The Complex Issues in Researching "False memory Syndrome"

The Australasian Journal of Disaster
and Trauma Studies
ISSN:  1174-4707
Volume : 2001-2

Effective Postvention for Police Suicide

Robert Loo

Human Resource Management and Organizational Studies
Univerity of Lethbridge
Alberta, Canada

Abstract

Suicide in policing has reached epidemic proportions. Departments are often left in the wake of trauma and grief, unable or unwilling to deal with the suicide of an officer. This article provides practical guidance to departments to assist them in dealing with the aftermath of a suicide. Methods of interdepartmental communications, procedures, and debriefing are discussed. A model designed for suicide postvention is also presented.

Effective Postvention for Police Suicide

Shneidman (1981) coined the term postvention, in contrast to prevention, to describe the sorts of actions taken after a suicide largely to help survivors such as family, friends, and co-workers. Postvention was seen as a natural extension to the established suicide prevention field partly because there will always be some base level of suicide even when highly effective suicide prevention programs exist and partly because the survivors of a suicide can be viewed as victims of post-traumatic stress (i.e., post traumatic stress disorder: PTSD) and, therefore, in need of assistance in dealing with their grief reaction.

Survivor Reactions to Police Suicide
The signs and symptoms of distress and bereavement resulting from the suicide of an officer might be a mix of any of the following commonly-reported reactions among survivors (DSM-IV, 1994):

• shock over the suicide;
• feelings of grief;
• feelings of helplessness;
• feelings of abandonment, isolation, and loneliness;
• feelings of depression and weepiness;
• feelings of guilt because they believe that they might have been able to prevent the suicide;
• sexual dysfunction;
• suicidal thoughts...the contagion effect;
• anger towards the suicided, the police department, other survivors, or the media;
• a loss of interest in work, family and friends, and other activities;
• increased work absences, lateness, and use of sick leave;
• alcohol and drug abuse; and
• disruptive sleep and eating patterns.

• Establish and execute your standing operating procedure (SOP) for postvention. The SOP should specify the key positions/persons responsible for initiating the SOP. For example, the immediate supervisor, the officer who first hears about the suicide (e.g., the duty officer), the departmental psychologist/health professional, padre/clergy, and internal affairs.
• Have a crisis team trained and ready to have a planning meeting to initiate the CISD. The team could be a mix of health professionals and trained peer counselors.
• Notify the departmental administration, next-of-kin, family physician and clergy if known, and other key persons.
• A departmental communication release should be made as soon as is practical to let fellow officers and staff now the facts rather than have the grapevine circulate rumors. Manage the external media by having a timely press releases so that facts rather than rumors reach the media.
• Have a carefully picked debriefing facility readily available. While it may be practical to use a room in a police facility, an off-site facility such as a meeting or conference room in a community health center, might be better for the survivors.
• Do at least one follow-up session to address unresolved concerns and any new issues that arose since the debriefing.
• Conduct a confidential evaluation of the postvention by having participants complete, for example, a confidential and anonymous evaluation questionnaire a week or two after the debriefing to identify particularly what worked well and what needs to be improved for future postventions. Alternatively, the evaluation might be conducted as a group session thus allowing for interactions among survivors but precluding anonymity.

A Model for Suicide Postvention

Figure 1 presents a model for suicide postvention for police which the remainder of this chapter follows. As seen in the model, two program areas are emphasized, the critical incident debriefing and survivor support, and two analysis actions, the psychological autopsy and the analysis of suicide notes. As seen in the figure, all components of postvention must be evaluated, particularly for their effectiveness, and improvements made for the future. Finally, the linkage between prevention and postvention is highlighted.

Critical Incident Stress Debriefing (CISD)

• CISD typically uses a single session, a half or even full-day session, although survivors may be referred to health service providers, clergy, or other sources for additional assistance if required.
• CISD usually uses a group session (10-12 survivors) partly so the various survivors have the opportunity share their common grief and provide mutual support and partly for efficiency given the likely limited number of experienced health services professionals readily available for this purpose. The group session can be seen as a 'decompression' session in an emotionally safe and supportive setting for survivors.
• CISD should occur within one to three days of the suicide so support can be provided in a timely manner to ameliorate the distress of survivors.
• A secluded and safe location is used to provide privacy and confidentiality.
• The selection, training, and experience of a facilitator or group leader is critical to ensure that the CISD process is conducted effectively. The facilitator should be a health services professional with extensive training and experience in CISD, PTSD, suicidology, and the grieving process (Faberow, 1992). It can be helpful to have a survivor act as co-leader if a survivor has the personal characteristics (e.g., emotionally stable, empathetic, effective interpersonal communications skills) and leadership qualities (e.g., can keep the group focused) to facilitate the process.

