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21 Feb 2007

By Tamar Kahn

Almost a decade ago, police captain Jeff Benzien shocked the world with his chilling demonstration before the Truth and Reconciliation Commission of how he had tortured detainees during apartheid by suffocating them with a wet bag.

His psychologist, Ria Kotze, told the commission he was unable to remember key aspects of the violence he perpetrated, not because he didn't want to come clean, but because he was suffering from post-traumatic stress disorder (PTSD) triggered by his work in the security branch.

Complaints of severe mental illness like Benzien's were rife in the South African Police Service (SAPS) in the late 1990s. Thousands of officers of all races, many of them perpetrators of terrible acts of violence, claimed PTSD had rendered them unfit for duty and quit the force. Many went on to seek payouts from the labour department's Compensation Fund, which provides financial support to people injured at work, and claimed on their disability policies.

The wave of applications took authorities by surprise, and sent them scrambling to tighten their screening processes for cops claiming crippling mental illness.

Even more disturbing, it raised a fraught debate about the veracity of such claims, leaving a lasting legacy of mistrust and suspicion that now stands in they way of genuinely sick officers getting the help they need, a Business Day investigation has found.

Previously unpublished data obtained from life insurance companies shows that while only a handful of policemen claimed permanent disability on the grounds of mental illness prior to 1994, payouts to cops soared to unprecedented levels in the late 1990s and early 2000s (see graph).

Sanlam, with the greatest number of police officers on its books, was hardest hit. Data provided by the company show annual psychiatric disability claim payouts to cops almost tripled from 1995 to 1998, rising from 215 to 600. The trend was unexpected as there had been no significant change in police officers' exposure to crime and violence in the transition from apartheid to a democratic state, says Sanlam's chief adviser for medical underwriting, Pieter Coetzer.

While their volumes were smaller, other life insurance companies experienced the same phenomenon. Metropolitan saw mental illness disability claims rise from a lone payout in 1993 to 35 in 2001, and then tail off to just four in 2005, with none at all paid out last year. Assupol's annual payouts to cops with mental illness peaked in 2002, at 78, with slightly more claims paid out to black officers than whites. An identical trend was evident at Momentum and Old Mutual, company officials say.

Other data sources tell a similar story. SAPS figures cited in a paper published by the University of Stellenbosch's head of psychiatry, Prof Robin Emsley, in the US Journal of Nervous and Mental Disease show the number of police officers who retired on psychiatric grounds rose from 27 in 1991 to 729 in 1999. Mental illness constituted a steadily increasing proportion of the disability claims, rising from 7% in 1991 to over 40% by 1997.

The retrenchments did not come cheap; the cost to the taxpayer in the first six months of 1994 alone, for 904 boarded police officers, was R250m, according to a paper published by Prof Lionel Nicholas in the South African Journal of Psychology.

"There was concern within the government employees' pension fund that there was abuse of the ill-health retirement benefits by certain departments, including the police," says Kuben Naidoo, a senior treasury official. "It was definitely placing a strain on the fund."

A close analysis of the pattern of disability claims lodged by police officers for psychiatric illness during the late 1990s and early 2000s reveals several anomalies that raise difficult questions about who among the thousands of officers trying to quit the force were genuinely ill. Although the life insurance firms cannot quantify the split precisely, they say more than four-fifths of the claims received were for PTSD, an anxiety disorder that can develop after exposure to a terrifying event or life-threatening ordeal such as rape, a car accident or military combat. Symptoms usually develop within six months of exposure to the trigger event.

