Law Enforcement and the “window” of attack against domestic violence

Human Behavior blog

In Iceland, the first 24 hours after a report of domestic violence, the window of opportunity is open. During this window there is multidisciplinary response from police, social work, legal experts, and from the child protective service that establishes a safety plan and targets supporting the victim from her household, and sometimes away from the dangerous intimate partner.The first 24 hours after the report comes in is critical. Victims are more likely to accept help if definitive, comprehensive assistance can be offered right away. Within the window of emotional opportunity.

The Iceland Project puts together the package needed to bring charges by having a team of social service and law enforcement investigators who work together during the “call out”. One reason cases of domestic abuse seldom make it to court is because days and days go by before investigators can interview the victims. Some go to work, and some do not make themselves available to officers. “In Iceland, twice as many women are reporting incidents of domestic violence to the police than they were two years ago. This is due to an ongoing police initiative to provide women with better-timed and better-located assistance, which is bringing the problem out of the shadows” as reported in apolitical in 2017. I have called for regular aftermath follow-up in cases of domestic violence as a form of community policing. Officers work in pairs and stop during the next day to complete a check-in. Victims are contacted by their abusers or the family of the abuser or may be harassed via social media and made to feel like it is their fault this occurred. I had one victim tell me she was beaten up by her husband because the dinner she had prepared was late and unsatisfactory. I stayed in contact with her until the family quickly sold their home and moved from the area. That is pretty typical whereas the abusive partner wants to keep his wife under control. As soon as she makes friends he moves her somewhere else. Even if he takes a different job. Cases of domestic violence here in the United States skyrocketed during the pandemic quarantine that also gave birth to new higher rates of substance abuse and changes in behavioral health and well-being.

Police in Reykjavik, Iceland believe that detectives or senior police officers must intervene within the window – 24 hours from start of a call out, to put together a strong case and collect evidence. They work in teams of 4 or 5. The former protocol was often several days after the call and coincided with the honeymoon period. Bail conditions frequently fail DV victims as the abuser is often bailed out within 1-2 hours. Egregious cases of DV should be held without bail until a dangerousness hearing may be initiated. The result of this usually resulted in cases being dropped and victims staying in dangerous relationships. In theory, victims are more likely to accept support and provide meaningful evidence in the first 24 hours after their abuse. The window program is designed to link victims with programs such as housing, psychotherapy, job assistance, and financial means for a new start.

The Iceland Window Project also offers perpetrators the same assistance and supports that victims receive. Charges against perpetrators of abuse have gone from approximately 24 percent of cases to approximately 30 percent of cases. This is a modest improvement at best, according to the BBC podcast People Fixing the World who report that caseloads have increased dramatically since 2014. In spite of modest changes in prosecution numbers the Window Project’s fundamental aim is to reduce intimate partner abuse. It is a well designed project to support victims and keep them focused on the problem. Many practitioners believe that when a family is in crisis, such as when police are called to the residence, that great change is possible. There has been some movement toward prosecuting abusers even when the victim changes her mind. This is a primary reason for the Window Project’s success. By getting statements, photos, and other evidence there is greater likelihood that cases can go to court even when the victim chooses not to prosecute police are now doing this on behalf of bullied partner/victims. Children who are exposed to severe domestic violence are more likely to go on and become victims going forward. Or worse, they grow up and do exactly what their abuser did.

Here in the United States victims of domestic abuse are at great risk. Especially as they prepare to leave their abusive partners. Law enforcement is required to arrest perpetrators of DV whenever signs of physical trauma. That is generally understood by the police and the abusive spouses. But what happens just as frequently, law enforcement officers send the abuser away for the night or weekend. This makes things worse for victims and children.

Law enforcement suicide: Using the psychological autopsy for questions of line of duty deaths

Officers often walk alone when exposure to trauma whittles away their resilience

Two Capitol police officers have taken their own lives since the insurrection at the U.S. Capitol on January 6, 2021. This information came after the two officers spent 5 hours fighting the insurrectionists sometimes in hand to hand combat often being humiliated and threatened. Jeffrey Smith, a Metropolitan D.C. Police officer, and Capitol Police Officer Howard Liebengood both “took their own lives in the aftermath of that battle” of January 6, according to an article in Politico on January 27, 2021. A third officer, Brian Sicknick, age 42 collapsed while on duty the day of the attack. He died in the aftermath of the insurrection a day or two later.

The manner of his death has been determined to be natural causes. Officer Sicknick died from multiple strokes according to the medical autopsy. Some reported seeing Officer Sicknick being struck in the head with a fire extinguisher during the riot. The official cause of death was stroke – or cerebral vascular attack and it is well-known that high stress situations can lead to stroke such as an insurrection or even shoveling one’s drive following a snow. Sicknick was only 42 years old and in good health prior to the Capitol attack. Officer Sicknick was afforded the honor of laying in honor in the Capitol Rotunda after death. Antoon Leenaars, past president of the American Association of Suicidology, described the patterns of thinking among depressed or suicidal persons, and explained how the use of “psychological autopsies” can uncover the key elements that are present in many suicides. This is an important first step in the battle to change officer suicide to become more attributed to line of duty death. This determination is owed to many of these brave men and women who died as a result of the recurring emotional trauma to which they were exposed.

“Jeffrey Smith was still fighting to defend the building when a metal pole thrown by rioters struck his helmet and face shield. After working into the night, he visited the police medical clinic, was put on sick leave and, according to his wife, was sent home with pain medication. Smith returned to the police clinic for a follow-up appointment Jan. 14 and was ordered back to work, a decision his wife now questions. After a sleepless night, he set off the next afternoon for an overnight shift, taking the ham-and-turkey sandwiches, trail mix and cookies Erin had packed. On his way to the District, Smith shot himself in the head.

Smith’s wife Erin reported after her husband took his own life

“On April 2, 2019, PERF and the New York City Police Department took an important step to elevate the national conversation on police suicide and to identify concrete actions that agencies can take to address this public health and public safety crisis. Our two organizations hosted a one-day conference at NYPD headquarters that brought together more than 300 law enforcement professionals, police labor leaders, researchers, mental health care and other service providers, policymakers, and others—including three brave officers who themselves have dealt with depression, PTSD, and suicidal thoughts in the past and who were willing to tell us their stories” according to published executory summary 2019. “The NYPD is making use of psychological autopsies, a research-based approach that attempts to better understand why someone took his or her life. Following an officer suicide, personnel try to reconstruct what was going on in the person’s mind by systematically asking a set of questions, in a consistent format, to the people with the greatest insights into the person’s life and mind—family, co-workers, and friends.” The psychological autopsies contribute to the existing database of information about law enforcement suicide in general, and they help guide individual prevention programs and establish in the line of duty rewards for those whose death’s may be directly associated with their recent tours of duty as in the example of the Capitol officers who died immediately following the trauma of the insurrection where each of them was prepared to die.

