Mental Health in the UK Police Force: a Qualitative Investigation into the Stigma with Mental Illness
Police work is a high-risk profession that can cause mental health conditions. With increasing sickness levels and falling police numbers, it is essential prompt mental health treatment be implemented. The study aims to explore institutional negativity and stigma in the police force towards mental ill health. Semi-structured interviews attended by five police officers with thematic analysis captured (i) police culture, (ii) the stigma of mental illness, (iii) disclosure of mental illness and (iv) breaking down barriers. Findings indicate police culture and attitudes to mental health may contribute to the causes of psychological illness, rather than the nature of the job itself. Increased education and awareness surrounding mental health have been shown to be fundamental in how an officer reacts to stress, but change is needed at a managerial level. Future research needs to explore the effects of mental health stigma on ethnicity and gender in the police force.
KeywordsPolice culture Mental illness Mental health stigma Discussing mental health Mental health awareness
A police officer is responsible for the prevention and detection of criminal activity, whilst maintaining public order (Myhill and Quinton 2011). Sickness absence has become a growing concern in the UK police force, employing approximately 130,000 police officers (Hargreaves et al. 2018): with half of officers taking sickness leave for mental health-related illnesses in the last 5 years (Police Firearms Officer Association 2017). This is not limited to the UK police force. For example, an Australian study reported a higher prevalence of mental illness among the police and emergency services than other professions (Harman 2019). Likewise, in Canada, mental illness is widespread among police officers; high proportions of them reported having suicidal ideation (10% during the past year, 28% in lifetime), planned suicide (4% during the past year, 13% in lifetime), and attempted suicide (0.4% during the past year, 5% in lifetime) (Carleton et al. 2018; The Centre for Addiction and Mental Health (CAMH) 2018). Mental wellbeing of police officers is a cause for concern in many countries, highlighting the need for further study.
Generally, mental illness in the workplace results in a significant economic burden (LaMontagne et al. 2014), due to long-term sickness absence (Thomas et al. 2016): 16 million days are estimated to be lost annually due to mental health issues such as stress, depression and anxiety (Office for National Statistics 2017).
Recent research has identified policing as a hazardous and stressful occupation (Deschamps et al. 2003; Liberman et al. 2002; Tuckey et al. 2012). The consequences of organisational stressors and the high-risk nature of frontline duty mean officers are at greater risk of developing psychological illnesses (Habersaat et al. 2015). Cumulative exposure to a number of potentially traumatic situations is an integral part of operational policing (Tuckey et al. 2012), and thought to be a predictor for the development of post-traumatic stress disorders (PTSDs) (Marchand et al. 2015; Marmar et al. 2006), depression, anxiety and other stress-related conditions (Husain 2014). If left untreated, mental ill health has the potential to adversely affect workplace performance and future career prospects (Heffren and Hausdorf 2016). The cost of stress-related illnesses for officers is viewed in the context of individual mortality and morbidity, culminating in reduced productivity, sick leave and premature retirement (Collins and Gibbs 2003; Summerfield 2011). As criminality on our streets increases, unpredictable events that the police encounter remain commonplace (Marchand et al. 2015). As such, there is a higher prevalence of stress-related illnesses in the police force than in the general public (Soomro and Yanos 2018).
It is vital for officers to look after their mental health; however, research by mental health charity Mind (2013) suggests that emergency services personnel are less likely to seek help for mental health conditions. Officers may resist disclosing their mental ill health for fear of stigma and negative reactions from colleagues (Bullock and Garland 2018; Kurtz 2008). Internal stigma, where the police stigmatise each other because of mental health problems, is pervasive in the police force and was identified as playing an essential role in influencing individual reactions to stress (Stuart 2017). It plays a significant role in the way a person responds to psychological distress and has been noted as one of the main reasons why officers avoid seeking help (Stuart 2017).
