Dr. Apurva Kumar Pandya, Dr. Somen Saha
1. Economic Evaluation, Specialist, Indian Institute of Public Health, Gandhinagar
2. Associate Professor, Indian InstituteofPublic Health, Gandhinagar
Address for correspondence: Dr. Apurva Kumar Pandya, Indian Institute of Public Health Gandhinagar, Opp. Air Force Headquarter, Near Lekawada Bus Stand, Lekawada, Gandhinagar-382042
How to cite this article:
Pandya A K, Saha S. Policing During COVID-19 Pandemic and its Impact on Mental Health. Journal of Mental Health Education. 2021;3(1)20-36
The coronavirus disease 2019 (COVID-19) pandemic has put the world on a standstill. Governments are forced to take immediate measures to control such a pandemic which include lock- down, forced isolation of infected patients, quarantine affected people and social distance. Therefore, viral outbreaks are often paralleled with symptoms of fear, anxiety, and depression (Banerjee, 2020; Brooks et al 2020; Ho et al, 2020; Roy et al, 2020; Yao et al, 2020; Zhang et al,2020). Police personnel have been a part of “essential workers” who are the first responders taking on active roles in the fields to prevent the infections and maintain law and order (van Dijk, & Crofts, 2017). The World Health Organization and other international agencies have recognized police personnel as first responders who are most vulnerable to mental health problems (Inter-Agency Standing Committee 2020; International Federation of Red Cross and Red Crescent Societies, 2020;WHO 2020).
The State Police Force (SPF) is a state-level agency which is in charge of maintaining law & order. The primary role of SPF is to uphold and enforce laws, control and prevent crimes. The Central Armed Police Forces (CAPF) refers to a group of seven security forces such as Central Reserve Police Force, Central Industrial Security Force, Border Security Force, Indo Tibetan Border Police, Assam Rifles, Sashastra Seema Bal, and National Security Guard under the authority of Ministry of Home Affairs in India. They protect the borders of the nation from external aggression and infiltration and aid the state governments in internal security, including insurgency, anti-nasalism and counter terrorism. The SPF has been the forefront of the COVID-19 pandemic in India. Personnel from CAPF (particularly Central Reserve Police Force & Border Security Force) were also engaged in the pandemic management, especially during lock-down phase. Police personnel had coordinated local shutdowns, enforced stay-at-home mandates and at present they are encouraging use of masks and social distancing in addition to their other usual responsibilities. The study conducted in 2019 revealed that the police force is understaffed and overburdened. The COVID-19 pandemic might have exerted tremendous stress and mental pressure on already strained police personnel. Public health and policing experts acknowledge COVID-19 pandemic as a significant stressor for police personnel which compounds the stress associated with their professional roles. They are not only vulnerable to infection but are also at high risk to develop mental health problems. However, their mental health and psychosocial support care remain neglected. We have reviewed existing literature on COVID-19 pandemic and its impact on police personnel with an objective to map studies conducted on police personnel mental health in the context of COVID-19, identify policing practices, strategies and recommendations to protect police personnel from stress and risk of infection ofCOVID-19.
Rapid scoping review was conducted using Arksey and O’Malley’s scoping review framework (Arksey & O’Malley, 2005). The empirical studies and grey literature on Policing And COVID- 19was reviewed. Electronic databases namely PubMed, PsychINFO, and Google Scholar were accessed. The following keywords “police,” “policing” “COVID19 pandemic,” “risk of infection,” “prevention,” “protection of COVID-19 transmission,” “mental health” were used. These key words were combined with Boolean operators to narrow down the search results. Subsequently, manual searches were executed to identify additional articles based on the references mentioned in the articles selected for full-text review.
Initial search yielded articles (PubMed 305; PsychINFO 13; Google Scholar 13000) of which 13013 were excluded based on title and abstract review. Later 223 articles were rejected basedon abstract review. Finally, 82 full texts were selected for review, of which total 18 records met the inclusion criteria. The PRISMA chart is presented in Figure 1. Full text of selected articles was critically appraised and data was synthesized using a meta ethnography approach(Britten et al, 2002; Hoon, 2003).
Prevalence of mental morbidity was considered as an outcome measure.
