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) https://www.necn.com/news/new-england/Maine-to-Consider-Red-Flag-Law-478687253.html 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
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Protection from abuse: the role of social media in the reduction of safety

WESTBOROUGH, MA March 20, 2018  Greater protection of victims of domestic violence is needed.  When provisions for a plan of safety are executed victims are expected be afforded greater safety but not always. Domestic violence victims are at greatest risk when they make the decision to leave a violent partnership.  This often means having a safety plan – especially when specific threats have been made. Safety plans are often drawn up by women in conjunction with counselors who specialize in helping families stay off the grid and hidden from violent spouses.  In one case of familial homicide and suicide it was clear that the commonalities needed to be exposed among cases of familial homicide.
In particular, when I teach law enforcement officers about DVH,  I encourage detailed witness statements much as possible especially if the victim described the fear and belief that she will one day be murdered by her partner. These documented statements, if spontaneously uttered, are often the greatest predictor of potential harm to victims and her children. If written into a police report the decision about dangerousness and bail may be influenced.
In the 2011 homicide from Maine, Steven Lake used social media to track his wife and 2 children from whom he was mandated to stay away.  Yet, if his wife posted a photograph of his children he went to great lengths to undermine their safety by identifying anyone who “liked” the photo or commented on it. He used these posts to triangulate her whereabouts and living arrangements.  This was a large part of what marginalized Stephen Lake and in turn Lake posted his own propaganda espousing his loneliness and love for his children. Lake garnered significant support from those social media “friends” who knew nothing about what he had done to require the protection from abuse order. Many, in fact, encouraged him to fight for his children which may have been a catalyst in his festering resentment and ultimately terminal rage. He was provided information and access to his wife’s social media platforms by a family member.  For her part, Lake’s wife wanted to remain close to her in-laws in an effort to normalize her children’s life as much as possible. For example  Lake’s parents were invited to the family’s thanksgiving celebration but declined because Steven Lake could not attend.
Similarities in domestic violence
Cases of domestic violence have similarities across socioeconomic status, ethnic and cultural background, and the cycle of abuse. The growth of social media platforms affords those inclined to control and isolate intimate partners from persons who might provide them security. Cases of domestic violence share the common theme of intimidation, coercion and control.  Social media are a fun and useful medium to keep in touch with friends and family.  But it is also lends itself to sometimes nefarious trolling to gain a perceived advantage in undermining the safety plan. Social media trolling contributes to the control they seek especially when victims seek protection.  In order to limit the impact of social  media stalking victims need to shut down all social media accounts and activity. Greater protection of victims and family members requires a comprehensive plan with provisions for times when they are violated – including mandatory arrest, risk assessment and no bail containment if deemed necessary.
“That is one conclusion of four former and current police officers in a recently released report. The men, who were volunteers and had no connection to the shootings, spent the last several months interviewing 69 people about the triple homicide and suicide in Dexter in June, to suggest ways to prevent future tragedies.” Portland Press Herald, November 11, 2011
The Psychological Autopsy report suggests improvements that may prevent future domestic violence homicides:
 Use of social media platforms by people involved in conflicts should be minimized, to prevent intimidation and stalking.
 Protection-from-abuse orders and bail conditions should mandate disclosure of all firearms that are accessible to the domestic-violence offender.
 An offender who seeks, hides, uses or attempts to acquire a gun or ammunition when a protection-from-abuse order is in place should be charged with a felony and not allowed bail.
 Bail amounts should be high enough to deter abusers from violating a protection orders.
 When a protection order violation involves a deadly threat, a judge should set bail, not a bail commissioner.
 Global positioning systems should track abusers during periods of protection orders in any incidents that involve deadly threats or evidence of weapons.
 At least two officers should be sent to all domestic-violence calls when officers suspect violence is likely.
 At-risk spouses should be advised to live in as secure an environment as possible, with deadbolts on doors, secured windows, motion sensor lights and a land telephone line.
 People charged with domestic violence crimes should not wait more than a year to go to trial.
The safety of potential victims including children is the penultimate goal of protection orders but too often they are ignored via stalking efforts that include using social media to track the activities of an estranged spouse.  This overt defiance requires careful analysis and requires the arrest of the violator.  Once this takes place a dangerousness hearing must take place before he or she is released but this rarely takes place.

