Co-occurring Illness: Effecting change at times of crisis

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WESTBOROUGH, MA  – April 24, 2017 There is no magic solution for de-escalating someone who is in “crisis” or emotionally distraught.  The loss of control may signal a failure of reality testing that can signal a diminished capacity to appreciate the consequence of their behavior.  This occurs frequently when people who have mental illness have co-occurring drug and alcohol addiction. It is true that the correctional system has more than its share of mentally ill prisoners but for many being in jail is the only way to stay sober.  The full capability to provide mental health services in the correctional system here in Massachusetts has not been realized.  The courts are reluctant to require that someone receive treatment for mental illness and/or substance abuse in lieu of going to jail.

Criminality and mental illness are not mutually exclusive so there will always be a high number of incarcerated persons with chronic underlying psychiatric diagnoses.  The prevalence of mental illness in the general population may range from 5-15 percent. The degree of mental illness in the correctional system may be as high as 40 percent by some accounting but the number is misleading. One needs to consider treating mental illness when it becomes a barrier to functioning such as in schizophrenia or bipolar depression where the symptom profile interferes with reality testing. Only then may a contract for treatment may be constructed to include medication and psychotherapy depending upon the diagnosis.  In cases where mental illness and co-occurring substance abuse exist a determination about primary diagnoses and treatment options must be considered.

“The consequences of dual diagnosis include poor medication compliance, physical comorbidities, poor health, poor self-care, increased risk of suicide or risky behavior, and even possible incarceration” according to Buckley and Brown, 2006

In many cases of emotional crisis those in need can be diffused with recognition of their struggle – such as death of family member or loss of employment.  By showing empathy for their emotional burden police officers and mental health providers can intervene and make a real difference.  But effecting change takes time and a consistent message that personal responsibility begins at home.  Instead of placing blame on a “system” that is filled with holes individuals need resilience and family support to get the help they require. teachinginprisonBefore I am criticized for being insensitive, I point to the 12-step programs in alcohol and drug recovery.  They are free and in many cases provide 24-hour support and mentoring at times of crisis. I strongly believe that if people can remain clean and sober than the need for crisis intervention will decrease.  Ostensibly, this is a perfect first step toward recovery and will bring forth a palpable reduction in emotion and reduce the potential for violence.  When substance abuse is stopped emotional growth is more able to take hold.  Healthy, more effective problem solving may result from prospering emotional maturity allowing for resilience and enhanced coping.

Stress can engulf individuals and families for a variety of reasons and should not be judged. People cope with stress differently and in many cases achieve emotional relief by having someone to talk to.  Some clinicians believe great personal change may be possible when coping skills are most frail.  But in too many instances, drug and alcohol abuse present a confounding variable when working with person’s diagnosed with mental illness. At the same time this raises the risk to law enforcement exponentially. Why?

One response to stress is the increase in substance use and with that increase there is often a worsening of any underlying mental health disorder such as depression and anxiety.  “There could be a common factor that accounts for both, primary psychiatric disorder causing secondary substance abuse, primary substance abuse causing secondary psychiatric disorder, or a bidirectional problem, where each contributes to the other.” (Buckley and Brown, 2006) Unemployment, early childhood trauma, financial burdens, and random emotional baggage result in a range of actions that foreshadow regression and failure of coping mechanisms that put us all at risk.  Some people are able to endure extreme levels of stress with little to no outward sign of distress while others boil over at the first sign of conflict or emotional ripple.

JAIL DIVERSION

There is a growing push toward alternative restitution and jail diversion for those with mental health and substance abuse problems.  In San Antonio, TX, the Bexar County jail had been filled to capacity for many years.  As a jail diversion and mental health program evolved the population dropped by 20-25 percent from 5000 inmates to 3800.  Data suggests that over one quarter of all prisoners may experience mental illness or substance dependence/abuse and are not receiving treatment.  But here in Massachusetts the systems are not available to make this innovation an effective reality in any scale.  Many departments are using jail diversion options such as drug treatment and counseling but here in Massachusetts psychiatric treatment cannot be court mandated. Arrest may not be indicated simply because a person is in crisis but those in crisis may be involved in some type of criminality such as assault, criminal threatening, domestic violence and property crimes. So what options are available? The drop out rate for patients suffering from major mental illness is quite high. They often stop taking prescribed medication and do not attend counseling sessions.