• The facilitator describes the process and sets the ground rules for the session particularly the need for confidentiality and a mutually supportive environment. The introduction of participants.
• Participants need to express their feelings about the suicide and the perceived reasons for the suicide. The results of such sharing in a safe and supportive group session should be emotional decompression and sense-making about the suicide.
• The facilitator or group leader should be able to use the group discussion to draw to out the multitude of signs and symptoms of distress as well as the grieving process for the group to examine and then move onto the important actions that help manage distress and grieving. Such actions could include continuing to meet as a self-help group to continue providing one another with support, linking to community services, conducting a stress self-assessment, techniques to improve open communication about suicide among family members and significant others, and performing deep muscle relaxation exercises to overcome muscle tension and aid sleep.
• An after action report should be prepared and disseminated to the police department and health professionals not simply as an administrative procedure but as a means of sharing points learned and pitfalls to avoid in future CISDs.

Social Supports for Survivors

Conservative estimates report that there may be as many as 28 persons directly affected by a suicide (Knieper, 1999). One could argue that, for police suicides, the number of significant survivors could be much higher given that not only family and friends are directly affected but virtually all of the police officers in a department especially small departments where strong bonds create a family feeling. Clearly, there is a need to provide support for these many survivors. Research has shown that survivors report receiving less support than desired or report being unaware of what support was available to them (e.g., Wagner & Calhoun, 1991). Such findings indicate that organizations need to do a better job of identifying survivors and communicating to them the availability of support services. For police departments, the imperative is to provide support for the family and fellow officers.

One potential issue is the macho image that still persists among some officers, that is, it is seen as a sign of weakness to ask for help or to actively participate in sessions for survivors. Another potential issue is the sigma associated with suicide in contrast to death by other causes such as vehicle accidents. For example, research found that widows of suicide tend to experience rejection from their husband's family and friends (Saunders, 1981). The point is that some survivors might be less likely to seek assistance or discuss the event with others because it was a suicide. Police departments might consider a policy requiring that officers attend CISDs and other activities intended for their assistance to ensure that all affected survivors receive at least some assistance.

While social support services initially brings survivors together for group and/or individual sessions, survivors may wish to form or to join existing survivor groups (visit the American Association of Suicidology www.suicidology.org to see an extensive listing of survivor groups across the USA).

The Psychological Autopsy

The term 'psychological autopsy' and the practice of performing psychological autopsies grew from the frustrations experienced in the Los Angeles County Chief Medical Examiner-Coroner's Office in the late 1950's where some deaths could not be properly resolved based upon the collected evidence (Shneidman, 1981). By changing to a multidisciplinary approach, the Death Investigation Team, involving behavioral scientists in addition to the traditional medical experts, greater success resulted in (psychological) autopsies. In addition, the interviewing of informants such as family members, friends, family physician, and co-workers added much independent information about the suicided and circumstances (Brent, 1989).

Since that time the term and process has evolved and broadened in scope; we are concerned only about the psychological autopsy in the context of police suicide. For us, psychological autopsies are useful in addressing three broad questions.

What was the Mode of Suicide?
Seeing as the majority of police who suicide use their service handgun, the method of suicide is usually easy to confirm. In some cases, such as hanging, asphixiation (e.g., carbon monoxide poisoning from vehicle exhaust), or drug overdose, the mode of suicide can also be easily confirmed. On the other hand, some cases can be more difficult to resolve because they involve multiple methods; for example, a drug overdose and drowning in a bathtub. Even more difficult to resolve are suicides that may appear as accidental deaths. For example, the single-vehicle fatal accident where an officer drives at high into a solid barrier when there are no mechanical, road, or weather conditions that can be proposed as reasonable explanations for the apparent accident.

