research on organizational 

connectedness has shown that the quality of 

peer relationships and organizational support of 

them are correlated with self-reported stress 

among officers, making both formal and informal 

peer networks critical to both organizational 

and individual resiliency.71 One interviewee also 

suggested that ongoing career mentoring can 

serve as a type of mental health check-in. 

And these efforts need to be led by officers 

whom people in the organizations trust and 

admire (working in consultation with professional 

behavioral health specialists). Command-level 

endorsement of the idea of taking care of yourself 

both physically and mentally is important, but it 

does not exceed the importance of the program 

being perceived as independent of management. 

Multiple interviewees noted that quiet but 

consistent support from senior leadership was 

critical to program success but that care must be 

taken so that command staff are not seen to be 

the ones pushing or forcing employees to use the 
Peer Mentoring Programs 3 3

services. The drive to use services comes from 

peers or immediate supervisors. Modeling the use 

of services can be important for senior leaders to 

do, however, as part of the process of normalizing 

help-seeking behavior. The inclusion of retirees 

in the peer support network can also improve 

perceptions of independence.

Recommendation 14. Support the expansion of peer 

programs to include broader health and wellness, not 

just critical incident stress.

Even for agencies that have peer support programs 

for those involved in critical incidents, serving 

in certain types of assignments, or involved in 

shootings, there is room to grow the programs to 

cover a wider range of issues—both personal and 

professional—that can impact officers throughout 

their careers. Peer programs that are involved in 

stress management training and mentoring young 

officers as well as assisting with advice on things 

like sleep, nutrition, finances, marriage and child 

rearing, balancing a career with caring for elderly 

parents, and all the other things can affect the 

officer on the job can raise their presence and 

profile with officers. Not only does this help show 

officers that they matter—that they are valued as 

people as well as employees—but it can also help 

break down the stigma of seeking assistance when 

in crisis. Reaching out to peer mentors you already 

know is always going to be easier than reaching 

out to strangers. 

Obstacles to adoption

But despite the longstanding practice and available 

evidence on the efficacy of peer support programs, 

they are not ubiquitous, and some departments 

face ongoing challenges to supporting welltrained peer programs. For very small agencies, 

the perception of confidentiality can be difficult 

to achieve even if there are strong peers in the 

department and the means to train and support 

them. For larger agencies, maintaining the network 

of peer mentors can be a challenge. It can be 

demanding work in its own right—so the peer 

mentors themselves need ongoing training and 

support. As departments appear to be moving in 

the direction of more holistic wellness programs, 

this movement may address the increasing 

demands of peer mentors risking exceeding the 

time and expertise of any one individual, particularly 

for those who are volunteering to serve their fellow 

officers in addition to their regular job duties.

Recommendation 15. Support alternative models to 

agency specific peer programs, such as through regional 

collaborations or labor organizations.

Part of the support for expansion of peer support 

programs should also explore alternative models 

for administering programs. For example, 

regional programs could be used to assist 

smaller agencies who may be unable to support 

an in-house program. In a regional or statewide 

effort, volunteers from multiple departments 

or even networks of retirees can provide peer 

support services to a broader area. This type of 

regionalized effort still allows for the program 

to be a bridge to locally available professional 

services when appropriate. It also can encourage 

trust in confidentiality by allowing officers to 

seek assistance and advice from a peer who 

can understand the experience without being a 

coworker in the same small department.

Rank-and-file organizations and labor unions may 

be a vehicle for delivering this type of non–agency 

based model of service delivery. More than 

one interview noted that in places where labor 

unions have contracted their own EAP providers 

the arrangement has generally been a positive 

development—helping to offset some of the 

general suspiciousness around confidentiality 

that officers have. In fact, regardless of where a 

program is housed, labor organization support and 
3 4 LAW ENFORCEMENT M E N TA L H E A LT H A N D W E L L N E S S A C T

engagement is critical. When new programs are 

created, perceptions of the owner or champion 

of the work can make or break program success. 

When labor organizations endorse programming 

and local providers, officers see those services as 

being for them. 

Recommendation 16. Support training programs for 

peer mentors for peer support programs to expand.

Agencies need to make serious investments in 

selection, training, and oversight of formal peer 

mentors. 