Domestic Violence Review – When Containment Fails

Domestic Violence Review – When Containment Fails

 WESTBOROUGH, MA February 15, 2018  The fact is that greater containment of high risk abusers is needed.  I have spoken with police chiefs, district attorneys, and state senators here is Massachusetts about conditions of bail. Whenever someone is arrested he or she is given the opportunity for bail – usually on his own recognizance. This means he simply promises to show up for his initial court hearing usually in the next 24-48 hours.  Unfortunately, no one seems to believe that a person can be held on “high bail” simply because one subject held his family hostage and threatened them with a firearm or another person tried to strangle his intimate partner.

 

im_cycle
Power and control – Cycle of abuse

The system of bail is directly related to a defendant’s prior history of crimes, convictions, and lastly, the nature of the crime for which he is seeking bail.  The cycle of abuse is posted to the left. It is all about power and control of the victim. On average, police are called after 9 prior episodes of abuse. In general, they arrive when the couple is in crisis and he may be feeling guilt and making excuses for his behavior.  Or other times, the couple is in the honeymoon phase of the cycle and one partner invariably refuses to press charges on his partner.  This is what really infuriates police officers called upon to answer these potentially violent calls. “It was all a big misunderstanding” according to the dangerous partner.
I have posted several essays over the years on the topic of “dangerousness” in terms of it being considered prior to the granting of bail.  The June 2011 case in Maine culminated after the abuser was released from jail on $ 2000 dollars bail. After his death the money was returned to his family.  Some district attorneys have tried to withhold bail money when the defendant fails to appear in court due to death by suicide after domestic violence homicide (DVH).  For many this seemed like a draconian response to families who were in pain and suffering immeasurable.

“Many believe there is a disconnect between the judiciary and the bail system.” Sefton, 2011


What can be done to assure greater containment?

Containment refers to the need to protect a potential victim and his or her family from a violent often marginalized family member who is showing red flags of impending terminal rage.  A Domestic Violence review panel conducted in June 2011 concluded that “there is nothing society can do for a despondent, abusive spouse whose obsession overrides the norms of society – even his will to live”.  If we believe this then we will erroneously surrender innovation in domestic violence prevention and harm reduction.  When high-ranking prosecutors say domestic violence homicide cannot be prevented society is cheated out of taking steps toward containment of those who may violate protection from abuse orders.  Lois Reckitt, executive director of Family Crisis Services in Cape Elizabeth, ME is quoted as saying that the wrong people are in jail when violence-prone abusers are released from custody to stalk and terrorize their family, as was the case in the Dexter, Maine tragedy in 2010.  Containment and harm reduction should be the focus of the legal system and social service agencies alike.  The judiciary and political machinery in states throughout America must speak out about protecting victims and families and not say there is nothing that can be done to stop DVH.

Sefton, M. (2011). Domestic violence and domestic violence homicide. Blog post http://enddvh.blogspot.com/2011/10/domestic-violence-review-when.html Taken January 16, 2018

Predicting the next mass shooting: do people just “snap”?

bigstock-Mental-illness-in-word-collage-072313WESTBOROUGH, MA January 21, 2018  Do people just “snap”? Rarely according to most literature I have read and published. The expression of violence is elicited slowly following a prolonged period of marginalized aloneness along with underlying resentment and anger according to Michael Sefton, Ph.D. This takes a great toll on relationships, loss of trust and a growing persecutory narrative that may become delusional.  The gunman in the Las Vegas mass homicide was described as narcissistic – a personality disorder vulnerable perceived rejection or disrespect often resulting in sudden rage, denial, decreased rational thinking, accusatory blaming, and often marked denial of responsibility. In the Las Vegas shooting it has been learned that the gunman had recently sustained a significant financial loss although its link to the people he killed remains a mystery.  There is typically some specific event that may trigger a violent event that could have been planned over months or years and evolve like the expression of some genetic permutation.