There are several main reasons for gathering these data. The obvious reason is to identify use of the service handgun or other departmental weapon such as a shotgun so that access might be better controlled, hopefully, to make future suicides using departmental firearms more difficult.

What were the Circumstances Surrounding the Suicide?
Determining when and where suicides occur might have implications for prevention (Lester, 1997).

• Did the suicide occur on or off duty?
• Did the suicide occur on a week day, weekend, or holiday?
• Did the suicide occur at night or during the day?
• Did the suicide occur at home, a police facility, patrol vehicle, or other notable location?
• Did the suicide occur on an anniversary or other special day?
• Did the officer give away personal effects just prior to the suicide or make other gestures suggesting a 'farewell,' 'a settling of accounts,' or reconciliation with others?
• Was there a noticeable mood change before the suicide?
• Was alcohol or drugs a factor at the time of suicide?

These data could identify patterns suggesting periods when managers and helpers need to be especially vigilant about potential suicides so that preventive actions could be taken. For example, if mood changes precede suicide, then supervisors and officers should be trained to identify such changes to help identify high-risk officers.

Why did the Officer Commit Suicide?
This is a critical question not only for identifying preventive actions but it is a question raised by survivors who might benefit, in a small way, from having the answer. Family, friends, and fellow officers raise this question wondering what could have so disturbing in the officer's life that suicide was the way out. For many officers suicide follows not just a single problem or critical event but the culmination of overwhelming several problems such as combined marital problems and career frustrations.

Ethical Issues
In conducting a psychological autopsy, one must treat all information and documentation as confidential. The integrity of the deceased must be respected. One must be careful not to cause further distress to survivors, for example, in the interview process. It is preferable that health professionals who are governed by a code of ethical conduct and subjected to disciplinary action by their professional body conduct interviews of survivors and informants. In any case all members of the team conducting the psychological need to be selected for their related expertise and personal suitability.

Suicide Notes

• Unbearable psychological pain and suicide as the escape from such unbearable pain.
• Problems in establishing and maintaining interpersonal relationships.
• Rejection-aggression, that is the turning inward of aggression rather against another person.
• The inability to adjust and overcome personal difficulties, or the perceived inability to adjust.
• The suicide note may serve as an expression of conflicting or ambivalent feelings about suicide such as wanting to be dead but also wanting to be rescued and to live.
• Identification-egression in that the person has an intense attachment to a lost or rejecting person. If this emotional need is not met, then suicide might be seen as the only solution.
• Ego, that is, the suicidal person him or herself is viewed as a cause of the problem if the person is unable to overcome their personal difficulties and wishes to die.
• Cognitive constriction, that is rigid, impoverished and concrete thinking, possibly as one result of trauma, might contribute to a person's decision to commit suicide.

Some researchers have focussed on alcoholism because of the strong association between alcohol abuse and suicide or attempted suicide. For example, Leenaars and Lester (1999) found in their analyses of 16 notes from alcoholics a suggestion that suicide is associated with a response to unbearable pain, often associated with alcoholism itself; and a history of trauma such as a failing marriage. Thus, suicide may be seen as an escape from an unbearable situation.

Other researchers compared suicide notes written by males and females to detect sex differences but these studies usually report no sex differences in themes (e.g., Canetto & Lester, 1999; Leenars, 1988; Lester & Heim, 1992). Age has been examined to determine if there are any differences in themes between younger and older persons who commit suicide. Lester and Reeve (1982) found that older persons tended to be more concerned about feelings rather than actions and less explicit about their intended suicidal action. More recently, Leenaars (1992) found that older persons tended to write more about painful personal problems, about being trapped by despair, and long-term instability, for example, alcoholism or the multiple loss of significant others. Add to these findings is the more obvious difficulty that some older persons, especially in our youth-oriented culture, can experience in adjusting to the vicissitudes of aging with its accompanying decline in physical functioning and health (Bauer, Leenaars, Berman, Jobes, Dixon, & Bibb, 1997).

Evaluation of Postvention

• identify areas for improvement;
• give recognition for a job well done;
• assess the cost/benefit of the services provided as well as potential opportunities for cost savings (e.g., outsource particular services) especially because police departments operate under limited resources;
• assess the ethical and legal aspects of the policies and programs for critical incidents or areas for improvement to protect users of postvention and the department from litigation; and
• assess the fit between postvention policies and programs with the department's other personnel and operational polices and programs.