Much has been reported about workplace stress (Alexopoulos et al. 2014; Kotera et al. 2018a; Morash et al. 2006; Violanti et al. 2016), and in regard to policing, a variety of research within the last 20 years has focussed on law enforcement’s perception of mental health in the community (Desmarais et al. 2014; Lamb et al. 2002; Soomro and Yanos 2018; Watson et al. 2014; Wood et al. 2017); however, the occupational psychological distress of police officers has received little attention in the research literature. Frequent exposure to operational stressors has the potential to significantly affect the psychological functioning of police officers (Marchand et al. 2015). Given the critical role of police work, it is crucial to understand the psychological strain this puts on officers. Increasing mental health awareness and education at an organisational level is essential in helping to alleviate the psychological symptoms derived from their occupation (Randall and Buys 2013). The experiences officers face at an operational and organisational level is decisive in determining their mental wellbeing (Deschamps et al. 2003).
Deschênes et al. (2018) reported that the culture and style of leadership within the police force has more influence in determining an officer’s mental wellbeing, rather than the actual nature of the job itself. Access to mental health support is provided through occupational health services by delivering one-to-one counselling. In contrast, despite access to those services, officers continue to face considerable psychological distress as a consequence of the pressures they encounter at an institutional level (Fox et al. 2012).
Regrettably, due to the lack of mental health training within police forces (Cummings and Jones 2010), additional training is required in order to change attitudes towards mental health (Booth et al. 2017; Soomro and Yanos 2018). Addressing these attitudes starts at a managerial level (Bell and Eski 2016). Line managers need education on how to identify the triggers and warning signs of mental health conditions among their officers. Preventative measures (Hayday et al. 2007), early intervention (Tuohy et al. 2005), together with prompt treatment from mental health services will help to ensure that periods of short absence do not turn into long-term sickness absence (Summerfield 2011).
The updated hypothesis extended from the original version of labelling theory (Scheff 1966) called into question the significance of stigma and stereotyping of individuals and the consequent discrimination, loss of socioeconomic status, low self-esteem and increased symptoms (Markowitz 2014). The modified labelling theory (Link et al. 1989) argued that labelling negatively influences mental wellbeing, even when it is not specifically the cause of mental disorders; labelling can make individuals feel isolated and discriminated, damaging their coping and social bonding skills (Link et al. 1989). Research in the field of modified labelling theory indicates that stigma plays an important part in labelling (Markowitz 2014). Accordingly, the present study aims to examine mental wellbeing of UK police officers, focussing on police culture and the attitudes towards the mental health of police officers.
Given the increase in sickness absence for stress-related conditions (Police Firearms Officers Association 2017), the mental wellbeing of police officers has become an increasingly important topic. A study by the Police Federation in 2016 involving 17,000 officers found that mental wellbeing among police officers was considerably poorer than that of the general population, with 39% needing help for mental ill health (Houdmont and Elliott-Davies 2016). Furthermore, socioeconomic factors such as increased budget restrictions, higher levels of crime and falling police numbers are placing more pressure on officers (Police Federation 2020). If this trend continues, it will likely create a more significant mental health crisis in the police force.
Police Culture and Mental Illness
Society has a stereotypical view of mental illness, and law enforcement is no exception. The culture of policing makes it difficult for officers to disclose mental illness, many of whom will subsequently suffer in silence. This culture of dominance and masculinity (Evans et al. 2013) as well as emotional self-control (Bell and Eski 2016) and stigma make officers resistant to help-seeking. Displays of emotional responses to work-related stressors are often regarded within police culture as a sign of weakness and not comparable with the masculine perception of policing (Kurtz 2008).
Stigma of Mental Illness
Stigma is a label given to those who may have a personal or physical characteristic that distinguishes them from others (Wester et al. 2010). This often places individuals into a stereotypical group, consequently leading to discrimination and isolation. Labels commonly associated with mental ill health not only have the potential to stigmatise, but to alienate individuals as well. The social stigma attached to mental ill health, and the discrimination people face, makes it difficult for them to seek any psychological intervention (Kotera et al. 2018b; Kotera & Ting, 2019). Furthermore, officers who experience increased stigma tend to have negative opinions about seeking psychological support (Soomro and Yanos 2018). Unsurprisingly, police officers suffering from mental ill health are seen as a marginalised community within the police service (Bell and Eski 2016). The decision not to disclose mental health conditions can adversely affect the wellbeing of officers (Stuart 2017). It is important to consider mental health stigma with regard to police work and the probable risks of disclosure.
