Violence prediction: Keeping the radar sites on those who would do us harm

crosshairsWESTBOROUGH, MA May 20, 2018 In response to recent acts of both terrorism and recurrent gun violence by home-grown psychopaths more should be done to maintain greater control over potentially violent persons. In the Las
Vegas concert venue and the more recent Texas church massacre it becomes
increasingly clear that predicting violence is practically impossible. At least this is
what we are led to believe. And yet when it comes to domestic violence
homicide the similarities in cases are almost carbon copy.
In the end, there is always at least a single person who knows what is about to happen and often does nothing to stop it. Whether this duplicity stems from cultural beliefs that what happens behind closed doors is nobody’s busy change in the way in which law enforcement manages these cases is essential. The buy in from police, legislators, judges, probation, and society needs to be fully endorsed for real change to happen and for safety plans to work. Many states across America are planning to enact “red flag” rules that will remove weapons from individuals with a known history of domestic violence e.g. choking spouse during fight. These behaviors toward a victim instill fear and point to the perilous danger that exists.
“Someone with a history, particularly a continuing history of violence, can be presumed to be dangerous.” Frederick Neuman, MD
Coercion and Control
Lenore Walker is a psychologist at the Domestic Violence Institute has published a theoretical description of the coercion and control model of DV. Victims are young and vulnerable to being emotionally and physically controlled. The Texas killer Devin Patrick Kelley had all the makings of a violent abuser from the time he was in high school and only now are people willing to talk about his darker side. Kelley was separated from his second wife who was just 19. Victims like this are often kept away from their families, not allowed to work, or when working are not permitted to handle their own funds. Some victims have to explain every cell phone call or text message they make or receive often being met with jealous fury. By robbing their sense of self keeps intimate partners emotionally isolated and insecure. They are often led to believe they could not live on their own and the children they share will be lost to them if they choose to leave. This “so called” male privilege keeps his partner marginalized and in servitude. It appears at first glance that Kelley was looking for the mother of his currently estranged wife likely enraged over steps taken to keep them apart as the divorce progressed through the courts.
Occasionally police or children’s services are called when intimidation and threats become violent. It is important to provide aftermath intervention and follow-up with families where domestic violence or chronic substance abuse occurs or families tend to disappear. Change is required to pay closer attention to those with whom law enforcement has frequent contact. Over and over
surviving family members speak of coercion and control on behalf of the abused.  Lives will be saved when society takes a closer look at red flag violence – these are the preincident indicators that violence and domestic violence homicide are possible. This is not new data nor are the stories very different.
I speak to police agencies and individual officers about DV and DVH offering detail from the psychological autopsy research we conducted on a sensational and tragic case in Dexter, Maine in which Stephen Lake killed his 35-year old spouse after 10 years of marriage along with their 2 children. The Lake case was very much like the Kelley murders in terms of the cycle of abuse and its early onset. It was thought that Lake was intending to go on a killing spree but was interrupted in the act by an observant police officer. Recently a police officer participating in the statewide DV task force in Vermont asked whether there is a single most important factor or predictor to the risk of DVH? Some believe the fear of being killed by her spouse and abject cruelty toward step children raise the bar significantly and as such are worthy of crafting one’s DV report and request for orders of protection around. But keeping the victim and her abuser on the radar screen will also reduce her fear and loneliness and offer greater protection. Other risk factors include: choking and recurrent
sexual violence – although victims seldom disclose this out of guilt and fear of not being believed.
People knew what might happen
The Psychological Autopsy of Stephen Lake consisted of over 200 hours of interviews with immediate family members on both sides. Stephen’s aunt was quoted as saying “I never thought he would take the kids” in reference to an acknowledgment of his depression and anger at the impending divorce. She believed Lake would take his own life in front of his wife and children as a final act of punishment they would never forget. But he went far beyond that as we again saw in the small church in Texas this week. We are getting better at teaching children and families that if the see something they should say something. This is the trademark line of the Transportation Safety Administration in its fight against terrorism. The same might be taught to neighbors and friends when domestic violence is suspected or known to be occurring. If you see something than it is incumbent upon each of us to do something to help those in harms way.

Neuman, F.  (2012) Is It Possible to Predict Violent Behavior? Can a psychiatric examination predict, and prevent, a mass murder? Psychology Today. Taken May 12, 2018

Violence in the Workplace: Do people just “snap”?

