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    Mental Health and Law Enforcement

    May 11 2022

    On this episode, we're joined by former San Antonio, Texas law enforcement officer turned mental health and policy consultant Joe Smarro and psychiatrist and medical director for the Crisis Services branch of Milwaukee County, Dr. Tony Thrasher. Listen as we explore how trauma and culture affect how police officers handle situations, how we can do a better job of ingraining mental health and wellness into law enforcement, and suggestions for improving outcomes for officers and our communities.

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    Transcript for Audio

    Christopher Chun-Seeley: Hello, welcome to Mentally Healthy Nation, a podcast of the American Psychiatric Association Foundation. I'm today's host, Christopher Chun-Seeley. Law enforcement careers have been under a microscope for decades, but despite continuous national conversations about policing practices, the mental health and wellness of law enforcement officers haven't received the same attention.

    Christopher Chun-Seeley: Fear triggers a fight, flight or freeze response. But, two of these are often trained out for law enforcement officers. So where does that leave these officers who are already carrying trauma as a result of responding to fatal car crashes, domestic disputes and homicides, and how is it affecting their mental health? On this episode, former Texas law enforcement officer turned mental health and policy consultant, Joe Smarro, and psychiatrist and medical director for the crisis services branch of the Milwaukee County Behavioral Health Division, Tony Thrasher, explore the effects of constant fear and always fighting in high stress situations, how we can do a better job of ingraining mental wellness into law enforcement culture and training, and provide care and support for officers before and after responding traumatic events. Let's join my conversation with Joe and Dr. Thrasher.

    Christopher Chun-Seeley: Thank you, gentlemen, again for joining us here today. Really excited to have this conversation. I would love if we could start off with both of you sharing, what peaked your interest to learn about and/or address issues at the intersection of mental health and law enforcement. Joe, how about you go ahead and get us started?

    Joe Smarro: First of all, thank you for having me here. And, I would say what peaked my interest was, I was doing the work on patrol and I actually had an unfortunate situation my first year on the job. My background was in the military, before that I was in the Marine Corps. So my first year on the job, I had an in custody death, and that kind of sent me into a dark space because I remember leaving the military, wanting to get away from death. And, I found myself in this situation where I fought with a guy for seven and a half minutes before my cover officer showed up. And as soon as we put handcuffs on him, he died. And, that situation was very difficult for me because again, that's not what I wanted to be a part of. And then, I remember just the procedure of being on admin duty and kind of being sidelined, feeling like I did something wrong.

    Joe Smarro: And then, when I went to CIT training, that's when I finally had the aha moment of, oh, wait a minute, this is what we're supposed to be doing. And, if we had had that training in the academy, crisis intervention training, I felt like I would've been more realistically aligned with the job that I was doing day in and day out. And so, I know we're going to talk later on about culture, but for me, that's where I really had that first light bulb moment. I was on patrol. I was out there doing my go getter stuff. It just didn't feel like a right fit for me. But once I went through CIT training, I had a major frame of reference shift. And then, once the mental unit started and I got on the unit, it completely saved my life and changed my career.

    Christopher Chun-Seeley: Thank you, Joe so much for sharing the, I think, heart wrenching story of loss, but also the impact that it had on you and what you were expecting out of a job, what you were trained to do, and then what you encountered out into the field did not match up. And, once that training was introduced, just what that meant for the unit that you served as well within the mental health unit and the creation of that is so huge. Dr. Thrasher, do you want to jump in and tell us a little bit how you got kind of started at this intersection of mental health and law enforcement?

    Dr. Thrasher: Absolutely. And once again, thank you as well for having me on to kind of give the physician perspective on this. I would say my introduction was twofold. One part was systemic, and one part was personal. The systemic one is when you work in the world of emergency psychiatry, as we do with both psychiatrists and emergency medicine professionals. You naturally are coming into play with law enforcement. Depending upon the state and how systems are set up, you are receiving a lot of individuals, either in law enforcement custody due to certain civil commitment statutes and/or simply because law enforcement is there helping, they are often the main transport, even for people that are not attached to any sort of hold, law enforcement is still helping them get to the care that they need, particularly after hours.

    Dr. Thrasher: So systemically, I think it's natural that I started to take an interest in this very important partner in our system. At a personal level, I think the more that I worked in emergency rooms, either medically or psychiatric emergency rooms, what you started to notice was there were so many similarities between frontline personnel. So by this, I mean emergency medical services, emergency medicine room staff, law enforcement, the people that are there 24/7, no matter what, often helping people through the toughest time in their life. And so naturally as a physician, I was already working with paramedics and a lot of ambulance based services, but I noticed there was not a lot of connection between the world of medicine and this other very important part of our frontline services, law enforcement.

    Dr. Thrasher: So at a personal level, I started to take more interest in that through either CIT training or other collaborations with law enforcement and mental health, not just from the systems point, whereas we're spending time together, therefore we should work together, but even noting the similarities and how many of the stressors and issues that affect frontline staff in medicine would also affect law enforcement.

    Christopher Chun-Seeley: Thank you so much, Dr. Thrasher. And I think, we're going to dive a little bit deeper into addressing some of the systems changes that are coming along when we think about emergency of response, especially for mental health. And, I think it is so needed to continue the partner in the conversations with psychiatrists and emergency professionals and those law enforcement officers. Because, when we do find individuals in the community who have SMI, serious mental illness, chances are they're being brought to emergency rooms, psychiatric emergency drop off centers, or the jails, right? Those are kind of the three options that we find right now. And, the more conversations that we can have across those aisles from a law enforcement perspective, educate our psychiatrists about what the experience of being out in the field, interacting with this community member, and then having to make this decision helps them to understand the role better.

    Christopher Chun-Seeley: And then, for law enforcement also to learn from psychiatrists and those other mental health professionals about that, which is so huge. And, as we all know, there's no shortage of stressful experiences that law enforcement officers are forced to encounter. But Joe, you've already mentioned you're a former law enforcement officer. I'm wondering if you can talk a little bit about how law enforcement culture contributed to your mental health and the mental health of your colleagues and even that creation of the mental health unit and the engagement of other officers in it.

    Joe Smarro: Yeah. It's such a huge piece. And, I genuinely believe that big C word of culture is the greatest barrier to the change that's really needed. A lot of officers don't realize this though coming in and we have to look at this from an inside out approach because I really do believe it's an inside job. And, because the culture of policing tends to be a very closed circuit type of group, they're not super receptive to any advice or opinions from anyone outside of the organization. It's almost always going to have to come from within.

    Joe Smarro: I'll tell you, when I went through the police academy, you hear a lot of just things in law enforcement or a paramilitary organization, which I've never liked, I don't necessarily agree with it and I don't think it's a good thing. And we know this. We know all this stuff out there about how police officers are trained. And, I really think that we need to reframe the way we recruit, who we recruit, how we recruit. And, it starts very early-on. I think we have to truly reimagine... we have to accept that we have a pretty low barrier to entry to get into this profession that has an incredible amount of responsibility, and yet there's almost very little requirement to actually get in, besides some basic physical fitness standards, pass a polygraph, be a relatively decent person and you can get in.