Peer mentors need to be nonthreatening and 

confident in being able to recognize the signs of 

problems because people aren’t generally good 

at identifying their own. Training is particularly 

important to building programs that are not single 

modality efforts. Not all approaches and treatments 

work the same for everyone, so comprehensive 

programs that can help officers find the right 

treatment fit for their needs is also important. 

Building programs that are trusted to assist officers 

in need but not viewed as overriding agency needs 

to hold people accountable to their own behaviors 

is also a balance made easier by having well-trained 

peer mentors with behavioral health professionals 

supporting their work.

Peer mentor training is not a single event but an 

ongoing investment in the program and its peer 

mentor staff, whether they are departmental 

employees or local retirees. Ensuring that peer 

programs have access to training that they can be 

sure is relevant and useful in a law enforcement 

context is critical. 

Any support for the expansion of peer support 

services within agencies also must not overlook 

the need to support the peers themselves. It can 

be emotionally draining and demanding work to 

help those in crisis—and peer supporters are 

not themselves behavioral health professionals. 

Programs need to consider the long-term exposure 

risks of retraumatizing experiences and ensure 

consulting relationships exist with psychologists, 

psychiatrists, or other mental health experts. This 

is particularly important for programs that identify 

peer mentors based on their previous experience 

with critical incidents, such as when support 

officers in shooting cases must have experienced a 

shooting themselves. While this experience can be 

invaluable, it can also lead to additional trauma for 

the mentor. 

Recommendation 17. Remember all the types of 

agencies, including federal, when supporting peer 

programs for law enforcement.

Often when we think of law enforcement, we 

focus on the state or municipal officers we see on 

patrol on our highways and in our neighborhoods. 

But thousands of law enforcement professionals 

are sheriffs’ deputies who work in courts and 

corrections. Many other officers are assigned to 

special units like homicide, sex crimes, narcotics, 

and others, sometimes working undercover. While 

many of the same stressors and health impacts 

exist for these officers, there are also others, 

particularly for those working in jails. Federal 

law enforcement officers face similar stressors 

and risks, but in a different work environment. 

Efforts to expand peer support programs for 

law enforcement need to cross all types of 

law enforcement. Support to expand programs 

in federal agencies may look different than 

similar efforts in state, local, or tribal agencies. 

Regardless of setting, the basic principles are 

the same: Provide support where officers are, 

be responsive to the experiences of officers, and 

support the whole health and wellness of officers.
Additional Recommendations to Support the Mental 

Health and Wellness of Federal, State, Local, and Tribal 

Law Enforcement Officers 

This report primarily sought to respond to the 

specific matters raised in LEMHWA, namely around 

peer support, crisis lines, annual mental health 

checks, and potential models from the DoD and the 

VA that could have applicability in law enforcement. 

However, in the course of conducting the research 

and consultation necessary to that task, we identified 

some additional broader themes concerning support 

for the mental health needs of law enforcement. 

In this section we look at the importance of privacy 

protection and resilience training, the needs of 

civilian support staff, and the benefits of whole-health 

approaches to officer wellness.

Privacy considerations are key to the 

success of peer-led programs

Protection of their privacy, both internally in a 

department and externally, is a major concern for 

officers seeking mental health care.

Internally, officers may face ridicule or professional 

scrutiny for engaging with what one interviewee 

referred to as “the sad clown club,” also known 

as the departmental mental health offerings. 

One interviewee said, “Every department will 

say that they have an EAP, but unless you have 

a departmental culture of mental health and 

wellness, it is an open secret that getting help 

can jeopardize your job.” Officers are aware that 

there is a departmental liability to fielding officers 

with ongoing mental health concerns. A federal 

interviewee said, “There are always agents who 

are simply going to pencil-whip the fitness-forduty assessment. You can’t really prevent that.” 

Although all officers understand the importance of 

medical and psychological fitness for duty, undue 

pressure within a department may keep officers 

from seeking help, preferring to appear as fit as 

possible and return to active duty in the shortest 

possible time. Other officers may have financial 

commitments that make the risk of unpaid time 

away from work untenable. Education, clear policy, 

and consistent processes may help officers take 

personal responsibility for their fitness, rather than 

hiding concerns that can be treated successfully 

and confidentially without endangering their 

employment. 