MENTAL ILLNESS, CRIMINALITY AND RESTORATIVE JUSTICE

bigstock-Mental-illness-in-word-collage-072313As a police officer I found jail diversion a discretionary tool that was used a great deal. Nevertheless there are times when arrest is the proper course of action but jail diversion remains a possible negotiating point for those charged with some crimes.  The correct response to intimate partner violence should include aftermath follow-up and intervention when the immediate crisis has settled from the events that brought police to this dangerous threshold. Arrest is mandated by state statute when one spouse has visible injuries. Whenever possible using a restorative justice model – often limited to incarcerated individuals – may allow those arrested for crimes against persons to reconstruct their encounters with police and gain concrete understanding of events and the impact substance abuse may have had on the actions taken by themselves and law enforcement. Some never attain empathy for victims, family members including action taken by police and wind up behind bars.  Police encounters with persons having co-occurring mental health and substance abuse are frequently violent and often result in charges for assault on a police officer and more. In the aftermath of these encounters offenders may be sent to treatment in lieu of formal charges with the understanding that sobriety and psychotherapy are indicated.  In cases of treatment avoidance police have the option to file charges later on.

Techniques for understanding mental illness may facilitate mutual understanding and establish the needed bridge to facilitate treatment as published in 2015 (Sefton, 2015). Those seeking diversion from incarceration must demonstrate the willingness to change and take responsibility for their actions.  The relationship between law enforcement and community agencies is one that requires a strong foundation and mutual understanding of the framework for reducing recidivism, criminality, and managing mental illness.


Buckley, P. F., & Brown, E. S. (2006). Prevalence and consequences of dual diagnosis. The Journal of clinical psychiatry, 67(7), e01-e01.

Sefton, M. (2015) Emotionally distraught – nearly one-quarter of all officer-involved shootings go fatal. https://msefton.wordpress.com/2015/07/01/emotionally-distraught-nearly-one-quarter-of-all-officer-involved-shootings-that-go-fatal/. Taken March 5, 2017.

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Saluting a fallen brother and bringing him home

WESTBOROUGH, MA March 18, 2017 Most people leave their homes and go to work.  Many work in sales or IT or perhaps they teach school.  It doesn’t matter because that all changes when you are a member of the fire service or a brother police officer. Then you become a member of a family that many say takes a hold of you like no other.  There is a bond among fire fighters and a respect that runs deep within the fire service – the family of firemen.  The bonds are forged in the hours of training, answering calls, and sitting chewing on the issue of the day.  And then one day someone goes down.  In police service it’s called the “oh shit” moment when something happens so quickly that your response is purely defensive sometimes too late as in the case of the Flagstaff, AZ 24-year old officer whose body camera recorded the oh shit moment that took his life last year.

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Boston Globe photo

Firefighter funeral traditions show our deep gratitude and respect for the honorable contribution they make to society. When a firefighter dies, he is considered a “fallen hero” and his funeral will indicate such an honor.    D. Theobald

The fire service is even more protective of its ceremonial reverence for the ultimate sacrifice made by a heroic fallen firefighter.  Everything stops. Every one steps up and does whatever is needed to support the surviving family and each other. Someone is usually assigned to stay with the bereaved family 24 hours a day. The ritual of bringing home a fallen fire fighter is age-old. Firefighters remain with the body and bring it home with care and reverence afforded a fallen hero.  This custom was once again brought to bear when Watertown, MA firefighter Joseph Toscano, 54 died while fighting a 2-alarm house fire this week.  The death of a fire fighter is a rare occurrence but happens frequently enough that most people can remember the show of reverence from members of the fire service everywhere.  In 2014, 2 Boston firefighters were killed in a wind-driven conflagration on Beacon Hill and who can forget the 6 Worcester firefighters who lost their lives in December 1999, or the Hotel Vendome fire in Boston that took the lives of 9 Boston firefighters over 40 years ago.

Watertown, Massachusetts has seen its share of catastrophe in recent years in the police and now fire services. The funeral will be attended by thousands of local firefighters and those from across the United States. Fire houses in Watertown, Boston, and elsewhere will make accommodations for out of town brothers and sisters attending the funeral. No member of the fraternal family is ever turned away.  The coffin will be on display for those of us so moved to pass by and offer a final salute to the firefighter and his family.  The honor guard will stand at head and foot in solemn deference for the ultimate sacrifice. The surviving spouse will be strong as she has been for many years over many calls for service.  Her husband has helped so many people.  He has seen much and has dealt with this before.  But as the flag draped coffin is moved into place the release of emotion will be palpable for all.  The fire chief will present the folded flag to Maureen Toscano his wife of over 20 years.  He will offer words of comfort to his five children. They will never be forgotten because they are part of the extended family of firefighters.  The 150-year old ritual of bagpipes will play Amazing Grace while men from Newton, Boston and Cambridge stand guard at the Watertown fire houses to allow every Watertown firefighter to attend the service. To grieve and begin the healing process.