Records were included when they meet following criteria:
- Studies carried out on state police or law enforcement or paramilitary force in the context of VIVID-19
- Studies focused on mental well-being, occupational stress or mental health problems
- Studies documented policing practices, strategies or recommendations on policing during health emergencies
- Grey literature such as reports, and guidelines Exclusion criteria Records were excluded when studies conducted with defense personnel or military personnel and those studies published in other than English language.
Records were excluded when studies conducted with defense personnel or military personnel and those studies published in other than English language.
The literature search was done by one researcher. The results were matched by repeating search exercises using key words and removing duplicating and unqualified records based on the exclusion criteria by another reviewer. Initial data extracted from the selected studies and data synthesis was done by AKP and was reviewed by SS. Full text of selected articles was critically appraised.
Out of total studies reviewed, only one study was conducted on police personnel during COVID- 19 pandemic as of 30th September 2020. Most studies were conducted in developed countries such as the USA, and UK indicating lack of research priority on this topic among researchers and practitioners.
COVID-19 presents a serious risk of infection and harm to police personnel (Alcadipani, Cabral, Fernandes, & Lotta, 2020). Various incidents during lockdown were noted where people attacked police personnel. For example, police personnel, beaten up by a group of people in Punjab, reported one police officer’s hand was chopped off and two were injured (Ghazali, & Sanyal, 2020). Similar incidents of beating up of police personnel were recorded in Maharashtra (Deccan Herald, 2020). The risks to physical health of police personnel from COVID-19 are clear as they continue to work in the COVID-19 environment. As of 21st September 2020, 99602 police personnel including CRPF personnel were tested positive and 574 personnel succumbed to death (Police Foundation of India, 2020). Furthermore, incidents of police suicide deaths were also recorded (Times of India, April, 27, 2020). COVID-19 poses a significant risk of harm to self, which represents one of the most significant factors linked to poor mental health outcomes following critical incidents, traumas, and disasters. Fear ofCOVID-19 infection is widespread among police personnel.
Recent study conducted in Maharashtra, 50 percent of police personnel are mentally disturbed due to fear of COVID-19 and faces challenges at the workplace (Kokane, Maurya, & Muhammad, 2020). The current situation of COVID-19 necessitates police personnel to work under trauma inducing conditions for longer than usual emergency situations, which may impact their physical and mental health. Thus, tracking the longer term psychological outcomes of police personnel is particularly important. Police personnel who are infected by the virus and/ or who lost someone, or suffer from chronic physical health or psychiatric conditions should be taken care and protected from adverse effects of COVID-19.
Impact on Family Members of Police Personnel
Whilst the sustained stress experienced by police personnel themselves may be harmful, the pandemic has significant implications for police families as well. Studies have not documented the impact of COVID-19 on families of police personnel; however, few studies have reported impact of traumatic conditions and emergencies on the families of police personnel. In the aftermath of Hurricane Katrina, many police had to cope with the impact of the hurricane on themselves and their families (West et al, 2008). Faust and Vander Ven (2014) described Hurricane Katrina as a worst-case scenario, as police were both victims and first-line responders. Of relevance to this discussion, research undertaken by Behere, Basnet and Campbell (2017) found that one family member’s threat to life predicts mental health of family and particularly impacts children’s mental health. Further, in the context of COVID-19, police personnel are fearful of bringing home the virus to their families. In turn,it is likely that family members also, at the same time, worry about their family member who is offering services to the police (Drew & Martin, 2020). Unlike other public health emergencies, the job of police personnel in the era of COVID- 19 is directly affecting the mental health of family members. However, research on the prevalence of mental health problems among family members of police personnel is lacking. It is assumed that usual levels of stress caused by the “routine” threat of policing among family members will be significantly increased in the COVID-19 context (Stogner, 2020; Drew &Martin, 2020).
Impact of COVID-19 on Mental Well-being
COVID-19 pandemic presents challenges for police leadership in supporting personnel in an environment that has both physical and mental health impacts (Kirby, 2020; Reicher, & Stott, 2020; Shirzad, Abbasi Farajzadeh, Hosseini Zijoud, & Farnoosh, 2020). A recent study conducted with police personnel in Maharashtra reported that half of the police personnel had mental disturbance due to fear of COVID-19 virus and one-third police were facing mentalstress due to other reasons related to their occupation (Kokane, Maurya, Muhammad, 2020). This is nearly double than the psychological disturbance indicated among the general population (28%) in the systematic review conducted (Rajkumar, 2020). The COVID-19 pandemic has affected police personnel as well as their families across the globe (Sriwijitalai, & Wiwanitkit, 2020; Laufs, & Waseem, 2020).