    Joe Smarro: And, on top of that, we also have relatively low compensation rates. Nothing is the same, policing is a highly fragmented profession where nothing is the same across the board. In some police academies you can go in 10 weeks, some you're there for 30 weeks. So, nothing is the same. And, what I tell people is, no matter where someone is in the country, in the United States of America, if they call 911, they have the same expectation. There's a universal expectation that they're going to get the same response, yet the type of officer they're getting is very different based on boundaries, borders, education level, compensation packages, pension packages. There's so many things with that.

    Joe Smarro: And then, specific to the culture, I really also believe that we have a culture of silence. We have a culture of suppression. We have a culture of shame. We do not have a culture of wellness, meaning we don't have policies in place that would actually encourage a first responder to come forward and say, I'm not doing well, I need help, I'm drinking too much, I'm suicidal and not be afraid that they're going to be sanctioned, they're going to be punished and get their weapon taken away, they're going to be put in a hospital, given a fitness for duty and ultimately pushed out of their job.

    Joe Smarro: And, personally again, in my own experience... and, here's what I learned, which I think is super important to understand Chris is, it's not just about providing resources because resources alone are never going to do the trick. And, this is the cultural issue, right? Especially my experience in my department in San Antonio, we had three full-time department psychologists. We had a 55 member peer support team. We had a six team member mental health unit, and yet we still had three suicides in 18 months. Why? It's not about giving me the resources. What I tell people is, again, focusing on the inside job, is you really have to look at it from having those inside champions that have utilized services. And, one of the beliefs I have of many is that therapy should be mandatory for all police officers in this country, starting from the day you start the police academy.

    Joe Smarro: You're going to be issued your PT gear, your books for reading, and here's your therapist, meet Dr. Thrasher. You'll meet with him once a month. And, this is going to happen throughout your entire career. And maybe, after a few years, it goes down to twice a year or three times a year, but until we're mandating something like this, I think the issues are going to continue to be the problem where the most dangerous part of our profession continues to be unprocessed trauma. We're killing ourselves at unprecedented rates and everyone knows there's an issue, but there hasn't been radical enough change to actually do something about it.

    Christopher Chun-Seeley: Joe, I think you gave us a lot to unpack right there. A couple things I want to point out and then I want to jump over to Dr. Thrasher to respond here is the concept of, if you build it, they will come, does not work unless you have that inside out mentality to come with it. Dr. Thrasher, I would love if you touched on how do psychiatrists and other mental health professionals build those relationships so that it does become an inside out piece. Especially because I think something else that you said Joe, about that suffering in silence, I think we see that in the medical profession as well with our physicians and our psychiatrists because of the same factor, right? If I'm not seen as fit to serve this population, then my license will be removed.

    Christopher Chun-Seeley: So I think there might be a lot of parallels to actually explore. Just throwing those concepts out there, Dr. Thrasher. Joe, when you started to think about police officer receiving therapy as a standard for their employment, such a wonderful concept. If we could require everybody to have, gosh, therapy as a part of their employment, where would we be today? But, I think that's a whole 'nother podcast episode. So Dr. Thrasher, I'd love for you to jump in.

    Dr. Thrasher: Yeah. I'm probably a little bit biased on that, because that sounds like a wonderful idea, but obviously I'm coming at it from one perspective. I'm happy to speak to that. The one thing I would add because Joe captured that so perfectly, is one of my favorite phrases from leadership training, which is culture eats process. And, what I see too often is people try to change things by process and by different trainings and educations. And, let's try this different scheme and let's try this particular paradigm. That's all well and good. But if the culture is not there, it will not make a difference.

    Dr. Thrasher: And so, I really appreciated Joe's perspective of that because I think that is the number one thing we try to address when I'm brought into consult on certain things. I don't even start with, hey, let's look at how we're doing it. What I ask is, how does your team feel about this topic? What are their beliefs? Do they feel like this is something they want to improve upon or do they feel this is something they are forced to do because somebody else is not doing it, which is a completely different cultural scope and it puts you in a completely different place as far as receiving education. So culture eats process, I think, can be applied to any field, but particularly Joe and mine.

    Dr. Thrasher: To your point on the parallels, there's a lot of parallels there. The increase in suicide amongst physicians in particular has been on the rise over the past decade. They've got down that there's enough physicians killing themselves every year to fill two medical school classes, which given the lack of physicians across the United States is a pretty big deal, not just as far as the individual level, but also the system level. So I do think there's parallels. And, the parallel that you bring up that I think is so important is, to seek out help, you are concerned as how you might appear to your team. And I think that's very important in law enforcement is teamwork. Somebody having your back. You're working in one of the most dangerous jobs known and as such, how can I trust the people around me to look out for me like I look out for them?

    Dr. Thrasher: And, I do think there can be a cultural opinion that having any issues in mental health makes you less trustworthy. I'm not saying that's accurate, but I think that's a cultural kind of urban legend that still does persist. And, to that point, I think Joe's point about mandating it, may actually have a lot of merit because if we leave it to kind of naturally flow amongst itself, we either might not get as big of a turnout as we would think or the people that need it the most will not be the ones signing up for it. So the people that are already fairly good at self-assessment, they know their strengths, they know their weaknesses are probably the ones that are going to sign up for it and they will do better. But I'm still worried about, I don't think that will grab the people and the officers that are killing themselves every year. The people that are scared to speak up because of how I'm going to be judged.

    Dr. Thrasher: And you definitely to your point, see that parallel amongst physicians. That's something you see very often with physicians that have their own mental health issues, is they're nervous to seek out care for how it could reflect upon them personally. And if that was to ever get out, or if people knew that, how that would affect me getting new clients, how that might affect their liability in malpractice actions or other legalities. So I definitely think you see it a lot. And, having therapy involved for any of these groups is so important.

    Dr. Thrasher: Another issue that was brought up, somewhat germane to what you noted is, how do we treat these individuals, not just compensation, which is an important piece, but also how do we support them? The majority of people work 8 to 5, 40 hour week jobs. 76% of an average week is not during those hours. So three quarters of the time when something happens, it's going to fall to this other group of people, which means even if we are trying to build other kind of psychiatric offices or clinics or therapy clinics, the after hours issue cannot be overstated. 76% of the time, we are relying on a group of people who don't have a lot of other support. They are there frontline safety nets. And as such, not only would I want to see their compensation approach that, either whether it be law enforcement or crisis mobile teams or whoever it may be, but also to have the organizational support for their mental health to recognize it's a lot tougher to handle something at 2:30 in the morning that it is at 2:30 in the afternoon.

    Joe Smarro: To piggyback on what Dr. Thrasher was just saying about culture eats process, what I realized is my last two years on the police department is this whole concept of, we have all the resources in place, but this catchy thing is, don't tell me what we have in place, show me what we have in place. And, officers are more willing to follow leaders who have been through a system than just saying, here's the number, go over there, do that thing. It's hard for them to trust.

