Year: 2015

Emotionally distraught – nearly one quarter of all officer-involved shootings go fatal

Michael Sefton, Ph.D. Dangerousness assessment, Police officer behavior , ,

WESTBOROUGH,MA July 1, 2015 As the analysis of officer involved shootings gradually becomes clear it becomes inevitable that people begin to wonder about the cumulative number of victims of these shootings who may be diagnosed with some form of mental illness.  When it comes right down to it the fact that these persons may or may not of been a victim of unjustified police officer involved shootings will be evaluated on an individual basis based on the use of force continuum to which all police officers adhere. “The underpinnings of violence are often present in some form or another whether or not someone has a mental illness ” according to Michael Sefton, Director of Psychological Services at Whittier Rehabilitation Hospital in Westborough, MA.  Now a groundswell of support has begun for victims of police shootings that may be the result of untreated conditions with psychiatric etiology.  Some are calling for advanced training in crisis management as a way of avoiding officer involved shootings of those who may be emotionally distraught.  I agree to a point that better police-citizen interactions may reduce the incidence of escalating violence.  But this will not work when someone is exhibiting the cognitive confusion and distorted thinking associated with terminal rage.

The Use of Force continuum guides officer response to violence and lethal threat
The Use of Force continuum guides officer response to violence and lethal threat

Police officers respond to violent scenes only to face real threats from people who mean to harm them or themselves whether mentally ill or not.  To say that it is because they lack training in techniques of crisis de-escalation that some deaths may have been prevented is unfair and short sighted. Lives may have been saved if those individuals purported to have metal illness had chosen not to pick up a weapon and become menacing.  Lives may have been saved if those same individuals were not intoxicated or high on drugs when they encountered the police and then became menacing. And again, lives may be saved if there were treatment programs available for those same individuals to provide containment of the most violent, unpredictable and paranoid and psychotherapy for those who might profit from the talking cure.  The facts are clear that deadly force was utilized in cases when someone’s life was threatened. Step one of de-escalation training calls for strong voice commands to “put down the weapon”.  In cases where these commands were not heeded the use of lethal force may be a last resort.

Police officers are called upon to use deadly force in the protection of themselves of someone else. Training and experience kick in when violent intentions are directed at police officers who are expected to protect potential victims from violence.  But yelling and pointing guns is “like pouring gasoline on a fire when you do that with the mentally ill,” said Ron Honberg, policy director with the National Alliance on Mental Illness cited in the Washington Post article on July 1. Mr. Honberg fails to realize that if officers are yelling and pointing firearms it is because the force continuum has already exceeded the level of a shoot-don’t shoot lethal force scenario. The degree of response intensity follows an expected path that is based on the actions of the perpetrator not the actions of the police.  The  Post integrated video clips from officer involved shootings and the Longview, TX incident depicts how quickly someone with a knife can cover the distance between two officers.  Read my published blog on the Myth of Mental Illness as it cites the truly low incidence of crime and violence among those diagnosed with mental illness.  (https://msefton.wordpress.com/2015/03/02/the-myth-of-mental-illness-and-school-violence/)