A Catholic Mass will be held.  The streets of Randolf where the family lives will be lined with a sea of blue uniforms each one holding back tears – having been through this before.

As Watertown firefighter Joseph Toscano knows it could well have been any one of his brother officers who fell that day and he would never have stood by for that.  A heroic effort was made to save the life of Joseph Toscano by members of the Watertown Fire, EMS and Police departments. He was rushed to Mount Auburn Hospital in Cambridge – the same place where MBTA Officer Richard “Dic” Donohue was rushed after the 8 minute firefight during the search for the marathon bombers in 2013.  Officer Donahue survived but lost nearly all of the blood in his body. Donahue retired from the Transit Police in 2016 after his promotion to sergeant and deals with chronic pain on a daily basis.  Emergency crews at Mt. Auburn were not able to revive Joe Toscano.

His body was carefully moved from the chief medical examiner’s office in Boston – just 5 miles away to Randolf – but he was never alone. Members of his department including his chief rode on Watertown Engine 1 and a ladder truck leading the hearse and a legion of police officers.  Firefighters from neighboring cities stood along highway overpass with hand salute as Firefighter Toscano was headed home. Among the most powerful of ceremonial rituals is “the last call.”  This occurs when the fallen officer is called on the fire band radio for all to hear – “Firefight Toscano come in….” there is silence.  The fallen officer’s call sign is again dispatched – silence once more.   Finally, the dispatcher indicates that the fallen officer has gone “10-7” signaling that he is no longer on duty – in this case signaling – the end of his watch.  A bell sounds 15 times indicating the firefighters final call.  Often the dispatcher will say something like “You have served your community with honor and reverence, good sir, we will take the watch from here.  Rest in peace – Firefighter Toscano and know you are a hero and will never be forgotten.”


Firefighter’s Prayer


When I am called to duty, God,
wherever flames may rage,
give me strength to save a life,
whatever be its age.
Help me embrace a little child
before it is too late,
or save an older person from
the horror of that fate.
Enable me to be alert,
and hear the weakest shout,
quickly and efficiently
to put the fire out.
I want to fill my calling,
to give the best in me,
to guard my friend and neighbor,
and protect his property.
And if according to Your will
I must answer death’s call,
bless with your protecting hand,
my family one and all.

New age cops – the future innovation of community policing

WESTBOROUGH, MA December 29, 2016 I have long been an advocate for prompt and comprehensive treatment for those afflicted with mental illness.  Now police are increasingly linking up with mental health agencies as a way of diverting mentally ill person’s from jails into treatment for their emotional affliction.  In my experience this is no easy task.  In some cases criminality and mental illness are not mutually exclusive.  Some who suffer with emotional issues like bipolar depression, drug addiction or anxiety may respond poorly to treatment and may need containment. Those most refractory to treatment often become most difficulty to manage in society.  The untreated mentally ill have a higher rate of violence than those in voluntary treatment.

psychology2As early as 1984, I served the pediatric population in Boston at the Boston City Hospital Pediatric Emergency Department as the on-call clinician in psychology. That same year I was appointed to the ED at Hale Hospital in Haverhill, MA for screening people in crisis.  Those who were stable and had support systems in place would be released – usually with an outpatient referral. Meanwhile, patients without at-home safe guards who could not plausibly answer the question “what brought you to the decision to harm yourself?” were admitted to the hospital.  Other mitigating factors like healthy living arrangements, employment, sobriety, and no history of suicidal behavior were positive indicators of future outcome.  It was a position I loved and is an important clinical role to this day across the United States.  Later as a community mental health psychologist in Long Beach, CA, I served the Children’s Service as someone charged with screening adolescents in crisis living across Los Angeles County. In each of these locations I worked closely with social workers, case managers, police and gatekeepers at state and county psychiatric units to find open beds for kids in need.