    Christopher Chun-Seeley: I want to amplify culture eats process. I think that's so huge. And, I think especially what Joe said about finding that champion, that internal champion that can speak to the successes and can model the behavior that comes out of engaging, that's a larger conversation we are trying to have as a foundation and even here, right? Wellness of officers, we're maybe focusing too much on the negative side of things instead of what happens when you actually engage in treatment and you actually find those supportive services that you need, whether that's mental health or not. There's a lot of different things that can impact a person's ability to be them full selves. And, how do we get to that moment of empowerment.

    Christopher Chun-Seeley: Joe, I'm wondering, how does the mental health of a law enforcement officer impact how they show up to individual cases? The job, you never know quite what you're going to get. And, even when you get a call, you never quite know what's actually going to be on the scene when you show up there. So how does that play a role in how they interact with cases in the field?

    Joe Smarro: It's huge. And to me, and this is what I tell people, whenever I do work with any police agency, and I say, look, sadly, we live in a society where we're very quick to sanction human behavior. Now, this is just human beings in general, right? From the time we're born, you get put in time out, you get your name on the board, you get a speeding ticket, you get put in prison. Everything is a sanction to a behavior instead of curiosity to cause. And, when it comes to police officers, I think again, the reason the most dangerous part of the job, and I'll have officers that say, well, that's because we have tourniquets now or quick clot and that's why we're not dying more.

    Joe Smarro: But, the numbers are the numbers. Yes, those things absolutely are true. And yet they still wouldn't catch the suicide numbers of the last several years. And, why we're even trying to justify or make an argument, I don't understand, even if it was just, we have 10 a year, we still should be doing the work to address those 10 a year, but we know it's way more than that. And, one of the things I tell people is, don't gauge the success of your department's wellness programs on, well, we haven't had a suicide here in 10 years, so we're doing good. We shouldn't be gauging against the metric of suicide. I said, go look at your internal affairs records. Let's see how many line complaints you're getting. How many officers are you writing up for use of force or insubordination or language on body camera.

    Joe Smarro: There's a really good chance if they're showing up to work, doing those things, that they're dealing with some personal stuff at home, that they're not having a stable environment, maybe their sleep is being impacted, they're going through a divorce, a custody battle. There's almost always something else happening. And because we're reactive, we're going to punish them for the call they did today on Friday, February 25th, at two o'clock, not realizing the way they handled that call right now is because of something from yesterday, last week or five years ago that they never dealt with.

    Joe Smarro: What we know about trauma is that it's unprocessed, it's only going to compound. And so now, it's just building on each other, it's building on each other and eventually it's going to implode and it has nothing to do with this person on this traffic stop or on this call, it's just, they couldn't carry the weight anymore. And instead of punishing them again, it's an opportunity for connection and correction, not just an opportunity to discipline. And so, I think we're missing an opportunity there to look at this differently because I do believe the reality to what you said, Chris, is that the officers aren't giving an opportunity to regulate in between calls.

    Joe Smarro: So they stay revved up. They're just amped up all day and then they go home and let's be honest, they don't have the best coping strategies to stabilize. And so, they turn to binge watching Netflix and drinking a 12 pack and then they go back to work again. And so, it's like a lot of them are not putting themselves in the best position to ensure the best outcomes.

    Joe Smarro: And again, this is where it's, again, it's not just understanding this through the lens of the individuals responsible, but I think culturally through each agency, they have to be looking at this holistically and take an honest look, not just touting your success because, well, we haven't had anyone kill themselves. But really looking at, as Dr. Thrasher was saying, anytime he does consulting work, it's like, how do people feel? And, allowing there to be a psychologically safe space where you can maybe have a confidential screening tool that you could really get honest feedback from your agency, that's like, yeah, I don't trust the administration.

    Joe Smarro: If I was struggling, I would not ask for help. That's good feedback. That's good data. But a lot of departments don't want to do that because the truth could scare them.

    Dr. Thrasher: I couldn't agree more. There's a lot of great pieces of that I fully agree with. I think it also gets back to Joe's original assessment that I think some degree of embedded mental healthcare within law enforcement goes a long way. Schedules are very difficult when you're working second shifts and cross shifts. And, it's very hard to take time off, to go see somebody to talk about this if you wanted to. Having somebody embedded that would be confidential is incredibly important. And, I think it would also ease the access, it would normalize it. Even if you could joke amongst each other, hey, what are you doing this afternoon? Oh, it's my turn to go see Dr. Thrasher.

    Dr. Thrasher: That's fine. Whatever it takes to get you there. But if everybody's having to do it, then you don't stand out. I also really liked his perspective on reactive versus proactive. And, I couldn't agree more. I think this goes in all professions. We all noticed the big disciplinary action, but it did not happen in a vacuum, it's been building for a while. Most successful businesses know to look at things like sick days, late reports being turned in. The small little things that lead to that buildup in giving our law enforcement specialists ways and safe ways at work to deescalate or to talk to people to deescalate, or just to be told, you know that feeling you're having, where you go home and you can't sleep, I understand.

    Dr. Thrasher: Normalize some of it so they don't feel like they're the only one. That's one of the hardest things I think in every symptom of mental health is the alienation and the loneliness. It's a very dangerous self-perpetuating cycle where you do feel like it's just you. I can give you all the statistics you want and you can watch all the different programs you want, but you still feel very much like it's just you or that your situation is in such a way that nobody can help. And, anything we can do at the workplace to really emphasize that proactively would help decrease some of those things.

    Dr. Thrasher: Because I fully agree, this is so much more than the sample size of deaths via suicide. It really should be, how is the overall mental health of our staff, which has been shown to reflect in productivity, which has been shown to be good for companies and businesses as a whole, let alone frontline people that work with individuals on their worst days, such as our two departments.

    Christopher Chun-Seeley: I want to emphasize the root causes, right, to what you might be seeing as a disciplinary action. That's what we talk with schools about, right? These disruptive or these withdrawn behaviors, there's root causes that might be happening. And, you're not the expert on it, but you can build a relationship with this person to bridge that connection. And, I think that's even more why it's so important to have kind of that inside out culture shift so that it's a colleague, who's saying, hey, I've noticed this change in you, man, I'm worried about you. I want to let you know that this is kind of who I've talked to internally and it's really helped me.

    Christopher Chun-Seeley: That alone can be a really huge phrase for individuals. And, either of you can jump into this question, but I'm wondering, does it play a role in how law enforcement officers connect individuals to appropriate crisis services and care if they themselves have been connected or trained in crisis intervention training and they have this knowledge base around mental health or better understanding? Do we see a difference in how officers actually approach those cases?

    Joe Smarro: Yeah. And, I'll just give you a personal perspective on this too, because I will tell you that when I first went to the mental health unit, I like many police officers was a huge hypocrite and I would show up every day and I would tell people on the calls, if you would just do X, Y, Z, if you would just go to therapy, if you would just go see your doctor, if you would just take your medication. I get that you're complaining about the police being at your house, telling you have to go to the hospital, but if you would just do what you're supposed to do, you wouldn't have to deal with the police. And, I would go home and I would drink a six pack, trying to fall asleep, staring at my Sam Brown, looking at my gun thinking, I don't want to live anymore while I'm going through my third divorce at 34.