Externally, officers are public servants. Unless 

the strictest privacy standards are maintained, an 

officer’s mental health care may be discoverable 

on the public record, be used in court proceedings, 

or affect employment eligibility. One federal 

interviewee said that his component had been 

making aggressive efforts to limit the impact that 

mental health treatment has on procedures such 

as background checks for security clearance so 

that agents would not avoid treatment for fear of 

curbing career advancement. 

HIPAA, the Health Insurance Portability and 

Accountability Act of 1996, is what most people 

think of as protecting their personal health 

information from public disclosure. But not 

everyone is a HIPAA-covered provider—it applies to 

doctors, psychologists, clinics, and pharmacies as 

well insurance companies and government-funded 

programs like Medicare, Medicaid, and veterans’ 

health programs. It does not apply to peer-run crisis 

lines or in-agency peer support programs. Clergypenitent privilege prevents clergy from being 

required to disclose confidential communications 

in a court proceeding, and that is why some peer 
 

36 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T 

support programs are run out of chaplaincy offices 

in law enforcement agencies. But not all programs 

can realistically be managed and maintained by 

ordained clergy, and there is no guarantee that 

privilege would extend to lay staff working under a 

chaplain’s purview. 

Even if most people are not aware that speaking 

with an employer-run crisis line or peer program has 

no privacy guarantee, all of our interviews made 

it clear that officers are. And if law enforcement 

officers are going to be encouraged to call peer crisis 

lines or make use of other peer-support services, 

they will need to know that what they say will be 

kept confidential. They need to have confidence that 

what they say will not be subject to public disclosure 

either to their chain of command—possibly 

jeopardizing their career—or subject to discovery in 

judicial proceedings, possibly jeopardizing both 

themselves and their agency. 

Knowing that the public can potentially access 

sensitive personal information may ultimately 

deter officers from seeking treatment. This may 

be of particular concern for smaller jurisdictions— 

most especially tribal communities—where there 

are limited service providers and other natural 

limits on privacy. 

Recommendation 18. Improve legislative privacy 

protections for officers seeking assistance from peer crisis 

lines and other peer-support programs. 

Very few states offer this kind of privacy protection 

for crisis lines and other programs run by agencies 

or active duty law enforcement volunteers. In 2009 

Washington State enacted legislation saying that 

“All communications to crisis referral services by 

employees and volunteers of law enforcement, 

correctional, firefighting, and emergency 

services agencies, and all records related to 

the communications, shall be confidential.”72 

Unsurprisingly, there are multiple public safety crisis 

lines with referral services based in Washington 

State. Indiana enacted legislation effective in 2017 

that exempts critical incident stress management 

service communications from being subpoenaed.73 

Illinois introduced similar, but more expansive, 

legislation that would create the Law Enforcement 

Support Program Confidentiality Act. If passed, this 

law would have 

“[Provided] that information, omissions, 

confessions, or other communication obtained 

by a participant in a peer support program 

involving a peer support counselor from a law 

enforcement officer, public safety employee, 

peace officer, firefighter, or emergency services 

personnel shall be considered confidential 

information and shall not be released to any 

person or entity, including, but not limited to, a 

court, administrative agency or tribunal, or public 

officer or employer, unless: (1) to the extent it 

appears necessary to prevent the commission of 

an act that is likely to result in a clear imminent 

risk of serious physical injury or death of a 

person or persons; (2) when required by court 

order; or (3) when, after full disclosure has been 

provided, the person who made the confession, 

admission, or other communication has given 

specific written consent.”§ 

§ This was in the enrolled language of H.B. 5231, 100th Gen. Assemb., Reg. Sess. (Ill. 2018) but was removed by amendment in final passage of Public 

Act 100-0911. It is expected that it will be addressed in the next session of the Illinois General Assembly. 

Guidance or model legislation is needed to 

ensure officers can make use of peer-run support 

services without fear of disclosure of private health 

information. Furthermore, efforts to expand the 

usefulness of peer-led support programs should 

be paired with efforts to collect meaningful data. 

