Police officers are regarded as the front line first responders to family conflict and domestic violence. For better or worse, the police have an opportunity to effect change whenever they enter into the domestic foray – whether an arrest is made or not. This affords them a window into the chaos within the effected family system and the opportunity to bring calm to crisis. In many cases, the correct response to intimate partner violence should include aftermath intervention when the dust has settled from the crisis that brought police to this threshold. At these times the communication between family and police may be operationalized, improved and redefined. When this is done it establishes a baseline of trust, empathy, and resilience.
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.
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.
WESTBOROUGH, MA July 6, 2017 Jail diversion is a hot topic across the country. The numbers of persons incarcerated for minor offenses and drug crimes has grown. Many of these individuals have mental illness or drug abuse in addition to their criminality. The interaction between poly-substance abuse or dependence and exacerbation of underlying mental health symptoms is complex. It is the focus of mental health advocates and criminal justice experts nationwide as it pertains to jail diversion and reduced use of force among law enforcement. In Massachusetts, there is a move away from mandatory minimum sentences for all drug crimes except for those involving the distribution of narcotics. Arguably, the impact on behavioral functioning when persons are gripped with co-occurring illness is a recurrent problem for law enforcement and first responders. I have written about the impact of co-occurring illness such as alcoholism on mental and behavioral health is previously published posts here on Word press Human Behavior (Sefton, 2017). It is difficult to uncover which comes first – the addiction or the diagnosed mental illness and yet they are inextricably linked in terms of the strain on public resources and health risk to those so afflicted. Why is this important?
The importance of treatment for substance dependence and mental illness cannot be understated as violent encounters between law enforcement and the mentally ill have been regularly sensationalized. The general public is looking for greater public safety while at the same time MH advocates insist that with the proper treatment violent police encounters may be reduced and jail diversion may be achieved. The referral infrastructure to provide a continuum of care in this growing population is available in very few places across America.
Models of Care
Yet in places like Bexar County, Texas the county jail population has dropped by over 20 percent as a result of crisis intervention training for police officers and mobile mental health teams to intervene with those in crisis. I have seen this for myself during a visit with the San Antonio Police Department where I rode with two members of the Mental Health Unit – Officers Ernest Stevens and Joseph Smarro. It takes training, medical and psychiatric infrastructure, community compassion, and active engagement with members of the community often left to fly under the radar to effectively reduce the jail population. When necessary those most in need must have 24-hour availability for detoxification, emergency mental health, and access to basic needs such as food, clothing, and medicine. In San Antonio they offer so much more including pre-employment training, extended housing, interview preparation including clothes, and opportunity for jobs.
Behavioral Analysis and Law Enforcement
The unpredictability of behavior in those who carry a “dual” diagnosis has emerged in the criminal justice system when jail diversion programs and treatment options are brought forth raising the specter of frustration over the limitations within the system. Cities everywhere are grappling with how best to intervene with the mentally ill in terms of alternative restitution for drug-related misdemeanor crimes in lieu of mandatory jail sentences that many crimes currently require. Some believe, as much as 20-40 percent of all incarcerated persons suffer with mental health diagnoses and are not getting the treatment they require. To provide a bare bones system would add billions to state and federal dollars spent on the needs of inmates at a time when measurable outcomes for in house care are limited.
In my practice I see many cases of co-occurring pain syndromes with other physical debility such as stroke or traumatic brain injury. Generally the emotional impact of two or more diagnosed illnesses yields a greatly reduced capacity for adaptive coping and puts a great stress on the individual system. The importance of addressing co-occurring substance abuse or dependence is now well recognized and with treatment can result in healthy decision-making, growth in maturity, and greater self-awareness. If legislators have a serious desire to reduce statewide numbers of incarcerated persons a comprehensive plan must be considered for both pre-arrest and post-arrest. Infrastructure for enhanced understanding of addiction and greater treatment options must be explored through a joint public and private initiative.
PROPOSED JAIL DIVERSION INITIATIVE
PRE-ARREST JAIL DIVERSION – No crime committed
If police encounter subjects with a known history of mental illness through their community policing efforts they should return the subject to his family or primary psychiatric caregiver – this might be a physician, physician’s assistant (PA), a nurse practitioner (NP), even a psychologist for immediate crisis intervention. Depending upon the nature of the police encounter such as during the nighttime hours the subject may be transported to a local emergency department for psychiatric evaluation. This model has grown less popular because of the growing wait times in local hospital emergency departments – especially for those suspected of mental illness and tends to make them increasingly agitated. Persons with mental illness are often homeless and come into police contact simply on the basis of panhandling or looking suspicious and out of place in the neighborhood. Often they are reported to police because they are talking to themselves, suspicious, and menacing toward pedestrians making them afraid.
The hospital alternative might be to establish regional psychiatric emergency intake centers available 24-hours daily. At one point states had regional hospitals that have been closed down releasing thousands of institutionalized patients into the community. The plan for de-institutionalization was to provide a neighborhood center at which the patient could continue his or her treatment and receive their needed medication to keep them symptom free.
Minor crime committed
When a crime is committed by someone with known or suspected mental illness such as simple assault, disorderly conduct, or shoplifting the responding police officer’s will have discretion whether to bring forth charges or not in exchange for an alternative disposition that would defer jail time. These are not new concepts. Law enforcement has always had the discretion to arrest or not arrest for many minor offenses. The choice often comes down to the subject demeanor and his response to police officer directives at the time of the encounter. In some cases an officer must arrest such as in the setting of domestic violence, child abuse, or as a result of a felony being committed.
