Discretion, Treatment and Alternatives to Jail

PART 2

WESTBOROUGH, MA July 16, 2017 In last weeks publication I introduced the problem of mental health and co-occurring substance abuse with some ideas about alternative restitution and treatment. These involve greater discretionary awareness among police officers.  More importantly options to jail require viable alternatives that will end the revolving door of minor criminality coupled with treatment for the breadth of addiction seen on a daily basis by law enforcement.

Mental and Physical Health Screening

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

Diversion Safety Plan

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

Bail, Confinement, Mandated Treatment

There is some thinking that higher amounts of bail may lessen the proclivity of some offenders to breach the orders of protection drafted to protect victims and should result in revocation of bail and immediate incarceration when these occur. I have proposed a mandatory DV Abuse Registry that may be accessed by law enforcement to uncover the secret past of men who would control and abuse their intimate partners. This database would also include information on the number of active restraining orders and the expected offender’s response to the “stay away” order. In cases where the victim decides to drop charges there should be a mandatory waiting period of 90 days. During this waiting period the couple may cohabitate but the perpetrator must be attending a weekly program of restorative justice therapy and substance abuse education. Violations of these court ordered services are tantamount to violation of the original protection order (still in place) and victim safety plan and may result in revocation of bail. If the waiting period passes and the perpetrator has met the conditions of his bail than he may undergo an “exit” interview to determine whether or not the protection order / jail diversion plan may be extended.

Guardianship

In many jurisdictions the mentally ill cannot be forced to take medication nor can they be forced into treatment. Adherents to this belief advocate on the behalf of the chronically mentally ill for the right to make these individual choices – treatment or no treatment. Ostensibly advocates seem unconcerned for the public health risks associated with ongoing drug addiction and major mental illness. There needs to be an active system in place to provide guardianship to individuals with repeated failed treatment that mandates treatment for those who cannot remain in a program of sobriety and psychotherapy in lieu of incarceration. In many cases a family member may be appointed temporary guardian for up to 180 days that allows decisions to be made about patient care up to the guardian not the patient himself who may be unable to stay on track.

 

 

Police are building bridges and throwing life savers

WESTBOROUGH, MA  – March 30, 2017  Police officers are being trained in crisis intervention techniques across the country and Canada. This training offers plenty of practice role-playing scenarios that come directly off of the call sheets affording a reality-based training opportunity. I recently spent time riding with members of the San Antonio PD mental health unit and have the greatest respect for the officers with whom I rode.  In contrast, some departments regularly have highly trained clinicians riding with officers bringing expertise in mental illness and abnormal behavior across the thin blue line.  It is thought that by sharing knowledge at working with unpredictable, drugged out, psychotic and delusional and angry who police encounter on a daily basis better outcomes may be achieved. No single model is best and all are still in the growing stages of establishing protocols for bringing those most disturbed individuals in from the margins. More and more officers are receiving CIT training every year.

The important part of crisis intervention training comes in the interdisciplinary relationships that are forged in by this methodology. Trust and respect between the police and its citizens builds slowly one person at a time.  Community policing is not a new concept but fiscal priorities often prevent its full implementation.  Just the same, there must be trust and respect between the police and the purveyors of crisis intervention and mental health risk assessment including doctors, nurses, and health care practitioners. This also takes time and training and the shared belief in the model.


“When officers are faced with a deadly situation, when there is a gun pointed at a cop, there is no time to go into mental health measures,” according to Grace Gatpandan, spokesperson for the San Francisco Police Department


IMG_7187
Michael Sefton, Ph.D. in 2017 photograph

The use of force continuum belies each officer contact and guides the process when police are called upon to defuse a dangerous encounter. It is best that a mental health contact be made long before violent threats are made – long before terminal rage erodes personal judgment. The community policing doctrine affords this front end contact and encourages officers to know the people living on the beat.