Guidance is needed on how best to securely 

collect and protect vital data so aggregated and 

anonymized data can be collected and analyzed to 

evaluate program effectiveness. 
Additional Recommendations 37

Building resilient officers begins, but 

does not end, in the academy

Resilience is the ability to cope with and recover 

from stress, adversity, and trauma. One interview 

subject observed that while he had long thought 

about the need to hire resilient people to work in 

this demanding career, he has come to learn that 

resiliency may not be innate and that it definitely 

can be taught. Recognizing this, some of the 

departmental wellness programs featured in 

the wellness case studies (such as Indianapolis 

and Milwaukee) are housed in or attached to the 

agency’s training facility. Another chief recounted 

that in his former departments he gave every 

recruit a copy of Dr. Kevin Gilmartin’s book, 

Emotional Survival for Law Enforcement, and 

tried to always bring Dr. Gilmartin to speak to his 

academy classes about what recruits could expect 

on the job and how to mitigate the stress and 

trauma risks. His hope that was that these future 

officers would avoid the worst effects of trauma 

exposure, be less afraid to seek assistance, and 

understand the cycle of recovery from trauma 

exposure. “With this hopefully they never reach 

the point of self-medication or self-harm.” And yet 

another interview pointed out that the work of 

people like Dr. Gilmartin and others are critical to 

reminding cops that they are “not just cops;” they 

are also people with relationships and interests and 

responsibilities away from the job, and those things 

are important to their ability to be resilient. 

It must not be ignored, however, that it is difficult 

to promote and build resilience in stressed 

organizations. Since 2008, most departments have 

experienced resource shortfalls across personnel, 

equipment, and training, and many interviewees 

pointed out the ongoing pressure to do more with 

less impacts officer morale. This is combined with 

challenges of recruitment and retention that have 

been exacerbated by a national discourse that 

makes many officers feel that both their profession 

and their professionalism are undervalued. In 

this environment, the organizational climate adds 

stress to what is already recognized as one of the 

most stressful occupations. Research is beginning 

to show that law enforcement officers operating 

under stress may well be at greater risk of making 

errors that can compromise their performance and 

public safety.74 In addition, the chronic stressors of 

police work can have a significant adverse impact 

on both physical and psychological health.75

But there is hope that developing stress resilience 

and self-regulation skills in officers can mitigate the 

negative effects of stress on decision-making.76 In 

addition to learning to quickly regain their balance, 

both psychologically and physiologically, after 

intense moments on the job, officers can also be 

given tools to help them manage thoughts and 

emotions that come up long after incidents have 

passed. Data suggest that “training in resilience 

building and self-regulation skills could significantly 

benefit police organizations by improving judgment 

and decision-making”77 and decreasing the 

frequency of on-the-job errors that can result in 

injuries, death, and even legal liabilities.

Recommendation 19. Support the identification, 

development, and delivery of successful resiliency 

training programs for both academy and periodic inservice settings. 

There is a growing body of evidence in support 

of increased resilience training in the academy 

both in terms of understanding the risks and in 

teaching skills that can help mitigate exposure to 

stress. There are agencies—including some of 

those featured in the case studies report—that 

have begun to bring resiliency training in their 

academies and in-service training programs, but it 

is not universal. And in an academy setting these 

discussions are fairly academic, as the recruits have 

no on-the-job experience. So retraining on both 

awareness and skills throughout a career is also 
3 8 LAW ENFORCEMENT MENTAL H E A LT H A N D W E L L N E S S A C T

key. It is generally accepted that health prevention 

interventions work best when there are follow-up 

refreshers to reinforce knowledge and skills.78

This training should include information on the 

physical effects of stress, skills to moderate the 

physiological responses to stress, the normalization 

of help-seeking behavior, and information on the 

benefits of peer support. Evaluation work of one 

such training model as implemented in Australia 

also suggests that training programs should 

focus on positive attributes—what they termed a 

“strength focused approach and narrative”—and 

the building of social cohesion among officers. 

This is supported by research that suggests that 

a sense of workplace connectedness is a vital 

protective factor against depression.79 And this 

is also consistent with research that has taken 

place in law enforcement agencies that shows 

that organizational factors have a greater impact 

on individual’s levels of stress than operational 

factors.80 Particularly for federal, state, and larger 

municipal agencies that run their own academies, 

this promotion of workplace connectedness can 

begin in the academy setting where recruits are 

future co-workers.

While there are existing training programs that 

focus on the positive strengths of police officers 

and remind them of what motivated them to serve, 

and those training programs can be a starting 

point, they are most often applied as one-time 

trainings in either the academy or at a single 

point in a career. Additional support to build out 

training programs that support officers through 

the many phases of their career and refresh their 

skills in modulating their stress response is also 

important. In addition, the use of on-line training 

modalities for supplemental or refresher training 

may be an efficient way of providing large-scale 

reinforcement training for the more than 800,000 

law enforcement officers working in this country at 

any given time.