The multiple deaths by suicide have renewed attention on another troubling and often hidden issue: Police officers die by their own hands at rates greater than people in other occupations, according to a report compiled by the Police Executive Research Forum (PERF) in 2019, after at least nine New York City police officers died by suicide that year. I was involved in the April 2019 presentation at 1 Police Plaza on the impact of LEO suicide as it related to the high incidence of police officer death by suicide. Police Commissioner James O’Neill gave an impassioned presentation imploring officers to get help and promising to “listen and eliminate stigma” of having trauma-related illness.

Regrettably, first responder suicide is generally not considered a line of duty death and as such, fails to yield the honor given to officers who die in car crashes, shoot outs, or other direct line of duty incidents. “Now, the surviving families of the courageous defenders of democracy, Jeffrey Smith and Howard Liebengood — who were buried in private ceremonies, want the deaths of their loved ones recognized as “line of duty” deaths”. These deaths lack the honor and pageantry that accompanied Sicknick’s memorial service in the Capitol Rotunda — Why is the distinction made between the many ways LEO’s die? 

The denial of this recognition diminishes the honor of one man’s service and by doing so, fails every man or woman who puts on a uniform by saying “your experience is yours alone”. And even worse, it amplifies the stigma attached to law enforcement deaths at a time when all else has failed them.

Michael Sefton, Ph.D. 2022

The careful analysis of antimortem exposure and actionable behavior that follows and event like January 6 or September 11 draw the clear, indisputable facts that link officer suicide to line of duty traumatic exposure. The denial of this recognition diminishes the honor of one man’s service and by doing so, fails every man or woman who puts on a uniform by saying “your experience is yours alone”. And even worse, it amplifies the stigma attached to law enforcement deaths at a time when all else has failed them. I cannot stand by this exception to what may be obvious line of duty exposure and police officer death especially after 9-11 and after the Capitol insurrection. But it should in no way minimize the loss of life attributed to suicide when years of exposure have gone unnoticed and even unreported by a law enforcement officer.

After the September 11, 2001 attack on the World Trade Towers there was an increase in LEO suicide. Men and women who witnessed the enormity of the attack coupled with the deaths of hundreds of police officers and fire fighters lost the will to grudge onward by no fault of failure character of their own. They swam in the muck and got wet and could not recover from darkness that engulfed them. The psychological autopsy would quantify these wounds just as the pathologist counts entry and exit wounds from an ambush. 

The juxtaposition of these facts cannot be ignored. Every one of the hundreds of police officers put their lives on the line as a result of the former president’s truculent narcissism. It would be a dishonor to the men who gave their lives by denying the causal underpinning of their deaths. Suicide by law enforcement officers exceeds the number of officers who die in in gun fights, car accidents, on-duty heart attacks, attacks by citizens, calls for domestic violence, and other police calls for service. “This fact thrust these most private of acts into the national spotlight and made clear that the pain of the insurrection of January 6 continued long after the day’s events had concluded, its impact reverberating through the lives removed from the Capitol grounds” as written in a recent Washington Post report. “It is time the District recognized that some of the greatest risks police officers face lead to silent injuries,” Weber said. “Why do we say that one person is honored and another person is forgotten? They all faced the exact same circumstances.” according to a report in the Washington Post by Peter Hermann in February 2021.

There are things that must be done when law enforcement officers die as a direct result of the the calls they take and the trauma they experience that directly results in their death. Neither of these officers would have died if they had not jumped into the crisis taking place at the U.S. Capitol. Both men were solid members of the Capitol and Metropolitan Police Departments and had no history of behavioral health claims. Neither officer was in trouble with finances, gambling or substance abuse, internal affair investigation, or marital trouble. In the days that followed, Erin said, her husband, Capitol officer Jeffery Smith seemed in constant pain, unable to turn his head. He did not leave the house, even to walk their dog. He refused to talk to other people or watch television. She sometimes woke during the night to find him sitting up in bed or pacing. Her husband was found in his crashed Ford Mustang with a self-inflicted gun shot wound that occurred on his way to the job.

Peter Hermann Washington Post 2-12-2021

Rioters swarmed, battering the officers with metal pipes peeled from scaffolding and a pole with an American flag attached, police said. Officers were struck with stun guns. Many officers were heard screaming into their radios “code-33” the signal for “officer needs help”. This usually is a signal bringing an “all hands” response to the scene of the emergency – in Metro DC, that would mean hundreds of officers would roll. Situations like this send chills down the spine of officers responding to calls for help – some are injured in car crashes racing to back-up officers in danger. It is always hoped that when the call for help goes out as it did that day that enough manpower will respond with enough force to push back on the crowd, however large. In this case, the crowd far exceeded the number of LEO’s available for duty and many officers expected to be killed by the mob. 

The psychological autopsy is a single case study of a death event that serves to uncover the psychological causes of death. This study would answer these questions and establish an understanding of worst case scenario of frontline exposure to trauma and possibly offer insight into underlying history that may have been anticipated and stopped. Without its use men and women die alone and often flooded with shame and loss of dignity. When law enforcement officers take their own lives this careful analysis of the hours and days preceding their time of death is essential to understand. “From this information an assessment is made of the suicide victim’s mental and physical health, personality, experience of social adversity and social integration. The aim is to produce as full and accurate a picture of the deceased as possible with a view to understanding why they killed themselves.This would answer the question as to whether or not the deaths may be considered to be line of duty, as they must. Psychological autopsy is probably the most direct technique currently available for determining the relationship between particular risk factors and suicide” Hawton et al. 1998

The evidence on Crisis Intervention Team (CIT) programs is thin, in part because these programs vary widely, with some representing basic officer awareness training and others composed of full-fledged and well-funded co-responder programs. However, the evidence on the impact of de-escalation training, which includes instructing police in how to identify and respond to people in crisis, is relatively strong.

Council on Criminal Justice https://counciloncj.foleon.com/policing/assessing-the-evidence/xvi-shifting-police-functions/ taken February 6, 2022.

I have proposed a Behavioral Health initiative in conjunction with changes in police policy and transparency that has been the central posit of social clamor since the death of George Floyd this summer. The International Association of Chief’s of Police (IACP) has a broad-based Mental Wellness program it is reporting on its website that highlights the importance of this kind of support. “The IACP, in partnership with the University of Pennsylvania (Penn) and the Bureau of Justice Assistance (BJA)’s VALOR Initiative, is customizing a program specifically designed to help officers and agencies by enhancing resilience skills. The cost of such a program will reap rewards in the form of career longevity, officer well-being, officer morale, quality of community policing, and greater faith and trust in law enforcement in general. Without psychological autopsy systemic failures in training and support often go unnoticed leaving men and women without a life saver to hold on to.