POLICE ENCOUNTERS WITH MENTALLY ILL CITIZENS

The Boston Globe Spotlight series on police encounters with the mentally ill cites one distraught parent who was quoted “I only wanted the police to disarm him not shoot him dead.” Unfortunately for this family, when faced with lethal violence it is the behavior of the subject that drives the ship in terms of what will or will not happen.  “When faced with a deadly situation, when there is a gun pointed at a cop, there is no time to go into mental health measures”. All too often people fail to see the cause – effect relationship between citizens with guns or other lethal weapons and the police officer response.  The use of force continuum follows the principle of causation by guiding police decision making based on the level of threat.

What came first the threat or the police action?  It is the primary action of the citizen the evokes the lethal response by police.  If citizens dropped weapons and listened to police officer directives during these high energy and chaotic events there would be fewer deaths.  To say they lack training in mental health is preposterous.  Almost as preposterous as saying if they were better parents the mentally ill subject might not aim his gun at police or threaten his mother with a knife.  No, the responsibility lies with the mental decision-making and subsequent behavior of the subject himself.  If mental illness drives the violent behavior than all weapons and substance use must be carefully controlled and eliminated.  When people attend psychotherapy sessions and 12-step recovery programs the proclivity for violence is greatly reduced.  Inevitably, drug abuse is a co-morbid factor that alters perception and fuels underlying anger and violent tendencies.  Who is responsible for this? When drug addition or alcoholism begin – all emotional growth including adult “problem solving” begins to fail until it is fraught with uncontrolled, impulsive violence. Rather than placing blame, greater emphasis on sobriety, counseling and developing emotional resiliency should be encouraged.


Lowery, W. (2015) DISTRAUGHT PEOPLE, DEADLY RESULTS: Officers often lack the training to approach the mentally unstable, experts say. http://www.washingtonpost.com/sf/investigative/2015/06/30/distraught-people-deadly-results/?utm_term=.86e44d33dfab Taken March 5, 2017

DVH in MA: 4-year old child begs father not to murder his mother

  • “… He stood in the doorway with a loaded gun and talked about killing himself and/or children and myself. He was bringing up old verbal threats and I thought they were going to come true”

Amy Lake – July 2010

WESTBOROUGH, MA September 15, 2016 The words above were taken from a requested order of protection in the state of Maine in 2010.  The threats upon this victim and her family became a reality exactly one year to the day after this order was put in place in 2011. Lake and her two children were murdered by her husband Steven Lake who killed himself as well. Immediately following the killings a Maine district attorney said “there was nothing we could have done to prevent these killings”. These were the words that triggered a team of professionals including myself to research the sequence of events that lead to this event.  A formal psychological autopsy was undertaken in 2011 following these murders and over 50 recommendations were generated (Allanach, et al 2011).

I am sick to my stomach as I write about another senseless killing of Wanda Rosa in Methuen, Massachusetts in late summer 2016.  The case resembles so many cases of domestic violence homicide – manipulation and control.  Ms. Rosa had a permanent order of protection but had recently modified the order to allow Emilio Delarosa to see the child they had in common. Why in the world would anyone allow Delarosa to see his son? He is no role model and the potential for terminal violence was readily apparent as depicted in the order of protection.  He expressed his intent to kill his girlfriend on more that one occasion.  Delarosa’s history of intimate partner violence had risen to the level of a permanent ban – signaling that the pattern of violence was undeniable and the red flag indicators for domestic violence homicide (DVH) were apparent in the eyes of the police and judiciary when the permanent order was granted.