Such evaluations should address at least the following questions regarding policy and programs (Patton, 1980, 1986).

Policy Area
Relying on an informal, unwritten policy or procedure, perhaps based upon past departmental practices, might not be a prudent approach given the scrutiny police services face and the potentially harmful effects of critical media coverage among other potential effects.

• Does the department have a written policy(ies) addressing postvention? If not, why not?
• How does the policy(ies) compare to those in other police departments and organizations?
• Have situations arisen that the policy does not address? If so, then identify required revisions to the policy(ies).

• Do the programs and services comply with the policy(ies)? If not, does the policy(ies) require revision or do programs and services need to be revised?
• What do the programs and services cost? Are the costs justified? Are there more cost-efficient ways of delivering the programs and services?
• Are the programs and services having beneficial effects for the stakeholders? Are ther any unintentional negative effects on stakeholders?
• How do the programs and services compare to postvention programs and services in other police departments and organizations?

• Are the programs and services adequately staffed?
• Are qualified professionals managing the programs and services?
• Are the facilities, equipment, and other resources adequate?

• Are the various stakeholders (e.g., survivors, departmental managers, police officers, local legislators and community leaders, health and community service providers) satisfied with postvention? What are their perceptions of postvention?
• What improvements can be reasonably made to better satisfy the stakeholders?
• Does the policy(ies) and programs neglect any stakeholder group?

• Is there full compliance with ethical codes covering, for example, confidentiality of medical and service files?
• Is there full compliance with departmental policies, regulations, and administrative procedures?
• Is there full compliance with legislation at the local, state, and federal levels?

• Departmental managers and supervisors might resist an evaluation for fear of being criticized or because they believe that the evaluation process would be too disruptive to the program.
• Some stakeholders might see an evaluation as a waste of resources in terms of staff and an evaluation budget especially if there have been no serious criticisms or critical incidents.
• Some might wonder if the evaluation will be objective or simply a management tool for self- promotion or some hidden agenda.
• Some might believe that any recommendations will not be actioned and that the evaluation will have little impact on postvention.
• Some stakeholders might be fearful that evaluators and others will get access to confidential or sensitive documents.
• A potentially serious problem is that required data and information to address the evaluation questions are not collected and available to the evaluation team. The need to have a confidential and secure data capturing and reporting system is necessary at the start of programs.

The Evaluation Team
Particular attention has to be paid to the composition and credibility of the evaluation team. The team should have representation from departmental officers and the police union, qualified health professionals, survivors and community stakeholders without becoming so large as to be unwieldy. The mandate of the evaluation team and reporting structure must be clearly defined, perhaps adopting existing guidelines used for audits or other program evaluations. The team must be on guard so as not to become co-opted by one or another stakeholder group but remain objective and 'professional' in their work.

The Evaluation Report
To be useful, the evaluation report must:

• present a balanced assessment showing good findings and areas for improvement;
• identify the limitations to the report, for example, areas where data were not available;
• present specific, practical recommendations preferably with the outline of an action plan;
• maintain the confidentiality and anonymity of contributors; and
• be distributed or, at least, available to the stakeholders.

Closing Comments

Select Sources

Critical Incident Stress Debriefing

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4^th ed: DSM-IV). Washington, DC.

Faberow, N. L. (1992). The Los Angeles survivors-after-suicide program. Crisis, 13(1), 23- 34.

Mitchell, J. T., & Dyregrov, A. (1993). Traumatic stress in disaster workers and emergency personnel. In J. P. Wilson, & B. Raphael (eds.). International handbook of traumatic stress syndromes. New York: Plenum Press.

Williams, T. (1993). Trauma in the workplace. Ibid.

Postvention

Shneidman, E. S. (1981). Postvention: The care of the bereaved. In E. S. Shneidman. Suicide: Thoughts and reflections, 1960-1980. Pp. 157-167. New York: Human Sciences Press.

Cain, A. C., & Shneidman, E. S. (eds.) (1972). Survivors of suicide. Springfield: Charles C. Thomas.

Psychological Autopsy

Beskow, J., Runeson, B., & Asgard, U. (1990). Psychological autopsies: Methods and ethics. Suicide and Life-Threatening Behavior, 20(4), 307-323.