This investigation is an individually designed case study that elicits a broad range of factual data regarding the antemortem behavior of a decedent in the immediate day or days leading up to the suicide. In this case, what are the events that transpired in the days before the two Capitol police officers took their own lives? The fact is that both men were exposed to incidents and participated in protecting the Capitol on January 6, 2021. Both men were engaged in hand to hand combat.  It is known that the insurrection resulted in the death of a fellow officer and the deaths of 4 other people engaged in violent mayhem in which these men and hundreds others may have been killed. Both men believed the insurgency was potentially deadly to them or their fellow officers. The psychological autopsy is especially important when first responders and essential workers are involved and die soon after. When LEO’s and first responders are put in fear of death or see other officers being placed in the direct line of fire, are vastly outmanned, and have no way in which to stop an attack, they are at high risk for the “hook” that comes from an acute stress reaction and over time and soon becomes a monkey on the backs of so many fine men and women.

Some agencies, such as the Fairfax County, VA Police Department, are beginning to implement periodic mental health check-ups for their officers and other employees. The goal is twofold: 1) to “normalize” the act of visiting a mental health professional, thus reducing the stigma against seeking mental health care, and 2) to identify and address potential issues early on. (PERF 2019)

“This heroic sequence of behaviors is besmirched by the bias against mental health responses to events that would bring any one of us to our knees. Men and women of law enforcement walk in the darkness, always in death’s shadow. It is time to recognize these officers and help them and their families to know they do not walk alone.”

Michael Sefton, Ph.D. 2018 Direct Decision Institute, Inc.

Departments should consider flexible job assignments or adding exercise to work schedules as a way to release stress. Mental health should be regularly addressed at roll calls, and departments generally have to reduce the stigma — in part by acknowledging the deaths. According to Dr. Leo Polizoti at the Direct Decision Institute, Inc. in Worcester, MA, an annual stress inventory should be conducted as part of the official officer evaluation program. This may be easily done by tracking high lethality calls that may be followed by mandatory defusing/debriefing as close to high stress incidents as feasible. Officers in Worcester, MA are given paid time for these aftermath behavioral health sessions.


Hawton, K., Appleby, L., Platt, S., Foster, T., Cooper, J., Malmberg, A. & Simkin, S. (1998). The psychological autopsy approach to studying suicide: a review of methodological issues. Journal of Affective Disorders 50, 269–276.

IACP (2021) Officer Resilience Training Conference https://www.theiacp.org/projects/law-enforcement-agency-and-officer-resilience-training-program, Blog post taken February 13, 2021

Police Executive Research Forum. (2019) Washington, D.C. 20036 Copyright by Police Executive Research Forum

Buckley, M and Sweeney, A. (2019) Chicago Tribune. Alarms sound after 6 suicides in Chicago PD. https://www.chicagotribune.com/news/ct-met-chicago-police-suicides-20190315-story.html?

Hermann, P. (2021) Washington Post. https://www.washingtonpost.com/local/public-safety/police-officer-suicides-capitol-riot/2021/02/11/94804ee2-665c-11eb-886d-5264d4ceb46d_story.html

Donovan, E. (2019) Former Director of Boston PD Stress Unit.” https://www.linkedin.com/pulse/po-ed-donovan-former-directorboston-pd-stress-unit-brian/

Stress and Burnout: Understanding the human stress response and its malignant power to impair

The neurobiology of burnout starts with high levels of stress hormones coupled with perceived lack of efficacy and fatigue

Stress is well-known to the medical community and is treated with lifestyle adaptation and management of symptoms and disease. Once stress becomes too intense, it has a measurable impact on one’s own health.  I have posted blogs about a variety of stressful circumstances, some are associated with personal behavior and lifestyle choice; others are more in line with exposure to traumatic, stressful events experienced by first responders like members of law enforcement or front line healthcare providers. 

As well as impacting professional growth, research suggests that extreme stress levels can impair social skills, overwhelm cognitive ability, and eventually lead to changes in brain functioning. People who under constant stress pay a price in being unable to fully relax. They report feeling under constant threat from forces beyond their control and being stuck running in place. “In a recent study, job satisfaction, overall there were little differences between groups in ratings after a mindfulness program. The study looked at the impact on job satisfaction among members of a university faculty using weekly mindfulness meetings. Among those who participated, there was a significant link between feeling calm and relaxed, and greater workplace wellbeing, with those reporting less stress and anxiety also noting higher levels of job satisfaction according to Dr. B. Grace Bullock reporting on an Australian study in efficacy of mindfulness training.

Burnout can leave people exhausted, unmotivated, anxious and cynical – the consequences of which can be catastrophic to business and front line workers across all sectors of society. This is especially true among healthcare workers, where the stigma associated with mental illness still enables silence among those most in need. It is the real deal and probably underlies the recent exodus of nurses, doctors, police officers, and other front line professionals who have had enough and are moving on from their jobs. At our rehabilitation hospital more and more staff nurses are opting for a shorter commute by changing jobs. Some are leaving to become stay-at-home mothers after 18 months of fighting the fight with the virus, all the while their children were home in quarantine – going to school on their laptop computers.

“In a recent study, job satisfaction, overall there were little differences between groups in ratings after a mindfulness program but there was a significant link between feeling calm and relaxed, and greater workplace wellbeing, with those reporting less stress and anxiety also noting higher levels of job satisfaction. B. Grace Bullock 2017

Stress tends to create significant reactivity within the body. This brings forth rampant chemical flooding by the adrenal cortex and other stress hormones. These chemicals can add to a decline in physical well-being.  These over active hormones are lethal for the medically infirm and physically vulnerable. Yet, for some people, stress is like a drug and creates a circular pattern of sensation seeking as described in the prototypic type A personality.

 The neurobiology of stress and PTSD is being studied and may be linked to primitive brain circuits involved in the fear conditioning response and its eventual, sometimes refractory extinction or habituation of on-going perceived threat (Do Monte, Quirk, Li, and Penzo 2016). As an example, Police work carries with it a neurobiological underpinning that is well documented in terms of the impact of repeated stress and exposure to traumatic events. Chronic exposure to traumatic scenes and a host of other factors gradually elevate the hypothalamus-pituitary-adrenal (HPA) axis in the brain and body of typical career LEO’s. “The human brain, having evolved to seek safety in numbers, registers loneliness as a threat” as reported in a recent NY Times piece. 

Stress effects all aspects of how we feel. Most physicians know that mindfulness techniques lower subjective levels of stress. However, even though paced breathing puts the brakes on sympathetic overdrive, people do not use it long enough to create habits. “Meditating”, according to Dr. Woolery-Lloyd, initiates “the relaxation response,” which activates the body’s parasympathetic nervous system and decreases cortisol and inflammation.” Yet even our primary care physicians and physicians in emergency rooms across the country are at risk from frontline stress, burnout and area at higher risk of suicide. This taken from a story written by Jessica Defino about the impact of stress on human skin in NY Times on 12/08/2020. The point being that the stress response is pervasive in human functioning and can wreak havoc on physical health including the integumentary system – our largest organ – our skin.

