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Substance use: A matter of trust

How to revolutionize substance use treatment for Canada’s cops

Male commits suicide by jumping in front of train. I’m tasked with picking up bits of body.

First on scene, murder victim has her throat slit and is partially gutted.

First on scene, suicide. Deceased blows head off with a shotgun. Can smell blood, gunpowder, charred flesh.

When asked to provide examples of traumatic police experiences, veteran police officer Andrew Leng from Hamilton, Ont., referred to his “rolodex of horrors.” Civilians recoil at the visceral nature of these images; we can’t imagine living through even one of these incidents. Yet for Leng, an officer since 1996, the hits just kept on coming.

Two fatal accidents within two hours in one night.

Intoxicated male struck by 18-wheeler. Body severely mangled.

Next, I see someone on fire. Man commits suicide by crashing his car.

Like many, Leng tried to manage his trauma alone. He started drinking. “I was angry, ruminating in my own stuff, self-sabotaging.” Still, he refused to seek help. “If you admit you’re struggling, all your use-of-force options are gone. My gun, my badge; the artifacts of our culture. Take them away and I’m broken.”

As the trauma accumulated, Leng developed undiagnosed PTSD. A fortuitous meeting with a sympathetic psychiatrist led to an inpatient stay at a treatment centre. Leng’s been well ever since and now helps struggling officers.

His ordeal is part of a well-documented problem in police work: addiction. According to the Centre for Addiction and Mental Health (CAMH), 36.7 per cent of municipal/provincial police and 50.2 per cent of RCMP experience current mental health symptoms; 29 per cent are in the diagnostic range for Post-Traumatic Stress Disorder (PTSD).

To Keith Clark, drinking to forget is a decades-old cop coping mechanism. “The occupational stress is enormous. We self-administer our drug of choice: alcohol.” Clark, now retired, was the Assistant Commissioner of the RCMP. His last position was Head of Change Management. His priority was to find better ways to support the members. “There’s this huge fear if you go to your boss and say ‘I’m suffering’, it sounds like you are weak, not dependable. We suppress it by drinking.” His comments are echoed by current officers, in an all-police confidential support/therapy group called HEART, run by addiction therapist Pat Davies.

My supervisor had a 40-pounder in his desk.

I was terrified not to drink. It was part of police life.

If you didn’t drink you wouldn’t be trusted.

HEART stands for Healing Esteem Awakening Reality Trust and is supported by the Toronto Police Association. To Davies, one of the traits that makes an officer excel on the job – empathy – is the very reason they succumb to drinking: to kill the pain. Davies says cops must be given tools to deal with the fallout of all that caring.

“What we do, see and feel leaves its mark. The result of some calls, you can’t unsee,” says Norm Lipinski, the Chief of the new Surrey, B.C., police service. He’s charged with building a brand-new force from the ground up and plans to scaffold wellness and resiliency into every aspect of his service.

But trauma is just one stressor; Lipinski adds shiftwork to the list. “A body is not designed to work nights. The strain on relationships; the pressure to be perfect. We’re the heroes and we’re supposed to be infallible. When we stumble, it’s more hurtful. We’ve let our fellow officers, family, society and ourselves down.”

Progressive police leaders see opportunity: to transform mental health and substance use support from lip service to something real and tangible.

Policing in the pandemic

Police officers routinely go for drinks after a shift, socializing amongst themselves. It is a chance to decompress with trusted colleagues, but the pandemic took that away. “Policing got a lot busier during COVID-19,” says Leng. He shares there were more angry and violent confrontations, more domestic violence, hate crimes, and gun sales.

“The pandemic was very challenging for policing. Police never had the opportunity to work from home. On every call, they were potentially exposed to the virus,” said Kyle Handley, chief psychologist with York Regional Police (YRP).

Then when it felt like things couldn’t get much worse, came the intense public outcry after the murder of George Floyd in police hands. The airing of a string of videos showing officers using force had a profound effect on the profession. Officers who once proudly patrolled began feeling like no one supported them. “Officers feel they are one bullet or one video clip away from losing their life, their livelihood and even their freedom,” says Clark.

Opportunity for change

Yet in these tense, turbulent times, progressive police leaders see opportunity: to transform mental health and substance use support from lip service to something real and tangible. “This is an unintended positive consequence of the pandemic. It made us pause,” says Lipinski. “We’ve gone from ‘let’s keep our people COVID-free’ to addressing wellness overall.”

It won’t be easy. In a national study by the Canadian Institute for Public Safety Research and Treatment (CIPSRT), interviewees believed attitudes and behaviours of management were creating organizational barriers to stigma reduction. The report concludes that significant efforts must be made to understand how to shift an organizational culture that still supports stigma. It states, “Officers need resources that are confidential and police-specific that normalize mental health disorder as a job hazard, not a personal failure.”

Handley has made those significant efforts. His Wellness Bureau at YRP is described as “best in class” by professor Linda Duxbury, an expert on change management at Carleton University. Handley says stigma is even higher for cops battling substance use, because of its nexus with discipline. “Help was referral-based, from your supervisor. I learned that was very stigmatizing, because the supervisor must assess: Is this person okay, or okay to do their job?”