Brent, D. A. (1989). The psychological autopsy: Methodological considerations for the study of adolescent suicide. Suicide and Life-Threatening Behavior, 19(1), 43-57.

Lester, D. (1997). Making sense of suicide: An in-depth look at why people kill themselves. Philadelphia: The Charles Press.

Shneidman, E. S. (1981). The psychological autopsy. Suicide and Life-Threatening Behavior, 11(4), 325-340.

Shneidman, E. S., Farberow, N. L., & Litman, R. E. (1970). The psychology of suicide. New York: Science House.

Social Supports for Survivors

Cain, A. C., & Shneidman, E. S. (eds.) (1972). Survivors of suicide. Springfield: Charles C. Thomas.

Knieper, A. J. (1999). The survivor's grief and recovery. Suicide and Life-Threatening Behavior, 29(4), 353-364.

Saunders, J. M. (1981). A process of bereavement resolution: Uncoupled identity. Western Journal of Nursing Research, 3, 319-335.

Wagner, K., & Calhoun, L. (1991). Perceptions of social support by suicide survivors and their social networks. Omega, 24, 61-73.

Suicide Notes

Bauer, M. N., Leenaars, A., Berman, A. L., Jobes, D. A., Dixon, J. F., & Bibb, J. L. (1997). Late adulthood suicide: A life-span analysis of suicide notes. Archives of Suicide Research, 3, 91-108.

Brevard, a., Lester, D., & Yang, B. (1990). A comparison of suicide notes written by suicide completers and attempters. Crisis, 11(1), 7-11.

Canetto, S. S., & Lester, D. (1999). Motives for suicide in suicide notes from women and men. Psychological Reports, 85, 471-472.

Leenaars, A. A. (1988). Are women's suicides really different from men? Women & Health, 14, 17-33.

Leenaars, A. (1991). Suicide notes and their implications for intervention. Crisis, 12(1), 1-20.

Leenaars, A. (1992). Suicide notes of the older adult. Suicide and Life-Threatening Behavior, 22(1), 62-79.

Leenaars, A. A., & Lester, D. (1999). Suicide notes in alcoholism. Psychological Reports, 85, 363-364.

Lester, D. (1997). Making sense of suicide: An in-depth look at why people kill themselves. Philadelphia: The Charles Press.

Lester, D., & Heim, N. (1992). Sex differences in suicide notes. Perceptual and Motor Skills, 75, 582.

Lester, D., & Reeve, C. (1982). The suicide notes of young and old people. Psychological Reports, 50, 334.

Shneidman, E. S. (1981). The psychological autopsy. Suicide and Life-Threatening Behavior, 11(4), 325-340.

Tuckman J., Kleiner, R. J., & Lavell, M. (1959). Emotional content of suicide notes. American Journal of Psychiatry, 116, 59-63.

Evaluation of Postvention Policies and Programs

Loo, R. (1987). Policies and programs for mental health in law enforcement organizations. Canada's Mental Health, September, 18-22.

Paton, M. Q. (1980). Qualitative evaluation methods. Newbury Park, California: Sage.

Patton, M. Q. (1986). Utilization-focussed evaluation. Newbury Park, California: Sage. Publications.

Posavac, E. J., & Carey, R. G. (1985). Program evaluation: Methods and Case Studies. Englewood Cliffs: Prentice Hall.

Rossi, P. H., & Freeman, H. E. (1989). Evaluation: A systematic approach. Newbury Park: Sage.

Web Sites

Australia

Lifeline Melbourne (www.lifeline.org.au)

Canada

Canadian Association for Suicide Prevention (www.suicideprevention.ca)
Suicide Information & Education Centre (www.siec.ca)

United Kingdom

The Samaritans (www.samaritans.org.uk)

USA

American Association of Suicidology (www.suicidology.org)
American Foundation for Suicide Prevention (www.afsp.org)
Suicide Prevention Advocacy Network (www.spanusa.org)
Suicide Awareness (www.save.org)

• Suicide and the Police Officer
• Suicide Survivor
• Beyond Stress (a series of six videos)
• Reducing Stress
• Understanding Depression
• Depression: Beyond the Blues

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