Recommendation 20. Support training programs 

that promote the universal application of preventive 

interventions, including skills to manage stress. 

In the preventive services world, interventions 

are generally classified as universal, selective, 

or indicated. The first applies to everyone in the 

population, the second to a group identified as 

being at greater risk, and the third to individuals 

who are symptomatic. Peer support and crisis lines 

primarily address the needs of the symptomatic. 

Critical incident stress management or other 

psychological health checks for trauma exposure 

for those in special assignments or present 

at major critical events address the selective 

population at specific greater risk. But whole 

career training speaks to the universal, and the 

use of this universal application has two potential 

benefits. First, there is a demonstrated population 

health benefit from the preventative application of 

information; individuals do not need to be suffering 

before exposure to treatment. Exposure may help 

those individuals better self-identify when they 

are in need of help in the future. They are more 

aware of the signs and have a better sense of 

what seeking help will involve. Second, universal 

exposure provides intervention for everyone, and 

no one is stigmatized.

A critical area for this universally applied training 

is in the area of teaching officers to manage 

their stress response more adaptively. Broader 

access to resilience training throughout a career 

is important because when individuals are under 

stress, the body’s sympathetic nervous system 

response can be triggered, raising their heartrate, 

reducing the ability to think critically, and potentially 

leading to declines in operational performance. In 

light of a growing field of study examining how 

people working in high stress jobs can be taught 

to manage their response to trauma and stress 

through things like breath work, mindfulness, 

and meditation, support to greatly expand law 

enforcement’s access to this is potentially a key 
Additional Recommendations 3 9

tool in a comprehensive approach to mental health 

and wellness. Those who make use of these selfregulation skills in their daily work can improve 

their job performance, their health, and their 

engagement with their personal lives.

Civilian staff must not be forgotten

To the extent that there is increased focus on 

mental health and wellness in law enforcement, 

it has largely been focused on the needs of 

sworn officers. However, as we were researching 

the provision of mental health services with 

law enforcement executives, membership 

organizations, clinicians, and others, there was a 

consistent prompting to ensure that the needs of 

civilian staff were not overlooked.

Quantifying and qualifying the provision of mental 

health services for sworn officers uncovered a 

scarcity of empirical findings. Looking into services 

provided for civilian staff of law enforcement 

agencies produced even less definitive information. 

The reason for this may be twofold:

1. Mental health and wellness services provided 

to civilian staff are hard to enumerate because 

their services are generally intermixed with the 

vast population of active municipal employees 

respectively. As such, they are empirically 

indistinguishable from all municipal employees. 

2. Services for civilian staff can be unintentionally 

overlooked by policy makers given the lower 

profile nature of their responsibilities and 

status within law enforcement agencies, 

their relatively scant numbers compared to 

sworn officers, the perception that they are 

sufficiently distant from duties that cause 

mental health–related stress, and the fact that 

they generally are not supported by strong, 

profession-specific advocacy organizations.

Regardless of the reasons, there were 

numerous anecdotal arguments made during 

the development of this report that encouraged 

consideration of expanding services to include 

civilian employees.

Recommendation 21. Encourage departments to 

make support available to nonsworn employees on 

the same terms as their sworn colleagues whenever 

possible.

The civilian staff most often mentioned as 

warranting enhanced services were dispatch, 

forensic, and crime scene investigation staff. It was 

argued that they engage in the same incidents that 

cause stress for officers, just in a different capacity. 

It was also stated that the inherent inability for 

dispatchers to achieve situational closure for 

the more stressful incidents they encounter is 

a particular cause of challenges. Simply making 

wellness programs available to these civilian staff 

members may benefit their personal wellness as 

well as overall agency operational readiness.

Whole health programs are the goal, 

but there is no single approach 

that will succeed everywhere

Throughout this report, the focus has primarily 

been on mitigating mental health challenges 

inherent to a career in law enforcement. However, 

several of the experts consulted while developing 

this report and during previous convenings on 

officer safety and wellness saw mental health 

challenges as part of the continuum of inherently 

impactful aspects of a career in law enforcement. 