“People do not just “snap.” When something horrible happens, like a murder or violent attack, we naturally look for a cause. “Snapping” is an easy way to describe what is actually a complex, yet understandable chain of events. Research into violent attacks and the behavior of the attackers can shed some light on how one moves down a pathway toward violence.” Swink, 2010

The capacity for behavioral science to predict when the next mass shooting will occur remains unrefined. Yet, by studying the cases of mass murder that have occurred in the past 5 years there are important pre-incident behaviors that may foreshadow a coming terminal event. Often there are people who know precisely what is going to happen.  In our study of a domestic violence homicide that took place in Maine, 2011 we were told by the aunt of the murderer that she expected her nephew to kill himself but expect that he would do it in front of his wife and children.  What ultimately happened was a murder suicide.  Steven Lake killed his wife and 2 children and made an attempt to incinerate their bodies before local police arrived.  At that point he made himself comfortable and ended his life and the Lake family timeline.


Swink, J (2010) The Pentagon Shooting: They Don’t “Just Snap” Posted Mar 06, 2010 Taken Jan 4, 2018

Analysis of Facts helps Reduce Harm to victims of DV

DOMESTIC VIOLENCE REVIEW BOARDS
WESTBOROUGH, MA  January 5, 2018 As we begin to make program recommendations for reducing intimate partner violence it is worth noting that change comes very slowly in protecting those who are most at risk. There is still a paucity of protective measures in place to assess and contain those who are most violent in our society. Retired New Braintree Police Sergeant Michael Sefton was in Augusta, Maine in October 2011 providing testimony about the results of the psychological autopsy conducted by Michael Sefton, Ph.D. Brian Gagan of Scottsdale, AZ, and Ron Allanach, Ed.D. of Conquitlam, BC, Canada and former Chief of Police Joseph Laughlin of Portland, ME.  Dr. Sefton, who holds a doctorate in psychology and is a licensed psychologist provider in Massachusetts provides neuropsychological and forensic consultation on domestic violence including domestic violence homicide and assessment of risk.  The report that was filed came up with over 50 recommendations directly related to reduced intimate partner violence. The report was cited over 12 times in a recent Maine Law Review publication on proposed Conditions of Bail. Little has changed in Maine since our first report in 2011 and there is no leadership to bring forth legislative dialogue.
PUBLIC INFORMATION
The testimony provided to the domestic violence review board offered details about a hideous case of family violence that ended with the homicide of 4 members of the same family and was culminated by an attempt to burn the bodies after the murders and the killer shooting at police officers responding to the missing victim. But they were too late. Their research was conducted over a 3 month period following the homicide deaths of Amy Lake and her children.  The team conducted interviews with over 60 persons with direct knowledge of Amy Lake, the victim, her two children, Monica and Cody, and the murderer Steven Lake.