The present study used a qualitative approach, attempting to explore the first-hand experience of police officers. Although police work is regarded as a high-risk occupation for the development of mental health conditions (Burke 1998), there is still a lack of empirical evidence to support these claims (Van Der Velden et al. 2013). Likewise, understanding of research into the attitudes of the police force towards officers with mental health problems remains limited (Deschênes et al. 2018).
Five participants were recruited through a referral from a charity, personal network, police forum and contact from within the police force. Participants were suitable if they were (i) over the age of 18; (ii) serving officers with mental ill health, or who had been on sick leave due to mental ill health or have left the police force due to a mental health condition and (iii) proficient in English. Participants who do not speak English, have not been diagnosed with a mental health condition or have had exposure to a recent violent crime or traumatic event which has impacted on their mental health were excluded from the study.
Appendix 1 summarises the participant demographic information. Participants consisted of four males and one female (three retired and two serving officers). The mean age was 52 years (range 43–62) old. Four participants described their ethnicity as white British, and one retired officer only disclosed his ethnicity as British. Three participants were currently married, one divorced and one single. The mean length of the time in the police force was 24 years (range 18–30 years). Officer rank included police constable (N = 2) and sergeant (N = 3). All participants had experienced a variety of mental ill health conditions such as stress, anxiety, depression and PTSD. As all participants have experienced some form of mental ill health; it was important to put measures in place to protect them should the interview cause them any psychological harm. The researcher was responsible for ensuring participant privacy and confidentiality and providing details of who to contact should the interview cause the participant any undue distress.
Semi-structured interviews were conducted to attain an in-depth understanding of the participants’ lived experiences (Sofaer 1999). The interview was guided by open-ended questioning, encouraging meaningful discussion (Weller et al. 2018) about each participant’s accounts of mental health awareness in the police force. The question order was determined by the flow of the interview. Interviews began with a brief overview of the participant’s career in policing, together with the reasons for the onset of their mental health conditions. All aspects of information and information-seeking were explored. Interviews were audio-recorded and lasted for an hour on average. Recordings were transcribed verbatim and analysed.
Participants were provided with a formal invitation to participate, an information sheet and consent form outlining the procedure, benefits and risks of participating. This included an explanation of how to acquire the results of the research, details of mental health services, voluntary participation, how to withdraw and contact information for the researchers.
After informed consent was granted, the researcher commenced the interviews using the proposed interview schedule as a basis for open-ended questioning (Appendix 2). On completion of each interview, all participants were thanked for their time, and a formal debrief was sent to each participant by e-mail which reiterated the purpose of the study, details on their right to withdraw and contact information of mental health services, along with contact details of the researchers.
Qualitative Data Analysis
Data were analysed using the thematic analysis (Braun and Clarke 2006), an approach used for identifying, analysing and reporting themes found in qualitative data. The purpose of using thematic analysis in the present study is that this method is regarded most appropriate to investigate into under-researched areas, while still providing high research rigour (Braun and Clarke 2006). Thematic analysis identifies patterns in the dataset to extract trustworthy and insightful findings (Nowell et al. 2017). In line with the recent updates on thematic analysis (Clarke and Braun 2018), the researchers of this study actively engaged with the personal accounts of participants, and reported findings in a straightforward manner.
The interviews were transcribed, read and re-read until the researchers became fully immersed in the dataset. This method of familiarisation set the foundation for the subsequent data analysis. Having become familiar with the dataset, a list of initial codes was manually generated to identify keywords. The extracted data were again re-read in order to double-check the initial codes. During this process, some codes were discarded due to inconsistencies with the dataset (Identifying). A slight overlap was noted in regard to the subtheme ‘support’; however, it was felt that the topic warranted inclusion in the two main themes: ‘the stigma of mental health’ and ‘breaking down barriers.’ Names for each theme were then finalised, providing each theme with names and explicit descriptions that were necessary to capture the essence of every theme (Analysing). Finally, the data were transformed into a written report, supported by empirical evidence (Reporting).
The analysis identified four themes: police culture, the stigma of mental health, disclosing mental illness and breaking down barriers (Appendix 3).
Theme 1: Police Culture
A recurrent theme throughout the interviews was a sense among participants that the culture within policing often inhibits any open and honest discussion around mental health issues with senior management and colleagues. Existing research has acknowledged that police culture influences work-related stress (Deschênes et al. 2018). Additionally, it can easily isolate officers from important support mechanisms, and in so doing, heightening the likelihood of developing a mental illness (Tuckey et al. 2012).