Attendees at the October 2017 OSW Group 

meeting discussed factors that endanger officers’ 

physical health. For example, they have little time 

to eat during their shifts and their diets may suffer. 

Shift work and overtime or the need to hold a 

second job may lead to inadequate sleep. Poor 
4 0 LAW ENFORCEMENT MENTA L H E A LT H A N D W E L L N E S S A C T

nutrition coupled with lack of exercise can lead to 

obesity, diabetes, hypertension, and an increased 

risk for cardiovascular disease. These risks exist 

even before the emotional stress of the job is 

added into the equation. 

Recommendation 22. The development of programs 

that promote whole health and officer resilience should 

be the goal of the profession.

The mutual dependency of physical and mental 

health is undeniable. In the case studies report, 

we see repeated evidence that successful officer 

wellness initiatives address a variety of physical 

health conditions alongside mental wellness 

components.81 In interviews, police physicians 

reiterated several main areas of focus that should 

be given high priority in every law enforcement 

agency as the building blocks of officer resilience: 

“Tactical trauma care. Law enforcement 

agencies must have standardized equipment, 

including trauma care kits, and training in 

tactical trauma care such as hemorrhage 

control. When an officer is shot or otherwise 

falls victim to trauma, the first responder to the 

scene is often a fellow officer.

Cardiac screening. The risk of heart disease 

appears higher among police officers than the 

general population and may be exacerbated 

by the acute surge of adrenaline that officers 

experience in critical incidents. When officers 

are not in good physical health the job is 

inherently more dangerous.

Fitness. Lack of fitness is a health risk for 

officers and a liability for their agencies. Every 

agency should promote fitness goals for all 

of its officers. In addition, agencies should 

consider a benefit or reward structure for those 

who meet or exceed them. 

Overweight and obesity. The risk of shift 

work and having a sedentary job places law 

enforcement officers at higher risk of being 

overweight or obese, both of which increase 

the risk of heart disease and stroke and make 

the law enforcement officer less successful in 

certain job related performance measures. 

Emotional or mental health. On a daily basis, 

law enforcement officers see small traumas 

that, over time, can have as significant an 

impact as a major incident. This can lead to 

a higher risk of self-medicating behaviors 

such as alcohol use.”82

The DoD and the VA clearly recognize the 

connectedness of physical and mental health, 

as together they provide a robust network of 

integrated programs and services for our nation’s 

active duty and reserve personnel, our veterans, 

their spouses, and their children. These programs 

include the spiritual and the secular, the preventive 

and the reactive; they strive for as many points 

of access to service as possible. This network 

is built on the backbone of the TRICARE health 

care system and continues to evolve in ways that 

strive to reduce stigma, expand access, and meet 

the unique mental health needs of our military 

personnel and their families.

A similar array of evidence-based health, wellness, 

stress reduction, and resilience programs needs to 

be developed, supported by organizational leaders, 

and encouraged within all agencies. One model 

that agencies could be encouraged to look at is 

Total Worker Health, which addresses many of the 

issues experienced by officers as well as a litany 

of other challenges faced by their families and the 

public.83 When this interrelatedness of physical and 

mental wellness is addressed by law enforcement 

agencies, that holistic attention will lead to 

healthier, more resilient officers.
Conclusion

Crisis lines, mental health checks, and peer and 

family support programs can be key components 

of effective law enforcement mental health and 

wellness programs provided they are appropriately 

researched and resourced. 

Crisis lines are a promising part of the necessary 

suite of services required to support and sustain 

officer mental health and wellness. To be effective, 

they should (1) be staffed whenever possible by 

counselors with law enforcement experience, 

(2) be staffed with counselors trained specifically 

on the needs of law enforcement officers, (3) have 

adequate privacy controls both to ensure collection 

of good data and to protect the clients who call 

for service, and (4) enable referral to vetted local 

service providers for callers ready to engage with 

interventions. In addition, they should be studied 

aggressively so that the evidentiary basis for the 

practice may be demonstrated.

While there is no universally accepted structure 

for mental health check programs, examples 

of programs that are believed to be effective do 

exist throughout American law enforcement. 

They are conducted using various approaches—

often based on the needs and interests of a 

department, the culture of a department, a 

department’s budget, the stance of prevailing 

police unions, and other factors.