Knowledge of COVID-19 and Precautionary Measures Used by Police Personnel
Inadequate knowledge and occupational exposure both are attributed as risk factors for infection among healthcare workers (Jiang, et al, 2020) which is relevant to police personnel as well. A qualitative research conducted in Maharashtra demonstrated that 50 percent of police personnel received information about the virus from social media such as WhatsApp and Facebook (Kokane, Maurya, Muhammad, 2020). Huge gaps in adhering to precautions were observed in the study. The same study reported that one-third of the total police professionals were using masks, sanitizer, and gloves in working hours to protect themselves; about 10 percent of police personnel were taking care of their personal health, and about half of them (51%) washed their clothes while returning home from the duty. This indicates a need for creating awareness on precautions among police personnel and their families.
Effectiveness of Mental Health Interventions for Police Personnel
Police leaders must consider what programs and initiatives are needed to support the psychological outcomes of COVID-19. Literature indicates mixed outcomes of mental health interventions for police personnel. Among the most recognized interventions in policing is the Critical Incident Stress Management (CISM), providing an “emotional first aid” to stabilize and restore pre-crisis functioning (Mitchell, 2003); Critical Incident Stress Debriefing (CISD), a specific technique designed to assist others in dealing with the physical or psychological symptoms associated with trauma exposure (Malcolm et al, 2005); Mental Health First Aid (MHFA) training (Intveld, 2016),peer intervention programs (Aronie, & Lopez, 2017), trauma resilience training (Arnetz, Nevedal,Lumley, Backman, & Lublin, 2009) and psychological first aid programs, such as Recognize, Evaluate, Advocate, Coordinate, and Track (REACT) (Marks et al., 2017). While reviewing these interventions for police personnel deployed during emergencies, Castellano and Plionis(2006) concluded that interventions lack consistent outcomes and more rigorous program evaluations are needed. The evidence on effective mental health programs in COVID-19 context is not definitive, hence, locally suitable short-term and long-term programs should be implemented in Indian context and effectiveness of such interventions should be documented.
Addressing Mental Health of Police Personnel: Learning from Previous Emergencies
The prevalence of post-traumatic stress disorder (PTSD) in police and first responders is associated with critical incidents and disasters. Different types of traumatic experiences produce different mental health problems. Based on a systematic review of the literature, prevalence of post- traumatic stress disorder was noted between 8 and 12 percent during and after 9/11 World Trade Center attacks in USA (Lowell et al., 2018; Laufs, & Waseem, 2020) whereas shortly after Hurricane Katrina, 19 percent of police personnel reported PTSD symptoms whereas 26% reported symptoms of Major Depressive Disorder (West et al., 2008). Long-term impacts of emergencies on police personnel mental health have also been documented. A study on prevalence of PTSD of police involved in 9/11 found that PTSD rates increased over time (Bowler et al., 2012). PTSD, depression or anxiety can develop up to six years following disastrous events (Wang et al, 2010). For example, a study conducted 20 months’ post-earthquake in Nepal revealed prevalence of mental morbidities among the general population (Kvestad et al, 2019). These indicate long-term impact of traumatic events on police personnel and highlight the need to address short-term and long-term interventions to address mental health issues of police personnel.
Best Practices on Policing: Positive Policing during the Pandemic in India
Positive policing perhaps one of the most important aspects of law enforcement, but often neglected as being secondary to the important role of enforcing the law. Positive policing is potential to transform police organizations by changing negative police subculture, and negative public perception.
During the pandemic, positive policing can be practiced that can create a lasting impact on the lives of people and change the image of the police as follow:
Collaboration between police and public health engagement. There may be a need to share resources and strengths between the police and health department. For example, the police had a resource for contact tracing of at-risk people (potential contact with the affected patient), and helped people in need of urgent healthcare in rural areas where there were no health facilities. Cyber police helped take actions to “fake and misleading” messages on social media.
