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, et.al. 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). https://doi.org/10.1007/s11896-018-9252-6
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
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On Police Identification of the mentally abnormal

How to recognizeWestborough, MA March 28, 2018 The police-mental health interaction continues to be one that neither party exhibit great confidence nor take great pride in.  Myths abound about how to treat those so afflicted – especially among law enforcement personnel. I have provided classes for LEO’s and generally they are not well attended and tend to bore the average officer. In Maine, LEO’s are required to have regular training in working with the mentally ill in order to maintain their LEO credentials. Other states in New England have similar requirements and now focus on psychological first aid and deescalation protocols.  I have presented on topics of assessment of risk and dangerousness with some success.  In- service training must be short and to the point or students will quickly lose interest.
The photograph above shows the cover of a guide book first written in 1954 that was instructional for police officers.  It was written to teach the law enforcement officers of the day to recognize signs of mental illness then defined as “abnormal people”.  It was written by 2 Louisiana State University psychologists and first used by a police agencies in the late 1950’s.  I have been trying to find a copy of this early version that was re-published in 1979 and now costs over $100.  It was written because police officers needed training and experience identifying features of psychiatric emergency. This was thought to reduce the uncertainty, fear and confusion around handling these cases by providing education including signs and symptoms.
After nearly 60 years, law enforcement is not significantly closer to understanding the mentally ill than they were in 1954. A colleague police psychologist Leo Polizotti, Ph.D. has an original copy of this booklet although I have not seen it as yet.  Dr. Polizotti provides consultation to law enforcement, officer selection interviews, and teaches a proactive approach psychological resilience to police officers that can afford them greater career satisfaction, professionalism, and longevity. Dr. Polizotti is tasked with supporting officers who are exposed to the daily grind of violence, suicide, homelessness, and its cumulative impact on a cop’s personal narrative.  His model suggests a fundamental change in how police officers interpret their experiences over time and acceptance of what cannot change and healthy adaptation.  He is a great asset to the Central Massachusetts community and across New England and espouses a model of stress resistance through adaptation.
“In 1954, the National Association for Mental Health first issued the book “How To Recognize and Handle Abnormal People: A Manual for the Police Officer.” Included were techniques on dealing with all kinds of “abnormal persons,” from psychopaths, drug addicts, and the “mentally retarded” to civil protestors and those involved in family disturbances.”  Posted by David Pescovitz, 2015
Text from 1954 How To Recognize and Handle Abnormal People: A Manual for the Police Officer is provided below.  It points out many of the outward signs of disturbed thinking often an underlying feature of those with mental illness – in this case something called ideas of reference. These signs are common among persons with early paranoia and are sometimes missed – even by members of the immediate family. This is still a common symptom of mental illness today and is considered to be the prodrome to a more serious loss of contact with reality. Ultimately, it comes down to who is at more risk for violence?  And how can we be sure?
It takes a healthy and educated police officer to observe, understand, and control unpredictable situations. Officers are required to adapt to the demands of individual calls for service.  A colleague Dr. Leo Polizotti has identified a model for coping with the strain of police service.  He cites the importance of avoiding apathy, withdrawal and bitterness on the job.  “Understanding the 3 C’s of hardiness, Challenge / Commitment and Control will assist officers to manage stress more effectively, resulting in fewer emotional and medical problems. By viewing each new situation as a challenge, instead of a threat, you become committed to that challenge. You can readily see yourself in control and better able to deal with the situation. You will enhance your “hardiness” or resistance to stress” Polizotti, 2018.   
“He may think, for example, that announcements made over the radio have something to do with him personally. He may even hear his name mentioned. These are called ideas of reference which, of course, means that the patient thinks people are referring to him in one way or another. In the beginning, ideas of reference may occur only occasionally, but they gradually become the rule rather than the exception, and finally they may develop into definite delusions of persecution or grandeur.”
The list below are the signs of “abnormal persons” that are printed in the booklet published in 1954:
  • He shows big changes in his behavior.
  • He has strange /losses of memory, such as where he is or what day it is.
  • He thinks people are plotting against him, or has grand ideas about himself.
  • He talks to himself or hears voices.
  • He thinks people are watching him or talking about him.
  • He sees visions or smells strange odors or has peculiar tastes.
  • He has complaints of bodily ailments that are not possible.
  • He behaves in a way which is dangerous to himself or others.
Interestingly, the bullet points above remain accurate today with the understanding that too many individuals suffering with a major mental illness also have substance abuse/dependence.  It is this fact that confounds most LEO – mentally ill encounters.  “Beyond the rigors of police work, lie the demands of a personal life, specifically a wife or husband and children. Maintaining a healthy and happy family life is on its own a demanding responsibility. Add these powerful life stressors and demands to the burdens of police work and  an officer may begin to feel the weight upon his or her shoulders.” Polizotti, 2018.  Emotional and physical strength and endurance requires hardiness that comes from personal responsibility and comittment to excellence and peak performance.  Greater focus on sobriety – including opioid and alcohol dependence is essential. If this can be maintained mental illness may remit to the extent that subjects can remain in the community. Programs like A.A., N.A., and other 12-step groups are free and often afford subjects great support.  In most cities there are 12-step meetings every day morning, noon and night.  The problem is getting people to realize they have a problem.  Even airports hold A.A. meetings for travelers in need of the 12-steps. We are working on a replacement manual like the one cited in this post.


Polizotti, L. (2018) Personal Life Demands. Presentation – Direct Decision Institute.
How To Recognize and Handle Abnormal People: A Manual for the Police Officer (1954) Matthews, R. M.D. and Rowland, L. Ph.D. NATIONAL ASSOCIATION FOR MENTAL HEALTH, INC. 10 COLUMBUS CIRCLE, NEW YORK 19, N. Y.
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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

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.

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.

im_cycle
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.