In 25 years since there has been very little innovation and fewer still treatment beds for those in need. Today’s depressed and emotionally wounded often spend days in emergency department hallways further wounded by a demoralizing system of delivery that is overwrought and has no place to send them.  This scenario was the case in 1985 and remains the case in 2016.  In Massachusetts and counties across the United States publicly funded hospital beds – including state hospital beds have been eliminated.  In the 1970’s and 1980’s the pendulum of advocacy swung toward community-based care and away from hospital-based treatment.  This left the chronically mentally ill without a support net for treatment, medication management and long range hope.  Many became homeless, unemployable and abusive of drugs and alcohol.

Police provide frontline intervention – often with little training

Police officers became the first line of defense as the hospital beds were eliminated. The mentally ill and those addicted to any number of drugs or alcohol grew homeless and sometimes menacing as they struggle with symptoms. Now police officers are being trained to intervene with these marginalized citizens with crisis management skills.  This poses a conundrum for the current zeitgeist of community policing theory in that the notion of dangerousness relies on critical scrutiny of the underpinnings of human behavior and often nonverbal indices of psychopathology. Some believe this is state of the art police science.  Departments from Augusta, Maine to Los Angeles, CA to San Antonio, TX are using frontline officers as crisis resolution specialists for police encounters with the acutely mentally ill. Many are paired with licensed clinicians while others are working the streets alone.

The collaboration between police and mental health personnel is not new.  But the use of police officers as crisis intervention specialists is innovative and gaining traction in many places around the country. Yet these officers must always be aware of the uncertainty of some encounters with police and those suffering with paranoia or psychotic, illogical delusions, PTSD, or traumatic brain injury that may not respond to verbal persuasion alone.  Decisions about when to utilize greater force for containment of a violent person is sometimes instantaneous.

The use of force must be fluid and officers in the field are expected to modulate the force they apply to the demands of the situation and be ready to respond to changing threat levels.             Michael Sefton, 2015

In 2002, I was appointed to a Massachusetts police department having once served in southern Maine right out of college.  As a psychologist I made an effort to bring mental health concepts into police work without much fanfare or interest.  Mental health topics are not as sexy as defensive tactics or firearm training, I was once told, so finding numbers was sometimes tenuous.  There are still many myths about intervening with those who are making suicidal and homicidal threats and training opportunities are taking on more importance.  Especially these days.  Suicide by cop became a phenomenon that no officer ever wants to confront. All violent police encounters guide officer behavior. “The degree of response intensity follows an expected path that is based on the actions of the perpetrator not the actions of the police” (Sefton, 2015).

Suicide by cop – predicting behavior

In the 2014 FBI Bulletin, Suicide by cop (SBC) is defined as “a situation where individuals deliberately place themselves or others at grave risk in a manner that compels the use of deadly force by police officers” according to Salvatore, 2014.  This happens more than one might expect and is often preceded by rehearsal events according to Salvatore.  “Suicide rehearsals are practice for the attempts that will follow within a few hours or days. SBCs may be tested. Officers should use caution when recontacted by an individual who previously presented signs of mental illness, had no need for assistance, was standoffish when asked what was needed, or was anxious to assure the officers that everything was fine. The initial contact may have been practice for an SBC.”

The best predictor of behavior is past behavior.  The prior demeanor that police have observed in those frequent flyers who pop up on police radar over and again often sets the stage for violent conflict later on. But not always.  Situations grow exponentially more grave in the presence of drugs and alcohol raising the level of lethal unpredictability. For many struggling with depression or other serious mental illness being sober or drug free can be the healthiest thing they can do for themselves.  The uncertainty of the SBC scenario makes the likelihood of a successful de-escalation a tenuous exercise in the life and death force continuum.

The motives for SBC are multifactorial and undeniably linked to poor impulse control associated with drug and alcohol intoxication.  The triggers are identified by Salvatore as “individuals who feel trapped, ashamed, hopeless, desperate, revengeful, or enraged and those who are seeking notoriety, assuring lethality, saving face, sending a message, or evading moral responsibility often attempt SBC”(2014).  Some believe they will become famous and earn large monetary settlements for their surviving families following a SBC scenario.  Other victims are tortured souls who make no demands and offer no insight into their suicidal motive and are killed when they advance on police or turn a weapon toward responding officers.

Training in police-mental health encounters has slowly taken hold.  This innovation in community policing offers hope for reducing fatal encounters.  No amount of training in crisis management will reduce incidence of SBC to zero but ongoing training to identify the behavioral indices of imminent violence, psychosis, and suicidal/homicidal ideation will reduce these lethal encounters.  Most officers are highly skilled at using their verbal skills to de-escalate a violent perpetrator without using lethal force – even when a higher level of force may have been warranted.