  • kids_imagesThe mere fact that someone has mental illness such as schizophrenia, bipolar depression, or anxiety has less to do with whether or not they are at higher risk for lethal force being used against them. Rather, the behavioral context in which they become involved with police officers, i.e. the “nature of the call” is what guides the and officers tactical use of force along a continuum.  The use of force continuum is drafted by the National Institute of Justice as a template for guiding the response of officers to tactical scenarios of degrees of resistance exhibited by civilians with whom they come into contact. Verbalization of commands tends to be the most commonly used by police in most encounters with resistant persons. For those individuals who exhibit more defiant and aggressive posture officers are permitted the use of elevated degrees of response (increased use of force) including the deployment of pepper spray and perhaps the deployment of a taser or baton for gaining compliance.  A confounding variable in all calls for service – including those where someone wants help for his illness is the co-morbid or co-existing addiction and substance abuse.  Its role on crime and violence elevate the threat exponentially.
  • In a published a blog I have reported that mentally ill persons are no more likely to be violent than individuals without mental illness. However, individuals exhibiting paranoia and those with the acute suicidal ideation are at high risk for acting out violently against police officers and engaging in “suicide by cop” behaviors and place them at greater risk for having lethal force being used against them.  There are no single words that will de-escalate someone who has decided on killing themselves or someone else.  More importantly, the dynamics of the suicide by cop scenario are a lose-lose for everyone involved – except perhaps the suicidal person who gets what he wants.
  • “Nationwide, police have shot and killed 124 people this year who were in the throes of mental or emotional crisis, according to a Washington Post analysis. The dead account for a quarter of the 462 people shot to death by police in the first six months of 2015” (June 30, 2105).  This is but a fraction of the number of persons who experience suicidal ideation on a daily basis who do not act out their behavior in such a destruction manner.  Published accounts have recently blamed the lack of police officer training in managing psychiatric emergencies as a possible underpinning of increased officer involved shootings of persons exhibiting signs of mental illness.  Arguably, as a psychologist who has worked with people in crisis, it is often quite difficult to assess who is most at risk for self-destruction because those who are most dangerous often appear quite sane. 2007 Virginia Tech mass murderer Seung-Hui Cho gave off few clues of his grave intentions before killing 32 innocent students – yet the video taped manifesto left no doubt that he was experiencing significant emotional conflict.  Ultimately, Cho had been hospitalized at least once for depression and paranoia but was free to purchase the firearms he used on April 16, 2007 culminating with his frenetic shooting spree and suicide.
  • In Los Angeles, CA the police have an active mental health response team that assist police officers on scene by “slowing things down” using trained, persuasive negotiation in an effort to defuse high stress incidents and lower the number of lethal encounters.  The program in L.A. seeks greater communication and understanding between the police and members of the mentally ill community, according the the Washington Post.  Mary Jo MacArthur is the assistant chief of the L.A. police training program.  She teaches that those in crisis do not process information like other persons and may experience fear and anger when given verbal commands they do not understand.  The L.A. model provides for professional support from trained psychologists or psychiatrists on scene.  But an officer who encounters an impulsive and violent man menacing with a firearm or knife cannot be expected to de-escalate and “slow down” a volatile situation when the threat of lethal force being used against them or someone else exists in real time.
  • It is inflammatory to say that police did not handle this case or that case appropriately. The use of force continuum is clear that force is met with similar degree of force in order to control and de-escalate. Any other mismatch of force place everyone in grave danger.  Once the lethal threat is neutralized – such as when the mentally ill person drops all weapons and submits to verbal commands to surrender – additional investigation and support may be provided by local mental health teams including hospitalization as needed. Another program exists in Vancouver, B.C. that I will review in my next update.
  • Police officers are regarded as the front line first responders to family conflict and crisis.  The most volatile scenes are those where mental illness coexists with substance abuse like heroin addiction and domestic conflict.  For better or worse, the police have an opportunity to effect change whenever they enter into the domestic foray or crisis involving members of the mentally ill community.  This affords them a window into the chaos and the opportunity to bring calm to crisis. In past blogs I have introduced the notion of aftermath intervention as a means to ending the repetitive nature of those in crisis.  Added training to deconstruct the myths of mental illness after each encounter may be useful but time is seldom provided for such debriefing.  As with many states who review domestic violence homicide – mental health response teams based on the L.A. model and post hoc analysis of red flag indicators of the potential for violence fueled by mental illness i.e. delusions, hallucinations, active PTSD, should be carefully crafted for officer and community safety.
  • “Community policing has long espoused the partnership between police and citizens.  The positive benefits of this create bridges between the two that may benefit officers at times of need – including the de facto extra set of eyes when serious crimes are reported” (Sefton, 2013).  These extra eyes may be called upon to identify red flags as they wave suggesting someone may be headed down the path of destruction.  In the case of some noteworthy domestic violence, post hoc analysis often reveals that people were aware that something was going to happen and not a single person stepped up to strike a warning (Allanach, 2011). Police agencies cannot work in a vacuum and must have the help of citizens if they are to have any impact de-escalating the mentally ill prior to onset of terminal rage.
  • In many cases, the correct response to intimate partner violence should include aftermath intervention when the crisis has settled from the crisis that brought police to this threshold. Techniques for understanding mental illness may facilitate mutual understanding and establish the needed bridge to facilitate treatment. When this is done it establishes a baseline of trust, empathy, and resilience and may lessen the likelihood of the violent menacing that demands force be met with force regardless of the diagnosis.  In the next blog I will identify the role of police officers in pre-incident intervention and identify a chilling case.  By the time a person is in crisis there may be little time to talk “sense” and de-escalate no matter how skilled and well trained the police become.