WESTBOROUGH, MA June 2, 2018  Violence in the workplace is commonplace but has taken a back seat in the setting of recent school shootings. Research on the “lethal employee” is becoming more reliable in the aftermath of of workplace violence. Nevertheless people commit murder in their workplace more than ever.  What should people do if they are worried about a co-worker becoming violent.  There are signs that someone is loosing control and may be thinking of violence.  A list of potential factors is taken below from the U.S. Department of Homeland Security publication from 2008. The term “going postal” refers to a workplace shooter or act of violence.  It evolved from workplace violence in the U.S. Postal service in the 1980’s according to a report published in 2008.

“One theory was that the post office was such a high-pressure work environment that it drove people insane. In the years to come, other cases of murderous rages by mailmen cemented the idea in the public mind. “Going postal” became a synonym for flipping out under pressure.”

“An active shooter in your workplace may be a current or former employee, or an acquaintance of a current or former employee. Intuitive managers and coworkers may notice characteristics of potentially violent behavior in an employee. Alert your Human Resources Department if you believe an employee or coworker exhibits potentially violent behavior” (2008)

Indicators of Potential Violence by an Employee Employees typically do not just “snap,” but display indicators of potentially violent behavior over time. If these behaviors are recognized, they can often be managed and treated. Potentially violent behaviors by an employee may include one or more of the following (this list of behaviors is not comprehensive, nor is it intended as a mechanism for diagnosing violent tendencies):
• Increased use of alcohol and/or illegal drugs
• Unexplained increase in absenteeism; vague physical complaints
• Noticeable decrease in attention to appearance and hygiene
• Depression / withdrawal
• Resistance and overreaction to changes in policy and procedures
• Repeated violations of company policies
• Increased severe mood swings
• Noticeably unstable, emotional responses
• Explosive outbursts of anger or rage without provocation
• Suicidal; comments about “putting things in order”
• Behavior which is suspect of paranoia, (“everybody is against me”)
• Increasingly talks of problems at home
• Escalation of domestic problems into the workplace; talk of severe financial problems
• Talk of previous incidents of violence
• Empathy with individuals committing violence
• Increase in unsolicited comments about firearms, other dangerous weapons and violent crimes

U.S. Department of Homeland Security. (2008). Active Shooter – How to Respond
Bovsum, M. (2010) NY Daily News. Mailman massacre: 14 die after Patrick Sherrill ‘goes postal’ in 1986 shootings. Taken May 19, 2018

C.I.T. or M.H. Co-Response: Which model is safer for everyone?


Dr M. Sefton (left) Officers Ernest Stevens and Joe Smarro of SAPD Mental Health Unit


