A Research Agenda to Support Mental Health and Wellness Programs for Federal First Responders and Law Enforcement

Concerns about the physical health, mental health, and safety of first responders and law enforcement officers have been increasing for some time. In recent years, the public has become more aware of the overall mental toll borne by law enforcement, and the tragic consequences of poor mental health.^[1]

Research suggests that the stress endured by police officers results in “higher rates of heart disease, divorce, sick days taken, alcohol abuse, and major psychological illnesses such as acute stress disorder, post-traumatic stress disorder, depression, and anxiety disorders.”^[2] Evidence also suggests that the suicide rate estimated for law enforcement professionals is higher than that of the general population for both men and women.^[3]

At the same time, the public perception of law enforcement, including officers at the U.S. Department of Homeland Security (DHS), has been polarized. Ensuring that officers’ mental health and wellness is continuously protected is integral to the DHS strategic plan’s priority of championing the DHS workforce. The safety and wellness of DHS first responders and law enforcement are critical not only to their personal well-being but also to their ability to do their work.

With approximately 80,000 federal law enforcement officers, intelligence analysts, and other staff in its agencies, DHS is uniquely positioned to take positive steps to change the professional culture to a model that prioritizes safety, health, and wellness. However, there is a dearth of evidence about the effectiveness of law enforcement mental health programs, which affects knowing what works.

The goal of this project was to synthesize evidence from the growing literature on mental health and wellness programs studied with law enforcement and first responder populations to help DHS identify and strengthen programs and policies for the federal workforce. RAND researchers also held interviews with key stakeholders in DHS and assessed programs to determine whether they were ready for evaluation. Findings from these tasks were used to develop a research agenda for future DHS federal law enforcement officer and first responder wellness research efforts.

Research Approach

To synthesize existing evidence and extract findings that would help DHS identify and strengthen programs to prioritize worker safety, health, and wellness, RAND researchers conducted a systematic review of the scientific literature to develop an understanding of the current state of the field. Academic and gray literature sources from 2015 through 2023 were included in the analysis if they focused on (1) studying the actual or perceived effectiveness of a wellness-related program, policy, intervention, or initiative; (2) law enforcement or first responders; and (3) a wellness outcome of relevance (e.g., substance use, morale, stress, trauma, well-being, physical health). Only English-language sources from U.S. or international sources were included, and the research team considered dissertations, theses, and magazine and newspaper sources. Of 3,012 articles screened, 91 met all the criteria for inclusion.

RAND researchers then interviewed 18 subject-matter experts involved in law enforcement wellness programming or research to get input on the research in which the individuals or their agencies were involved and their perspective on the most-pressing topics related to law enforcement wellness. The interviews also inquired about what specific research needs are not being addressed by their agency or by the field. Likewise, the interviews focused on finding programs that were ready for evaluation. For this evaluability assessment, the RAND team conducted follow-up interviews with key staff from five unique DHS wellness-related programs to assess their readiness for an evaluation. The data collected from the literature review and interviews were used to identify research questions, study designs, and research challenges for the research agenda.

Key Findings

After reviewing mental health and wellness programs for law enforcement and first responders in the literature and interviewing key stakeholders in DHS, RAND researchers distilled their findings, which are summarized here. Figure 1 briefly describes the types of mental wellness programs considered in the review.

Wellness Program Effectiveness According to the Literature and Interviews with Stakeholders

In the literature, the most-studied wellness programs for law enforcement and first responders focused on group prevention skills and knowledge training, psychotherapy, physical fitness, and mindfulness training. The researchers found some evidence that psychotherapy and mindfulness training reduce mental health symptoms. Physical fitness programs were also generally effective.

However, the limitation for most of the studies was that they did not use rigorous methods, such as large sample sizes, random assignment of participants to treatment and control groups, and outcomes other than knowledge change (e.g., mental health and wellness outcomes). In addition, there were relatively few studies for some programs, such as suicide prevention training; mobile health applications; and peer support, mentoring, and chaplain programs. This limited the conclusions that could be drawn from these studies.

According to interviews, certain programs, such as suicide prevention training, physical fitness programs, mindfulness training, and mandatory postvention efforts (i.e., interventions conducted after a critical incident), were generally described by employees across DHS components as effective. However, in each type of program, there was considerable variation in content and delivery, making it difficult to draw conclusions about the program’s effectiveness or to determine whether the DHS programs discussed by interviewees were consistent with effective practices in the literature.

Readiness for Rigorous Evaluation

Most of the programs included in this evaluability assessment were not ready for a rigorous impact evaluation. Barriers to evaluation included a lack of time and resources to conduct an evaluation and insufficient leadership support. In addition, programs did not have existing data-collection efforts or access to data for research.