    Joe Smarro: I'm a hot mess, yet I'm out there every day giving people the best life advice in the world. And I'm, why is it not connecting? And, it's because I was trying to lead or advocate through an authentic place and I wasn't myself doing it. And I'll tell you, Chris, true story, when I first started going to therapy again, because I went my whole third grade year, a lot of childhood trauma... when I first started going to therapy at the VA, I had been out of the Marine Corps already like eight years, no therapy in my adult life, hadn't processed any of my childhood sexual abuse, physical abuse, leaving home at 15, I hadn't processed any of my PTSD from combat, I wasn't even diagnosed at that point, but when I started going to the VA, because I was at rock bottom, I became so on fire for... I knew there was something that was drawing me to mental health, as there was for a lot of people that go into mental health, right? It's like this journey of self discovery.

    Joe Smarro: But as I was helping myself, I became so much better at helping other people and very quickly, even my own unit, they recognized, man, Joe is so good at this. It was only because I became willing to do the work myself and I myself twice a week sometimes was going to therapy twice a week. And then, I wasn't ashamed of it. I was very proud. I was proud of the fact that I was showing up for myself. And so then, I would come to work and debrief with people and, hey, I learned this in therapy last night, this new technique I learned about, hey, they gave me this Alpha-Stim to put on my ear lobes and help me with some anxiety. It's incredible. But now, I'm not just leading through a theory I read in a book or something.

    Joe Smarro: And again, that's not to minimize or diminish clinicians or psychiatry, but people are going to connect when they can see the human behind the approach rather than just the sign pointer saying, do this next, go through that door next. And, when they feel like, oh, you yourself have been through this too, absolutely, I'm going through it right now and it's hard. But, it inspires them. I think it gives them a little bit of hope that they feel like it kind of levels the playing field a bit and it doesn't make you seem like you're way above them and it's some unattainable goal.

    Dr. Thrasher: I couldn't agree more. Lived experience matters and makes a huge difference. And, I also think human beings are wired in ways that we have not fully researched to understand authenticity, whether that be because it's your own individual background, whether it's because you have their sincere best intentions at mind and you're putting your emotions in there with their emotions to make sure it happens, people recognize authenticity. So much like Joe did, I think people can tell the difference between somebody who can either say, I've been there, let me show you the way or other people that may say, I may not have been there, but I know where to get you there and I care enough to see it happen.

    Dr. Thrasher: People understand caring. You don't have to use that word per se, but they understand it. They can see it. We've seen this in standardized. We've seen this in real life occasions. They can tell the difference between somebody who's going through the motions and somebody who really wants to see you do well. And you can't fake that. It's either there or it's not. And so, to your question, Chris, I think people's own past experiences influence what type of assistance they're going to give others. And, from what we've learned about trauma informed care, when it comes to frontline staff, a lot of people that choose frontline jobs have got their own history of trauma.

    Dr. Thrasher: So a lot of times, you're not taking a blank slate and teaching them about things, you're either trying to get them to use their experiences to the person's advantage and help others. And, sometimes you have to undo some maladaptive patterns that you've learned from those traumas as well. But, I think it's still an excellent starting point. Because once again, people can tell the difference. They know if you're just saying, here's a sheet, follow this sheet, et cetera, et cetera. Like you said, go through that door. As opposed to, I see you, I care about you. You've been to my ER three times in a week. I've been called to your house on observation visits twice in the past week. I care about you and want to see you get better. What can I do? What can you do? What can we do together?

    Dr. Thrasher: That type of authenticity makes a huge difference. And depending upon your mental health, it can be easier to go there or easier not to go there. So to build off Joe's earlier example, if you yourself are struggling, it's really hard to be that open and authentic because then you start to question yourself, I'm giving this advice, why am I not following it? So I think it's really easy when you see somebody who's struggling to be the assistant, it makes you wonder what does that say about them? Well, why is that uncomfortable? Is that because we're hitting a little bit too close to home and it could be. Then, that gives you another opportunity as a coworker or a supervisor to intervene and try to make their life better, too.

    Joe Smarro: Yeah. And Chris, real quick to just jump on that. I think if we zoom out a little bit too, an interesting reframe is again, I think we get hung up on words, but law enforcement officers have to be willing to accept the fact that we can debate all day long, should it be our job? Should it not be our job? That's not what we're supposed to be doing. But, the reality is, if we reframe the idea that we are just law enforcement officers... the reason I was so successful at my career doing this was because I didn't see myself as a law enforcement or an enforcer of the law, I really did see myself as like a peer advocate.

    Joe Smarro: And, it allows you to see people differently when you realize that we're wanting the same things here. Right, we're both struggling in our own ways. Instead of me being frustrated that I called to your house, this was like an opportunity for me to express gratitude. And I'm sorry, this is the worst day of your life right now, but, hey, this is a great opportunity for us to connect on a higher level and get through some meaningful thing together. But, we have to be willing to incentivize that for officers. And instead of them just naturally resisting, well, I didn't join to become a mental health expert. And, what I tell them is, I wish we were to record every single police officer's onboarding when they sit in front of their panel and they're asked, why do you want to do this? I said, I really believe that a lot of them, most all of them are being honest and they'll say all the beautiful things. I just want to serve my community. I want to do good for people. I want to do all this stuff.

    Joe Smarro: And then, I think the police academy in large part shifts that. They really become afraid, they become paranoid and it makes it very difficult to see anything other than just black and white. You're either a criminal or you're a citizen. And so, we have to kind of, again, slow down, zoom out a little bit. And, if we can slowly drip in this idea that, look, we're all just peer advocates out there with a badge and a lot of authority, but that's all we're doing is we're just peer supporting one another in the community. I know they would certainly appreciate that from a community standpoint.

    Dr. Thrasher: Well said.

    Christopher Chun-Seeley: Yeah, this idea of authenticity and vulnerability combined together, being such a powerful tool is really huge. Something that really stuck out to me was the fact that if you're listening right now and you're not in the law enforcement field, you're not a police officer, but you have a mental illness or you're experiencing mental wellness on the continuum where you are on the mental health condition side of things, you might bring a very valuable skill to the table if you take care of yourself and you engage in support services to become that law enforcement officer that is more of a community member; we're peers, we're trying to get you to the place where you want to be and I'm here to help you do that. I think that's a culture shift, right? That probably needs to happen as well.

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    Christopher Chun-Seeley: I know we've touched a little bit already on embedded mental health services for everyone on the police force, we've touched on crisis intervention training. Are there any additional recommendations that you can think of? I know you kind of talked about entry into the police academy, Joe, as far as selection goes. Any other thoughts on some of these changes and how we advocate for those changes?