REFERENCES

  • Ronald Allanach et al., Psychological Autopsy of June 13, 2011, Dexter, Maine Domestic Violence Homicides and Suicide: Final Report 39 (Nov.28,2011), http://pinetreewatchdog.org/files/2011/12/Dexter-DVH-Psychological-Autopsy-Final-Report-112811-111.pdf
  • Lowery, W, Kimberly Kindy, K, Alexander, K. Distraught people – deadly results, Taken June 30, 2015 http://www.washingtonpost.com/sf/investigative/2015/06/30/distraught-people-deadly-results/?hpid=z3
  • Sefton, M. (2013) Blog: Aftermath Intervention: Police first to the threshhold. December 8, 2013 Taken June 30, 2015, https://www.msefton.wordpress.com/2013/12/08/aftermath-intervention-police-first-to-the-threshold/

What is the impact of being connected – Our tie to technology

Michael Sefton, Ph.D. Health Psychology, Human Behavior ,
Image
Front page banner from Marathon bombings

It is time to look at the impact of digital connectivity

WESTBOROUGH, MA  January 12, 2014  Elevated stress and tension are sometimes the price of technology.  When human beings become fixated with having all the updated information there becomes an overload of sensory stimuli including images, text and integrated multimedia.  In times of national emergency people stay connected to sources of information like CNN, the Washington Post, or other national media source.  Arguably, this can save our lives and bring us valuable information and needed instruction at times of national crisis.  At the same time, the tethered tie to technology reinforces adrenaline junkies like never before.

Prior to culmination of last years terror attacks in Boston, readers and television viewers alike may have been glued to their internet devices waiting on every new post of information.  Meanwhile thousands of people took to the twitter feeds and other social media to post their impressions and notify the world that their tiny digit footprint was alive and well in cyberspace and on the ground.  All the while, they white knuckle their smart phones posting and tweeting with hope of reaching someone who might regard their importance and be mindful.  Unfortunately, there is a price to be paid when this type of sensational event occurs.  The human  body reacts each time a flurry of tweets is released with alarm, threat, grief, and satisfaction.  The human interpretation of these stimuli have the power to create dramatic physiologic changes in the autonomic nervous system.  These lead to insidious, heightened autonomic arousal, increased blood pressure, anxiety and perhaps burn out.

Pavlov had it correct when he described how rewards shape human functioning and how frustrated animals become neurotic trying to gain some fickle reward.  Behavior is molded through a series of subtle reward and punishment protocols.  Rewards result in an increase in behavior.  Punishment will cause a behavior to become less frequent and eventually extinguished. In 2014, the  ‘need to know’ is rewarded by having immediate access to information.  This is a good thing.  Web sites that falter or offer old news are forsaken for the more instantaneous text and images – like old magazines.  Media outlets have taken to social media to access this demand by offering immutable news snippets in the form of tweets or other posts.  If this information is accurate and reliable people will listen (or read) in great numbers.  But this can go too far when people overdose on social media.  For a variety of health reasons it is often a good idea to turn off your digital ping and allow yourself some old fashion quiet.  Relaxation is something that comes when the body quiets itself and slowly resets the baseline axis of rest.

The fight/flight mechanism that keeps us on guard plays a primary role on how people feel after episodes of high stress.  Feelings of frustration, lack of focus, chronic fatigue, and even depression can result from an over reliance social media stimuli like an unfed addiction.  Each time information about the Boston Marathon bombing was released people began filtering a barrage of data being generated – some reliable and accurate and some distorted and confabulated.  How many times did we refresh the screen on our smart phones only to see that same header and feel frustrated or angry at the snail’s pace of new information?  

People asked “what should we tell the children” when referring to the bomb blasts in Boston.  Television had taken over the airwaves with live broadcasts.  For several days before the capture of Dzhokhar Tsarnaev the Boston metropolitan area was closed down making it seem like a ghost town.  Massachusetts Governor Duval Patrick asked for a voluntary closing of business including the shut down of public transit, buses and trains.  People began to feel the loss of freedom so common in other places on the globe like the West Bank, South Sudan, and now Syria where people live in perpetual fear of violence, torture, and persecution.  But this was occurring on U.S. soil in a vibrant city on a day where thousands of visitors were running a race for as many causes as you can realize – and perhaps some personal cause of freedom.

Experts finally agreed that the best response would be to turn off the television and allow kids to process what they may have seen.  There come’s a time when the technology begins to overwhelm.  Too much stimuli results in the over abundance of stress hormones that can trigger physical discomfort and interfere with sleep, cardiac rhythms, mood, and needed rest.

The long-term consequence of technology is unclear.  The human cost is measurable in terms of information overload and digital dump.  Some believe our brains adapt to the instant gratification of social media and develop a graving for the deluge of tweeted stimuli or some instagramed image.  Slowly, the body learns to habituate the barrage of stimuli selecting only that which is most novel or unique using a form of cognitive triage.  In the process of habituation people seek more and more stimuli to raise the digital threshold for avoiding boredom, stagnation, and falling prey to yesterday’s news.