“Why don’t we come up with a program before bad things happen?” asked Dr. Englert. “Bad things are going to happen. When they do, the person, the individual, and their family will be more resilient, more able to recover quickly from that event.” said Alexa Liacko, ABC News interview. It is in being vulnerable that we are able to stretch our emotional experience that brings forth growth and reduces stigma. You cannot expect frontline healthcare and first responders to walk through water and not get wet.


Lloyd, C et al. (2002) Journal of Mental Health 11, 3, 255–265

Writing reports that work for victims of DV: Tools for measuring risk for DVH

There were times that at the end of a midnight shift in Westbrook, Maine, outside Portland, and New Braintree PD, in Massachusetts that I had reports to write for incidents I had been assigned during the shift. More than once, I snuck out of the patrol office and went home – too tired to write. And more then once, the sleep I so wanted was disturbed by the day sergeant or court officer looking for my report. Or sometimes, when I did stay, my writing was not my best effort because I was tired. Report writing is an art and is now a large part of both the academy training and field training programs. Law enforcement officers are better trained and more highly educated than ever which is essential in these times where every word is public property. The media, the citizenry, and the police hierarchy are all slicing and dicing every paragraph of today’s reports looking for your mistakes, it seems. The reason I write this is that police reports have consequences and if important statements, or officer observations, or photographs are omitted, cases may be lost. It is essential that report writing be taken seriously because, in the setting of domestic violence, lives depend on it.

Just like any report document that is to be handed out to anyone who might request it, particularly underpaid defense attorneys who swim in circles, like sharks looking to devour a poorly written report and its author. Report writing needs to be concise and laser focused. Particularly important is the reason for the call. Why did this victim call today? We know that the abuse tends to escalate successively. Sometimes, it is only when children become involved that a victim will move to stop the violence. In Vermont, a teen boy shot and killed his father when the man drunkenly waved a pistol threatening the family. And in Maine, a 13 year old boy was found to be hiding a 20 gauge shotgun and ammunition on the day he and his family were murdered by his father Steven Lake.  Our analysis of the Maine case led us to understand that the boy was likely intending to defend his mother and sister against a violent and unpredictable father.  He may have been seeking to load the weapon when his father snuck into the unlocked house and overpowered the family. 20 gauge shells were found in the child’s bed and under his pillow.

Image from Mobile ODT
When conducting assessments or forensic exams with a victim of domestic violence (DV), any reported history of strangulation places the person at a higher risk for more serious violence or homicide by the hands of their intimate partner. By recognizing signs of strangulation, healthcare providers can help to mitigate long-term damage, properly document any evidence of abuse, and provide referrals for seeking safety assistance. Sara Vehling 2019

Risk assessment tools provide quantifiable data that may be used to develop actuarial projections as to degree of risk and dangerousness. Report writing now should include assessment tools that uncover potential risk to victims. Jacqueline Campbell, RN has a valid risk assessment tool for determining whether there is high risk to potential victims that can be living in the home while officers are still on scene. Campbell’s work is readily available in the DV literature and known to most of us. The Ontario group in Canada also has a reliable tool – ODARA used by law enforcement agencies across the country. In my agency we adopted both tools after the research was complete from The Maine homicides. The national leadership includes Lenore Walker, in addition to Campbell, who both have published a good deal over 25 years on DV and its cycle. Walker believes that women and families are exposed to great harm when the abuser is out of jail only hours after terrorizing his family. It rarely mitigated the next beating. 

I propose holding the abuser until his first arraignment perhaps as long as 2 days. This allows for a cooling off period. Minutes are like hours while sitting in a municipal cell block often eating fast food 3 times a day. But the 8th Amendment of the Constitution guarantees that bail shall not be unfairly denied or excessively harsh. In truth, the modification of bail conditions in some instances must be done in real time to account for the severity of individual cases of DV and unique red flags. Experts have said that when a victims says ”I know he is going to kill me” then there is a greater likelihood that she may be correct and a protective, safety plan should be put in place. On the continuum of risk, expecting to be killed is only slightly less dangerous as physical attempt to kill or maim. In these most dangerous cases, there are tactical measures that must be written into protective orders such as GPS monitoring, forfeited bail and remand to custody for violation of protective orders, social media restriction, no contact with victim and children, no contact with victim’s family or friends, and supervised visitation, when only appropriate. It is these cases where the police officer’s report must be first rate and bullet proof.

A period of being held in custody until initial arraignment will enhance public safety and public trust in the short run. If applied to all persons arrested because of domestic abuse, then it would not unfairly impact only the poor or disenfranchised. Abuser’s should not be able to buy their way out of jail nor should they be free to wander their communities stalking their supposed loved ones. Steven Lake who killed his family and himself in Dexter, Maine posted his love for his children nightly and had piteous social media “friends” encouraging him to “fight for his children”. Little did they know he was planning the onerous events that would end the Lake family timeline forever. The Maine Law Review in 2012 reviewed changes in conditions of bail and cited our research over 12 times in its review of conditions for the release of persons in jail for domestic violence. Protective factors include the abuser having full employment and a substance free environment.

As the reader begins to understand report writing requires a visceral response and poignant understanding of this hidden social maelstrom. There are legitimate reasons for seeking “no bail” holds on some people arrested for domestic violence when high acuity and high risk exist together. These have been posted by me in the Human Behavior blog.


Campbell, J. (1995). Assessing dangerousness. Newbury Park: Sage. Nicole R.

Bissonnette, Domestic Violence and Enforcement of Protection from Abuse Orders: Simple Fixes to Help Prevent Intra-Family Homicide, 65 Me. L. Rev. 287 (2012). Available at: https://digitalcommons.mainelaw.maine.edu/mlr/vol65/iss1/12

Ronald Allanach et al. (2011) 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.

Vehling, S. (2019) Taking your breath away – why strangulation in domestic violence is a huge red flag. Blog post https://www.mobileodt.com/blog/taking-your-breath-away-why-strangulation-in-domestic-violence-is-a-huge-red-flag/ taken March 15, 2022

Mac Walton. (2019) Bail Reform and Intimate Partner Violence in Maine, 71 Me. L. Rev. 139. Available at: https://digitalcommons.mainelaw.maine.edu/mlr/vol71/iss1/62

Domestic Violence Homicide: crafting protective orders with teeth and laws to support victims in fear of being murdered

Domestic violence homicide shares common red flag warnings that are discernible when prosecutors take time to connect the dots.

In Maine, Texas, and across America, the criminal justice system – including prosecutors, too often fail to protect victims of domestic and family violence from their abusers — even when the “red flag” warning signs are obvious as they were in both these cases. In this post, and the March 15 post, I talk about the importance of report writing and truly  understanding DV on a visceral or gut level. To truly understand what is going to happen requires a realization that just below the surface may lie a wolf in sheep’s clothing. 

What happens next?  The failure to see what danger exists as officers interview victim and abuser. This is often because no dangerous assessment has been initiated and secondly, because there are too few prosecutors and judges who connect the dots and understand the cycle of domestic violence. Protective orders must contain contingencies for those abusive partners who do not respect the order of protection and violate its provisions at will. Any violation should be met with revocation of bail and immediate arrest. 