Permanent orders of protection are rarely granted unless the pattern of violence was so prevalent and unremitting that the potential of harm or death to the victim and her family was unsurpassed as in this case.  It is known that Delarosa was manipulative and controlling of his girlfriend getting her to drop charges over and over and later alter the terms of the restraining order – ultimately resulting in her death.  Secondly, the person against whom the stay away  order is granted must have demonstrated a blatant indifference of the order of the court by having recklessly violated the order over and again. It should not have been altered.  In the past 18 months cases meeting these requirements (such as this one) have resulted in intimate partner violent deaths.  The Jarod Remy 2013 murder of Jennifer Martin is a despicable reminder of the need for change in cases of DV. Remy killed his girlfriend by stabbing her multiple times as the couple’s 4-year old child bear witness. In spite of laws designed to reduce the likelihood of DVH Rosa was not adequately protected.

Rosa’s boyfriend Emilio Delarosa is on the run as of September 20.  He is accused of murdering his former girlfriend after years of abuse, strangled her to death as their 4-year-old boy pleaded with him to spare her life, according to court records. “No Dad” the child was heard to say over and over. As in the Remy case, the 4-year old witnessed his father choking  Wanda Rosa until she was dead.

“I suspect there is a strong likelihood that he too will be among the deceased in the coming days as is the common eventuality among those who commit the unconscionable, violence that manifest in this terminal event” according to Michael Sefton, Ph.D., director of psychology and neuropsychology at Whittier Rehabilitation Hospital in Westborough, MA.  When some men violate the permanent protection order it is the result of unbridled rage and defiance against a “system” they believe has failed or unfairly humiliated them said Sefton in a release. They are murderous and often turn their rage inward in an act of suicide. I would look for the triggers of what set Delarosa’s terminal rage into action.  It could be something as simple as being told he needed to have monitored visitation with is son or learning that the female was seeing another man – both conjectural on my part.  After the alleged killing Delarosa was heard to say “It’s over, it’s over, it’s over” when speaking to his sister.

“Domestic violence is not random and unpredictable. There are red flags that trigger an emotional undulation that bears energy like the movement of tectonic plates beneath the sea.” according to Sefton.  A psychological autopsy should be undertaken to effectively understand the homicide and in doing so contribute to the literature on domestic violence and DVH according to Michael Sefton who with colleagues published the Psychological Autopsy of a case from Dexter, Maine where a father murdered his child, estranged wife and ultimately himself (Allanach, et al, 2011).  In the days preceding the murder there are usually red flags or pre-incident indictors that people see that signal the intentions of the murderer.  These clues provide police and the judiciary with data to craft protection plans and are the commonalities found in cases of DVH across the state and across the world.  Some red flag behaviors signal the emergence of imminent terminal anger that can be seen in the social media accounts of intimate partners who go on to kill their spouses.  I am quite interested in the compelling reasons that Delarosa may have argued that resulted in the change in the permanent order of protection.  The outstanding Boston Globe article about the slaying is a sad reminder of the early warning signs of DVH.  All the red flags were present.  In a blog published in 2013 I list the tell tale warning signs of intimate partner homicide and the need for tougher bail conditions (Sefton, 2013).

The impact on the child will be lifelong. At age 4, children are developing their sense of gender identity in the setting of developmental growth, cognitive maturity, social functioning and continued individuation. Imagine the child who is reunited with his parent after a period of mandated protection due to DV.  He is now able to see his family and may be fraught with both excitation and fear.  It would be normal for the child to have fantasies of reunification of the family and perhaps self-blame for not having stopped the action of his father. Just like the daughter of Jennifer Martin and Jarod Remy this 4-year old boy will forever be reminded of the life he will not have.

Ronald Allanach et al., Psychological Autopsy of June 13, 2011, Dexter, Maine Domestic Violence Homicides and Suicide: Final Report 39 (Nov. 28, 2011), http://pinetreewatchdog.org/files/2011/12/Dexter-DVH-Psychological-Autopsy-Final-Report-112811-111.pdf.

Sefton, M. The red flags of intimate partner violence. Blog post taken October 2, 2016.

Sefton, M. Prior history of crime not predictive of DVH. Blog Taken October 2, 2016. post: http://enddvh.blogspot.com/2013/07/prior-criminal-history-used-to.

