Wanted: Police officer to protect life and property and secure the safety of citizens. The work environment may be physically demanding, stressful, and dangerous.

Advertisements for police officer positions may list 20 or more requirements for the job, but they rarely specify the inherent dangers that come with the profession. Whether an officer has been on the job for a day, a year, a decade, or more, there is the omnipresent possibility of that officer becoming involved in a traumatic incident. How well you deal with the aftermath of a shooting, a fatal accident, a crime against a child, or any number of other traumatic situations is determined by a number of factors. When an individual's inability to cope with the effects becomes too overwhelming, then he or she may develop Post-Traumatic Stress Disorder.

Today, the initials PTSD are familiar to many in law enforcement. Less known are the vagaries with which it is incurred, manifests, and is treated. In 1980, the American Psychiatric Association introduced PTSD in its Diagnostic and Statistical Manual of Mental Disorders, and has since refined the criteria by which PTSD is diagnosed.

PTSD is not new. The symptoms associated with PTSD have long been recognized. The horrors associated with the trench warfare of World War I saw hundreds of thousands of service men physically and emotionally scared, with fewer means of dealing with their trauma. At the time, medical professionals labeled this phenomenon as combat fatigue or shell shock.

As time went by, not only was PTSD diagnosed of war veterans, but of others who'd suffered some damage to their psyche as the result of being exposed to a traumatic event. High on the list of professions associated with the condition are first responders, including fire, EMS, and law enforcement.

Symptoms of Misery

Ord Elliott, Vietnam War veteran and author of "The Warrior's Silence," points to the similarities between war veterans and law enforcement personnel. "In law enforcement, men and women are facing many of the same things that you do in combat. You're risking your life. It's perhaps a different form of combat; it's certainly the threat of combat."

In the wake of a traumatic incident, it is not uncommon for law enforcement officers to be plagued by insomnia, fatigue, loss of appetite, recurring thoughts and nightmares, anxiety, depression, numbness, or fear for their own safety. Worse, inability to maintain intimacy with their loved ones or increased feelings of guilt can lead to severe depression or even suicidal thoughts.

If anyone doubts the power of mind over body, all they have to do is look at the very real repercussions that the stressed mind can have on a body further stressed by endless sleepless evenings, night terrors, and sweat-soaked sheets. It is hardly surprising that these effects should become self-replicating and self-strengthening as the sleep-deprived person's judgment becomes increasingly subject to question.

Cultural Barriers

PTSD can be greater than the sum of its already heady parts, so dealing with PTSD is a formidable challenge for the profession. When officers, dispatchers, and civilian law enforcement personnel are diagnosed with PTSD, it is important that they, their departments, and their family members be able to seek out and find treatments that best suit their individual needs.

Perhaps the largest barrier to finding effective treatments and support systems is the culture that exists within law enforcement. The profession requires officers to rein in their own emotions in order to take control of complex situations. Flipping that emotional switch and turning their focus inward can be difficult for those engaged in a profession steeped in "never let them see you cry" sensibilities. Even when their department offers mental health services, officers may be reluctant to use the service fearing lack of confidentiality or the perception of weakness.

Terry Bykerk, a retired Grand Rapids, Mich., police officer, notes that individuals may react differently to a single traumatic incident. "What can be a minor experience to one person can be traumatic for another. There may be a higher risk with someone who is an introvert, less social, less physical. They tend to be gatekeepers with their emotions."

The first step toward breaking down the emotional and cultural barriers in law enforcement is to address the issue during academy training. Bykerk cofounded the public safety training organization Two the Rescue, which conducts pre-incident education in police academies for both police recruits and their loved ones. He notes the importance of addressing the issue early and often: "People are starting to believe that there has to be a change in the way we deal with this problem because the numbers aren't getting any smaller."

To reinforce understanding of mental health issues within the profession, Two the Rescue also provides in-service training for all emergency responders. "There still is the stigma of seeking help and a belief of being weak, but our method of training with family and friends seems to be helping this in leaps and bounds," notes Bykerk. "Once we are able to convince the decision makers that this training is needed, pre-incident education in combination with after-action methods reduces not only PTSD, but divorce, alcoholism, and suicide rates among emergency responders."

Anonymous Help

Adam Pasciak agrees that early intervention is the key to successfully treating PTSD in law enforcement. As a sergeant with the Redford Township (Mich.) Police Department, Pasciak received injuries in an on-duty shooting incident that would later lead to his retirement. He then earned a Ph.D. in clinical psychology, and now works with law enforcement personnel with the expectation that his own experiences will bring a fuller understanding to issues facing officers.