WESTBOROUGH, MA May 5, 2018 When people are in crisis law enforcement officers respond to the call for help. Because of a spate of police officer involved shootings there is a call for less police violence.  Yet in fact, it is the primary action of the citizen the evokes the lethal response by police. Those who call for “more police training in mental health counseling and less training in the use of firearms” have never been faced with the life or death conundrum – kill or be killed. Meanwhile, police officers are being called upon to de-escalate hazardous encounters daily using skills taught to them in the academy or in-service training. A detective in an urban department recently told me that the majority of their calls for service are for people exhibiting signs of mental illness.
The Department of Justice published a BJA Spotlight on Safety article entitled Defusing Difficult Encounters that essentially teaches officers to slow down the scene by projecting calmness and establish rapport. This is done by asking open-ended questions, e.g. “tell me what happened today”? Constantly assess the dynamic, changing threat by using communication strategies, defusing strategies, and mindfullness. Finally, take action using the minimum about of force needed to bring about a peaceful outcome.  Taking action does not necessarily mean the subject is arrested or goes to hospital.  In my experience if family members are actively engaged in the person’s life they may assist with aftermath intervention such as detox, rehabilitation, or hospitalization, if needed.  Ultimately, the use of force continuum follows the principle of causation by guiding police decision making based on the level of threat in any police encounter.
There are two dominant approaches to encounters of police and persons with mental illness. The first involves having mental health clinicians either ride along with patrol officers (or detectives) and roll on calls that involve someone exhibiting signs of mental illness. In some cases clinicians are housed at police facilities and interview subjects once they are brought in for determination of needs – rather than simply sending the person to the local emergency department.  The second method of police-mentally ill interaction teaches LEO’s to directly engage the person using skills they are taught such as empathic listening, establishing rapport, defusing emotional crises, and initiating treatment options e.g. hospitalization, medication management, return to psychotherapy, detoxification, 12-step AA or NA meetings.  Family members are encouraged to facilitate some treatments and I believe play a large role in keeping family members sober.  The drug or alcohol abuse often makes the mental illness more unpredictable and unstable.  Significant threats to public safety and direct risk to police officers can be mitigated if the abuse of drugs and alcohol can be managed by members of the immediate family.
Crisis Intervention Training (CIT) for police officers is an expensive and ambitious program that teaches first responders how to recognize and engage citizens exhibiting signs of mental illness.  I have seen this for myself work smoothly in San Antonio, Texas in 2017.  The SAPD is using a program developed by police and mental health professionals in Memphis, TN in the early 2000’s and adopted by SAPD in 2003.  I was fortunate enough to ride with two of the department trainers Officer Ernest Stevens and Officer Joseph Smarro.  I was shown the MH intake facility and met Roberto Jimenez, M.D, the program medical director who began his career at Boston City Hospital as I did. I visited the entire continuum of services including Bexar County sponsored housing and career development programs.  It was quite an experience and I remain in contact with the unit to this day.  Some believe that this “sensitivity training” will reduce the number of officer involved shootings with those who are known to be mentally ill. CIT training offers plenty of practice role-playing scenarios that come directly off of the call sheets affording a reality-based training opportunity.
In something of a contrast many department utilize the service of a mental health expert – usually a clinical social worker or licensed mental health counselor, to provide the de-escalation intervention, dialogue and liaison with mental health services to reduce the need for jail and the risk to everyone involved from escalating behavior and missed understanding. I have spoken to police officers accustomed to this method who believe it works well.  They develop a rapport and trust in the mental health clinician who comes on the scene only when it is safe to do so to begin their assessment. This too is designed to reduce the risk of unintended consequences and divert individuals away from jail and into treatment programs. Given the speed at which violent encounters take place I believe there are risks to everyone involved using this model of de-escalation. When an officer has one instant of hesitation he or someone else may be victimized in the time it takes to make contact, size up the call, and gain compliance.
The NYPD uses a clinician model that tracks hospital discharges and uses a preemptive strategy meeting with mentally ill persons prior to any growing crisis.  Their belief is that by keeping them off the police radar they reduce the likelihood of an acute crisis and divert potentially lethal encounters.
“Steve Coe, the CEO of Community Access, an organization that advocates for the mentally ill and works with the NYPD training officers on how to treat that community, said he hopes the task force focuses on creating a system that also would dispatch social workers to emergencies involving the mentally ill.” according to a report in the Wall Street Journal – April 21, 2018
Crisis Intervention Team training (CIT), is a progressive first-responder collaborative effort that works closely with community stakeholders, health care organizations , and various advocacy groups. The CIT model was first developed in Memphis and has spread throughout the country. The San Antonio Police Department adopted this model in 2003 and it has continued to grow immensely year after year. 40-hour CIT training allows law enforcement officers to respond with a new skill set which has a myriad of benefits both data specific and anecdotally. Additionally, CIT in San Antonio directly benefits individuals with a mental illness, while improving the safety of patrol officers, mental health consumers, family members, and citizens within the community. Because CIT is a collaborative program, it provides the foundation necessary to promote community and statewide solutions to assist individuals with a mental illness.
The 40-hour CIT model aims to reduce both stigma, and the need for further involvement with the criminal justice system through jail diversion programs. CIT provides an opportunity for effective problem solving regarding the interaction between the criminal justice and mental health care system. San Antonio Police Chief William McManus has mandated the 40-hour CIT training to all cadets and peace officers on the department. The San Antonio Police Department has fully embraced CIT by allowing a full-time Mental Health Detail to grow from two-officers to 10-officers, according to a SAPD spokesperson with knowledge of the SAPD program.
Dual Diagnosis – Mental Illness and Substance Abuse/Dependence
Arguably, when the police are called to keep the peace or investigate a violent person call they are required to meet the threat with heightened awareness for their personal and the safety of the immediate family and others.  If the violent person is actively aggressive or menacing with threat of lethal injury to the police or others than there is unlikely going to be any de-escalation until the threat of lethal force is eliminated. More often than not the person of interest is intoxicated or under the influence of drugs as well as suffering from some form of mental illness like depression or paranoia.  In the time it takes to find just the right words to engage a threatening subject who is waving a firearm or machete or baseball bat people may die – including members of the police who are trained and responsible for calls like this. When people attend psychotherapy sessions and 12-step recovery programs the proclivity for violence is greatly reduced.
No single model is best and all are still in the growing stages of establishing protocols for bringing those most disturbed individuals in from the margins. More and more officers are receiving CIT training every year according to Sefton in 2017.  Inevitably, drug abuse is a co-morbid factor that alters perception and fuels underlying anger and violent tendencies. On the other hand, if the violent person responds to officer directives to cease and desist all violent action and submit to being taken into protective custody or arrest – only then can mental health assessment be initiated.

