Mental health risks among death investigators are unavoidable, but have long been dismissed or downplayed by the mental health community, governments (their employers), and even medicolegal death investigators (MDIs) themselves. That may be changing.
I’ve written elsewhere about the physical risks—musculoskeletal injuries from heavy lifting, infectious diseases, and chemical (drug) exposure—inherent in medicolegal death investigation work. Those risks contribute to job stress and anxiety, but they are not its major drivers.
Recent research on mental health risks among death investigators
It’s not always the grim physical realities of the work that makes medicolegal death investigation so stressful.
The living, not the dead, are the major stressor for MDIs.
These are the top stressors identified in study results released by the U.S. Department of Justice in October 2023:
- Aspects of interacting with family members of decedents (anger, intolerable grief, verbal abuse)
- Lack of understanding from political stakeholders and community leaders about their work
- Fatigue
- Staff shortages
- Working more than 24 hours in a row to complete work assignments
An example of “lack of understanding from political stakeholders” is the pandemic-inspired “Protecting America’s First Responders Act of 2021.” The first responders included police, firefighters, or emergency responders, but not death investigators.
In other words, employers, supervisors, and public administrators could do much to mitigate stress and burnout among MDIs, should they choose to do so.
Impact of the COVID-19 pandemic
During the COVID-19 pandemic, soaring caseloads, staffing shortages, and direct exposure to the virus exacerbated stress among MDIs.
A national study of health workers reported that 45.6% felt burnout often or very often in 2022. Similarly, a 2021 national survey of mental health and well-being among MDIs found that four out of ten experienced “moderate to high levels of stress related to their employer and the nature of their work,” and “three out of 10 experienced moderate to high levels of burnout.”
Job requirements for death investigators
A Marine recruiting website boasts “There is no room in our ranks for those who fall behind. Because of this, we constantly and continually take recruits to the brink of exhaustion in ways that test their toughness physically, mentally, and even ethically.”
Compare some of the requirements listed in a recent MDI job posting:
- Availability 24 hours a day, seven days a week, 365 days a year
- Exposure to hazardous environments, including but not limited to waterways, roadways, harsh weather, and unsafe structures
- Exposure to blood borne pathogens, biohazardous materials, noxious odors, and graphic scenes
- Ability to work in emotionally charged and sensitive circumstances, including autopsies
- Exposure to secondary trauma-related stressors
One difference: new Marines receive thirteen weeks of boot camp training, while new MDIs have to learn on the job.
Types of mental health risks among death investigators
This is just a brief listing of the often-confusing terminology around stress-related disorders.
Responses to stress vary widely.
It’s important to note that not all MDIs will experience a stress-related disorder.
- Vicarious Trauma: Also known as secondary traumatic stress, the term recognizes that exposure to violence against other people can trigger symptoms. The national Office for Victims of Crime (OVC) has a website dedicated to resources for vicarious trauma. Their Vicarious Trauma Toolkit information is available in a 2018 slideset or can be viewed in a video available on that OVC website.
- Critical Incident Stress: Also known as traumatic incident stress, this acute reaction has many possible physical and mental symptoms. According to OSHA, most incidents of critical incident stress last anywhere from two days to four weeks.
- Burnout: “Symptoms of burnout include exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment” according to a Columbia University study of forensic professionals.
- Depression
- Anxiety
- Post-Traumatic Stress Disorder (PTSD): The diagnostic criteria for PTSD include a requirement that symptoms last longer than four weeks. Limited research tells us that, like other first/last responders, coroners and their staff are at risk for PTSD.
Coping strategies for MDIs
Peer support through activities such as gatherings and sharing accomplishments is one of the most preferred and effective MDI coping strategies.
Formal counseling, even when available, may not be accessed because most counselors are not familiar or comfortable with the work of MDIs. To address this disconnect, coroners and medical examiners or MDIs themselves could seek out support from local police chaplains or other counselors familiar with the traumas of first responders.
Last responders are often advised to have a hobby or interest outside of their jobs. Given staff shortages and long hours in the profession, this is difficult but worth aiming for.
A National Institute of Justice webinar featuring IACME president Kelly Keyes and Katharine Pope discusses strategies to increase resilience. The webinar reviews the MDI Align app which offers mindfulness and wellness activities geared towards MDIs. An early study of its effectiveness found that scores for sleep, depression, PTSD, and self-assessed coping significantly improved in a sample of fifty-three participants.
Mitigation opportunities for administrators
Coroners and medical examiners can:
- support MDIs by refusing to allow them to be bullied or traumatized by angry family members
- advocate with public administrators for adequate staffing
- allow time off or counseling time for MDIs who’ve experienced particularly traumatic cases
- Identify external counseling resources
- establish peer support/debrief opportunities
- model work-life balance
Public administrators and policy makers can:
- publicly recognize and reward contributions by coroner/medical examiner staff
- provide adequate budget, staffing, and safe work environment
- learn about the role of death investigation in public health and the justice system
Conclusion
The mental health risks of medicolegal death investigation work are gradually being recognized. Implementing coping strategies and mitigation efforts will improve job satisfaction, retention, and physical and mental health among those who carry out this important work.
If you’re a coroner, medical examiner, MDI, or anyone working in medicolegal death investigation, what are your coping strategies or suggestions?
Featured image credit: Christina VandePol, all rights reserved