Mental Health

sec_arr Introduction

Authors: Gaurava Agarwal, MD and Michael Levine, MD, MPH, FACOEM

Publication year: 2020



In many cases, the well-educated, well-motivated law enforcement officer (LEO) whose mental health condition is properly treated can be capable of safe and effective job performance. However, untreated psychiatric conditions or unresponsiveness to treatment, may place the LEO at risk for significant impairment or sudden incapacitation. Symptoms may interfere with good judgment and the ability to interact with others. For some LEOs, internal stimuli may be distracting. These factors may jeopardize the LEO’s ability to perform essential job tasks. In all cases, an individualized clinical evaluation of the LEO’s mental health condition should be performed to determine whether the LEO’s condition permits safe and effective job performance.

In writing this document, the LEO Task Group reviewed existing mental health qualification standards for workers in other safety-sensitive fields. These are summarized in Appendix C. The following concepts support guidance of the Task Group:

  • Mental health disorders (and some treatments) in the LEO may pose a risk to the individual officer, co-workers, and the general public
  • law enforcement work creates unique stresses, hazards, and safety concerns for LEOs with mental health disorders
  • the course of a mental health disorder is not always predictable
  • treatment efficacy can take several weeks to months to assess
  • development of adverse effects requiring medication changes is not uncommon
  • even when treatment is efficacious, LEO adherence is often sub-optimal
  • non-adherence is often underestimated by mental health providers
  • for many mental health disorders, the risk of recurrence is high

Psychological evaluation of LEOs most often occurs during the pre-employment phase after the conditional offer of employment. However, it is also acceptable to order such evaluations to assess the fitness for duty of current officers. In Watson v. City of Miami Beach, 177 F.3d 932 (11th Cir. 1999), the Eleventh Circuit considered the legality of a fitness-for-duty evaluation (FFDE) for an officer who displayed “unusually defensive and antagonistic behavior towards his co-workers and supervisors,” but whose job performance was otherwise satisfactory. Id. at 934. Recognizing that “[p]olice departments place armed officers in positions where they can do tremendous harm if they act irrationally,” the court held that the Americans with Disabilities Act (ADA) does not “require a police department to forego a fitness for duty examination to wait until a perceived threat becomes real or questionable behavior results in injuries.”

This document does not address administrative issues, such as inappropriate performance or conduct, which occur in the absence of a mental health diagnosis, nor is this document meant to address every type of mental health disorder. For example, personality disorders can lead to performance or conduct issues and are rarely accommodated with work restrictions. It is anticipated that behavioral manifestations of personality disorders will be handled administratively rather than medically. This document is limited to mental health disorders that are most common and relevant to LEOs.

The police physician should always assess for adverse effects from any medication or other treatment the LEO may be using to treat these disorders (see LEO Medications chapter). For issues relating to substance use and abuse, see the LEO chapter on Substance Use Disorders.

This chapter addresses the following mental health conditions as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th edition (see Appendix A).3

  • Depressive Disorders
  • Bipolar Disorders
  • Anxiety Disorders
  • Psychoses
  • Post-traumatic Stress Disorder (PTSD) and Acute Stress Disorder
  • Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)