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Dr. X’s Free Associations
Thursday, December 15, 2011
The police officer discussed below is an acquaintance, not a patient. Certain details have been omitted or altered to protect his identity and the following is published with his permission.
Some time back, an acquaintance who is a police officer shot and killed a gun-wielding criminal. In the aftermath, he went through a routine departmental investigation that included a psych consultation. Later, he received an award for heroism because his actions may have saved the lives of bystanders.
The officer explained to me that he had been depressed for several months. He thought he was doing fine when he went for the psych consultation, but realized later that he was still “in shock” at the time. He added that even if he knew he wasn’t fine, he would have lied to the psychologist because the department would have taken his gun and assigned him to a desk job if it was known that he was having difficulty.
He wanted to know if a doc from outside the department would be obliged to report him to his department if he went for therapy or got an antidepressant prescription filled without using his regular pharmacy or prescription coverage.
Short answer: No. Not only would the doc NOT be obliged to report the fact that he was in treatment, but reporting it to his department would represent an impermissible breach of his right to confidentiality. An exception could arise if he posed an imminent suicidal or homicidal threat. At that point, clinicians have an affirmative obligation to do the minimum necessary, including breaching confidentiality, to warn others who might be at risk or to protect the patient from himself.
What about an antidepressant prescription? Automatic desk duty if you take an antidepressant, he emphasized.
Again, psychiatrists are not informants for employers, even if the employer is the police department. If he paid for his medication and office visits out of pocket, the only way it might come to his department’s attention would be if he were drug screened by his department, and the prescribed medication was one of the medications they check in the screening. I also explained that a psychiatrist concerned about his possession of a firearm might refuse to prescribe a medication for him unless he informed his department.
I suggested that if the psychiatrist’s concern rose to that level, it would be important to consider the option of informing his department, even if it meant temporary desk duty, but he didn’t receive this well. He felt sure that doing so would kill his future with the department. He was also afraid that other officers would see him as an unstable “head case.”
We discussed drug testing further, and he explained that his department conducts random drug screening of both hair and urine. So would antidepressants show up in such a test?
This is something I didn’t know for sure because it would depend on the kind of test used.
Out of curiosity, I did a little checking and it looks like his department may use a 10-panel drug test for urine, which detects recent use. The hair test detects less recent use.
For the curious, here is what the Rapidcheck 10-panel drug (urine) test detects:
Benzodiazepines (minor tranquilizers)
That would leave the most frequently used antidepressants out of the drug panel.
The conversation with my acquaintance reminded me of questions about how to best handle anxiety, depression, PTSD and medication in active duty service members. The military has been fine with prescribing antidepressants and sending soldiers back into combat, but is this what should happen with police officers, or is the most cautious approach used by this particular police department the best way to go? The problem with the most cautious approach is that it deters self-reporting and badly needed treatment. I’d be willing to bet that only a small fraction of the officers experiencing psychological distress seek help when policies on benching officers in treatment are absolutist.
This also reminds me of the mandated reporter conundrum for psychologists, psychiatrists and psychotherapists. Offenders don’t seek help because they know they’ll be turned in to authorities. Making us mandated reporters of patients who self-report is motivated by a commitment to protecting children, but it may not protect anyone because patients know that we have to report them if they tell us about their behavior. Does such a policy make the child advocate feel morally good at the expense of children? Just raising this question got me blasted in every direction in another blog once. It’s easy to take an absolutist position when you aren’t personally familiar with the real world implications.
Anyway, I was talking about police officers. Are policies that automatically bench an officer in therapy or an officer on antidepressants actually counterproductive? I suppose that this might be the best way to go for legal protection of the department–maybe–but is this the best way to protect police officers and the general public?