Commentary: A police officer’s lot is not a happy oneBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2252 (Published 19 April 2011) Cite this as: BMJ 2011;342:d2252
- Simon Wessely, professor
Derek Summerfield’s time spent working as a psychiatrist in the occupational health department of London’s Metropolitan Police Service was frustrating for him, and for the police officers that he saw.1 Summerfield found little evidence of formal mental disorders in the officers; they perceived him as a barrier between themselves and the ill health retirement to which they felt entitled. Labels such as post-traumatic stress disorder or work stress were common, ill defined, and rarely led to satisfactory treatment. Instead, Summerfield felt that professional, occupational, and domestic issues were more relevant, but ones that both doctor and officer were powerless to address. Summerfield echoes the comments of two sociologists who link the medicalisation of the workplace and the epidemic of work stress: “Why do problems and antagonisms which previously led to the picket line and the political demonstration now so often lead to the general practitioner or the counsellor?”2
Summerfield is describing the stasis that can develop once an employee starts the search for ill health retirement, especially if this is for mental health or quasi-mental health problems. A similar systems inertia has been postulated in the vast US Veterans Administration, which cares for former service personnel with a service related disability. Once veterans file for disability, treatment of their problems becomes increasingly fraught and fruitless.3 The dilemmas of the employee trapped in a system that creates perverse barriers to recovery and leaves both patient and doctor increasingly irritated and powerless, have been recognised. Carol Black’s 2008 report for the Department of Work and Pensions noted the problem, but whether the proposed reforms will tackle it remains to be seen.
As with the armed forces, sources of stress within the police force are somewhat different from the popular perception. Of course, both police officers and military personnel are occupationally exposed to traumatic events. However, these are not the main sources of stress in the police, any more than in the military.4 What outsiders call trauma, is for many the reason why they have joined the uniformed services. Instead, too many studies to cite report that organisational culture and workload are the chief causes of unhappiness and stress within police forces.5 It is the violation of professional codes of conduct and behaviour that are more likely to lead to occupational psychiatric injury in all the uniformed services.
Summerfield’s dispatch from the occupational front line can be contrasted with the situation in the UK armed forces. Most people who join the services intending to make it their career will expect to leave in their 30s and 40s, with only a few progressing to the highest ranks. They will receive a good pension and a generous resettlement package to prepare them for a second career. There is a separate process surrounding the award of war pensions, which are to recompense those who have been injured in service, and for which medical evidence is necessary.
One reason such a system has evolved is because war is a young person’s game. The physical strain of deployment, and the impact on families, becomes increasingly onerous as you enter middle age, and most will choose to develop a second career.6 Likewise, for police officers who have not made it to senior command, there comes a point when chasing criminals or grappling with rioting students is no longer for you. But Summerfield is suggesting that the process of leaving, at least in the Met, has become increasingly medicalised, with the result that officers leave embittered and encumbered by inappropriate medical labels that will make it far more difficult for them ever to work again.
Working lives have changed beyond recognition over the last century, but for Summerfield’s police officers some things have not changed as much as we might believe.
“If any single factor dominated the lives of nineteenth-century workers it was insecurity . . . They did not know when accident or sickness would hit them, and though they knew that some time in middle age they would become incapable of doing a full measure of adult physical labour, they did not know what would happen to them between then and death.”7
Cite this as: BMJ 2011;342:d2252
Competing interests: The author has completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from him) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; He is an honorary civilian consultant adviser in psychiatry to the British army.