Salvatore, T. (2104), Suicide by Cop: Broadening our Understanding. FBI Law Enforcement Bulletin, September. Taken 12-29-16 Bulletin website https://leb.fbi.gov/2014/september/suicide-by-cop-broadening-our-understanding.

Sefton, M (2015) Blog post Law Enforcement- Mental Health collaboration. Taken 12-28-16, https://msefton.wordpress.com/2015/11/27/law-enforcement-mental-health-collaboration/

Predicting violence: the psychology of bail and alternatives to incarceration

WESTBOROUGH, MA July 19, 2016 The Worcester Telegram published the story of a case of domestic violence that occurred in that central Massachusetts city of 185,000.  A police officer was dispatched to a residence where a subject was suspected of violating the terms of a restraining order.  RO’s – as they are commonly referred to – offer a safety net between the victim of domestic violence and the abuser.  RO’s are authorized by a district court judge who is on call night and day. They are not authorized unless substantial threat to the victim exists.  These orders are carefully crafted by investigating police officers whose reports highlight the exact nature of the violence and the reason the victim needs protection.  Protection orders are offered to the victim after the first sign of physical violence. It has been espoused that the police are not called until after the 6th or 7th episode of domestic violence.  DV is a secret affair between members of a family who are often ashamed or embarrassed to come forward for help often until things gradually get worse – sometimes years into a pattern of violent dysfunction. Greater latitude for judges in handling violent offenders must be legislated including holding someone without bail.  This rarely takes place due to the fact that so many abusers are law abiding citizens and have no record against which to negotiate bail. Arguably, at some point violent spouses must be held for the safety of the victim and her children as in the case of Jared Remy in 2013. Remy killed his live-in girlfriend Jennifer Martell in front of the couple’s 4-year old daughter hours after being released from custody for violating an order of protection.

In other cases of violence against the police, noncompliant behavior that results in violence toward police officers must be dealt with in kind including no bail holds, dangerousness assessments and GPS monitoring for those who may be released. Past behavior is the best predictor of future behavior.  In Massachusetts one police officer lost his life because a career criminal was repeatedly released on no or low bail.  Auburn Police Officer Ron Tarentino paid the ultimate price in exactly such a case.

“Hindsight tells us that this guy should have stayed in jail. Maybe, if the court had had more time to spend on the case, that would have happened. However, we can’t generalize from this case to all cases, according to Vic Crain, a New Jersey-based Market Research and Public Policy firm.” Vic Crain, personal correspondence July 2016.

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Cycle of abuse in domestic violence is well described – TAKEN 2016

On this day, a Worcester police officer was cut with a steak knife wielded by the angry spouse who was being arrested for violation of the stay away order. Bail conditions must be carefully considered whenever a restraining order is violated. It is a sign that the alleged perpetrator has blatantly ignored a legal court order by contacting his partner in some way – even by telephone or via social media. He need not be menacing against his spouse and family. Violation of an RO may signal an outright decline in the violator’s coping skill and perhaps an ominous sign of impending terminal rage toward a spouse.  Terminal rage results in a loss of self control along with an erupting emotional maelstrom of blame and hate – sometimes resulting in a fugue state. Episodes of terminal anger will last just so long and ultimately results in the self-destruction of the abuser.  The cycle of abuse in DV is well described by Lenore Walker and is depicted to the right.

In Gardner, MA on 7-19-16, a North Carolina man was charged with burning two vehicles and menacing his ex-wife with a shotgun. He is being held without bail until a hearing can be held to determine if he is dangerous and should be kept behind bars according to the Worcester Telegram story. The Worcester case resulted in charges of violation of restraining order, mayhem, assault and battery with a dangerous weapon and attempted murder.  A Worcester Police Officer was severely cut with a knife during the violent arrest.

Decisions on bail of the two cases described are straight forward and no bail was allowed in either until such time as the court psychiatrist or psychologist was able to assess dangerousness.  This is where society needs to begin the change in expectations for those involved in DV – measuring dangerousness.  The measurement of dangerousness can be nebulous and forensically uncertain.

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 retrospect, Jared Remy was a prototypic abuser and ultimately Ms Martell was left unprotected when he should have been behind bars. Whether or not he had bipolar illness, abused drugs – including steroids or likely both Jennifer was no match when Remy launched his fatal attack.  But all who know Jared say he loved Jennifer Martell and his daughter.