"There is no question that not enough attention is paid to mental health among police officers," says Pasciak. "Undoubtedly, more focus in the academy on how to stay mentally healthy would help—except that these officers tend to be younger and less likely to see how they might be negatively affected. I've found that older officers are more willing to discuss troubling incidents. I imagine that has to do with feeling less like they are competing with anyone and that they have to keep up a facade."

To avoid the stigma associated with psychological services, Pasciak developed the Website , which provides an anonymous forum for officers to share their experiences and provide support to one another in a non-judgmental way.

Another confidential source of support for officers in need is Safe Call Now , also established by a former police officer, Sean Riley. By calling or e-mailing Safe Call Now, public safety employees and their family members can speak confidentially to peers who understand the demands of a law enforcement career and receive referrals to mental health professionals and services.

A number of similar hotlines and confidential forums exist to provide support for law enforcement personnel. As valuable as these outlets are for helping to combat the stigma surrounding mental health in law enforcement, they do not replace the need for more formal support systems within law enforcement agencies. It is imperative that departments offer employee assistance programs, whether developed in-house or outsourced, to their employees.

Statewide Support

The State of South Carolina has developed the South Carolina Law Enforcement Assistance Program (SCLEAP), which provides critical incident stress management to any agency or department within the state for law enforcement officers and civilian employees who have experienced a traumatic event.

Clinical director for SCLEAP, Andrew Gruler, a former special agent with the U.S. Secret Service, believes that the willingness of officers to seek help is changing in most departments. "When I started in law enforcement in 1976, no agent would admit that they were having issues. We felt that was a sign of weakness, and it showed we were not cut out for the job. I now see officers who voluntarily come to see me. More and more officers are seeking help not only for mental/stress issues but also drug and alcohol issues. To quote Dylan, 'The times they are a changing...'"

The South Carolina program also sponsors post critical incident seminars, developed by the FBI, to help law enforcement officers, civilian employees, and their significant others who are struggling with PTSD and critical incident stress. The three-day seminars, held twice yearly, provide group discussions led by law enforcement peers, education, and mental health services.

A similar program designed specifically for first responders who suffer from PTSD and other mental health problems is offered through the Brattleboro Retreat. The Uniformed Service Program, led by former Rhode Island police officer Frank Gallo, also emphasizes peer support and provides opportunities for physical activity in a calm and relaxing environment. The retreat has nine miles of trails, a ropes course, a basketball court, and other facilities, and offers a number of psychotherapy groups, including mindfulness training, sleep and dream therapy, acceptance and commitment therapy, recreation therapy, practical recovery, and trauma sensitive yoga.

As clinical director for the First Responder Support Network, Dr. Mark Kamena believes that the build-up to the treatment program is as important as attending the program itself. The Network conducts the West Coast Post-Trauma Retreat, a six-day residential treatment program for first responders and their spouses, as well as an educational program of advanced peer support training for first responders. Prior to participation in the program, each participant is paired with a peer coordinator who maintains contact and provides guidance in preparation for the retreat. During the program, clinicians, chaplains, and peer counselors—often fellow officers or firefighters who have gone through the program—work directly with the individual to develop a 90-day treatment plan that is tailored to his or her specific needs. Following the program, monthly follow-ups and periodic assessments are conducted to maintain progress toward the individual's recovery plan.

Covering the Costs

Funding for PTSD programs is often covered by worker's compensation or health insurance, employee unions, or the employing departments, minimizing the amount of out-of-pocket expenses for the individual.

For officers seeking treatment programs for PTSD, it is important to find a program that meets their individual style and pocketbook. Kamena suggests that officers first receive an evaluation from a qualified physician, particularly someone who understands PTSD. If an officer's agency does not offer an employee assistance program, they can call their local Veterans Administration Hospital and ask for recommendations to local therapists who treat PTSD.

It is important to note that PTSD can have far-reaching effects—to an officer's family and friends, co-workers, and the public they continue to serve. More importantly, officers who have experienced a traumatic event and are having difficulty coping must understand that they are not alone.

"Although most civilians can never understand the horrors of the job—of perpetually wondering what that last moment of life might be like—there are ways in which the families of officers, and others, can help," notes Vietnam War Vet and author Elliott.

"For families who know their loved ones have been through a traumatic event, trying to get them to talk about it or deal with it or pressing them is probably the wrong thing to do. Just being there, being patient, listening, being supportive in a quiet way, knowing that they may behave differently is something to expect rather than something to react to negatively. The softer way of being with someone is helpful. You won't go wrong with loving tolerance while seeking the help of a trained professional to help your loved one work through problems like depression and anxiety," Elliott says.