The beneficial effects of peer counseling in law 

enforcement have been documented in studies 

with both federal agents and police officers.84 And 

key to the success of any peer support program is 

providing appropriate training and ongoing support 

and supervision for the peers. Careful identification 

and selection procedures for peers are also crucial. 

They need to be people in the agency whom other 

officers will trust and view as understanding. And 

they need to have links to mental and behavioral 

health professionals to be able to provide a bridge 

to more traditional care.

But even beyond these, some additional ideas from 

the DoD and the VA experience could be replicated 

in the law enforcement context. This report has 

looked to highlight some of the possibilities, but we 

do so recognizing that not every law enforcement 

agency or community is going to be starting 

from the same place. Interest in and support for 

expanding programs and services and for exploring 

comprehensive approaches to wellness are going 

to be important going forward. Many DoD and 

VA programs are supported behind the scenes 

by networks of clinicians and service providers. 

It is one thing to build the public campaign or the 

resource page or call line and encourage officers 

in crisis to use it. It is another thing to have a 

network of trained professionals behind the 

campaign, resource page, or call line where 

those officers can be referred for ongoing, 

affordable, and convenient care. And as the DoD and 

VA demonstrate, none of this is possible without a 

leadership mandate and broad agency support.

We would be remiss if we closed this report without 

speaking to why law enforcement–specific care is 

important and thank Congress for this opportunity to 

address this critical need. As was mentioned in one 

interview, “I don’t know of another workforce that 

is more skeptical than cops,” and that for mental 

health professionals working in this arena, “a cop 

is going to size you up quick and you risk being 

written off as . . . not able to understand the ‘real’ 

world they operate in.” This is not a criticism of law 

enforcement officers; in fact, an ability to quickly 

assess a situation is exactly what we train officers 

to develop as a vital skill in keeping both themselves 

and their communities safe. But it means many 

practitioners we have spoken to have noted that 
4 2 LAW ENFORCEMENT MENTA L H E A LT H A N D W E L L N E S S A C T

clinicians and behavioral health programs will only 

get one chance to make a first impression. And 

this perception is backed up by researchers who 

have noted that for a program to be sustainable, 

the focus needs to be on feasibility, acceptance 

to law enforcement community members, and 

attractiveness to providers.85

Put another way, ecological validity may be more 

important than scientific efficacy. Or, real-world 

perceptions are potentially more critical to program 

acceptance than evaluative outcomes. The use of 

law enforcement community–based participatory 

research to identify, design, and evaluate programs 

that support law enforcement wellness may very 

well improve the chance of program acceptance 

within the profession. And these efforts to 

bring researchers and clinicians directly into 

the world of law enforcement will only stand 

to increase their understanding of the unique 

nature of the job. 

Congress clearly understands this important next 

step of educating clinicians on the climate and 

culture of law enforcement in order to increase 

program and service acceptance. Section 3 of the 

Law Enforcement Mental Health and Wellness Act 

states that “the Attorney General, in coordination 

with the Secretary of Health and Human Services 

(HHS), shall develop resources to educate mental 

health providers about the culture of Federal, 

State, tribal, and local law enforcement agencies 

and evidence-based therapies for mental health 

issues common to Federal, State, local, and tribal 

law enforcement officers.” The DOJ looks forward 

to working with the HHS on this effort over the 

coming year, along with continuing its many other 

efforts to support the mental health and wellness 

of our nation’s law enforcement officers. Increased 

information and educational materials for agency 

leaders and clinicians combined with increased 

support for peer support, crisis lines, mental 

health checks, and training as described in this 

report will greatly improve the health and wellness 

of the men and women who dedicate themselves 

to the public safety of all our communities.
Appendix A. Recommendations

1. Support the creation of a public service 

campaign around law enforcement officer mental 

health and wellness in conjunction with National 

Mental Health Month.

2. Support the development of resources for 

community-based clinicians who interact with law 

enforcement and their families to help them better 

understand some of the unique risks facing their 

clients and what resources may be available to them 

as members of the first responder community.

3. Support programs to embed mental health 

professionals in law enforcement agencies.

4. Support programs for law enforcement family 

readiness at the federal, state, and local level.

5. Encourage departments to allow retired law 

enforcement officers to make use of 

departmental peer support programs for a select 

period of time post-retirement or separation.