In these cases charges may be brought and held as long as the subject entered treatment or remained abstinent from use of drugs or alcohol – the jail diversion plan. If they failed to follow the terms of their diversion plan the charges would be re-instated and sent to district attorney for prosecution. The alternative is a revolving door of addiction and petty crime that, at times, will escalate into violent crime. As a society more can be done to reduce criminality and jail diversion through empathic, sensitive treatment options.
WESTBOROUGH, MA April 30, 2017 The Northeastern Association of Criminal Justice Sciences has announced the date for its upcoming annual conference to be held in Rhode Island at Roger Williams University in Bristol. The conference will be held on June 7-10 2017.
The topic this year is Forensic Mental Health: Contemporary Issues and Interactions Involving Justice-Involved Persons with Mental Illness that has been in the news when it comes to police encounters with those so afflicted. In Massachusetts alone over 120 people thought to suffer with mental illness have been involved in lethal force situations with law enforcement between 2008-2016. The program is still being drafted but I have been invited to present the Psychological Autopsy as a Forensic Tool along with my colleague Brian Gagan and co-author of the Psychological Autopsy of Steven Lake – Dexter,
Maine Homicide-Suicide in 2011.
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
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.
WESTBOROUGH, MA March 21, 2017 When working as a police officer I was asked to take the statements of women who were asking for protection from an abusive spouse or intimate partner. These requests were usually granted by the on-call judge – especially if children were at risk or a history of physical abuse was suspected. But these orders only last a short time – perhaps a weekend. In order to have restraining orders extended the victim is expected to go to the district court and swear testimony that specifies the reasons for an order of protection including threats or actual physical harm, forced sexual contact, pathological jealousy – whatever. Sometimes this happens and protection orders are extended usually for 6 months. During this time the couple is expected to sort out their differences and engage the help of a family therapist, if possible. This rarely happens.
“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 Michael 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 Sefton who with colleagues published the Psychological Autopsy of a case from Dexter, Maine where a father murdered his children, estranged wife and ultimately himself (Allanach, et al, 2011).
More often than not, the victim fails to appear for this process and the protective order goes away without any consequences. Why? In the time between the initial emergency order and the Monday morning when the victim is expected to substantiate her initial claims she may have been bullied by her spouse and worked over by his family, his friends and whomever he can enlist in his camp to get her to let it go. She is made to believe that she cannot function without her abuser. When children are involved an abusive spouse will usually say that child protective services will take the children for whatever reason he comes up with. He promises to destroy her credit worthiness, she will be penniless, and he threatens to share lies about her on social media pages for all to see. He may also promise to kill her and cut her to pieces to be used as fish bait – as I have been told in a case being investigated by my former agency. But he swears his love for her always.
This happens over and over.
In some cases the order to extend the restraining order results from elevated risk to the victim and recurring threats of violence. In these cases orders of protection go on for months or years at a time. This type of bullying is an example of the often secretive coercion that takes place in DV and intimate partner abuse is flagrant and often goes unreported. It must be considered whenever an initial order is not sustained especially if the victim fails to appear.
In some cases there is more than one order of protection issued to protect one or more intimate partners. This is a red flag and should have bearing on the bail requirements but seldom does. There should be some follow-up with the original complainant by the police department to investigate her reasons for not pursuing the extended order of protection and determine what impact bullying may have played on the victim’s decision. In rare cases permanent orders are granted because of compelling evidence that the victim and her family remains at risk – usually the result of stalking.
In March 2014, I published a blog in which the Massachusetts Supreme Judicial Court granted a permanent restraining order even though the former spouse was living in Utah and was remarried. In 2014 the Boston Globe did a story on the case written by Martin Valencia essentially raising the spector of the abuser in this case and the current impact the court order has on his day to day life in Utah.
Kevin Caruso was unable to get a job as a youth baseball coach because of a continuing order of protection here in Massachusetts that shows up on his CORI report. He could not own a firearm and was sometimes hassled at airports. The SJC ruled that Kevin Caruso must submit “clear and convincing evidence” that he no longer poses a danger to former girlfriend in a case dating back to 2001. The Supreme Judicial Court in Massachusetts has required that Mr. Caruso provide proof that “he has ‘moved on’ from his history of domestic abuse and retaliation”. It is well-known that male abusers move from one abusive relationship to another. A colleague Dr. Ron Allanach wrote “In the Caruso case, the Court is proactive, sensing the burden is on the offender rather than the victim; thus, the responsibility for proof that Mr. Caruso has “let it go”, poses no danger to the victim and has done the necessary therapy on his own behavior and to figure strategies to change, rests precisely on the shoulders of the offender where the burden should always remain.” The SJC called the frustration felt by Mr. Caruso the “collateral consequence” of the permanent restraining order put in place initially issued as a result of his threats to kill his former girlfriend. Time alone and location has no bearing on whether a permanent order is sustained. No person should live is fear that a former partner is going to appear at her workplace or stand behind her in the line at Starbucks while she thinks about what blend of coffee she might want.
“Substantive decisions about bail or no bail holds will be more reliable by having access to the violent history of domestic violence offenders and the protective orders that have been issued time and time again.” Michael Sefton
Allanach, R. Court is proactive. Personal correspondance. March 2014
Sefton, M. 2014, https://msefton.wordpress.com/2014/03/11/collateral-consequences-stay-away-orders-that-are-forever/ taken January 21, 2017
Valencia, Milton. SJC rules on Utah man’s permanent restraining order. Boston Globe March 11, 2014, taken March 24, 2017
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.
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.”
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.