I will post the 10 risk factors below for specific warning signs common to DVH. This begs the question, why are cases of domestic violence homicide not more fully examined with a psychological autopsy? These examinations might add to the body of knowledge and create impetus for change in DV law including bail conditions as suggested in the Maine Law Review in 2012 and again in 2017. There needs to be more bite to protective orders so that victims can move on with their lives rather than live in constant fear as I have posted over and over. Recently, in 2017, the Maine Law Review listed changes in bail conditions that were recommended by Nicole Bissonnette, an attorney and member of faculty at University Law School in Portland, Maine. Heretofore, these have been largely ignored by legislators in Maine. Ms. Bissonnette has written about Bail reform in at least 2 papers published in the Maine Law Review as noted above. I will write about these two Maine Law Review papers shortly.

In early 2021, the police in Austin,Texas were beset by a horrific case of domestic violence homicide. On April 18, 2021, a former police officer killed the family while picking up his son for a monthly supervised visit. The child’s mother encouraged these visits as important to the boy’s development and relationship with his violent and sadistic father. While exchanging pleasantries, the child’s father shot and killed his former wife and step-daughter.  And he killed his daughter’s young boy friend and immediately fled. Detective Broderick was captured 20 hours later and is being held. Yes, the abused was a former law enforcement officer. 

Texas law requires surrender of all guns following a domestic assault. The question remains, had Broderick been relieved of his firearms or did he acquire a weapon after leaving the police department? In Texas, “timely relinquishment of firearms is an essential dynamic of violence prevention. We must work together to ensure that individuals subject to a weapon forfeiture order surrender their firearms immediately” according to Travis County District Attorney Jose Garza in a May 2021 story. So we are led to believe that he turned in his firearms and was relieved of his license to carry a concealed weapon. It is not specifically reported that these conditions were met. However, as it pertains to GPS monitoring a judge believed that because he had been compliant with conditions of his release, including wearing the GPS ankle bracelet for 3 months, that it was no longer required. Why?

This comes in response to the murder of three members of a single family, allegedly by a former police detective who had been ordered to stay away from his wife and step-daughter. He was in direct violation of the order. His court-approved  visitation with his son was to be supervised and on April 18, 2021 during a time where Mr. Broderick was to pick up his son, the murderous assault was initiated: killing 3, including his former wife and adopted daughter. What were the red flag triggers? Was something missed?

In the Texas case there were people who knew what might occur, like murder of former wife, the issues surrounding Broderick and his loss of employment and pending felony trial were among the many triggering factors.

Common sense look at facts

Police need broad discretionary authority in dealing with any violation of orders of protection including no bail holds and danger risk assessment

Following the 2020 arrest for sexual assault of a child, Broderick resigned from the Travis County Sheriff’s Department. He was initially held on $100,000 bond. A family friend remarked, “I kind of had a feeling that this is where he was going, because he was lost,” she explained. “He lost everything. He lost his family. There was a protective order for a reason.” He was lost?  That gives him the right to violently kill his former wife, adopted daughter, and her male friend? Many in our society are lost and do not go on to commit violent homicide.

Like the Austin homicide, in other cases I have reviewed, trends “someone knew” what would happen if the abuser was released from custody. This is a red flag. And facts indicate Mr. Broderick had a violent history including rape of a child and most certainly should have been kept in custody through his trial. What possible good could come from releasing this man into society? And more specifically, why was the victim’s plea for greater protection apparently ignored? At the very least, Mr. Broderick should have been wearing the GPS monitoring bracelet when he was out of custody. The judge who allowed him to stop wearing the GPS monitor should be removed from the bench for such a poor judgement call that she indicated was based on her experience with usual cases. This was not one of the “usual” cases and the fact that someone knew what might happen and kept quiet is despicable and should be made a felony crime of obstruction of justice.Any threat of death and use of firearm removes anything usual about a case of intimate partner violence.

The 16-year old child, who was among the victims, begged for a more restrictive supervision of her step-father who had been released from jail and was not required to wear an ankle bracelet after only a period of 3 months. An order of protection was brought against former police detective. There was a protection order in place but even the teen knew that orders of protection were “not worth the paper they were written on.” 

“Because Mr. Broderick committed this heinous crime after he paid a money bond to be released on charges related to sexual assault against a child, Texas law permits his detention without bail.” Wes Wilson, KXAN television Austin, TX

There is a case to be made for careful analysis of behavioral health functioning of abusers. That seems to be common sense right? But this sometimes does not occur. As a law enforcement officer in Massachusetts, I made an effort to introduce risk assessment tools to quantify a subject’s dangerousness. This is important but is not yet universally adopted here in Massachusetts. Nearly 10 years on, the psychological autopsy conducted in 2011, looked at the red flag warnings that are common to DVH everywhere – including the case in Austin. What brought my attention to the case in Maine was the purported prosecutorial impotence argued by Christopher Almy, the county district attorney, that there was “nothing that could be done to protect the victim, Amy Lake and her two children, from her estranged husband Stephen Lake. That statement was inspiring. Imagine if you and your family were depending upon the police to protect you as Amy Lake was? Everything that could be done was in place. But the protection order had no teeth. So Steven Lake snuck into the Amy’s home at 5 AM and staged a despicable murder scene, ultimately killing the children he claimed to love while Amy was forced to watch. Ending with her shotgun murder and is own death by suicide. 

“Domestic violence is not random and unpredictable. There are red flags that trigger the emotional undulation that bears energy like the movement of tectonic plates beneath the sea.” Michael Sefton (2016)

In an article on the 8th Amendment regarding bail in cases of domestic violence, the Maine Law Review, first in 2012 and an updated second publication in 2017, cited the importance of carefully crafted conditions of bail especially among men who are found to have violated the conditions often by stalking and using social media to intimidate and contact potential victims also by trolling family members in an effort to locate estranged spouse and her children who may be in hiding. Both Amy Lake and Austin, TX mother of 3 expressed an interest in having children remain in contact with extended family in spite of pending serious criminal charges. This opened up access to the perpetrator to information about current living arrangements, employment, after school activities, and other potential clues that raised the risk of further domestic violence and ultimately DVH. In Austin, the victim expressed a wish to allow her estranged husband to have contact with the little boy – his son in spite of pending felony charges brought forth by the 16-year old step-daughter who rightfully feared for her life. Why was her fear ignored or minimized given her history of having been sexually assaulted by her adoptive father and his animosity toward her for reporting the abuse to law enforcement. He blamed her for his loss of career and status as a local detective with the Travis County Sheriff’s Department.