Becoming an example by actions and positive messaging. Police can play a crucial role in spreading a message of positivity, community and strength. Many police personnel have adopted innovative ways to appeal to people to educate and stay home. For example, Tamil Nadu traffic police devised “corona helmet” to educate people and urge them to remain home, Maharashtra police efforts increating mass awareness.
Assisting people in need is vital in this crucial time. For example, In the National Capital, police had helped the elderly in arranging grocery, Meerut police distributed food to the needy while Bareilly police fed the hungry and poor. Documenting best-practices among police personnel across the country can be inspiring and motivating not only for peers but also help spreading positive messages about policing to the public and in turn, can create a positive image of the police. In this direction, Police Foundation of India has recently documented best-practices across police forces in the times of COVID-19 which is appreciable. Disseminating these practices to police personnel across police organizations would be a welcome step.
Police organizations play a critical role during public health emergencies (Sharma & Hossain, 2019; van Dijk, & Crofts, 2017). Recent efforts by police organizations to protect the country fromCOVID-19 pandemic must be acknowledged. During enforcement of lockdown, police personnel went through high risk situations coupled with long hours of duty, multiple shifts and inadequate personal protective equipment.
Various organizations put forth guidelines for police personnel. However, recommendations for coping in the longer term are limited. All guidelines lack information about the fact that, while they may not experience immediate distress, delayed psychological effects can be expected and they should monitor their psychological health over time and seek support even following the pandemic.
State Police Force (SPF) and Its Role in Managing Pandemic
The SPF played a central role in responding to COVID-19 pandemic. It is common to observe negative police-citizen interactions that are characterized by low-levels of trust with several instances of the police brutality and poor accountability structures (Common Cause & Lokniti, 2018). Negative public perception of police force severely affects people’s satisfaction with the rule of law and results in a trust deficit. At the same time police personnel experience the occupational stress and limited resources (Common Cause & Lokniti, 2018; Singh & Kar, 2015). These challenging working conditions make police work even more taxing and it is likely that theCOVID-19 pandemic might have exacerbated their stress. Despite miniscule resources, SPF has taken up the challenge of enforcing the lockdown and promoting public health. They are playing the role of not only maintaining public order but also aiding public health officials in ensuring compliance with state or local public health orders. Even after lockdown is lifted, they are expected to work closely with the Health department and ensure compliance with state or district or local corporation’s COVID-19 related public orders. Such additional duties for a longer duration exert extreme stress. While shortage of personal protective equipment has made the fight tougher, considering their nature of duty, increasing physical and mental health demands are more taxing. Despite they are at the risk of contracting COVID-19 and other physical and mental health ailments, their healthcare needs particularly during pandemic are not addressed. This pandemic has perhaps gathered attention from researchers and public health experts on attending healthcare needs of police personnel to prepare them for the long haul.
Recommendations for Police Leadership Team
Based on the findings of this review and the key insights drawn, a call to action is urgently needed to support police personnel as they continue to experience the stresses of an active COVID-19 environment. At the same time, it is equally important to strategically plan interventions for post- pandemic situations. Evidence-based guideline on addressing mental health concerns during and after COVID-19 pandemic for police leadership team is required.
- Police organization leaders should clearly establish how police personnel are to interact with the community and enforce the rules. The role of police personnel should be focused on informing the public about the current restrictions and encouraging individuals to comply with the state and local emergency health declarations.
- It is also critical that police organizations develop a contingency plan for potential staffing shortages as a result of the spread of COVID-19. It is important to cross-train personnel for temporary duty assignment to assure proper coverage of essential duties.
- Police organizations need to develop a methodology for identifying specific groups of police personnel that may require additional support—those that are at higher risk due to greater trauma exposure (occupational duties, crisis in the family, sickness, death in the family), previous medical and psychiatric history. Such at-risk police personnel should be offered less stressful duties along with mental health intervention.
- Police agencies need to educate their police personnel on the delayed impact ofCOVID19 for themselves and their families, ensuring understanding that mental health concerns are not necessarily immediate.
- Given the unique nature of COVID-19 compared with other types of trauma experienced by police, continuing health monitoring of the police personnel is warranted.
- Adequate psychosocial support intervention should be available to assist personnel in managing their mental health during the active COVID-19 period and provide continued access to support in the longer term.
- Psychosocial support intervention should recognize psychological issues such as depression and anxiety and timely link with specialized mental health care services. Such intervention should also include police families, considering both are impacted.