6. Support the development of model policies 

and implementation guidance for law enforcement 

agencies to make substantial efforts to 

reduce suicide.

7. Support the creation of a Law Enforcement Suicide 

Event Report surveillance system, possibly beginning 

with a focus on federal law enforcement agencies.

8. Support rigorous research that can evaluate the 

efficacy of crisis lines and, if supported, provide 

data toward considering them an evidence-based 

practice.

9. Support the expansion of crisis lines for law 

enforcement that are staffed with call-takers and 

counselors with a law enforcement background.

10. Consider support for a national crisis line for law 

enforcement.

11. Support research to determine the efficacy of 

mental health checks, establish which approaches 

are most effective, and provide resources that 

move law enforcement toward best practices.

12. Consider methods for establishing remote 

access or regional mental health check programs at 

the state or federal level.

13. Support the expansion of peer support 

programs to ensure all officers have access to this 

important wellness service.

14. Support the expansion of peer programs to 

include broader health and wellness, not just 

critical incident stress.

15. Support alternative models to agency 

specific peer programs, such as through regional 

collaborations or labor organizations.

16. Support training programs for peer mentors for 

peer support programs to expand.

17. Remember all the types of agencies, including 

federal, when supporting peer programs for 

law enforcement.

18. Improve legislative privacy protections for 

officers seeking assistance from peer crisis lines 

and other peer-support programs.

19. Support the identification, development, and 

delivery of successful resiliency training programs 

for both academy and periodic in-service settings.
20. Support training programs that promote the 

universal application of preventive interventions, 

including skills to manage stress.

21. Encourage departments to make support 

available to nonsworn employees on the same 

terms as their sworn colleagues whenever 

possible.

22. The development of programs that promote 

whole health and officer resilience should be the 

goal of the profession.

4 4 LAW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
Appendix B. Abbreviations, Acronyms, and Initialisms

BJA Bureau of Justice Assistance

COPS Office Office of Community Oriented Policing Services

DHA Defense Health Agency

DHS U.S. Department of Homeland Security

DoD U.S. Department of Defense

DoDSER Department of Defense Suicide Event Report

DOJ U.S. Department of Justice

EAP employee assistance program

EBH embedded behavioral health

EMT emergency medical technician

FRG family readiness group

FY fiscal year

HHS U.S. Department of Health and Human Services

HIPAA Health Insurance Portability and Accountability Act

LEMHWA Law Enforcement Mental Health and Wellness Act

LEOKA Law Enforcement Officers Killed in Action

MCL Military Crisis Line

MHS Military Health System

NLEOMF National Law Enforcement Officers Memorial Fund

OSW Group Officer Safety and Wellness Group

PTSD post-traumatic stress disorder

SWAT special weapons and tactics

VA U.S. Department of Veterans Affairs

VALOR Violence Against Law Enforcement Officers and Ensuring Officer Resilience and 

Survivability

VCL Veterans Crisis Line

VHB virtual hope box

Notes

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Conclusion

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abs/pii/S0005796710002251.

5 0 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T


Chapter 5 3
Good mental and psychological health is just as essential as good physical health for law enforcement 

officers to be effective in keeping our country and our communities safe from crime and violence. With 

the passage of the Law Enforcement Mental Health and Wellness Act, Congress took an important step 

in improving the delivery of and access to mental health and wellness services that will help our nation’s 

more than 800,000 federal, state, local, and tribal law enforcement officers. Many things, including 

strong relationships with the community, help keep officers safe on the job. This act called for the U.S. 

Department of Justice (DOJ) to submit a report to Congress on mental health practices and services in 

the U.S. Departments of Defense and Veterans Affairs that could be adopted by federal, state, local, or 

tribal law enforcement agencies and containing recommendations to Congress on effectiveness of crisis 

lines for law enforcement officers, efficacy of annual mental health checks for law enforcement officers, 

expansion of peer mentoring programs, and ensuring privacy considerations for these types of programs. 

The DOJ is pleased to respond to this requirement of the act with this report.

U.S. Department of Justice

Office of Community Oriented Policing Services

145 N Street NE

Washington, DC 20530

To obtain details about COPS Office programs, call 

the COPS Office Response Center at 800-421-6770.

Visit the COPS Office online at www.cops.usdoj.gov.

e121803899

Published 2019