    Joe Smarro: So just a quick snippet of radical change, I think would be interesting to look at would be if we instantly raise the age to 25 to start your police training, right? Because, prefrontal cortex isn't developed yet, still impulsive. Maybe we should slow down on giving you that level of power and authority. A second would be either acquiring a four year degree, which gives you some education, which ultimately gives you confidence. Or if you don't, because again, college is not cheap... but, if you don't have a four year degree, then you have at least two years of working in social services where you learn to develop compassion before you're given a gun and taser.

    Joe Smarro: And then, the third thing would be that the minimum salary starting is $80,000. And, I say that because if we're compensating people that have this level of responsibility, it's a zero mistake game, right? It's like an airline pilot, you're not allowed to make mistakes. And so, they should be treated as such, but it also should be much more difficult to get into. Now, specific to the mental health, again, I think standardized care, I think mandating from the top down. This is including the chief. But, I also think like weekly at roll call, doing some type of quick guided meditation to where it's, initially it's going to be weird and people are going to laugh, doing breathing exercises. Having something in place where, hey, we just had this difficult call, it was a major motor vehicle fatality with a deceased child, everyone that responded, shut it down, we're going back to the house, we're going to do a debrief.

    Joe Smarro: I know there's CISM, I know that they have this, but some departments, they have all the stuff, they just don't use it. They don't know how to use it. There's no consistency on implementation. It's just something that they like have and it's, oh, yeah, we've been through the training, but no one actually does anything with it. And, until these things become standardized practices, they're always going to be taboo and uncomfortable. But, I think we have to have visionary leaders that are willing to do the uncomfortable things. And again, because I do believe it's a top down and bottom up, I think the toughest portion to penetrate in policing is mid-management.

    Joe Smarro: You get chiefs that are a lot of public heads and spokespersons, and they say all the beautiful things, you get recruits that are super moldable and they've got incredibly malleable brains that are like, yes, whatever you say, master, I'm in. But, it's those 15 to 25 year, the captains, the deputy chiefs, the mid-managements that are really stuck in that archaic old school way of thinking. And it's what really, I think, prevents us or slows us down from kind of reaching our goals or objectives because you can have a chief all day long that says the right things.

    Joe Smarro: And again, personal experience, we have a chief that says all the right things, but I met with a deputy chief who since retired and he told me. He said, "Joe, if I ever find out I have a man or a woman that is not mentally strong enough to do this job, then I don't want them in my uniform." And I said, "Well, chief, that's just going to make my job more difficult because now I have to figure out how to help them without you finding out." But, that's a piece that when you have leadership telling you things like that, it's just going to make the job of everyone underneath them and above them more difficult. And so, if we can figure out a way to really get the buy in from that mid-management, I think that would be one of the best ways to do it.

    Dr. Thrasher: I really like the three things by the way, 825 public sector experience and the pay raise, I think is spot on, on the front end of things. One other thing I like about what you're describing is, right now, I think mental health and law enforcement is either used at the front end, it's discussed as a screening tool, or at the back end when they're thinking of terminating or somebody can't cut it to use that phrase. But, very rarely is it normalized as a day in and day out tool. And, I often compare it to the officers that I work with as exercise.

    Dr. Thrasher: So law enforcement requires significant physical strength and endurance, and most officers, I know, do some type of work to continue to work out and exercise that part so they're always good at their job. I often suggest it's very similar with your mental health. You have to do just the same amount of work and just the same amount of attention to it. And, the nice thing about embedding this in a roll call, is it doesn't feel like somebody did something wrong. We're calling in mental health because somebody messed up. We're calling it in on a totally normal Wednesday because we think it's good for you. And there's a lot of very interesting topics you can cover there that get back to Joe's part about being... I'm going to use the word public servant.

    Dr. Thrasher: I think I like to do that with my own staff who forget sometimes that no matter what our education or backgrounds are, in the end, we're here at 9:30 PM with this person as a public servant. We are providing the best customer service possible to help this human being who's just like us. And so, I think one of the biggest things you could go through at roll call is this difference between being authoritative and authoritarian. The idea of we're not trying to get people to respect our authority, we're trying to show them that we care about you and I have a certain knowledge base or skills that I think would be of great use to you.

    Dr. Thrasher: But, that's something that is very based in mental health training. You don't need to be in trouble. You don't need to be feeling depressed to learn that. You can really embed that in some of these skills for front facing public servants, which I think is something law enforcement, to Joe's point, that's what you're really doing. And, calling it law enforcement, I've never thought about that, but it really does give it an interesting bias. Doesn't it? Because if I'm not enforcing the law, because you're not breaking a law by being mentally ill and having a terrible day, why am I here? And, degree of sometimes even branding goes a long way. Human beings, words do matter. The words that we use do imply how we think and how we feel. It's an interesting thought I'd never given much concept before.

    Joe Smarro: Yeah. It's one of the things I say that we should get rid of because I follow it up with, there are certain laws that are just meant to be broken. If you're a homeless individual with a serious mental illness, guaranteed, you're going to be walking in the roadway or you're going to be trespassing on a... And, we know that criminalizing behavior is not effective. But, from a law enforcement standpoint, it's like, well, there's this law and they broke it so I must enforce it. And, it really allows for some pretty simple thinking. And so, I think just kind of getting rid of that term altogether would be a great place to start.

    Christopher Chun-Seeley: These are all wonderful ideas. And, I think the more that the foundation and the APA as a whole... And Joe, I know that you're heavily involved in this work that we can continue to push some of those conversations forward, I think if we make all of this happen with raising the age and increasing the salary and then moving upstream like Joe was talking about with the police academies and screening process for them. But, I also think there's a role for psychiatrists to play in engaging with police academies to assist in creating that culture of wellness from the beginning. So how can psychiatrists engage with police academies, Dr. Thrasher, to assist in creating that culture?

    Dr. Thrasher: I think once again, trying to find the ability to be there on a regular basis and not just when things go wrong. I find that most of my introduction to law enforcement is when we're being brought in, because in their mind something went wrong or something is off course. Therefore, can you help us correct it? And that's fine for making an introduction, but once again, I think what Joe and I have been really saying this whole time is how important it is for mental health to be watched every single day and taking care of just like your physical health every single day.

    Dr. Thrasher: So, I think psychiatrists learning more about law enforcement. And, I think learning more about this partnership, because I think the more that psychiatrists work with law enforcement, you're going to recognize a lot of the same struggles that they're going through are not uncommon to people that work in traumatizing professions. And as you noted, you may be exposed to trauma and not even know the effect it's having on you in the moment. There's a lot of literature on this, and sometimes it's not till years or decades later, that you fully recognize how those traumas have affected you and your growth and how you interact with other people.

    Dr. Thrasher: So simply having somebody around to talk about that and to normalize it, that's a big part of this, is normalizing the behavior. So that middle manager, that deputy chief, that Joe mentioned, so that they can understand just because somebody is dealing with trauma, doesn't make them weak. If anything, I'd argue, it's probably one of the strongest people on your force, because despite that background, here they are leading the charge. How do we get ourselves in there to help? And, that I think is a big part.

