CAPT Arnold Farley for LCDR Christine West RN, MSN, MPH

1. Follow-up Mental Health Assessment in the New Orleans Police Force USPHS Scientific and Training Symposium San Diego, California May 26, 2010 CAPT Arnold Farley for LCDR Christine West RN, MSN, MPH Centers for Disease Control and Prevention National Institute for Occupational Safety and Health Hazard Evaluations and Technical Assistance Branch

2. Objectives Compare and contrast the mental health symptom prevalence of NOPD personnel at 2 and 15 months after Hurricane Katrina Describe personal and occupational factors that may have influenced mental health outcomes in police officers Identify recommendations to NOPD personnel for coping with adverse mental health symptoms

3. What is NIOSH? • National Institute for Occupational Safety and Health • Part of the Centers for Disease Control and Prevention • Conduct occupational safety and health evaluations and make recommendations for workplaces

4. Background • 2 NIOSH surveys Requested by NOPD management • October 2005: 2 months after Hurricane Katrina • December 2006: 15 months after Hurricane Katrina • Follow-up visit Sept 2009 • Discuss findings, ongoing concerns and additional recommendations

5. 1st Survey, 2005 • 912 NOPD personnel participated • 60-70% participation* • 80% Male /Average Age: 38 Years /Average Job Tenure: 11 Years • 19% symptoms consistent with PTSD • 26% symptoms consistent with major depression • PTSD symptoms associated with involvement in crowd control, body recovery • Depressive symptoms associated with rare family contact, uninhabitable home, and isolation from regular NOPD assignment • Both PTSD and depressive symptoms associated with being assaulted and injury to family member * Denominator estimated

6. 2nd Survey, 2006 • Compared results to 1st Survey • Only included those who participated in 2005 survey • Determined prevalence of physical and mental health symptoms in 2006 • Distributed anonymous, self-administered questionnaire to police at several locations • Distributed resource packet of medical and mental health referral information

7. What was in the Questionnaires? • Work history and locations • Family circumstances, level of damage to residence, use of sick leave, personal activities, and job satisfaction • Physical and mental health status • Respiratory / skin rash / gastrointestinal symptoms • Posttraumatic stress disorder and depressive symptoms • Past medical history • Use of counseling services and health care services

8. What was in the Questionnaires? • Work history and locations • Family circumstances, level of damage to residence, use of sick leave, personal activities, and job satisfaction • Physical and mental health status • Respiratory / skin rash / gastrointestinal symptoms • Posttraumatic stress disorder and depressive symptoms • Past medical history • Use of counseling services and health care services

9. Results of 2006 NIOSH Survey • 808 NOPD personnel completed questionnaire • 68% response rate • 72% Male • Average age: 40 Years • Average job tenure: 13 Years • 85% commissioned police officers • 61% field/patrol capacity

10. Comparison of Symptoms 1st to 2nd Survey

11. Use of Counseling Services

12. Satisfaction with Job Factors

13. Group Characteristics from Findings • PTSD and depression changed little • Higher rates of PTSD and depression • Symptoms may persist in some personnel • Continue to experience stressors from routine duties and reminders of hurricane • Disruption of social support structure • Living in temporary homes

14. Gastrointestinal Symptoms • Increase in gastrointestinal symptoms from 2005 to 2006 • Did not evaluate exposures • Stressful life events and anxiety may be related to physical symptoms

15. Counseling Services • Use of services did not increase • Lack of awareness • Personnel may be uncomfortable seeking care • Lack of availability of services in the city

16. Limitations • Actual symptom prevalences may be different from reported prevalences • Self-reported symptoms • Unable to survey personnel on sick leave (~5%) • Unable to conduct direct comparison of symptoms • May not be able to attribute symptoms to hurricane events • May be underestimation of mental health symptoms due to reluctance to report

17. Recommendations • Develop strategies to increase use and acceptance of seeking care and treatment • Develop and implement a comprehensive occupational safety and health program: • Joint employee-management committee for safety and health • Medical screening / pre and post event • Employee assistance program • Develop strategies to increase social support

18. Follow-up visit to NOPD in September 2009 Presented summary of findings from 2nd survey report Provided additional recommendations Presented strategies for improved social support Met with department representatives and officers to discuss ongoing health and safety needs of personnel Distributed handouts to police district stations

19. Additional concerns raised Sep 2009 • Personnel continue to recount stories about their experiences during Hurricane • Continue to live apart from families, and in some cases this has resulted in divorce and custody battles • Observed increased anger, irritability, excess alcohol consumption, and requests for time off • Continued reluctance to access services • Need for additional officers on force • Lost 20% of police force since Hurricane

20. Handout on giving and receiving social support • Developed for NOPD • Reluctance to seek care • History of suicides in police force • Reliance on coworkers for support • Lack of mental health resources in NOLA • Lack of awareness from management • L.A.S.E.R.: Look, Ask, Support, Evaluate, Receive • Acronym to help personnel remember several important steps to looking out for each other and offering social support • Adapted from Psychological First Aid : Field Operations Guide

21. Recent changes and developments • Louisiana Spirit Program • City-wide hurricane recovery resources • Employee Assistance Program • Working on funding mechanism in Department • Department Disaster and Preparedness Plan • Includes policy for liberal use of furlough and sick leave, and completion of a personal emergency evacuation plans • Guidance on accessing health care during the disaster, ensuring the safety of evacuation sites, and procuring food and water

22. Acknowledgements • Co-authors: • Charles Mueller • Bruce Bernard • Richard Driscoll • NOPD management and personnel • Major Juan Quinton • Dr. Armond Devizen • NIOSH field assistants and supervisors The findings and conclusions are those of the author and do not necessarily represent the views of the National Institute for Occupational Safety and Health

23. More Information • Contact Information: Project Officer: cawest@cdc.gov Behavioral Scientist at NIOSH: dwiegand@cdc.gov • Health Hazard Evaluation Program: www.cdc.gov/niosh/hhe • Link to Health Hazard Evaluation Report in October 2005 and December 2006: http://www.cdc.gov/niosh/hhe/reports/pdfs/2006-0027-3001.pdf http://www.cdc.gov/niosh/hhe/reports/pdfs/2007-0067-3076.pdf • Science Blog on police and stress: http://www.cdc.gov/niosh/blog/nsb063008_policestress.html

24. References • Abramson D, Stehling-Ariza T, Garfield R, Redlener I [2008]. Prevalence and predictors of mental health distress post-Katrina: Findings from the Gulf Coast child and family health study. Disaster Med Public Health Prep 2(2):77–86 • Carlier IV, Lamberts RD, Gersons BP [1997]. Risk factors for posttraumatic stress symptomology in police officers: a prospective analysis. J Nerv Mental Dis 185:(8)498–506. • DeSalvo KB, Hyre AD, Ompad DC, Menke A, Tynes L, Muntner P [2007]. Symptoms of posttraumatic stress disorder in a New Orleans workforce following Hurricane Katrina. J Urban Health 84(2):142–152.  • Fullerton CS, Ursano RJ, Wang L [2004]. Acute stress disorder, posttraumatic stress disorder, and depression in disaster on rescue workers. Am J Psychiatry 161(8):1370–1376.  • Galea S, Brewin CR, Gruber M, Jones RT, King DW, King LA, McNally RJ, Ursano RJ, Petukhova M, Kessler RC [2007]. Exposure to hurricane-related stressors and mental illness after Hurricane Katrina. Arch Gen Psychiatry 64(12):1427–1434.

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