- Conduct concurrent monitoring and evaluation of interventions and support services, ensuring that programs and initiatives are evidence-based and serve to maximally impact on improving police mental health.
- Integrate interventions with the system for sustainability and long-term. There is a need for a 28 Journal of Mental Health Education | NIMHANS |VOLUME 3 ISSUE 1 | April 2021 holistic support and recovery system for the police personnel so that efficiency of police force can be utilized effectively in future for such type of public health crisis.
Recommendations for Psychosocial Support Intervention
Strengthening psychosocial support for improving mental health of police personnel have the potential to play a major role in overall wellbeing. Psychosocial support helpline along with the low-cost primary prevention model such as “peer counseling” program has potential to improve mental health conditions. Further, use of technology such as mobile based training applications for educating police personnel on coping strategies can be explored.
Self-management Strategies Reported in the Literature
Various national and international organizations have published guidelines and training manuals for police personnel (CDC, 2020; Inter-Agency Standing Committee 2020; PHFI, 2020; WHO, 2020). We have synthesized key points as follow:
Precautions For protecting from COVID 19 infection during the field duty
- Maintain a physical distance of at least 6 feet.
- Use personal protective Equipment.
- Wear a mask.
- Practice cough hygiene (While coughing or sneezing, cover the mouth with a handkerchief or cough or sneeze into the upper sleeve, not your hands.)
- Practice proper hand hygiene. Wash hands with soap and water for at least 20 seconds or sanitizer. Wash hands after touching surfaces like car handles, door handles or elevator doors etc. Avoid touching your face, nose or eyes with unwashed hands.
- Disinfect vehicle. All surfaces that may have come in contact with the patient or materials contaminated during interacting with people (e.g., touching floors, walls and work surfaces) as well as patrol car equipment, steering wheel, gear shift, a dispatch radio module, door handles and edges should be thoroughly cleaned and disinfected using soap/detergent and water or 1% Sodium Hypochlorite solution. Vehicles can be cleaned after every shift.
- Clean essential items/gears. COVID-19-infected droplets may be able to live on nearly any surface. Clean and disinfect duty belt and other equipment like a gun or stick prior to reuse. Consider sanitizing items that are frequently touched during a shift such as a phone, laptop, clipboard, etc.
- Seek help. Seek medical care early if a fever, cough and difficulty breathing are experienced.
Precautions during the duty in the camp
Personnel Can protect themselves from infection when they are in the camps by following steps.
- Maintain physical distancing
- Practice proper hand hygiene.
- Practice cough hygiene.
- When you cough or sneeze, cover your mouth with a handkerchief or cough or sneeze into your upper sleeve, not your hands.
- If you have symptoms like fever, cough, sore throat, or shortness of breath, seek immediate medical care and inform the supervisor.
Protecting partners, families and friends aftershift
Police duties can potentially expose themselves to COVID-19. Before coming back into direct contact with their family, police personnel should maintain physical distancing measures. Based on COVID 19 pandemic guidelines for law enforcement published by the International Criminal Police Organization, follow steps given in the box while returning home.
Precautions To protect families from infection
- Clean or decontaminate your work equipment, including shoes, avoiding the spread of particles/dust;
- Take off duty clothes and wash them with laundry soap as soon as feasible. Handle them and wash them in a way that limits exposure to skin, eyes, environment and other clean clothes (avoid shaking clothes);
- Take a shower or wash exposed skin with soap and water;
- Self-monitor for signs of illness as well those of family members.
Precautions while enforcing crowd control
Larger gatherings offer more opportunities for person-to-person contact and therefore pose a greater risk of COVID-19transmission. Some steps towards positive policing are presented below.
- Meet with community elders/ religious leaders at the event venue: Explain them 30 Journal of Mental Health Education | NIMHANS |VOLUME 3 ISSUE 1 | April 2021 respectfully, try to convince them, be respectful, develop a contingency plan that addresses various scenarios described below which you may encounter during a COVID-19outbreak.
- Establish relationships with key community partners and stakeholders: When forming key relationships with local stakeholder for any events, include relevant partners such as the local public health department, community leaders, faith-based organizations, vendors, suppliers, hospitals, hotels, airlines, transportation companies, and law enforcement. Collaborate and coordinate with them on broader planning efforts. Clearly identify each partner’s role, responsibilities, and decision-making authority. Participate in community wide emergency preparedness activities.