Maine Law Review

“Although Maine’s statute lists these prohibitions, it lacks the enforcement tools to protect victims against violence associated with guns and other weapons, which is a major factor in Maine’s domestic violence deaths.” Nicole Bissonnette, 2012
HIGHEST RISK
Most researchers agree it is nearly impossible to predict when DVH will occur.  However, the psychological autopsy provides many obvious red flags that offer clues to an impending emotional conflagration or explosion of anger and blame.  The problem in the 2011 case was two-fold.  First, the requirement for bail was not seriously considered because Lake had no criminal history – and yet Mr. Lake had demonstrated an unwillingness to adhere to the legal mandates of the order of protection and violated the court order at least 4 times over the year before he killed his family. Given this unfettered lack of personal control, he should have been held for a hearing of potential dangerousness.  And secondly, the cache of firearms that Lake was known to have kept was not surrendered to police nor was an effort made to obtain the 22 weapons Lake owned by members of law enforcement. No one thought the guns would be an issue.
Many believe that when the victim indicates a strong fear belief that her spouse intends to kill her that risk of DVH is elevated exponentially and must be taken as fact. These often unspoken fears illustrate the need for supervision, assessment of potential for dangerousness and containment of PFA violators. Substantive red flag factors suggest a true risk of violence exists. The study also found that individuals with heart disease who are depressed will often have higher inflammation levels in their body. Many studies show that a combination of exercise and fatty acids, such as Omega-3 found in salmon, can reduce inflammation and consequently reduce bouts of depression and mood swings.In the sworn statement in 2010 for an order of protection, Amy Lake specifically reported that she feared that her husband might kill her. These fears of death would come to fruition one year later. And they did come true in despicable, horrific fashion.
It is not uncommon that red flags are often present early in the relationship as people reported during our research interviews during the psychological autopsy.  Many people we spoke to were aware something agregious was going to happen.  These include obsessional jealousy, threats of death, sexual aggression, unwillingness to integrate into extended family, any use of a weapon, and others.  In the course of their research Sefton and Gagan interviewed Dale Preston who was convicted of DVH in 1982 and served 18 years in Maine State Prison for the murder.  When asked what may have stopped him from killing his wife, Mr. Preston indicate “there was nothing that could have stopped me…”  In these cases, a greater awareness of risk or dangerousness is essential and in some cases a person must be contained for the safety of others.  Such containment requires NO direct contact with an abusive spouse, GPS monitoring, house arrest, or no bail imprisonment.
The case in Maine occurred in June 2011 – exactly 1 year to the day after the victim obtained a protection from abuse order from her husband.  The murders occurred 2 weeks before the divorce was to be finalized and were likely triggered by the abuser’s anger over not being permitted to attend his son’s 8th grade graduation ceremony.  The Bangor Daily News presented details of the recent psychological autopsy presented recently in Augusta, Maine.  Over 30 states across America have formal homicide review boards.  “To make this general deterrence aim successful, abusers must not have access to their victims nor to potential weapons, and the risk of punishment associated with breaking the law must outweigh the abuser’s urge to commit the conduct.” said Denaes, 2012. Bail is a judicial condition that allows a person to be released from jail with the promise to appear in court to answer to charges. Bail also provides for public safety by keeping violent offenders in jail when necessary.
I make an effort to review those published from New England states.  Vermont has an excellent annual report of domestic violence homicide and publishes all recommendations and changes in statutory requirements following individual cases of DVH.

Ronald Allanach et al., Psychological Autopsy of June 13, 2011, Dexter, Maine Domestic
Violence Homicides and Suicide: Final Report 39 (Nov. 28, 2011),
http://pinetreewatchdog.org/files/2011/12/Dexter-DVH-Psychological-Autopsy-Final-Report-112811-
111.pdf.
Nicole R. Bissonnette, Domestic Violence and Enforcement of Protection from Abuse Orders: Simple Fixes to Help Prevent Intra-Family Homicide, 65 Me. L. Rev. 287 (2012).
Available at: https://digitalcommons.mainelaw.maine.edu/mlr/vol65/iss1/12
Johannes N. Denaes, PUNISHMENT AND DETERRENCE 7 (1974) (“General prevention may
depend on the mere frightening or deterrent effect of punishment—the risk of discovery and punishment
outweighing the temptation to commit crime.”).
See id. at 34-35

Public Awareness Needed for Meaningful Jail Diversion

teachinginprison

“If mental illness drives the violent behavior than all weapons and substance use must be carefully controlled and eliminated.” Sefton, 2017

Westborough, MA December 21, 2017 Jail diversion is a hot topic across the country even here in Massachusetts. Since July, 2017 the Massachusetts Legislature has passed sweeping changes in the Criminal Justice System.  Locally and across the country, the numbers of persons incarcerated for minor offenses and drug crimes has grown in some cases exponentially. Many of these individuals have mental illness or drug abuse in addition to their criminality. The interaction between poly-substance abuse or dependence and exacerbation of underlying mental health symptoms is complex and multifactorial. The interaction of the two is sometime lethal as reported by the Globe Spotlight team It is the focus of mental health advocates and criminal justice experts nationwide as it pertains to jail diversion, alternative restitution and reduced police use of force. In Massachusetts, there is a move away from mandatory minimum sentences for all drug crimes except for those involving the sale and distribution of narcotics. Arguably, the impact on behavioral functioning when persons are gripped with co-occurring illness, such as alcoholism, is a recurrent problem for law enforcement and first responders. I have written about the impact of co-occurring illness such as alcoholism on mental and behavioral health is previously published posts here on Word press Human Behavior (Sefton, 2017). It is difficult to uncover which comes first – the addiction or the diagnosed mental illness and yet these are inextricably linked in terms of the strain on public resources and health risk to those so afflicted. Why is this important?