Subtheme 1.1: Macho Culture
I’ve seen too many people, particularly the police, adopt the macho attitude, go pop and some of them are dead, some of them become alcoholics, some had to leave the job because they plunge from one crisis to the next. (Participant 3).
It’s a bit like the shell-shocked veterans in World War 1, being branded as cowards and shot, you know, they’re cowards. (Participant 4).
Participant responses were consistent with research reporting that policing encourages masculinity, self-reliance and emotional control, which in turn has a negative impact on help-seeking behaviour (Johnson 2016).
Subtheme 1.2: Emotional Response Is a Sign of Weakness
You’ve got to be able to go out and unload to somebody, who might not necessarily know anything about the police. (Participant 3).
I didn’t recognise it as what it was; I just thought I was grumpy…you don’t see them creeping up, and in the end, the thing that tips you over the edge, the thing that makes your bottle overflow if you like can be something quite small because you’ve got used to dealing with stuff. (Participant 5).
I would just talk about what happened to me, and for me that makes me feel better. (Participant 4).
You sort of bottled it up for years, you just kept going because I had a young family to support. I had to earn the money and the overtime and one thing and another. I think I got to a point where I’d just had enough. (Participant 2).
I’ve watched the biggest and hardest people bottle it all up, being the big macho man and end up in psychiatric wards. I can think of one person who took his own life. (Participant 3).
It is clear from the preceding accounts that police culture inhibits emotional expression, often perpetuating the stigma associated with help-seeking for psychological distress (Tuckey et al. 2012), or for fear of stigma and discrimination from colleagues (Waugh et al. 2017).
Subtheme 1.3: Coping Strategies
You can’t put enough adrenalin into your body to counteract the stress; you develop bad habits like drinking because it was the only way I could get to sleep and then you physically and mentally push yourself to the edge. (Participant 1).
… I’d started relying on alcohol… I’d started using alcohol as a coping mechanism. (Participant 5).
…generally, if you want promotion you need to go in CID [Criminal Investigation Department], a big drinking culture which I’m very averse to. (Participant 4).
Drinking alcohol is consistent with the need for police officers to maintain a certain image (Karaffa and Koch 2015; Shane and Andreychak 2008) and has been historically used to numb depressive feelings. Research has identified a link between problematic alcohol intake and higher levels of depression and anxiety in police officers (Karaffa and Koch 2015).
Theme 2: Stigma of Mental Health
Participants reported the adverse outcomes of developing mental illness whilst working within law enforcement. Responses included stigmatising attitudes and discrimination, self-stigma and lack of empathy.
Subtheme 2.1: Stigmatising Attitudes and Discrimination
Some people that I spoke to when it happened were very negative because obviously there’s a stigma with it. (Participant 1).
If anything, I would argue there’s probably less stigma in organisations like the police than there is in most of the private sector. (Participant 3).
In contrast, a mental health charity, Mind (2017) states a higher prevalence of mental health problems has been found in the public sector, with a lack of support available following disclosure. This contrast may imply underestimation of mental health issues, linking with repressive coping (i.e., unconsciously deny negative emotions and information to secure a positive image (Garssen, 2007) that is often seen in a masculine culture (Kotera, Green & Sheffield, 2019)).
Subtheme 2.2: Self-Stigma
I was paranoid, part of my anxiety was paranoia, so I thought that everybody hated me, I still get that sometimes now. You can get really worked up about what other people think about you. (Participant 5).
Every time I spoke to her I burst into tears, it was a mixture of frustration, anger and shame. Shame that I’d gone pop, shame that I thought I’d let myself down. (Participant 3).
Subtheme 2.3: Lack of Support from Line Management
I think it’s the inability to say; actually, I’ve been affected by this, and someone to say, you know what, I’m affected by it as well, it’s really bad isn’t it. (Participant 4).
In the end what tipped me over the edge, and I think it was building for a long time was a lack of support from senior managers. (Participant 5).
I was very clearly on the brink, that somebody should have realised that. And I think they probably did; they just did not do anything about it. (Participant 5).