San Antonio Mental Health Unit (2018) Personal correspondence on Crisis Intervention Team – Mental Health Unit.
Sefton, M. (2017). Police are building bridges and throwing life savers.  Blog post Taken April 21, 2018

Maine to Consider “Red Flag Law”

WESTBOROUGH, MA April 25, 2018  Maine is the latest state to consider a so-called red flag law. It would let family members or law enforcement officers petition a judge to take away a “high risk” person’s firearms temporarily, if the judge determines the person poses an imminent risk. In a recent post I describe the updated terminology for individuals who are a potential threat called Gun Violence Restraining Orders.  The proposed action would allow law enforcement to remove the firearms of people who are known to be threatening or physically violent toward intimate partners.  “Felons, the dangerously mentally ill, perpetrators of domestic violence – these people have demonstrated their unfitness to own a firearm” said David French, 2018.  In cases such as these police have reasonable cause to disallow gun ownership based not on prior conviction but on the elevated risk to potential victims.
Here in Massachusetts, in August 2013 I published a blog after the death of Jennifer Martell who was murdered in front of her 4-year old daughter by Jared Remy, son of Red Sox broadcaster and former player Jerry Remy.  The younger Remy had received one break after another some say linked to his celebrity father’s influence.  He was never held until a dangerousness hearing could be undertaken.  Had this been done Ms. Martell may be alive today. In 2011, Stephen Lake murdered his wife and children after he was kept from attending his son’s 8th grade graduation.  Lake had exhibited several red flag warnings prior to the murders.  In spite of these he was not held nor were his firearms removed form his control Allanach, et al. 2011.
Several states have debated similar red flag laws in the wake of the school shooting in Parkland, Florida. Supporters argue a red flag law could have prevented the Parkland shooter, but some gun owners say it’s an overreach that threatens their 2nd Amendment rights.
Like many states in the U.S. Maine has more than its share of calls for domestic violence and domestic violence homicide.  “All law enforcement personnel who respond to incidents in which an individual’s mental illness appears to be a factor receive training to prepare for these encounters; those in specialized assignments receive more comprehensive training. Dispatchers, call takers, and other individuals in a support role receive training tailored to their needs.” Communication between members of a response team with awareness and understanding of red flag warnings will reduce the impact of coercion and control that belies the secretive relationships between intimate partners.  It will also bring to light the need for danger assessment and containment of people who are high risk for violence as in the case of Jared Remy in Massachusetts and Stephen Lake in Dexter, Maine.

Red Flag Warnings (2018) Taken 4-4-18
Allanach, R.A., Gagan, B.F., Loughlin, J., Sefton, M.S., (2011) The Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide and Suicide. Presented to the Domestic Violence Review Board, November 11, 2011

Career as LEO: Finding Resilience in the Ruins

WESTBOROUGH, MA May 1, 2018 Police officer behavior is a growing interest of mine especially in 2018 when everything is being watched by various citizen groups and the ubiquitous media looking for signs of police bias and egregious acts of abuse. Questioning every decision and reviewing all reports under the guise of freedom of information and transparency.  Is it any wonder that departments nationwide are having difficulty recruiting men and women to join the ranks as police recruits?  Many departments are offering sign-on bonuses like Salt Lake City, UT and San Jose, CA and others.  Some agencies are left shorthanded after having personnel poached by neighboring departments with bigger payrolls and greater opportunity for growth, training, and overtime. I still believe the police service is among the best career a person could choose and served 15 years both in Maine and Massachusetts.