The importance of treatment for substance dependence and mental illness cannot be understated as violent encounters between law enforcement and the mentally ill have been regularly sensationalized. The general public is looking for greater public safety while at the same time MH advocates insist that with the proper treatment violent police encounters may be reduced and jail diversion may be achieved. The referral and treatment infrastructure needed to provide a continuum of care in this growing population is available in very few places across America.

Yet in places like Bexar County, Texas – including San Antonio and 21 other towns or cities – the county jail population has dropped by over 20 percent as a result of crisis intervention training for police officers and mobile mental health teams to intervene with those in crisis. I have seen this for myself during a visit with the San Antonio Police Department where I rode with two members of the Mental Health Unit – Officers Ernest Stevens and Joseph Smarro. These men are exemplary in their assessment and intervention skill for keeping identified subjects off radar screens and out of the revolving door of the county jail.  It takes ongoing training, medical and psychiatric infrastructure, community compassion, and active engagement with members of the community to fly under the radar and effectively reduce the jail population. When necessary those most in need must have 24-hour availability for detoxification, emergency mental health, and access to basic needs such as food, clothing, and medicine. In San Antonio, they offer so much more including pre-employment training, extended housing, interview preparation including clothes, and opportunity for jobs.

The unpredictability of behavior by those who carry a “dual” diagnosis has emerged as a confounding factor in the criminal justice system raising the specter of frustration over the limitations within the system. Jail diversion programs and treatment options are needed in order to retain public safety goals and provide for needs of the mentally ill and substance dependent. In Massachusetts, cities and towns are grappling with how best to intervene with the mentally ill in terms of alternative restitution for drug-related misdemeanor crimes in lieu of mandatory jail sentences that many crimes currently require. The Massachusetts legislature has taken up Criminal Justice Reform and passed a bill in late 2017 making changes in the mandatory minimum sentencing laws.  Some believe, as much as 20-40 percent of all incarcerated persons suffer with mental health diagnoses and are not getting the treatment they require. To provide a bare bones system would add billions to state and federal dollars spent on the needs of inmates at a time when measurable outcomes for in house care are limited.

In my practice, I see many cases of co-occurring pain syndromes with other physical debilities such as stroke or traumatic brain injury. Some of these cases are substance dependent and live lonely, chaotic lives.  Generally the emotional impact of two or more diagnosed illnesses yields a greatly reduced capacity for adaptive coping and puts a great stress on the individual system. The importance of addressing co-occurring substance abuse or dependence is now well recognized and with treatment can result in healthy decision-making, growth in maturity, and greater self-awareness. If legislators have a serious desire to reduce statewide numbers of incarcerated persons a comprehensive plan must be considered for both pre-arrest and post-arrest. Programs greater understanding of addiction and added treatment options must be explored through a joint public and private initiative.

Mental and Physical Health Screening

At time of arrest the individual must have some level of mental health assessment if mental illness is suspected or documented. When I was a police officer prior to 2015 we often asked the D.A. to provide a court clinic assessment of the suspect to rule out suicidal ideation or delusional thinking. This must also include a screening for dangerousness especially when a subject is arrested for intimate partner abuse. Next a health history questionnaire should be undertaken to screen for co-occurring illness – both physical and mental. If a diabetic suspect is held without access to his insulin he is at great risk of death from stroke. Similarly, a person arrested for assault who suffers from paranoid ideation is at greater risk of acting violently without access to psychiatric medication. Finally, an alcoholic brought to the jail with a blood alcohol level greater than 250 is at great risk for seizures and cardiac arrhythmias when delirium tremens begin 6-8 hours after his last drink. The risk to personal health in each of the scenarios above must be taken seriously and the obtained data should be factually corroborated. Police departments across the United States are pairing up with private agencies to provide in-house evaluation and follow-up of individuals who fall on the borderline and may not be easily assessed by the officer in the field.