Firearms are a major cause of DVH and in every state are required to be taken from men with active protection orders in place. This was the default expectation in the two cases described here but in the case of Stephen Lake his arsenal of 22 firearms were not removed from his possession in spite of court orders.  Similarly, the Austin killer was left with at least one firearm used to kill his family.  Lake left 9 suicide notes many of which were rambling, angry tirades toward his wife and in laws.  The Austin killer did not take his own life and was captured. This is atypical especially among law enforcement officers raising the specter of possible psychological analysis of his motives. This make the two cases in this post very different at this level. To what extent Texas authorities will endeavor to understand the events that preceded the murders remains unclear although, like the Aurora theater shooting, having a bad guy to study is rare. This means nothing, aside from an opportunity for personality and psyhopathology to be brought up at trial perhaps allowing Mr Broderick to avoid death row.  There is not much in the public media since the crime and his capture. However, gaining a comprehensive understanding of the red flag warnings in this case is recommended and will add to the body of literature on domestic violence. Why he chose not to kill himself is itself a mystery. 

One could argue that the Austin killer shared several commonalities with the Maine case including sexual violence, threats of death, pathological jealousy, violation of the order of protection. The Austin murderer, Mr. Broderick was a SWAT trained police officer who resigned his position after being arrested for sexual assault on his step daughter.  He should not have had a firearm pending the outcome of his case. Stephen Lake, on the other hand, would never stand trial – something he knew was a fact. Lake was keen on the idea that the cost of his divorce was a mere $0.35 cents – about the cost of one bullet. In this case his sister and aunt understood how angry and troubled Mr. Lake had become and said nothing, until we conducted our hours-long interview for the psychological autopsy.


Domestic violence homicide risk factors

  1. Threatens to kill spouse if she leaves him – pathological jealousy
  2. Actual use of firearm or other weapon anytime during domestic violence incident
  3. Access to firearms even if he never used them – veiled threats
  4. Attempt at strangulation ever during fight
  5. Forced sex anytime during relationship
  6. Unemployment of perpetrator
  7. Stalking via social media – one or both spouse use social media to intimidate or garner support
  8. Presence of unrelated “step” child in home
  9. Spouse finds new relationship soon after separating
  10. Low bail release from custody – high bail holds are essential in DVH mitigation

Conditions of bail and 8th amendment freedoms – reflections on domestic violence homicide

The 8th Amendment guarantees that people will not be faced with unfair conditions while in custody nor should they have undue hardship following adjudication. But when victim safety requires it then some modification of this rule must be considered. Dangerousness to possible victims requires some abusive subjects (usually men) be held without opportunity for bail at least as long as it takes to confirm that there is no immediate danger to possible family members. This evaluation sometimes takes hours to days to complete. In Massachusetts, here in the US, some courts have court clinics that can assess persons in custody for risk of suicide and dangerousness. The pandemic has reduced this option significantly and arraignments were conducted virtually for months. Many district courts work with domestic violence agencies on a regular basis sometimes in the court buildings near court rooms.

Maine Law Review

Not much has changed since the Maine Law Review cited our work in its 2012 in Nicole Bissonnette’s review of bail conditions following domestic violence. Ms. Bissonnette published second paper in 2017, in the same MAINE Law Review that gives some quick and easy fixes for the 8th Amendment conundrum as it pertains to domestic violence. It is a fact that victims generally do not call police when the abuse first begins. It is also a fact that if a victim has been threatened with death if she “leaves” or “asks for a divorce” then her risk is substantially elevated and a safety plan must be provided including an order of protection.

The 8th amendment guarantees that excessive bail nor excessive fines shall not be required when someone is in custody and when found guilty of a crime. In many cases of domestic violence assault, abusive spouses are released on personal recognizance – essentially no bail is taken. Abusers are required to show-up on the next court day (usually Monday morning) and answer to charges of assault, domestic abuse, or whatever the evidence shows. The 8th Amendment also specifies that punishment for crimes shall not be excessive, overly punitive or harsh. It is frequent that abusers may have no criminal record whatsoever. Given that fact, it is hard to argue for high bail in a case where the defendant is unlikely to skip out on an initial hearing. This is precisely the reason why officer reports must include detailed statements from victims and witnesses – especially children.

I agree in principle that bail should not be punitive but neither should a family be faced with constant fear and danger because of the arrogant defiance of an abusive spouse. People without means do not have money for bail and some individuals are unfairly kept in jail simply because they or their families do not have cash for release from custody. So, a person who may be unemployed and was picked up for shoplifting and has 2 prior arrests may have an artificially high bail so he sits for weeks in a county jail awaiting trial. There are times when dangerous supersedes the right to be released from custody. This requires close scrutiny for making bail conditions that reflect risk to community and red flags for individual families.

In the 2017 Maine Law Review, Nicole Bissonnette restated her 2012 premise that bail conditions must be considered carefully when it comes to letting violent intimate partners out of custody. Ms.Bissonnette smartly cited the work done by this author and colleagues that brought these issues into sharp focus (Allanach et al. 2012). The importance of orders of protection cannot be understated in preventing domestic violence homicide. “The purpose of this follow-up comment is to evaluate the existing (PFA) system and assess methods of improving outcomes while avoiding prohibitive fiscal impacts” according to Ms. Bissonnete, 2017. The process, structure and failings of the existing system will be illustrated by the tragic deaths of Amy Lake and her two children, who were murdered by Steven Lake, despite the PFA in effect at the time. It was this case that brought domestic violence homicide into national prominence and provided substantive recommendations for mitigating DVH. Information is often unavailable to bail clerks or even judges when PFA’s are needed most. Information such as whether the defendant has previously violated conditions of release, probation or other orders, including, but not limited to, violating protection from abuse orders according to Jennifer Thompson, 2004. When these factors are affirmed then bail conditions must be revised in real time accordingly. Substantial bail for violation of protective orders is but one of them. Some believe that having non-refundable, very high bail is the only sanction to prevent recurring violations of the PFA. The 8th Amendment informs that bail may not unfairly impact people without employment and those who do not have financial means to buy there way out of jail.

There are cases, as recently as 2021 where a protection order was denied and domestic violence escalated into death of the New Hampshire suspect and critical injuries to intimate partner who became the victim. A judge did not think a protective order was warranted. Similarly, in Austin, TX, a disgraced police officer shot and killed his step-daughter, the teen’s boyfriend and his former wife in April 2021, even after the teenage girl begged for a protective order with the option to hold the abuser in jail. Her fear was palpable. The shooter was required to wear an ankle bracelet for 90 days after which he was free to stalk his former family who were trying to move on. There were several flaws in the safety plan in this case that ultimately triggered the terminal event such as coming together for planned visitation so the former police officer could visit his son who was not murdered. In New Hampshire, a judge denied a protective order on the basis that the abuser had not been violent since 2016 although acknowledged that the man was coercive and controlling. The victim, Lindsay Smith, was shot and critically wounded in Salem, MA in November 2021. Her former boyfriend, who had stalked the victim for the years since the break-up reportedly said he intended to forever “turn her life upside down” died from a self-inflicted gunshot wound. This may have been avoided if the temporary restraining that had expired had been approved to become a permanent restraining order as the victim had petitioned.