It is essential to recognise signs of mental illness in an employee but also to provide them with the opportunity to talk about how they feel without the risk of encountering negativity.
Theme 3: Disclosing Mental Illness
Advantages and disadvantages of disclosing a mental illness
Enables the individual to receive support
Fear of stigma
May lead others to disclose their conditions
May feel discriminated
Provides education of mental health conditions to others in the workplace
May affect career prospects
Employers may provide reasonable adjustments
Individual may feel undervalued
Changes people’s attitudes towards mental illness
Places more focus on the condition than the ability to perform in the job role
Helps employees to identify changes in mood and behaviour
Job application may be rejected
Subtheme 3.1: Effect of Mental Illness on Career Advancement
If you’ve a form of mental health illness you will not get on; you will not be promoted, …people will not want you on their section. (Participant 4).
My experience is the attitude of officers universally that I worked with. Depressed, depressed are timewasters. (Participant 4).
Subtheme 3.2: Relationship with Fellow Officers
He’s been here for donkey’s years, he should be able to handle this sort of thing...and then suddenly to watch me go pop. (Participant 3).
Subtheme 3.3: Attitudes towards Sickness Absence
As an institution, they were very very good, in getting me better, at making me understand, but back at work that was a different ball game. You’ve got your colleagues who are still at work, still running around like idiots and they’re like, oh fucking hell, you’ve had three months off, you know, I should have gone off with stress. (Participant 1).
It’s down to individuals. I’ve been in the job a long time, and I did know most people, most people did know my history, and those that didn’t could read it. I got looked after really, I was just open and honest with them, I didn’t try and big anything up, a lot of people gild the lily I suppose. Sort of just play straight baton, they looked after me. (Participant 2).
…we’re gonna keep paying, realise it’s job-related PTSD that you’ve got, so they made special dispensation that I’d be paid, I’d get a full wage. (Participant 2).
Despite the contrasting views on how sickness absence was viewed, it is important for line management to work with their staff to help reduce periods of sickness absence.
Subtheme 4: Breaking Down Barriers
Death by suicide occurs more in police officers than it does in the line of duty (Miller 2005). This is often due to the compounded stress experienced by police correlated with high rates of suicide (Collins and Gibbs 2003; Fox et al. 2012; Gutshall et al. 2017).
Subtheme 4.1: Support from within the Force
The welfare side was very very good, very quick. (Participant 1).
If you’re in a very vulnerable position which I was, the slightest thing is too much, your thought pattern is already distorted. (Participant 4).
I went through extensive counselling, and for somebody to say what you’re thinking, it requires a certain confidence, faith in the individual you’re talking to, and a release of unburdening yourself from your own private thoughts. I don’t think a lot of people can do that. (Participant 4).
I was referred to occi health by my then line manager, well I asked him to refer me to occi health. (Participant 5).
You would find increasingly as my career progressed was that people would be more open in talking about these things. There was no sort of hiding it. (Participant 3).
Subtheme 4.2: Increasing Education and Awareness
Oh, I think there was a lack of awareness because I remember a civilian member of staff, really nice guy and he used to go on about sickness levels, and he’d go, ah these malingers, “Stress? So and so’s off with stress, it’s malingering, it’s malingering!” He used to go on about it. (Participant 4).
The best way to describe it is if you’ve broken your leg and you’ve got a caste on, you can see that. (Participant 1).
Subtheme 4.3: Changing Attitudes
It has made me much much stronger and much more resilient, and the other thing is, I can see stress in other people. To be fair, I’m really glad I went through it because I’ve totally changed my outlook, I’ve totally changed the way I work, the way I look at everything in life. A very positive experience to go through, even though at the time it didn’t feel like it. (Participant 1).
…the police are trying to do more, I think they are trying to recognise signs of stress in people, and what have you, that’s what they’re training line managers to do anyway, they are putting us on courses about stress management and things like that. (Participant 5).
It is important that line managers are trained on how to identify the symptoms of mental ill health and help to reduce the psychological distress for officers (Bell and Eski 2016) if we want these attitudes to continue changing. Increasing awareness is important in order to spot the signs of mental illness. It is also important for fellow colleagues to recognise the signs.
It’s only because I’ve been through the process myself that you’re able to recognise and assist with certain stuff. (Participant 1).