I have answered calls like these and they are mostly the same. I am trained to look for “red flag signs of violence” that would automatically raised my level of concern. Unfortunately there are people who believe intimate partner violence is nobody’s business.  That belief system is harmful. Slowly people are learning that secret violence robs our society of its civility.  My police report in all cases would specify the immediate need for a dangerousness hearing – especially when there had been more than one prior order of protection and violating an existing order of protection.  Other facts such as substance abuse, loss of job, a blended household, pregnancy and the lack of transportation add to the risks of leaving a violence man in the household.

The reporting party in a recent case had been threatened by the spouse.  These verbal threats began as soon “as I said I do”with slight humor.  The physical abuse began shortly thereafter. On this day he was angry at his wife wife who had spent the day with her sister and had arrived home the same time as her husband.  Dinner was not ready.  This led to a significant escalation of his baseline level of anger, suspiciousness and borderline paranoia by the time police were called.  He had thrown the dishes all over the kitchen and dining room out of protest – lamenting his lazy wife.  His children were frightened and crying.

The signs of violence are finger marks on the neck from choking, forced intercourse, obvious trauma from open or closed fists, threats of death or some other random act of stupidity toward a spouse that leaves her and her children in great fear.  Any of these should result in arrest.

Research is clear that separating spouses for the night does not positively impact the level aggression and risk in the household as much as the formal arrest of the aggressor.  What usually happens is the police break up the fighting couple by sending the aggressor off to the home of a friend or family member – less often to jail unless there are obvious signs of abuse. Arrest is mandated by law when physical signs of abuse are apparent. It has become all too often the case that hindsight – taken seriously – may have saved a life.

There needs to be a clear consequence for the violation of a protection order – and yet violent abusers are given chance after chance as in the case of Jared Remy.  In the research I conducted with 3 colleagues – cited below – failure to hold a spouse when there are numerous red flag warnings. In this case, after holding his family hostage for 3 hours at gun point, a reluctant and frightened spouse called the local sheriff’s department.  Patrols found the perpetrator who remarked to his son “your mother has done it this time…” as the blue light were activated.  He later went on to murder his wife and his two children – including the boy mentioned in this post.

REFERENCES

  1. 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
  2. Crain, Vic (2016) personal correspondance, “Hindsight shows us this guy should have stayed in jail”, July 17, 2016.

America’s moral failure: Veteran health and the slide into oblivion

WESTBOROUGH, MA December 26, 2015 The topic of suicide among America’s war veterans comes up over and over when morbid stories become known – generally after the death of a former soldier, marine, or airman. This must raise the consciousness of each of us and greater attention to the health of our veterans is our moral duty. So far, the incidence of suicide among America’s war heroes seems not to have diminished in 2014.  22 veterans are said to commit suicide daily – more than are killed fighting in war. How is it possible that more is not being done for these men and women and their families?  A society unmoved by these facts is a moral failure.

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Amy Miner now speaks out on PTSD (AP PHOTO – Holly Ramer

No greater failure comes to mind but the case of Kryn Miner, a Vermont veteran of 11 wartime deployments who was killed by his son in 2014 after threatening his family with a firearm. Miner was seriously injured in 2010 sustaining a TBI after a roadside blast threw him into a concrete wall. But it was not his first exposure to trauma. He returned to his home with a brain injury and PTSD and was unable to receive the treatment he needed to release his demons.  His wife Amy was quoted as saying “the truth of the matter is if we can’t take care of our veterans we shouldn’t be sending them off to war.”  Miner’s mental health slowly languished as he fought the fight to gain access for veteran’s health benefits.

America failed to provide for access to meet his basic needs causing both he and his family to suffer immeasurably.  Some might argue that Kryn Miner and his family represent the unconscionable and symbolic misfortune of  America’s war heroes. Ironically, it was Kryn Miner who strove to gain access to benefits for many of his fellow Iran and Afghanistan war veterans via the Lone Survivor’s Foundation.  Eventually, he became a spokesman for the foundation.  But Miner struggled with his own demons that eventually cost him his life in a troubling case of patricide in rural Vermont.  Kryn Miner suffered with a traumatic brain injury and post-traumatic stress.  On the day he died, he had attended a wedding with his wife and arguably consumed too much alcohol.  He became angry and menacing ultimately threatening to kill his family.  In self defense, one of Miner’s children used a handgun to defend members of the family.  The state’s attorney general did not bring charges calling Miner’s death a justified homicide.