However, a significant proportion of South African police and defence force members who developed PTSD after 1994 did so many years, sometimes decades, after their initial exposure to trauma, according to Emsley's research. He suggests long-serving police officers found the raft of changes that accompanied the demilitarisation of the police force after 1994 so stressful that they developed severe psychiatric illness. For starters, 11 separate police services from the former homeland states and the old SA were amalgamated into the new SAPS. At the same time, the powers accorded to police officers were curtailed and they were required to account more closely for their actions in handling suspects. Affirmative action policies were also introduced, and many cops steeped in the "swartgevaar" and anticommunist propaganda of the apartheid state suddenly found their old enemies were now their bosses. When the old system validating their often violent behaviour was swept away, many police officers began to crumble, says psychologist Trevor Hough, who has counselled upwards of 200 policemen in his 10 years of private practice.

"If you've bred a race of psychopaths and they suddenly don't have a place to function, they decompensate - and the easiest diagnosis is PTSD," he says. Decompensation is a medical term used to describe a person's inability to maintain normal defence mechanisms in response to stress, leading to a personality disturbance or psychological imbalance.

While many cops were genuinely suffering, there was also a rapid realisation among some disenchanted officers that PTSD might offer an easy way out of an organisation in which they no longer saw a future. Many also mistakenly believed their payouts would be sufficient to stand them in good stead if they retired. The majority of psychiatric disability claims came from men in their 30s and 40s, data from the life industry show.

In the closed world of the police force, where mental illness is usually regarded as a sign of weakness, disgruntled officers took pride in gypping the system. And it was also a convenient way for the new government to rid itself of high-ranking officers who had enthusiastically embraced the orders of the previous, repressive regime, says Dr Eugene Allers, former president of the South African Society of Psychiatrists (Sasop).

"There was no political will to keep them there, and they (management) didn't want to use the labour route," says Allers. "It was a complete abuse of medicine and psychiatry."

No one knows how many officers' claims of psychiatric disability were fake, since there are no objective criteria for measuring PTSD, but both the life insurance companies and the compensation fund spotted a large number of claims that looked suspiciously similar. Medical professionals and cops appeared to be colluding to cheat the system.

"One Pretoria-based psychiatrist had a PTSD 'farm' where he coached 20 or 30 policemen at a time to simulate this condition," says Coetzer. "It was absolutely fraudulent. He was seeing people from all over the country."

Industry sources interviewed by Business Day confirmed this psychiatrist's breach of professional ethics. He was investigated by authorities, but was apparently never prosecuted. He was murdered three years ago.

Cops also taught each other how to construct stories that would fit the profile of someone suffering from PTSD, a culture that to some extent continues today, suggests Coetzer.
"We had a case where a person described how he just couldn't take it any more at work one day, went totally berserk and shot seven holes in the roof. He was diagnosed with PTSD, but we rejected his claim because he could still work in another job. He phoned me and said, 'How can this be? A colleague of mine had his claim admitted, and he only shot three holes in the roof'."

Sanlam had rejected 50% of the psychiatric claims it received from police officers from 1997 to 1999, says Coetzer. Sometimes this was because they were capable of working in a less stressful environment and did not meet the criteria for payouts, but more often it was because their claims just did not stand up to close scrutiny, he said. The company's repudiation rate has fallen sharply in the past five years, and is now less than 10%.

Authorities also noticed a suspiciously large number of policemen who had been recommended for a medical board at their first visit to a psychiatrist, says Allers. Usually one would expect a specialist to provide therapy and attempt to treat a patient's depression and anxiety with a variety of medication over a period of at least two years before concluding a person was resistant to treatment, and therefore disabled, he says.

There is ample anecdotal evidence of men apparently crippled by mental illness who subsequently went on to open thriving businesses or take up positions in the private security industry, says SAPS assistant commissioner Caroline Namoyi.
"There are crooks who feign illness with such skill that you give them medical boarding, at taxpayers' expense," she says.

The historic surge in claims for PTSD was also fuelled in part by a deep-rooted and lingering misconception among police officers that the illness is chronic and disabling, when in fact international studies show most patients with symptoms make a full and lasting recovery, says Allers. Often there was little or no attempt to redeploy stressed officers to a different post, such as an administrative desk job, he says.