Barriers to Program Use

Interviews identified barriers to wellness program use, some of which were unique to the law enforcement profession, such as the influence of a workplace culture that discourages help-seeking and the fear of losing one’s security clearance or approval to carry a firearm. Insufficient understanding of law enforcement culture was also cited as a deterrent to seeking support or continuing to use counseling services.

Organizational barriers to program use include a lack of resources to fund programs or on-site mental health clinicians and employees not feeling that they have sufficient time to seek out support. In addition, many DHS employees operate in remote environments that make it more difficult to provide on-site wellness resources. Other reasons, which are more common across other types of industries, include concerns about confidentiality, insufficient supervisory support, and lack of awareness of the resources available to employees.

Recommendations for a Future Research Agenda

Future research and evaluation remain a top priority as DHS continues its work in implementing health and wellness programs. Research is critical to improving and strengthening these programs. Research can inform evaluation and performance management, which, in turn, can increase the efficacy of ongoing programs and thus ensure the most effective use of limited resources. Conducting research allows program leaders to consider and develop criteria to assess program effectiveness, develop appropriate data-collection capabilities, and consider external evaluations of programs.

Drawing on findings from the literature review and interviews, the research team developed recommendations for a future research agenda. Figure 2 shows the key steps involved in developing an agenda.

Initial Considerations

The first step is to determine the outcomes of interest. With the understanding that DHS might have a unique population, researchers can help practitioners plan, implement, and evaluate their programs to achieve results. This includes thinking about needs and resources, goals, evidence-based practices, fit, capacity, plan, implementation, outcome evaluation, continuous quality improvement, and sustainability. Having initial discussions to identify the purpose and scope of an evaluation and the most important stakeholders can help prevent wasting resources on premature or misfocused research and can inform judgments about the worth and usefulness of a potential evaluation.

The second step is to determine what adjustments, if any, will need to be made to program design and implementation and what measures or data systems are needed to support a more useful evaluation. It is critical to bring in relevant stakeholders to build consensus about the program and its evaluation. The third step is to formalize an agreement between evaluators and the program office on what is most important in the program, what problems might be anticipated with evaluation, and what is needed for successful evaluation.

1. Establish consensus on the outcomes of interest
2. Determine adjustments needed to support a more useful evaluation
3. Formalize agreement between evaluators and the program office
4. Identify research questions
5. Identify measures of the outcomes of interest

Initial Research Questions and Measurement

The next step is to develop questions to be answered by the research. The team combined the results of the literature review and the expert interviews to create a preliminary list of high-priority research questions, along with potential study designs to answer the questions, and methodological challenges (see table). Any future research acknowledges that foundational knowledge on this topic is needed and that research funding is critical, as are appropriate research designs that necessitate adequate data and methods.

After identifying research questions and establishing group consensus on outcomes of interest, the final step is to identify measures of those outcomes. Many outcomes, such as stress, depressive symptoms, physical health, and burnout, were shared across the different types of wellness programs included in the literature review. Short, validated, self-reported measures are available for each of these outcomes, and could be included in a wellness program evaluation. The choice of measure will depend on the goals of the research and anticipated outcomes and as practical considerations related to the research context (e.g., time available for respondents to answer questionnaires).

Conclusions

A wide variety of wellness programs have been implemented across DHS. Although existing research has found support for the effectiveness of certain programs, barriers to program evaluation mean that few programs are currently ready for evaluation. Nonetheless, steps could be taken that could increase programs’ readiness for an outcome evaluation, such as developing logic models, identifying metrics, and collecting outcome data.

Although a lack of program standardization could make it challenging for DHS to adopt existing programs, DHS could consider focusing on program areas that have strongest research support, such as psychotherapy, mindfulness, physical fitness programs, and group skills and knowledge training. Future research priorities identified in this study could also help DHS develop an ongoing research agenda with the potential to improve existing wellness programs and identify where needs are still unmet, ultimately leading to better organizational and wellness outcomes.

Notes

• [1] Joseph Choi and Brooke Seipel, “Fourth Police Officer Who Responded to Jan. 6 Attack Dies by Suicide,” The Hill, 2021; Brian R. Nanavaty, “Addressing Officer Crisis and Suicide: Improving Officer Wellness,” FBI Law Enforcement Bulletin, 2015; John Violanti, “PTSD Among Police Officers: Impact on Critical Decision Making,” Community Policing Dispatch, 2018.
• [2] U.S. House of Representatives Committee on the Judiciary, “House Judiciary Committee Approves Bill to Improve Mental Health Services for Law Enforcement Officers,” press release, October 12, 2017.
• [3] John M. Violanti and Andrea Steege, “Law Enforcement Worker Suicide: An Updated National Assessment,” Policing, Vol. 44, No. 1, 2021.

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Topics

• Depression
• Emergency Responders
• Law Enforcement
• Posttraumatic Stress Disorder
• Suicide
• Workplace Wellness Programs