    Dr. Thrasher: I know one of my most rewarding personal interventions was with our negotiating unit. So these were the individuals that of course are involved in very long, traumatic, drawn out situations in the field. And for many of them, because you are so invested in it, you don't debrief it right away. You don't really come down for several days and start thinking about it. And, what you found was a lot of very intelligent people that want to do the best by the people that they serve and were somewhat unaware of all the trauma that they were incorporating week after week after week. And, they knew they needed help for it, but what type of help was somewhat unclear.

    Dr. Thrasher: So I think from a psychiatric standpoint, as people that work with trauma, as people that work on building people up and helping people achieve their optimum, it seems like it's a natural fit with law enforcement. Not to mention recognizing all the good law enforcement does for us. As someone who is a big proponent of law enforcement mental health collaborative teams, it never seeks to amaze me how much these very dedicated individuals will put their safety on the line, oftentimes to clear areas for us or to make it clear for us to talk to somebody in a dangerous situation.

    Joe Smarro: If I added one thing, it would be just, because I've seen this, where you have a leader of an academy bringing in the psychologist and they set them up for failure right away. Like, hey, this is Dr. So-and-so, they're just here to make sure we're we don't get in any liable trouble. So right away, they're like, oh, so I guess we don't take this serious. You don't really believe in this. So if you're telling me that, it's just for this. And so, I think having the conversations, small to start, setting expectations, making sure that it's clear on both parties, what the goal is, that way there isn't any of those negative handoffs and that you can have a true, meaningful handoff to like, hey Dr. Thrasher, I'm giving you access to these cadets or these recruits or these officers. And, the reason I want you here is, because I'm concerned about them.

    Joe Smarro: This is all, it sets the stage again so that they would know, okay, this is serious, it's not a mockery, we're up here joking about it. I think that would be important too, just because I've seen the negative side where it's like, hey, here's Dr. So-and-so, they're just here to make sure we stay out of trouble and kind of check the box. And, it's like, rest assured no one's going to be listening or taking that serious.

    Dr. Thrasher: Joe, I think you've been in rooms I've been in before. So yeah, as I've sat there thinking, well, this should be interesting for the next two hours. And, one other thing I would stress to any psychiatrists or mental health professionals that are on listening to this podcast is, I think it's also incumbent upon us to learn about law enforcement. It's very difficult to be a subject matter expert and come in and want people to hear from you and learn from you if you yourself are not learning about who you are trying to work with. And so, that's one reason I've enjoyed these things as well is, I feel I've learned a lot more during ridealongs and other things.

    Dr. Thrasher: You'll never be completely understanding of it because I'm not performing those duties. But, I think it helps me better understand the specific stresses and a lot of the triangulations and complexities that officers are put in, which was one of the first things I thought of when Joe mentioned the age. It was not just the brain development, but thank you for calling that out, but also there is just a lot of complexities for things that are supposed to be black and white. They are very rarely black and white out in the real world. And so, you're taking 22 year old adults and trying to have them balance the legalities, the civil rights, the public relations, the politics of their particular department. That's a really stressful thing to put anybody in the middle of. And, I didn't fully appreciate that until I started learning more about law enforcement.

    Joe Smarro: And this is going to excite you, Dr. Thrasher, you said 22, we just did some work in Iowa and at their academy there was an 18 year old.

    Dr. Thrasher: Oh, dear goodness.

    Joe Smarro: They have to be 18. Yeah. And, my heart breaks and I'm, oh my goodness, you are not ready. Yeah, it's very concerning.

    Christopher Chun-Seeley: And so, when we're thinking about this as kind of a larger picture here, I know we've touched a little bit on what it means to maybe respond to individuals with mental illness when we're thinking about providing mental health and support services to law enforcement officers and to trainees in the academy, but what does it mean when we actually provide what the officers need when it comes to wellness and support and trauma responsiveness, and thinking about PTSD and all of these different factors? What does this do for our larger community?

    Joe Smarro: To me, it's the single most important aspect. Because again, what is the only acceptable emotion for male in this country? Anger. And so, now you have a predominantly patriarch profession where you have a lot of men and now they're given this training that is kind of high speed and you're armed. And, we learn the use of force continuum and here we go. But, the reality is that, and I believe this and I sat on a chief's advisory board for six months where you look at every complaint use of force shooting, everything that an officer gets in trouble for. You watch the video, you read the reports and then you make a recommendation for discipline.

    Joe Smarro: And, what I believe through doing that in my own work and it's not a popular opinion in law enforcement... but I genuinely believe that at least half of the time, at least 50% of the time, that a police officer uses force, it's because of the police officer. We instigate the situation. Why? Because, we don't know how to deal with our own fear. And, when we become afraid, if I lack emotional intelligence, if I lack the capacity or the confidence to communicate with someone through my emotion, the only thing I know how to do is suppress that emotion and then I can act out. And now, if I get angry, that's an acceptable thing. And so, that feels very comfortable to me.

    Joe Smarro: But, to tell someone on a call while I'm in a police uniform, hey, your behavior is making me really nervous right now, I'm actually getting scared, they're like I've got three heads when I say this. But, I've proven it effective. I've used it and I've seen the impact it can have when it shocks the other person of like, wait, what, I'm scaring you? And, it's like, yes, you're scaring me and I don't want to get hurt. But again, this is for years of my therapist handing me a feelings wheel, making me do a body scan and tune into what I'm feeling in this moment and talk through it. And, I'm feeling pressure in my back or... but, I've had to do that work.

    Joe Smarro: And so, now I can see why when I was on patrol before I went to the mental health unit, before I started helping myself, if you start acting in a certain way that makes me confused, the one thing I know how to do is to force the situation, to go put hands on you. And if you pull away, now you're resisting and now it's just green light go. And again, we are forcing this situation. Not realizing, oh, the reason I escalated was because you made me uncomfortable or you made me afraid and so then I realized that I overreacted. But again, this is a foreign concept to a lot of police officers that have a hard time hearing that.

    Joe Smarro: But, I know it to be true. And, I've seen it so much on multiple different avenues of when things go poorly, it's typically because... and again, there are some absolute justified officers having to use force and do their job for sure. But I've seen it very often as well, where there's a use of force incident and it's because the officer got impatient, became afraid, got scared and didn't know how to communicate. So then, they just relied on the skill that they're very confident in, which is using force.

    Dr. Thrasher: Yeah. Vulnerability is not a dirty word. And, I think what Joe said is so true is particularly as men, particularly as men, I think, in law enforcement, is you're given this idea of projecting strength and that sometimes projecting strength will make other people more amenable to whatever you want them to do. The truth is really the opposite, is when you project strength and intimidation, it often will encourage other people who are scared, mind you, and having a very difficult day to then react in kind. And then, you watch afterwards say, oh, I can see why that went that way.

    Dr. Thrasher: So to your question, Chris, I think if this can really get out widely, then what we end up doing is people that can do a self-assessment and can perfectly understand that being vulnerable and recognizing your own fear is not uncommon. That fear is innate. You cannot turn that off without brain surgery, which is not something I would suggest. So fear is going to be there. And so, we shouldn't be trying to hide from it, if anything, and this is training security and physicians, which is much different than law enforcement, but there's some parallels, I say, when you're going into that situation, you know you're going to be afraid, right? Well, I was hoping not to be. Don't hope not to be, you are going to be afraid and that's okay. That is your body's way of telling you, I want to be careful. I don't want to make a misstep. I'm prone to things getting kind of sideways. Except your fear.