- Stay away from uncooperative individuals. When dealing with uncooperative individuals, limit contact and practice hand hygiene.
- Avoid or limit direct contact with documents. Avoid touching documents and documents are touched, wash hands immediately with soap and water or use sanitizer.
- Stay away from uncooperative individuals. When dealing with uncooperative individuals, limit contact and practice hand hygiene.
- Avoid or limit direct contact with documents. Avoid touching documents and documents are touched, wash hands immediately with soap and water or use sanitizer.
Stress-management strategies during COVID 19 pandemic
Police personnel engaged in an emergency, and those deployed in the field duties are facing tremendous stress.
- Avoid information overload and rumours: Limit news consumptions of news from TV or social media. It creates fear, panic, and anger. Access latest information from the website of the Ministry of Health and Family Welfare, Government of India, helpline numbers, or from the WHO.
- Improve eating habits. Eat sufficient, healthy, nutritious food. Eat fruits and keep yourself and keep yourself hydrated.
- Stay positive. Focus on positive aspects. Talk about the positive incident with colleagues.
- Deep breathing. Sit, close your eyes and take deep breaths. Whenever you are stressed, angry or affected by overthinking, take a pause, drink water if needed and take a deep breath for 1to 5 minutes or more.
- Engage in physical activity. Move around, basic stretching exercises may help. Physical activities help reduce fear, anxiety and improves mood.
- Stay connected with family. Stay in contact with family and friends through phone or video calls or email.
- Avoid drugs. Avoid using tobacco, alcohol or other drugs. In the long term, these can worsen mental and physical well being.
- Develop an attitude of gratitude. Studies show gratitude to improve well-being. Maintain a gratitude diary. One can write a gratitude journal. Appreciate and thank the Universe by writing at-least 1 positive thing that happened in a day.
- Follow spiritual or a religious ritual. Studies indicate that it can improve wellbeing, help in coping with stress and reduce symptoms of mental illness. Based on a person’s preferred spiritual path or religion, engage in prayers, namaaz, yoga, meditation, chanting, mantra recitation, worship, and so.
- Provide social support to your colleagues. Talk with colleagues, stay connected and extend personal help ifunny colleague needs support.
- Talk to the supervisor. Talk with a supervisor if you are directly impacted or have a family member impacted by a stressful event in the family. And prepare a flexible duty schedule.
- Seek mental health help. If you are not able to manage symptoms of stress, sleeplessness, irritability, fear, seek help. Talk with a medical officer in the camp or use a helpline number for assistance. For psychosocial support, use psychosocial support helpline.
Precautions and strategies for Supervisors and Administrators
Supervisors and administrators play a vital role in protecting the health (including mental health) of their subordinates.
- Educate police personnel hand and cough hygiene.
- Avoid public duty, if police personnel are not well.
- Roll call briefing. Physical distance should be maintained while police attendance in the evening.
- Flexible schedule for vulnerable staff. If personnel are not well, provide immediate medical care. If personnel are having a family crisis, provide an alternate schedule that is less stressful. ● Providing Medical Checks for police personnel. Police personnel should be provided with guidance on protection from COVID 19 and regular health check-ups. Screening booths should be set up at police quarters.
Implication for Future Research
Future study can map existing studies (completed and on-going studies) on mental health as 32 Journal of Mental Health Education | NIMHANS |VOLUME 3 ISSUE 1 | April 2021 well as mental health programs for police personnel in India. This will help assess effectiveness and scale-up best programs. Prospective research can focus on assessing prevalence of mental morbidities, resilience and coping mechanisms used by police personnel of different cadres in the context of COVID-19 pandemic and in general. Implementation research to create evidence is commanded. It may be perhaps more pertinent to undertake a clinical and cost effectiveness analysis to see how investing in mental health can improve health outcomes of the police, their performance and the policing.
The COVID-19 pandemic has exacerbated stress among both police personnel and their families. Protecting police personnel during the pandemic such as COVID-19 is essential. In the absence of mental health service provision within the police force, intervention to prevent mental health problems and treat mental health conditions among police personnel is inescapable. In this crucial time, implementation of sustainable mental health interventions and generating evidence on its effectiveness are needed without delay.
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