The desire to mitigate police discretion in domestic violence cases stems, in part, from problems relating to “the inherent ambiguity of the police-citizen encounter in the context of domestic violence.”

Jennifer Thompson, 2004 Maine Law Review

The domestic violence literature suggests that after 5-7 beatings victims will reluctantly summon police – especially if they fear either they or their children are about to be murdered. The details Calais, ME case of domestic violence are being carefully guarded even today. It is known that Daniel Phinney, 26 was out on bail after being arrested and charged with domestic violence and criminal threatening in May 2013. At that point he must have both physically assaulted his significant other and threatened to kill or maim his family resulting in the charge of criminal threatening. Police are quick to say that Phinney had “no prior criminal history” perhaps in an effort to obfuscate public outrage evoked by the system of bail in Maine that releases violent abusers over and over again on low bail. Had anyone made an effort to determine the degree of risk posed by Daniel Phinney prior to his release? Had anyone registered safety concerns based on the defendant’s behavior and history? If there had been routine aftermath follow-up then this may have been a known fact. A psychological assessment of Phinney may have provided important details about his impulse control, substance use, coping skill, and proclivity toward violence and had been charged previously with domestic violence. Phinney was killed by police in a stand-off in Calais, Maine shortly after being released from custody.

The case is reminiscent of the 2011 Steven Lake homicide in Dexter. Lake had twice been released on bail before murdering his family.  The medical autopsy concluded that “in spite of psychological counseling (the state) failed to appreciate the degree of anger and violence in Steven Lake”.  He had also been charged with criminal threatening after holding his family at gunpoint as he drove home the point about how much he loved them but he could not let Amy move on. 

Using a firearm in the commission of a domestic violence incident is defacto evidence of dangerousness and no bail shall be considered until such time as all firearms are collected and a viable safety plan is in place for potential victims including police protection. Michael Sefton, Ph.D. 2021

I was a member of a team that conducted a psychological autopsy on Steven Lake that resulted in over 50 recommendations to the esteemed Maine Attorney General’s Homicide Review panel in November 2012. At first glance there appears to be brash indifference toward the court protection order and the failure to remove firearms held by the defendant. It is now important to study the case of Daniel Phinney and others, so we ma learn from the many red flags exhibited in the weeks prior to his death. These red flag events must lead to stopping and containments points in future cases of domestic violence and domestic violence homicide. No family should be kept in fear by a spouse whose loathsome behavior derails all human spirit and sense of dignity.

At what point does the well-being of victims and potential victims rise above the abuser’s right to bail?

Michael Sefton, 2014 on the 8th Amendment and PFA orders


Allanach, R 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.

Bissonnette, NR (2012). Domestic Violence and Enforcement of Protection from Abuse Orders: Simple Fixes to Help Prevent Intra-Family Homicide, 65 Me. L. Rev. 287. Available at: https://digitalcommons.mainelaw.maine.edu/mlr/vol65/iss1/12

Thompson, J (2004). Who’s Afraid of Judicial Activism? Reconceptualizing a Traditional Paradigm in the Context of Specialized Domestic Violence Court Programs, 56 Me. L. Rev. 407.

Sefton, M. (2021) Domestic violence and the importance of red flag warnings for preventing homicide. WordPress Blogpost. https://msefton.blog/2021/04/24/domestic-violence-and-the-importance-of-red-flag-warnings-for-preventing-homicide/ taken 2-25-2021

Get rid of behavioral health stigma once and for all

This video is about an introduction to a post that will be forthcoming in a short while it is reference to law enforcement officers and the suicide death of officers who carry trauma. The video tells about LEO stigma associated with officer behavioral health and its decline. In it, Michael Sefton, Ph.D. describes the need for understanding fluctuating moods among mid-career law enforcement officers – those most at risk for trauma-related crisis. Sefton implores departments everywhere to analyze deaths by suicide for consideration of “line of duty” designation. In stigma, behavioral health problems are a product of centuries of police culture in which perceived weakness is stigmatized. Cops know their brothers have their back, no matter what, but they still don’t want to be seen as the one who’s vulnerable” according to a recent Men’s Health article written by Jack Crosbie. He published a report about suicide in the NYPD during Mental Health Awareness month in May 2018. Over 300 clinicians and law enforcement personnel came together at police headquarters in Manhattan in April 2019 in an effort to take on law enforcement suicide. I sat amongst a row of NYPD sergeants and enjoyed their company as we learned about how to let go of the stigma and understand the impact of personal job-related experience.

In order to be considered for line of duty status following suicide, law enforcement must offer annual stress assessments and tracking and defusing after high lethality incidents. This will link any stress and behavioral health issues to calls for service that officers had during the reporting period. Just as psychological screening is done pre-employment, so too should annual stress assessments be undertaken for officer longevity and career satisfaction. Men and women found to have an elevated stress response and symptoms may rotate to other roles in the department while receiving support. After a period of time they return to their prior status and duty. This is more difficult to achieve in smaller or more rural agencies.

“The NYPD is making use of psychological autopsies, a research-based approach that attempts to better understand why someone took his or her life.” 

According to Hartley, et.al., 2007, “repeated exposures to acute work stressors (e.g., violent criminal acts, sad and disturbing situations, and physically demanding responses), in addition to contending with negative life events (e.g., divorce, serious family or personal illness, and financial difficulties), can affect both the psychological and physiological well-being of the LEO population.” This is well known. But there are factors that interfere with coping as stress increases. These factors must be studied and applied to law enforcement officers who are most at risk. Those officers who grow more distant and see fewer and fewer options for life. It is in this decoupling of frontal decision making and problem solving circuits and the narrowing of focus that suicidal behavior becomes a plausible next step. At some point, a suicidal person believes there are no other choices and that the world would be a better place without him or her.

The run away fight/flight mechanism that keeps us on guard plays a primary role on how people feel after episodes of high stress, both normal and abnormal. Career longevity depends upon developing healthy coping skills to deal with all life has to give including accumulated traumatic experiences. Feelings of frustration, irritability, lack of focus, chronic fatigue, and even depression can result from an over reliance on social media stimuli like an unfed addiction. 

Chicago PD: suicide strategy session

Dr. Leo Polizoti (right) and Dr. Michael Sefton (second right) were invited to Chicago to discuss the impact of police suicide on officers and family. Our work with Dr. Thomas Joiner brought to light some of the important factors that contribute to LEO death by suicide. A return consultation was interrupted by the pandemic in 2020. The event was hosted by Dr. Daniel Holler of Daninger Solutions of Fort Lauderdale, FL.

The multiple deaths by suicide have renewed attention on another troubling and often hidden issue: Police officers die by their own hands at rates greater than people in other occupations, according to a report compiled by the Police Executive Research Forum (PERF) in 2019, after at least nine New York City police officers died by suicide that year. I was involved in the April 2019 presentation at 1 Police Plaza on the impact of LEO suicide as it related to the high incidence of police officer death by suicide according to Sefton in 2022. 