    Dr. Thrasher: And I really like Joe's point of communicating it. I use that with deescalation, with patients in the emergency room all the time, as I'll tell them, I've been doing this for decades and you're scaring me, can we please talk about this in a different way? And people just immediately deescalate when you were vulnerable with them. I make a joke out of this. I can only imagine as someone who's a specialist in this, and I'm scared, I can only imagine what your family was feeling before they called law enforcement to your house. But, that type of bonding, that vulnerability, which goes back to a question you had about a half an hour ago, really ties us back to, we're both human beings here, I want to help you. I'm not any more special or less special than you. Let's try to find some common ground.

    Dr. Thrasher: And I just like to way Joe phrased it, because I do think a lot of professionals, particularly men, are scared to say that they were afraid. When in fact, simply calling that out allows you to prepare for it. It's just like a professional athlete that understands certain parts of their job are going to be painful. They don't pretend it's not going to be painful. They prepare, they train, they stretch their limits to get used to what that pain feels like during game time situations, and then how still to succeed and to perform at a high level.

    Christopher Chun-Seeley: Gotcha. I don't think it's just anecdotal, Joe. We have a really good relationship with Judge Steve Leifman out of Miami-Dade County. And, when they provided services to their police officers, their use of force incidents almost for reduced down to zero. Like you said, if you're prime to fight, flight or freeze, but you only have one option because you've been trained to exert one option. So I think there's a lot to be said there. Before we kind of get to closing thoughts here, as I'm sure you both know, July 16th of this year, 988 will be available nationally for calls, texts, and chats, for those experiencing a mental health, behavioral health emergency.

    Christopher Chun-Seeley: Based off our conversation today, Joe, you've you've said it before, you've heard from officers, we don't want to be the mental health responders. And, Dr. Thrasher, you've heard it as well, that there are mental health professionals that want to be these individuals to respond in the field. So what are your concerns and what are your hopes for this new 988 number and how do you think it will impact law enforcement and emergency medical providers?

    Joe Smarro: My instinctual feeling is, I'm hopeful because I'm just glad that it's happening. My concern is that whatever the learning curve is going to be, anytime there's something new like this... When I teach cops, which I do often in law enforcement, I teach them and I ask them... we complain a lot about the types of calls we get in mental health. But I said, have you ever spent time with someone and asked them, why is it you thought to call the police today? Well, because I'm suicidal. Well, yeah, I get that, but why did you call the police?

    Joe Smarro: And, they have no ability to think that there was an alternative. And, again, I spent my career doing this where I would say, look, it worked out this time because we're here, but did you know next time you're in crisis, when it comes, I'm going to actually write out some steps for you. Did you know we have a crisis line? Did you know that you could call the doctor yourself? Did you know you could make your own appointment? And they're like, what? Just mind blown. I had no idea I could do this for myself. And, to be very careful, I would tell them, look, I'm not trying to get rid of you as a client. In fact, I would love the next time you need services, you to do this on your own. And then, I want you to call me and tell me how it went for you. And, let's celebrate together that you are able to help yourself.

    Joe Smarro: But, there's not enough people spending time to actually educate people. And it's where I give the story of, look, we've all heard, you can lead a horse to water, but you can't make them drink. And, what I say is, that's not our job. Our job is to make the horse thirsty. Because, the thirsty horse will find its own water. So if we educate them, if we advocate for them, if we inspire them, if we give them something through demonstration, maybe they'll be willing to do it on their own. With this 988, I think it's going to be a similar concept. There's going to be a learning curve. I think there's some people who think it's just going to be an instant fixed cure all. I can call 988, but we know that it's still going to lead to police having to respond if there's any threat, if there's any suicide in progress.

    Joe Smarro: So I just want to make sure we're also, and I know they've been doing a lot of work, but it's kind of the parallel to seeing the mental health in policing problem as a mathematical problem, meaning in the community. And, they think if we just subtract police, that way we can ensure there's no guns showing up to these mental health calls, people with a mental illness won't get shot. And to me, I think it's an addition problem. It's not a subtraction. We should be adding clinicians to law enforcement so that they can correspond and do things together. But, I don't think just carte blanche, just let's remove cops from taking mental health calls. That way we know that for sure you're going to have a different outcome. I think police officers are incredibly trainable.

    Joe Smarro: And again, through personal experience, I have a company that does this. We train two main groups of people; first responders, police, fire, EMS, non-first responders, clinicians, mobile Christmas workers, nurses, doctors, the like, and I imagine Dr. Thrasher might even agree with this. I cannot tell you how much easier it is to train the police, to get them to role play, to get them to understand the concept and try. When I'm training clinicians in mental health, mind you, as a former law enforcement officer and right away, there's this like, what are you going to teach me? I have my bachelor's in psychology. I already know all the theories and the modalities. And then, we go to role play and they just stand there and cry or freeze up and say, I can't do this, I have anxiety. And I'm like, this is what you do for a living. It's unbelievable to me.

    Joe Smarro: I think there's room for growth. I think having clinicians trained to work with police officers who are trained. The problem is a lot of cops aren't trained. And I know that's a very scattered fractured answer. Dr. Thrasher's going to do a much better job being succinct, but I love that 988 is coming online. I think there's huge upside. I'm just concerned that people are going to assume that this is going to fix everything and we're still a long ways away from that happening. Police still need to be trained, clinicians still need to be trained, mobile crisis response units still need to be implemented and developed. And, 988 can be a resource that all of these things collectively point to.

    Dr. Thrasher: Joe, I think you hit the points quite succinctly actually. It's not a simple answer, Chris. I am optimistic. This is definitely a step in the right direction. I'm very excited for that step in the right direction. That being said, I think how we frame this during the rollout is very important. I do think there are some things being said publicly and at large stages that probably are putting 18 carts ahead of the horse. And to that point, I'm also a big fan of a co-responder model. I think there will be certain cases where purely clinician response makes perfect sense and other ones where a mixed response would make sense. And others, sometimes, where a purely law enforcement response will make sense. And I think what we've really been missing all these years is a way to triage that, AKA the 911 call, which will then often be triaged.

    Dr. Thrasher: Do you need fire? Do you need law enforcement? Do you need EMS? I'm hoping some of this will happen. And so, I am very optimistic. But, I share Joe's point of view that I think we are going to be working together and we should be working together because both of us have significant supply and demand problems. And, that's probably my largest concern with 988. So I'm in a fairly well resourced city. We have a wonderful mobile team. We have really good relationships with law enforcement and still law enforcement outnumbers mental health by over 20 to 1. So when somebody is having that worst day and it's one o'clock in the morning and they call... and remember, when you're in crisis, one minute feels like one hour. So the idea of waiting 10 minutes is not an option and I don't blame the person for that. That's how we would all feel in that scenario, who is going to get their fastest?