This family, like so many others has suffered immeasurably and will experience the pain of this death forever. It would be all too easy to point the finger at the Veteran’s Administration Healthcare System for having too few mental health clinicians or too long a waiting list. In fact as much of an advocate Kryn Miner was for his brother servicemen and women he did not help himself. He threatened his family with a firearm and may have killed them all were he not stopped by a courageous child in a unconscionable turn of events that no one could anticipate.

Are childhood sports becoming venues for expression of unencumbered anger?

WESTBOROUGH, MA January 20, 2016  “Childhood sport represents an opportunity for children to learn the value of teamwork, sensible competition, winning, and loosing. Some important lessons in life emerge from the spirit of youth competition,” according to Michael Sefton, Ph.D., Director of Psychology at Whittier Rehabilitation Hospital in Westborough.  “I have coached youth hockey up through high school-age boys and have found 99 percent of the families I worked with to be very reasonable and respectful,” remarked Sefton in preparation for the blog post.  Just as importantly the games must be fun or children will not want to play. In recent years there has been a growing notoriety of fan behavior while attending the sporting events of children.  It is almost a “mob mentality” as parents shout at referees over botched calls, yell at other players, and become obstreperous toward the opposing fans.  Sometimes this becomes violent as it did in Reading, MA in 2002 when two men squared off and fought over a youth ice hockey practice resulting in the death of one.  “The fight was less about hockey than about the loss of control and unencumbered anger” according to Sefton. For his part, Thomas Junta who outweighed the victim by over 100 pounds was sentenced to 8 years for manslaughter.  He was released from the state’s prison in Concord, MA in 2011.

Social scientists have been interested in mob behavior for years and when it comes down to what the underpinnings of fan behavior experts cite alcohol, adrenaline, and blind team loyalty as primary culprits. But as far as parent behavior at childhood sporting event goes some parents become delusional and behave out of some overdriven striving on behalf of their child. Some parents see scholarship money in a child as young as 5-years old when in actuality only 2 percent of athletes will ever receive scholarship funds for playing football for example, according 2008 NCAA published data – most receive only a partial scholarship package and not the coveted “full ride” – published in the NY Times.  As a parent I took my children to an NCAA ice hockey playoff event that was so much fun. The kids were given ice time to skate with coaches and players from the playoff teams.  During this time I attended a parent education seminar on scholarships and the lengths to which some parents will go to get their child athletes noticed.  How is it possible that an angry father might physically attack a volunteer referee over a missed call or become enraged at a youth coach over the amount of playing time a son or daughter receives?

According to Brooke De Lench, Mom’s Team executive director, parents lack the basic coping skills to respond to the ups and downs of their kid’s competition and are injured when their child does not succeed. De Lench seeks a shift from an adult-centered model to a child-centered philosophy as a way of eliminating unruly and sometimes outrageous fan behavior. When fans loose control the results can be deadly. “We lose ourselves when we watch our children play sports” said Sefton who regularly attends high school parents’ night in Massachusetts speaking on concussion.  But becoming lost as children play youth soccer or football must never include losing control as it sometimes does. Because for some parents, a child’s failure, or even the perception of failure may evoke strong emotions.

In 2002 during a youth hockey practice 2 children jostled and battled for the puck.  One parent, confronted the coach, whose son it was involved in the on ice scrap.  He objected to the rough play during the on ice scrimmage.  A shouting match ensued followed by the 270 pound Thomas Junta, 45, jumping the much smaller Michael Costin, 44, and punching him violently and killing him in front of his child and other players in the ice arena in Reading, MA.  Junta was charged and served 8-10 years in the state’s prison for manslaughter.  The lives of both families were destroyed by this event.  Both Junta’s and Costin’s boys have grown into troubled men and have themselves served time in prison.  This sensational story left quite an impression on me as an outrageous exemplar of state of the art parenting.

Most of us know there is much psychology in youth sports including developing core beliefs about winning and loosing, team cohesion, mastery of physical skills, and the growth of healthy competition. Balance is needed pushing children to become something for which they are may not be physically or emotionally equipped. Just as important parents must recognize their own feelings at their children’s games and accept that some things should not be worthy of the fight to end all fights.

Dr. Michael Sefton is a neuropsychologist and former police sergeant in Westborough, MA .  He along with 3 colleagues published a psychological autopsy on the Dexter, ME domestic violence homicide from 2011 and presented the research before the Domestic Violence Homicide Review Board at the state house in Augusta, Maine in November 2011.

via Are parents at kids’ sports games harmful? (Opinion) – CNN.com.