Use of Force continuum – Shoot – Don’t Shoot: Mental Illness and the Use of Force – Officer confronts man with non lethal gun

Police agencies expend a great deal of LEO resources dealing with citizens with mental illness. The Washington Post (2015) and the Boston Globe (2017) both did large feature stories on police use of force against mentally ill persons. The profiles were gut wrenching but only one example illustrated the emotional toll on law enforcement officers who are involved in fatal use of force situations. This fact fails to illustrate the emotional toll officer involved shootings has on member of law enforcement. The Boston Globe Spotlight Series entitled The Desperate and the Dead was published in 2016. I have written about officer involved use of force for over 5 years now.

The interaction between poly-substance abuse or dependence and exacerbation of underlying mental health symptoms is complex. It must be studied. The interaction of the two is sometimes lethal as reported by the Globe Spotlight team. The focus of mental health advocates and criminal justice experts nationwide is to provide options for jail diversion. Programs like alternative restitution have reduced sentencing and have not reduced the police use of force. Lethal force results as a function of the behavior of the subject. His capacity to listen and follow directions guides the force that will be used against him when confronted by law enforcement. It is impossible to utilize de-escalation techniques in all cases of police-mental illness encounters.

I have featured some very troubling cases including a case of patricide in Vermont. In that case, Kryn Miner, 44 was shot and killed by his son in 2014 after threatening his wife and stating that he was going to kill his family. Ironically, Miner and his wife has just returned from a wedding. Kryn Miner was intoxicated and had both PTSD and a traumatic brain injury. He was on a waiting list for care at the local V.A. Miner threatened his family with a gun a year before his death but the event was never reported to police. Current and former police chiefs said that without large-scale police retraining, as well as a nationwide increase in mental health services, these deadly encounters will continue. The loss of veterans from suicide remains a significant moral shortcoming.

“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,” SFPD Chief Grace Gatpandan said in 2015.  Washington Post (2015) Lowery, W. et al. DISTRAUGHT PEOPLE, DEADLY RESULTS: Officers often lack the training to approach the mentally unstable, experts say

Gun violence is a public health problem. The American Medical Association is now recommending physicians ask their patients whether there is a firearm in the home. Especially among older adults, divorce and substance abuse contribute to the risk of suicide by means of a firearm. This information may raise physician awareness and set off warning signs especially in patients without social support. According to David Rosmarin, M.D. at McLean Hospital in Belmont, MA – Rampage violence or spree violence is rare but always sensational- “violence is the currency of what we do” so MD’s need to become comfortable with the conversation about violent intention. The serious mentally ill account for only 3-5 % of all US violence – substance abuse is a big factor in violence according to Rosmarin.  Violent intention is frequently communicated in advance.  “There were signs along the way that were ignored” according to Rosmarin. These signs may be important when building systems of care and training LEO’s who are expected to de-escalate dangerous citizens and with limited training.

“I called 911 so they could disarm him, not kill him,” Joan Hart told a reporter in 2007 after her suicidal husband, James, 65, was fatally shot by Quincy police in their backyard after charging officers with a knife. Boston Globe Spotlight Team 2016

The quote about is heart breaking because the outcome of that call for help was not good. All officer involved shootings are carefully investigated as part of normal protocol. People fail to appreciate the impact the OIS has on the officers involved. No police officer leaves his house with the intention to get into a gun fight. “There will always times when police officers encounter those with mental health needs especially in times of crisis and social disorder. Training and education offer the best hope for safe and efficient handling of cases. A continuum of options for detox, dangerousness assessment and symptom management must be readily available – but sadly here in Massachusetts they are not” Sefton, 2016

___________________________________________ Boston Globe Spotlight Series (2016) Desperate and the Dead. Washington Post (2015) Lowery, W. et al. DISTRAUGHT PEOPLE, DEADLY Sefton, M. (2016) Human Behavior blog post: https://msefton.wordpress.com/2016/03/24/deadly-force-continuum-changing-officer-safety/ Taken June 4, 2019

Loneliness, loss, and fading resilience in the tarnished golden years: languishing with loss of purpose

The isolation felt by people in quarantine can leave the average person feeling numb and emotionally languished. Recently, I provided a zoom conference on the psychological impact of the coronavirus in November 2021 from my office at Whittier Rehabilitation Hospital in Westborough, MA. It was well attended, largely by people who are psychologically minded and aware of the points I endeavored to make. My target audience was the people who were struggling and vulnerable to decreased coping during covid-19 recovery. I am unsure we hit the mark I was hoping for with the target audience.  The fallout in mental health from the coronavirus is real and it is now recognized as a public health menace among recovering adults. It is now being seen in children and adolescents with growing concern. Just like younger patients, loneliness and social isolation in older Americans are serious public health concerns putting them at risk for dementia and other serious health conditions including failure to thrive, sepsis, malnutrition, addiction, and mental illness according to a CDC report. For many individuals in quarantine, the nightly happy hour started earlier and earlier raising the specter of worsening substance abuse and addiction. The liquor stores were soon to be considered essential services and package delivery became a common source of re-supply. The impact of isolation, emotional loss, and social detachment undermines public and behavioral well-being across the life span. It is a co-occuring illness among illnesses afflicting millions. I see it in my own family as nerves are frayed now almost 2 years in – first noted in the blog post published in May, 2020 (Sefton, M.). In this fourth wave of the virus called the Omicron variant, people are tired of hearing about social distancing, mask mandates, and rising infection numbers. I see it every day.

I have worked with older clients for over 25 years first as a post doctoral fellow at Boston City Hospital – now BUMC. Long before the pandemic, my work at Whittier Rehabilitation Hospital has been to provide support and direct service to patients’ suffering from debility associated with decline in physical health along with the psychosocial needs and changes. All too often, this includes feelings of loss of control and sadness that is palpable in our short conversations. Many seniors feel invisible and the virus exacerbates these feelings. Declining health further instills the loss of purpose and amplifies the stigma of being seemingly infirm. The lack of purpose germinates from the passing of a spouse, close friends who move or have died, food and financial insecurity. It precedes a death wish and it’s associated demoralization. My mother was infected with the coronavirus in mid-April 2020 before the vaccine was introduced. She lived in the same nursing facility where I lost my 93-year old aunt in the first wave of the virus in May, 2020. My mother survived the virus but it has taken a significant toll on her physical and cognitive well-being. We were not permitted to see my mother during her illness and my aunt was alone on May 1 when she succumbed to the virus.

Trauma informed therapy refers to the critical understanding of one’s emotional history and supports the model of early traumatic experience being one underpinning of many mental health outcomes and threatened resilience later in life. These kinds of experiences have an impact on people who have had loved ones die while in lock down across the country and can engender guilt and helplessness. Often, singular front line medical staff are alone with patients who succumbed to the virus – sometimes holding the fading grip of another disappearing life. This heroic act of empathy happens without fanfare or even a moment to process its importance and acknowledgment of the person’s passing.