In a bid to unify the industry's approach and weed out fraudulent claims of mental illness, the Life Offices Association and the South African Society of Psychiatrists developed guidelines in mid-1996 for assessing psychiatric disability claims. They emphasised that the treating psychiatrist should not, as far as possible, perform the disability assessment, and stressed that it was unethical for a doctor to declare a patient disabled before all reasonable treatments had been explored. However, the Health Professions Council of SA, which oversees the ethical conduct of doctors, only adopted these guidelines in 2003, according to information on its website.

At the same time, many life insurers increased premiums and tightened their rules for paying out psychiatric disability claims, for example by introducing waiting periods of several years before they would pay out lump-sum benefits.

Government also tightened its rules for incapacity leave and medical retirement, says Naidoo, while the SAPS closed loopholes in its procedures for assessing psychiatric disability claims, according to Namoyi.

While these changes reduced the number of malingerers attempted to cheat the system, stricter criteria and a more lengthy assessment process have created difficulties for genuinely traumatised officers, she concedes.

When treating cancer, "you have to be radical and cut some of the healthy skin so it doesn't recur," she says. "Yes, genuinely sick people do suffer in the process. But our rules have to be stringent," she says.

While SAPS senior management is clearly concerned about mental illness and is at pains to emphasise that counselling will not damage an officer's promotion prospects, little trace of their good intentions appears to have filtered through to station level. More than 500 policemen committed suicide between January 2000 and September 2005, according to the SAPS, and hardly a week goes by without news of a policeman involved in a family murder or domestic violence.

Officers interviewed by Business Day on condition of anonymity describe a climate of suspicion, in which colleagues seeking psychological help are derided as weaklings, and the few cops with access to the limited number of in-house psychologists are afraid to consult them.

"Members are sceptical of counselling, alleging that the more they attend, the more their chances of getting promoted are curtailed," says Boiki Tsedu, spokesman for the police union Popcru. "The role of policemen is looked down upon by the general public. They don't feel valued by society and they don't feel sufficiently supported."

Policemen are also wary of trusting police psychologists who by definition are torn between serving the needs of their patients and their own careers, says Hough. "How can you go to someone who works in the system when you are there to complain about that very system?"

Several SAPS sources who asked not to be named suggested the fact that in-house psychologists are accorded rank poses further problems in the hierarchy-conscious police force. "How can a superior officer confide in someone of lower rank?" asked a senior black policeman.

While there is no shortage of money to fund positions for psychologists, chaplains and social workers, most qualified staff are confined to urban areas, concedes director Anton Grobler, who heads the SAPS psychological services. Grobler declined to provide figures on the number of vacant posts, saying this was impossible to determine since the force was being restructured.

However, former and current police psychologists interviewed by Business Day describe difficult working conditions with insufficient staff, high turnover rates, and an environment unsympathetic to their patients' needs.

"I was one of only two industrial psychologists for the entire Western Cape," says Aretha van der Merwe, who quit the SAPS last year. She said she was frustrated by officials continually ignoring her advice to place the traumatised police officers she assessed in alternative posts.

Studies in Gauteng and Western Cape show that up to half the police officers in the SAPS have some symptoms of post-traumatic stress disorder. Many will soldier on, drawing on their own internal resources to cope with the violence and stresses of their jobs, but many others are dangerously vulnerable, at increased risk of depression, suicide and violent outbursts that threaten their lives and the lives of those who love them. Without trustworthy and affordable means for them to get help, there is little hope of a decline in the number of personal tragedies among the men and women charged with keeping us safe.

These articles are part of an occasional series on mental health and the police, supported by a fellowship from the US-based Carter Centre, a not-for-profit public policy organisation founded by former US president Jimmy Carter and his wife Rosalynn. If you have comments, or a story of your own to tell, contact kahnt@bdfm.co.za

Copyright 2007. Used with permission from Business Day.