Diversion Safety Plan with Mandated Revocation

Next, the probation and parole department must obtain an accurate legal history prior to consideration for bail. A nationwide screen for warrants and criminal history based on previous addresses is essential. In many places these are being done routinely. In the case of someone being arrested for domestic violence he may have no convictions thus no finding of criminal history. For these individuals the dangerousness assessment may bring forth red flag data needed for greater public safety resulting in protection from abuse orders, mandated psychotherapy, and in some cases, no bail confinement when indicated. Releasing the person arrested for domestic violence without a viable safety plan increases the risk to the victim and her family, as well as the general public – including members of law enforcement.

Bail, Confinement, Mandated Treatment

There is some thinking that higher amounts of bail may lessen the proclivity of some offenders to breach the orders of protection drafted to protect victims and should result in revocation of bail and immediate incarceration when these occur. Mandated treatment may be more successful when legal charges are held as leverage where after 6 months of sober living and regular attendance at 12-step recovery meetings charges can be dismissed or modified to each individual case.  This takes a complete overhaul of the front end of criminal justice system and requires buy-in by judges, district attorneys, and individual family members.

When it comes lack of compliance and repeated domestic violence, I have proposed a mandatory DV Abuse Registry that may be accessed by law enforcement to uncover the secret past of men who would control and abuse their intimate partners. This database would also include information on the number of active restraining orders and the expected offender’s response to the “stay away” order. In cases where the victim decides to drop charges there should be a mandatory waiting period of 90 days. During this waiting period the couple may cohabitate but the perpetrator must be attending a weekly program of restorative justice therapy, 12-step recovery and substance abuse education. Violations of these court ordered services are tantamount to violation of the original protection order (still in place) and victim safety plan and may result in revocation of bail. If the waiting period passes and the perpetrator has met the conditions of his bail than he may undergo an “exit” interview to determine whether or not the protection order / jail diversion plan may be extended or whether he/she has met all requirements.  In any case further police encounters will be scrutinized and prior charges may be re-instated or filed as needed.

Michael Sefton


Sefton, M. (2017) Human Behavior Blogpost: https://msefton.wordpress.com/2017/03/30/police-are-building-bridges-and-throwing-life-savers/ taken December 10, 2017

Mentally ill American’s and their proclivity to act out against authority

Westborough, MA December 15, 2017 The popular press is filled with ideas and criticism about what best to do with those afflicted with mental illness.  The resources available to law enforcement are practically nothing in the average community.  I have answered calls in west central Massachusetts where a citizen asked for referrals for counseling for a family member who was addicted to something or other.  Too often I had nothing to offer.  Generally speaking unless someone has money to pay for psychiatric services they are left to languish on the waiting lists of community mental health centers.  In emergencies many show up or a taken by ambulance to the emergency mental health center nearest their place of residence.  This usually ends up costing them thousands of dollars and hours of their time only to be told they must follow-up with a primary care physician. The entire process can be demeaning and inhumane.

In a prior post I have advocated for the use of 12-step recovery programs to help those with substance abuse and dependence.  These are not psychotherapy and are often leaderless meetings. There are have daily meetings in every city and town.  12-step programs teach the understanding addiction and loss of control from addition, coping by taking one moment at a time in order to remain substance free and belief in a higher power. In many cases new members of AA or NA – or any compulsive behavior recovery group – may have a sponsor who comes forth and provide 24/hour support. I encourage family members to attend meetings with their loved one in show of support. Sobriety can begin tonight at the 7 PM meeting in Watertown, Worcester or Anytown, USA.

The interaction of substance abuse and mental illness is complex.  Persons with drug and alcohol addiction must be expected to become sober with the help of substance abuse treatment and family support. The risk of violence and suicide declines when sobriety can be maintained.   Michael Sefton, 2017

“We have to get American police to rethink how they handle encounters with the mentally ill. Training has to change” according to Chuck Wexler, executive director of the Police Executive Research Forum, an independent research organization devoted to improving policing. People carrying a dual diagnosis are at greatest risk for self-destruction – including intimate partner violence and suicide by cop.


Sefton, M (2017) Blog post: https://msefton.wordpress.com/2017/01/16/police-as-therapist-the-inherent-risk-of-unconditional-positive-regard/ Taken 17 November 2017