 

Law Enforcement – Mental Health Collaboration

WESTBOROUGH, MA November 28, 2015 In a recent post the issue of mental illness and police use of force has been the subject of scrutiny.  The pairing of police officers and mental health counselors is becoming a compelling option in some departments.  In a previous blog post I published an essay ostensibly denouncing the utility of these patrols in part because it presents a greater level of risk to police officers, ride-along psychotherapists, and the community at large (Sefton, 2015)

Over 100 persons with known mental illness were the victim of lethal force following a suicide by cop scenario or some other violent encounter resulting in the rapid escalation of the use of force continuum. Police officers train for these situations and are expected to meet force with force.  These encounters sometimes end up in a lethal force standoff where split second decisions can wind up in a deadly outcome.  As quickly as encounters may escalate, police are trained to de-escalate their use of force as the situation dictates.  The use of force must be fluid and officers in the field are expected to modulate the force they apply to the demands of the situation and be ready to respond to changing threat levels.

The current population of jail inmates is said to have a higher percentage of people suffering with mental illness than ever before.  Since the early 1970’s an effort has been made to deinstitutionalize those with severe mental illness leaving many to flounder in the streets.  The National Alliance for the Mentally Ill believe as many as 20 to 40 percent of prison inmates may have severe mental illness and may not be receiving the needed treatment to allow them to rehabilitate.

Police are increasingly linking up with mental health agencies as a way of diverting mentally ill person’s from jails into treatment for their emotional affliction. This is necessary to free police to serve the public interest more efficiently and safely. Treatment options are quite limited especially in rural communities who may be underserved by specialists in psychiatric emergencies.

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British Psychological Society (BPS) photo

Police in Augusta, Maine have paired with crisis counselors two nights per week in order to provide support and expertise to police in the handling of mentally ill suspects with emphasis on de-escalating and diverting subjects from jail. Larger agencies routinely interface with mental health experts.  Courts across the country have in-house clinics that can provide up to date assessments of persons with suspected mental illness or risk for suicide and homicide.

In Massachusetts many smaller police agencies must pay overtime for police officers to sit in hospitals or outside of jail cells watching a mentally ill person who has been arrested.  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. This is very expensive for small departments and takes a police officer off the road sometimes for 48 hours until the prisoner can be brought before a judge. Coupled with a high prevalence of cases of substance abuse and the growing menace of opioid addiction, police officers have their hands full with cases in which changes in mental status add to the complexity of decision-making and breadth of alternative dispositions.

This author was employed in an agency that generally deployed a single officer on duty.  When a mentally ill person was arrested the agency was forced to call in off duty personnel to transport and supervise the prisoner to assure for his or her safety.  This policy was implemented in any case of arrest whenever a person has ever had a documented history of depression with suicidal statements.  Across Massachusetts police dispatchers have access to a database of names of individuals with documented history of police interaction while mentally ill. This affords the police a heads up when a call goes out involving persons with a proclivity for suicidal behavior.  This protocol was not necessary and offered no help whatsoever to the person under arrest.  It resulted in emotionally vulnerable persons being held in custody longer than necessary out of fear that once released they would be at high risk of suicide and leave the police department liable and open to litigation.

The myths associated with mental illness – especially in the police service are abundant. For example, here in Massachusetts anyone arrested with a known history of suicidal threats needed to be watched while in custody – sometimes for one or two days until they could be brought before a judge. The question of suicidal risk should be made by psychologists and psychiatrists familiar with emergency mental health and crisis intervention.  Police officers are inherently apprehensive about legal action being brought against individual officers for decisions made because of a lack of understanding and training in dealing with those in crisis. District court judges have no greater training in suicide assessment and prevention than the cop on the beat and the decision about suicidal risk should not be left to them.  The police should turn to the experts whenever the question of risk for suicide arises and once evaluated the disposition may be straight forward gradually reducing the myths associated with this difficult population.

I agree with calls for added training for police officers in dealing with the mentally ill as a way of eliminating the myths that obfuscate decision-making and risk officer safety.  Agencies are making greater efforts to divert the mentally ill away from jails and the legal system whenever possible.  But for diversion to work well the city and county need to provide treatment programs at each point a mentally ill person comes into contact with the criminal justice system – from interactions with cops all the way through the courts, according to an NPR-Kaiser Health News report in July 2015. Our current system of liaison between mental health and law enforcement must be forged by greater cooperation and mutual understanding of the needs of those suffering from emotional illness such as depression, PTSD, and now a growing population of the addictions including alcohol and prescription pain killers.