The psychosocial context of frontline police work has played a crucial role in the development and progression of mental illness, whether inflicted by traumatic experiences or by the more common pathway to psychological injury (Tuckey et al. 2012).
The present study elucidated the first-hand experience of police officers’ attitudes towards mental health problems, relating to the police culture. Five participants reported that the police culture was indeed affecting negative attitudes towards mental health problems (Theme 1), entailing mental health stigma (Theme 2), which hindered police workers to disclose their mental distress (Theme 3). Lastly, they suggested the ways to counter these challenges including a supportive workplace atmosphere and education (Theme 4).
One notable finding was that, as reported recently (Stuart 2017), police culture has a significant effect on attitudes to help-seeking behaviour and emotional responses to psychological distress. Any display of emotional response to work stress in police officers can be considered as a sign of weakness or inability to perform their role and goes against being tough, aggressive and in control (Kurtz 2008). Officers are therefore expected to maintain emotional self-control. Police culture is often thought of as a problematic feature of policing, which is averse to change and progress (Cordner 2017). This ‘cult of masculinity’ and ‘machoism’ is not only viewed as negative and persistent features of policing (Silvestri 2017) but also in other occupational groups such as the construction industry (Fielden et al. 2000), and the military (Karaffa and Koch 2015), which is typically male-dominant. It is interesting to note male dominance and gender featured greatly in a review of the literature (Fielden et al. 2000; Silvestri 2017; Veldman et al. 2017). Further research into this area could address these barriers.
The theme ‘the stigma of mental health’ represents feelings of discrimination towards mental illness experienced by some of the participants. The negative perception held by others towards them tended to be discriminatory in nature. Attitudinal barriers such as self-stigma were expressed and associated with feelings of shame, anger, frustration and paranoia (Gabriel and Liimatainen 2000). Some participants identified the negativity they faced from fellow officers and senior management. The effects of police-to-police mental illness-related stigma (Stuart 2017), self-stigma and perceived stigma were also apparent throughout the dataset. All participants conceded that colleagues negatively viewed mental illness. Moreover, consistent with previous literature (Maguen et al. 2009; Van Der Velden et al. 2010), depression, anxiety, PTSD and stress were among the main reasons for sickness absence among the interviewees (Harnois and Gabriel 2000; Husain 2014). Participants additionally reported that alcohol was frequently used as a coping mechanism. Further, police culture expects officers to remain calm and controlled; therefore, any emotional expression is severely limited (Pogrebin and Poole 1991), making difficult for officers to disclose their mental distress. As suggested, mental health awareness and understanding in the workplace and education about mental health could break down the barriers for officers to receive support. Moreover, training and development can help ameliorate the mental health status of police workforce. For example, induction training that informs the daily challenges and demands of the police profession would be useful for new officers to better prepare for various challenges that they may encounter during their duties (Gershon et al. 2009). Even though mental health is an essential factor of day-to-day policing, particularly in the community, it is an area which has been somewhat neglected (Cummings and Jones 2010). Future research should evaluate the effects of such training and development on the mental health attitudes of police workers, and their mental health status. Considering that poor mental health of police forces is a cause for concern in many other countries, more comprehensive studies (e.g., cross-cultural comparison) can offer useful insights to this international problem.
There were several limitations in this study. Although a thematic analysis did not aim for generalisability, the sample size was modest: more data would strengthen our findings. Relatedly, only one participant was female. Other demographic variables that are associated with mental health and stigma (e.g. age, position, cultural background; Kotera et al. 2018a) needed to be adjusted. Notwithstanding the relatively limited sample, this work offers valuable insights into the culture of policing and the mental health of its officers.
The present study sought to elicit experiences from a sample of five police officers. The findings from this study indicate that sources of psychological illness have more to do with the organisational culture and attitudes to mental health than the nature of the job itself. The findings presented above highlight the need to increase mental health awareness in the British police force and to target institutional stigma, which is fundamental to breaking down attitudinal barriers. As sickness absence continues to rise due additional pressures put on officers, like budget cuts, fewer officers and increased crime, it is vital for police forces to recognise the signs of mental illness in their officers. Officers of all ranks must undergo education and implement changes in working practices to help reduce symptoms of psychological distress among its officers.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.
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