Sgt. Michael Sefton Retired NBPD 2015
Police recruits undergo 6-8 months of rigorous physical conditioning, mental preparation for scenarios of all kinds, and legal and policy education for the particular state and local department for whom they are employed.  A growing part of the academy training has to do with maintaining healthy habits and staying positive and emotionally resilient over a long career in the law enforcement profession.  Officers are provided the physical training they need and behavioral health training necessary to face a career with high stress and often unbearable pain and suffering.  The effectivness of these lessons depends upon the follow through as officers embark on their journey.  The career success they have may be directly related to the application of resiliency training to build and maintain physical and emotional hardiness that lasts a lifetime according to Leo Polizotti, 2018.
Reduced stigma will afford officers the chance to express themselves, lower stress and tension, and seek help when situations evoke or release the ghosts of cases past – often the underpinning of PTSD. This openness has not yet found its way into the law enforcement culture and while physical fitness has taken hold for career satisfaction – mindfulness has not become fully embraced.
The key to any new skill set is to train for events that may be unexpected and to apply emotional well-being strategies to after incident debriefing.  All too often police officers keep to themselves the underlying emotional impact of some of the calls they face and tend to minimize the psychological impact on them.  Yet it is well know that some calls leave their imprint on the human psychie.  How could any person walk away from the Newtown school shooting in Connecticut and not feel numb and traumatized no matter how senior a man you were.  Clearly the LEO’s and other first responders demonstrated heroic service to the Newtown Community – just at they did in Boston following that city’s 3-day seige that culminated with the execution of Officer Sean Collier, an MIT police officer and later an 8 minute fire fight in Watertown, Massachusetts. But in private moments what effect does this have on human resilience?
“Having a winning mindset and thinking more positively about the Law Enforcement profession you have chosen can go a long way toward limiting the effects of burn out, reducing illness and lessening traumatic reactions to critical incidents.” Leo Polizotti, Ph.D.
Police officers are needed more than ever and as a profession LEO’s need support and continued opportunity for training in all areas police service including handling the once-in-a-career “shit show” that clearly leaves its mark.  Resiliency training requires ongoing training – just like defensive tactics and legal updates.

Polizotti, LF (2017) Psychological Resilience : From surviving to thriving in a law enforcement career. Personal Correspondence. Taken 4-21-2018

The myths and risks to individuals with mental illness

WESTBOROUGH, MA April 8, 2018 The myths attributed to persons afflicted with mental illness need to be directly addressed and corrective programs must evolve provide enhanced understanding and awareness of mental health.  Police officers encounter citizens with mental illness daily and often are called upon to calm a volatile situation often with very little formal training. This fact is changing as more police officers are trained in Psychological First Aid and Crisis Intervention Training – 2 programs that afford front line officers with the behavioral observation skill and communication necessary to reduce risk to police and the public from highly charged persons exhibiting signs of mental health crisis.
Psychological experts believe mentally ill persons lack the higher order planning to execute the complex steps necessary for anything more than petty crime – more often associated with co-morbid substance abuse.  This is where the problem lies. “The myth is you have to be “crazy” to do something like this (active shooter). So retrospectively, you look at people and you say, wow, this obviously – that guy should have been branded – but alcohol accounts for a great deal more violence than mental illness does.” according to Joel Dvoskin in an APA interview dispelling myths about the mentally ill.
Remember it is a fact that those with mental illness are rarely violent and those who commit violence are rarely mentally ill.
Until recently,  here in Massachusetts many smaller police agencies are forced to pay overtime for police officers to sit in hospitals or outside of jail cells watching a mentally ill person who has been arrested. This policy grew from the fear of litigation if someone dies in police custody who is known to be a mentally ill person.  Specifically, if a police officer arrests a person with a known history of suicidal ideation it has been policy among many agencies to provide an officer to monitor the prisoner to assure for a safe transfer to court. If this occurs on a week end night that often means that someone must have eyes on the person in custody until the next available court date.
But is this truth or is this part of the myth associated with those taken into custody for crimes committed while suffering from a substantive mental illness? Or is the problem really associated with substance abuse?
“Pre-arrest diversion also has been shown to be successful when law enforcement and mental health professionals respond together to behavioral health emergencies. Individuals are more often referred to the services and treatment that they need, rather than enter the criminal justice system as an offender. This co-responder model has delivered great results in Massachusetts to date. Programs run by Advocates, a human services agency, in partnership with several police departments in Middlesex County and funded in part by the Department of Mental Health have generated over 4,000 diversions and $11 million in savings since 2003.” Diane Gould Worcester Telegram February 2018