The Day She Said Goodbye

 The day she said Goodbye

Michael Sefton

Who knew that the day she said goodbye would be the day that set a clock to start ticking.  Her parents thought they were an ill-matched pair from the start but they did not want to interfere.  Even her best friend said he should cut him loose.  Who knew that by saying goodbye that her risk of domestic violence homicide was increased by a factor of five?

But wait, isn’t it important for victims of domestic violence to break away from the coercive grasp of their tormenting intimate partners?  A sign of empowerment, they say.  She wanted to move on, finally having the courage to say goodbye after he held them all at gunpoint.  Ranting that if she ever tried to leave him he would kill her.  His hubristic thinking was never as obvious as on the day she said to goodbye.

The next day, he knew something was up when the sheriff’s deputy pulled in behind his truck and activated the pulsating blue lights.  “Your mother has really done it this time” he said to his 12-year old son.  He also had a clock ticking, unbeknownst to him or anyone else.  The boy’s mother never wanted this to happen and never expected it would become so dangerous to she and her 2 children just when she decided it was time to say goodbye.  The deputy who took him into custody that day was in fear for the child’s mother, he would admit at some point.

Victims of domestic violence are at greatest risk when they decide it is time to end the cycle of power and control. Those who work with victim’s advocates are thought to experience less abuse and report a better quality of life. This takes time, and time is all they have in the world to break the chain of violence.

People thought he was just a neighborhood bully.  They later learned he was intimidating, sadistic and sexually aggressive.  He hated his daughter when she was born and he wished she were a boy.  When she started to walk he would trip her and laugh.  It was a joke to him he would later say.  No one knew but there was a clock ticking for the little girl as well.  These were the first red flags.  Together these three shared a secret, with him.

After being criminally threatened, she was issued an order of protection.  It meant that he could have no contact with his wife or the children.  It also required that he attend counseling sessions.  In spite of this, the extent of his anger was never fully appreciated according to a state official.  Meanwhile, she also filed for divorce and he began to fester.  His jealousy and suspicion grew.  He too had a ticking clock only his was more of a ticking bomb.  Just because she had the nerve to say goodbye.

That year was a dream come true.  She met new people and managed the transition to a single parent household better than most.  She taught kindergarten and was everybody’s mother.  That year she began to feel happy – people noticed.  Her children too started to move on.  On social media websites she would post her pride in her kids with photographs and video.  She had a plan that would keep them all safe from him.  Soon it would be time to say goodbye to the controlling, manipulative abuser.

Not so fast.  He was not satisfied with this arrangement.  His wife could no longer put up with his charade.  In the months after he was ordered to stay away from his family the impact of his estrangement began to whittle away the exterior of bravado.  Arguably, he did what he pleased like standing in line behind her at a local coffee shop in violation of the court order.  He launched a social media diatribe lauding his achievements as a father and husband.  He lied about all that he had done and minimized having held a firearm on his wife and children.  Suddenly it was her fault that he could not see the children.  She was harming the kids by keeping them from their beloved father, he espoused.  Poor soul.  The irony in his internet blitz was lost on a bevy of friends who “liked” his daily status reports. They insisted he fight for his children. Time was ticking toward the 8th grade commencement exercise he wanted to attend, ostensibly to portray himself as someone everyone knew he could not become.  Time too was growing near to the final divorce decree and to his day in court.

By now people began hearing the ticking clock.  Family members said a change came over him.  He was depressed and talked of suicide.  “When I do it, it will be on CNN” he managed with his typical hubris.  He faced the end of his 10-year marriage and a court trial from his action one year previously.

All at once, the totality of his anger and deception came into focus to the police who saw his truck in her driveway.  They were called when she failed to come to school on that day.

Some saw how much danger they were in and did nothing.  Red flags raise the specter of risk.  “I never thought he would take the kids” said a family member, in a matter of fact way.  Others blamed a district attorney for not lightening up on the stay away order saying if the D.A. had only allowed him to attend the commencement exercise he would not have done what he did.