Like most forces, YRP has long had critical incident and peer support – both officers and civilians – but it’s been informal. After an Ontario Ombudsman report revealed the dangerous level of occupational stress in Ontario police officers, YRP Chief Jim MacSween decided to revolutionize mental health and substance use support. “We did not have specialized services for addiction. It was a significant gap.” Handley was hired as the force’s first full-time psychologist to formalize a wellness program.

But like the title of CIPSRT report, it’s all just “window-dressing” if officers still don’t trust their superiors enough to ask for help. “The trust factor is crucial,” says Lipinski. “Cops don’t trust so easily. They only listen to other cops.”

So how to get them to trust an outsider, a psychologist? That was Handley’s foundational challenge: build up trust to break down stigma. “Because of mistrust, members wouldn’t come to us. We had to go to them.” Handley created peer support 2.0, and the wellness team embedded itself into each of YRP’s five districts. “We got out there with members, went on ride-alongs, and we set up localized care teams because each area had its own culture. With each four-member team embedded in each district, we observed officers over time and built trusting relationships.”

That didn’t happen overnight, admits Dr. Handley. “Now when a supervisor or colleague notices something, they inform peer support, who are trained in confidentiality. This model allows us to be present when a critical incident happens, so we can immediately support those at risk of developing PTSD. Because we share their experience, we are one with them.”

In substance use challenges, the YRP Wellness Bureau employs harm reduction. “We meet members where they are at. We work with them through the stages of change. Our model allows officers to get mental health and substance use help while the vast majority remain active members.” The pilot, completed last year, resulted in a 200 to 400 per cent increase in officers reaching out for help and the decision to permanently provide the service to all employees. Handley is in the process of rolling out the embedded program force-wide.

Even with improved trust, confidentiality remained a key concern. Officers with substance use disorders don’t seek help because they don’t believe their supervisors and peers will keep their secret. Handley’s team piloted an innovative tech solution that virtually guarantees it: ALAViDA, a LifeSpeak company.

ALAViDA, Canada’s first completely digital evidence-based substance use treatment provider is designed as a one-stop-shop approach for any level of substance use disorder – alcohol and drugs – mild, moderate and severe. ALAViDA aims to connect patients with behavioural coaches, therapists and physicians who work as a team to deliver personalized care right to their smartphones.

To Elliot Stone, president of ALAViDA, the technology offers management a subtle, but profound shift in thinking. “If you’ve set up a truly supportive plan for substance use, employees would access it just like they do their physio or dental benefit, with complete confidentiality. No one knows that I need physio on my back or a filling. Nor should they. And that’s exactly how we should deliver substance use support. No one needs to know I’m struggling with alcohol or receiving treatment unless my health condition impacts my behaviour or performance at work in a serious way. Normalizing is key to destigmatizing.”

“We looked at ALAViDA’s experience with Fraser Health, a large B.C. health region with over 32,000 employees,” said Handley. “We saw parallels – the stigma, the fear of disclosing an alcohol problem – is as shameful for nurses and doctors as it is for police. And like police, doctors and nurses are also held to a higher standard.”

In conclusion

None of this happens without police leadership willing to change. Clark stated, “In a comprehensive study during my time on the Change Management Team, we found the number one determiner of the health and productivity of a unit is its leader.”

“Police management must believe mental health is a core service. Our senior managers have undergone trauma-informed leadership training,” says Dr. Handley. They’ve learned to effectively support people going on accommodation. For example, it can be as simple as not using the word ‘accommodation’; the intention here is to stop people from using it as a dirty word.

To Clark, “only when leadership sees admitting one’s mental struggles as a sign of strength, will we know we’ve finally changed the culture.”

References

1. CAMH Police and Mental Health 2018 Discussion Paper.
2. Bikos, L.J. (2020) “It’s all window dressing:” Canadian police officers’ perceptions of mental health stigma in their workplace. Policing: An International Journal, 44(1), 63-76. https://doi.org/10.1108/PIJPSM-07-2020-0126
3. Marin, André. <i>In the Line of Duty.</i> October 2012. Accessed at: https://www.ombudsman.on.ca/resources/reports-and-case-summaries/reports-on-investigations/2012/in-the-line-of-duty
4. Sheldon, Mia and Amha, Matthew. “Black market guns: Where they’re coming from and how they get into the hands of criminals.” CBC/Radio-Canada. Accessed at: https://www.cbc.ca/news/national-gun-trafficking-straw-buying-smuggling-firearms-1.5126228
5. “A New COVID-19 Crisis: Domestic Abuse Rises Worldwide.” The New York Times. Accessed at: https://www.nytimes.com/2020/04/06/world/coronavirus-domestic-violence.html
6. The Canadian Press. “Number of reported hate crimes set new record in 2020 as other crimes decreased: Statistics Canada.” CBC/Radio-Canada. Accessed at: https://www.cbc.ca/news/politics/statistics-canada-hate-crimes-1.6389976

Maureen Palmer is a former CBC journalist and producer who co-owns Bountiful Films. She made the documentary “Wasted”, for CBC’s Nature of Things, about her partner Mike Pond’s search for evidence-based addiction treatment. She’s now a subject matter expert writing primarily about substance use.