Dvoskin, J. (2018) Speaking of Psychology: Dispelling the myth of violence and mental illness Episode 27 American Psychological Association

Gun-violence Restraining Orders

firearm-revolver-bullet-gun-53219.jpegWESTBOROUGH, MA APRIL 8, 2018 Restraining orders in cases of domestic violence have been around for decades or longer. At times people require formal court orders of protection from those who might bring forth violence to loved ones.  I have personally written over 50 requests for protection of a victim of domestic violence.  Most of these are temporary order issued by an on-call judge who listens to police officer statements over the telephone.  They are usually granted and valid through the next court day – generally within 48 hours.  The problem is that after the 48 hours is up the conflict between intimate partners has been long forgotten resulting in a waste of police resources and an irritated district court judge. Obviously this is not always the outcome.
In Massachusetts, the MGL 209-A covers orders of protection and its legal underpinning. Section 3B in MGL 209-A requires the removal of firearms from those with active RO’s taken out against them.  As many as 50 percent of restraining orders (RO’s) also called protection from abuse orders (PFO’s) are continued because the victim showed up at court and testified as to the protection she believes is needed and fear she feels living with her intimate partner.  These are not new and the complaints and dysfunction among intimate partners is a continuous drain on LEO resources.
Calls for service because of domestic violence are frequent.  Police officers are often asked to keep the peace at times when violence has occurred.  Arrests are mandatory when physical injury has occurred.  At this point police are required to remove the violent spouse and offer protection from further abuse to the victim and her family.  When RO’s are granted there is a growing belief that guns should be taken from subjects against whom RO’s are granted.  Experts say these GVRO laws are modeled after domestic-violence restraining orders that also authorize police to take away guns from people who pose threats to their partners, but with safeguards.
“Ensuring the mental wellness and health of first responders has long been an under appreciated task for the heads of police agencies. U.S. law enforcement has learned from tragic events over the years and now trains to respond to threats with the best equipment and practices known today. However, many chiefs are not prepared to deal effectively with the intense scope and unanticipated duration of the aftermath of these events, and many chiefs are unaware of the impact such events will have on their communities and the officers in their agencies.”
“These red-flag laws are a possible solution because they’re an intermediate step between doing nothing and trying to involuntarily hospitalize an individual,” said Christopher Slobogin, a law professor at Vanderbilt University.
“While LEO’s may be more resilient, law enforcement officers also quietly deal with an outsized share of our society’s violence and death. As a result, too many officers struggle with alcoholism, post-traumatic stress disorder, and depression.”
“You can’t just call up law enforcement and say this person that I’m mad at is a danger to me, it is not possible without judicial oversight,” said April Zeoli, a professor who studies domestic violence at Michigan State University. Her research shows these restraining orders reduced intimate partner violence by 13%.
“Research data provide strong evidence supporting the effectiveness of emotional fitness training to enhance resilience, positive emotions, cognitive flexibility, and emotional well-being, and more importantly, they strengthen professional pride and organizational commitment” according to Tung Au, in the Journal of Police and Criminal Psychology in 2018.
Felons, the dangerously mentally ill, perpetrators of domestic violence – these people have demonstrated their unfitness to own a firearm” David French, 2018
Supporters say the “red flag” measure—also known as a gun-violence or extreme-risk protection order—offers a way to address a legal conundrum: how to take action against people perceived as an imminent threat to themselves or others, but who haven’t done anything illegal.

Au, W.T., Wong, Y.Y., Leung, K.M. et al. J Police Crim Psych (2018).
French, D. A (2018) Gun Control Measure Conservatives Should Consider. National Review, February 2018
Kamp, J. and Mahtani, S. (2018) States Consider Laws Allowing Courts to Take Guns From Dangerous People  ‘Red flag’ measures are gaining ground after Florida high school shooting. Wall Street Journal