No one knows what the impending loss of time meant to him, time in jail? Time alone?  What happened next is well documented.  He set his alarm clock for 4:45 and wrote letters to his family — 10 in all.  “I’ll see you in hell” he scribed to his wife. He entered the rental home while they slept, his intentions known only to him.  For 2 hours he raged on setting the scene.  Finally time stood still for all four.  The family’s timeline came to an end – all at once – all because she had the courage to walk away, to make a better choice for her children, and to say goodbye once and for all.

Michael Sefton, Ph.D.

Dr. Sefton is a police sergeant in New Braintree.  Along with three colleagues, Ron Allanach, Brian Gagan, and Joe Laughlin researched the Psychological Autopsy of the June 11, 2010 Dexter, Maine Murder/Suicide and made over 50 recommendations for reducing harm to people living with intimate terrorism.  They presented their findings before the Domestic Violence Homicide Review Board on November 11, 2011 in Augusta, ME.

Read more:

http://www.enddvh.blogspot.com

What are “red flags” in intimate partner violence?

Law enforcement is regularly on the front line in making decisions about the likelihood of imminent violence. In the case of domestic violence police need to key in on specific behaviors that can signal elevated levels of risk to victims and children. Why?  Because over half of all cases of domestic are not reported to police.  As a result, front line responders need to be aware of both tangible and less obvious indicators of risk know as red flags.  Red flags may be predictive of future violence.  “As the totality of these red flags come into focus it becomes incumbent upon each of us to take action on behalf of those most at risk – as we are mandated to do in cases of child and elder abuse” (Sefton, 2011).

Past behavior is thought to be the best predictor of future behavior.  The history of a prior order of protection should signal to police the proclivity for violence.  This information is readily available to the street officer via the mobile data terminal seated next to him in his cruiser.  In Massachusetts, police are privy to prior protection orders and whether or not a suspect ever violated those orders.  Special care for victims may be needed in cases where suspects repeatedly violate DV “stay away” orders.  Arguably these facts should bear greater weight when determining bail conditions than criminal record alone for those arrested for intimate partner abuse.  Unfortunately, in most cases, they are not.

Victim safety should be the first consideration in any treatment plan involving spousal abuse.  Police officers have significant latitude when making decisions about disposing of cases domestic abuse.  Recommendations should include a review of the frequency, severity, and potential risk factors in the case, and consider the need for a victim safety plan.  Police may be the first in a line of many to recommend the safety plan for a battered and abused family member.  They regularly make decisions about risk based on what they see at the scene.  Red flags sometimes jump out when they interview the parties involved e.g. bruises, scratches, burn marks.  All too often decisions about “risk” are based upon what transpired prior to arrival rather than in consideration of what might happen once officers leave.  Risk factors must be included into police officer discretion.

In respect to victims of domestic violence, it is vital that red flags and risk factors become the first of its kind “road map” to reduce harm to families who find themselves in the cross hairs and assure that victims and their safety plans are not abandoned or ignored.

  1. Sefton, M (2011) Risk Assessment. Retrieved January 27, 2012. http://www.enddvh.blogspot.com

Road Map to Violence

ROAD MAP TO VIOLENCE – WHAT CAN WE DO TO PREDICT VIOLENCE?

There is no single road map to understanding the complexity of human behavior in general and homicide in particular.  If there were the rate of domestic violence homicide might be reduced to zero.  Unfortunately behavioral analysis as a science has not evolved into a reliable enough predictor of murder and cannot envisage when terminal rage might be unleashed.  The psychological autopsy is the study of individual cases that uncovers details about the pre-incident behaviors known as red flags. The application of this information can identify commonalities among cases of domestic violence so that police and social service agencies might have justification for early stopping and when necessary containment of high risk abusers.