    Dr. Thrasher: So, in addition to the education that Joe mentions, I think how we perform our duties under 988 will help either reinforce people to start using it or to go back to 911 because it's quicker. And, I think that's going to be a hard thing. So much like Joe had advocated earlier and I will stand by him for the 80,000 minimum for law enforcement, as we start to look to flesh out the clinician response, which is not very big across the country on second and third shifts and weekends, how are we going to compensate them? You are not going to be able to pay people 35, $40,000 to work weekends and nights. And right now, with the market for healthcare being what it is, I'm speaking to any physician administrators listening to this, you're going to be competing with plenty of Monday through Friday, no weekends, no call jobs.

    Dr. Thrasher: How do we enforce our best and our brightest that Joe and me can train to get them ready for those crisis calls? How do we financially compensate them to make that type of commitment and to share their talents with the 988 project? I think we have the people out there, but it is going to be supply and demand, because it's so much simpler to take a job that doesn't involve crisis. How do we in a business sense, become a differentiating cost to bring that talent over to our mission and to our aim. So, I do think 988 will get us there, but I have a feeling Joe and I are pretty aligned on our realistic approach to how it may play out. And, also understanding the subjectivity of while it is a federal guideline, states are being allowed to set it up differently.

    Dr. Thrasher: So, yeah, I think you will see some discrepancies based upon how mental health activities are funded. There is already a great deal of state by state disparity in mental health reimbursement, which the foundation is more of an expert on than me. I think we will see that play out in 988 as well.

    Christopher Chun-Seeley: This is just my viewpoint, but I think 988 is the opportunity to build the system of care that we all really envision for our community. And, I think it's going to take collaboration and partnership in the local communities to really make this happen because of just what you said, right? There's this federal mandate, but there's no real money backing from the federal government to invest in these things for sustainable future, right? Where, when we actually are talking about some of these things, it's adjusting budget from paramilitary to more supportive wellness services for officers and community members and thinking about what that looks like as a whole.

    Christopher Chun-Seeley: And thank you, Joe, for your authenticity and your vulnerability on this podcast. I know we've talked before, but you are the example to the role model of that inside out kind of culture champion that you talked about because you're not only telling your own story, but you're showing the pathway to success. I think what we're seeing is superhero Joe, when even before you were just regular Joe. And, when we think about standard of care for officers, mental health professionals need to be engaged in that conversation. And, it's going to take individuals with lived experiences and it's going to take community members at the table as well to make sure that these decisions that we're making are not made in a silo of just criminal justice or just mental health professionals or just the community. It really has to be that cross collaboration across the board to make that cultural shift that is needed.

    Christopher Chun-Seeley: So, that is my rough summary of this wonderful conversation here today. But I do just want to leave the final words with our two guests, Dr. Thrasher and Joe, and in the interest of our conversation today, I'm going to start out with Dr. Thrasher and then go to the inside to Joe to end us today.

    Dr. Thrasher: Thank you, Chris. I think this conversation is incredibly important, not just to the 988 project, but to the wellbeing's of both sides of this coin, right? To law enforcement and to mental health and the idea of this being collaborative and not one or the other, which some of my concern was some of the 988 framing was, we'll do this and then law enforcement will be out of it. And, I don't think that's wise in many arenas, whether or not law enforcement is responding to mental health cause, law enforcement's still a significant mental health burden that we want to help.

    Dr. Thrasher: So this should be a collaboration that grows as we both learn about each other. I appreciate the forum to talk about it today and to talk with Joe. For any of the physicians on here, I just really challenge all of us to better understand our partners in this mission and our partners in trying to improve patient lives and to also see a lot of the similarities. Because, I think the more you kind of get down into frontline work, you'll find that we have markedly more similarities in how we handle things and the same stresses that we have as to some of our other partners, such as in law enforcement. By learning that, we can either be in an assistant kind of in a one-on-one, or as you mentioned, Chris, would some of you out there consider embedding yourselves with law enforcement and really helping large groups to try to get to this higher mission at the end? Either way, I think it's a very positive direction to take.

    Joe Smarro: And Chris, thank you for yourself and the foundation and Dr. Thrasher, this is my second time being on a show with you and each time I'm just blown away by you and just the way you think and speak. So this was a lot of fun for me. My final takeaway is again, regardless of which side of this you're on, remember that we are far more alike than not. And, your profession is not an identifier, it is just a job. And, that's regardless of where we fall. There's a great quote from Dr. Susan David that I love. And she says, "The price of admission for a life well lived is suffering." Life is hard. And when we try to do anything of value, we're going to be challenged. We're going to face some resistance, but in that is our opportunity to grow and to learn from one another.

    Joe Smarro: And so, I think when we are willing to be vulnerable, when we are willing to accept our humanness, we will actually find that we have so much more in common and we'll stop resisting the ability to connect with one another. And so, again, I just want to say, thank you. I appreciate this opportunity to just share space with Dr. Thrasher and to reach the members of the foundation and the listeners to your show. Thank you so much, Chris.

    Christopher Chun-Seeley: Joe Smarro is a decorated combat veteran from the United States Marine Corps. He honorably served two tours in Afghanistan and Iraq with the first battalion fourth Marines. In 2005, he joined the San Antonio police department where he became one of the original members of their mental health unit, which Smarro helped to grow into a nationally recognized best practices policing unit. In addition to being one of the main subjects in the HBO documentary, Ernie & Joe; Crisis Cops, Smarro has been featured in multiple media outlets, including the Ted Talk, I See You. He's the founder and CEO of Solution Point Plus, a national training and consulting firm that focuses on cultivating mental wellness to maximize human capital and promote safety within organizations.

    Christopher Chun-Seeley: Dr. Tony Thrasher is a board certified psychiatrist and employed as the medical director for the crisis services branch of the Milwaukee County Behavioral Health division. He received his psychiatric training from Washington University in St. Louis Barnes Jewish Hospital, and has had many leadership roles across the psychiatric field, including president of the American Association of Emergency Psychiatry, president of the Wisconsin Psychiatric Association and distinguished fellow of the American Psychiatric Association. Additionally, he enjoys teaching as a clinical associate professor with the Medical College of Wisconsin and serving as the chair for the Wisconsin State Task Force, combining leaders in emergency medicine and psychiatry on topics, affecting the patient experience.

    Christopher Chun-Seeley: Thank you for joining us for this episode of Mentally Healthy Nation. I want to encourage you to check out our free resources at the foundation website, at apafdn.org. And, a special thank you to our guests today, Joe and Dr. Thrasher for your candid and vulnerable conversation around what we can do to address the mental health and wellbeing of our law enforcement officers. To all our listeners, please take care of yourselves and take care of your communities. We are all in this journey of wellness together.

    Christopher Chun-Seeley: The views and opinions expressed in this podcast are those of the individual speakers in their personal capacity only, and do not necessarily represent the views of the American Psychiatric Association Foundation or the views official policy or position of the institutions and organizations with which the speakers are affiliated. The content of this podcast is provided for general information purposes only, and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.