People who grow up in war zones demonstrate a similar malfunction in their system of arousal marred by hyper vigilance due to perpetually imploding stress hormones.  This is the result of chronic exposure to unpredictable chaos and the stress associated with a lack of control.  Neuroscientists can now pinpoint the impact of stress on hardwired changes in the brains of children growing up in places without lasting peace.  Social scientists attribute similar developmental mechanisms to the cognitive behavioral underpinnings of children exposed to severe domestic violence.  Stress has undeniable impact on all human functioning and public health.  Not enough is being done to infuse knowledge and understanding into the emotional Molotov created by chronic stress.  Why would healthy people create an unhealthy lifestyle in the absence of uncontrolled calamity?  If the dynamic of 24/7 connectivity adds to our health woes than its seems intuitive that we would cut down on our hunger for apps and need for the unending adrenaline dump created by this technology.

What will become of quiet space, solitude, and the capacity to be alone?  There is nothing more irksome than someone walking through a grocery store while chatting on a cellular phone as if she were alone in a comfortable study – laughing, telling personal stories, perhaps arguing with a detached spouse.  As much as I glare at that person – willing them to choke on the gum they seem compelled to chew, they seem totally oblivious of my overt distaste for them.  This person can not be alone even for the time it takes to procure items for the nightly supper or the few needed toiletries for an upcoming trip about which we shoppers heard tell.

To be alone and to experience alonness is a healthy function.  The loneliness felt by many can drive the unquenching thirst for data, information, and the pseudoconnection that comes with a digital age and the feelings of angst at not getting pinged.

Saying no to Netta: When skin popping takes you to the grave

Michael Sefton, Ph.D. Human Behavior

WESTBOROUGH, MA May 24, 2015 It’s time I write a paper about the role of heroin on addiction and the dramatic rise in overdose-related deaths. More needs to be done for people addicted to heroin.  The town in which I live has had three or four young adults die from heroin in the past 12-24 months.  These were real life people who went to school with my children and could be seen in the sports pages excelling on the field of play.  They were high school graduates from great families.  They were attending college.  They had homes or apartments to live in. They had names and faces.

Some heroin users falsely believe nasal Narcan can bring them back from the dead.
There is no shortage of stock photos available to depict this scourge. Each of them leaves me feeling sick.

Heroin addiction is a gripping, life suck that robs and maims anyone who uses it. I am a psychologist but make no claims about helping those suffering from the physical and emotional gird of heroin. There is no bottom to the cycle of addiction for many individuals and their families who often spend a fortune on psychotherapy, rehabilitation programs, 12-step programs, and nasal naloxone. Most individuals trying to kick the heroin habit require 4 or more trips to rehabilitation.

This is the story about Netta and the boy who grew addicted to its insidious lure.  Netta was a term given to heroin or more specifically, the nick name for “the works”.  This refers to the needle, spoon, filter, and lighter used to inject heroin into the vein by someone wanting to party. There can be no party without the works and this boy kept his immaculate. This addict strangely personified his rig as a friend or more importantly, a friend who could bring forth comfort and a rush of euphoria that nothing else can match. He was not one to share needles with others and most often used when alone.  He also knew this friend could not be trusted and expected to die one day perhaps ironically after deciding to get clean and sober.  An overdose can take you to the grave and has done so with a vengeance in 2015 here in Massachusetts and across the country. The man about whom I am writing died recently of an overdose that some believe was intentional.  He had grown tired of the cycle of addiction and pain and sickness.  He died alone.

For many addicted to heroin saying ‘no’ is not an option and becomes a game of Russian Roulette. It does not matter to Netta whether or not you are rich or poor he will take you for all you have.  He will leave you numb and sick and looking at cotton shots for just a little more.  In many states like Massachusetts, police, fire and other fire responders have been trained to administer nasal naloxone.  Arguably, family members too should be given the antidote which can reverse the effects of heroin and other opioid drugs if administered soon enough. That is where the confusion comes in because while naloxone can reverse or eliminate the effects of opioids in the brain it cannot reverse the cascade of organ failure and brain injury associated with oxygen deprivation.

There needs to be some intervention that can help individuals addicted to heroin and more importantly to help them when the urge to party comes up over and over during recovery.  There should be support for their family members so that they might understand the allure and better connect with those who are living a life with friends like Netta.

The Myth of Mental Illness and School Violence

Michael Sefton, Ph.D. Active shooter, Dangerousness assessment, Human Behavior , , , ,
This blog was initially published in March 2013 as a retrospective on the recent spate of “active shooter” tragedies across America.  There have been several high-profile shootings in the past 3 years that have involved perpetrators whose mental health is in question.  This is often not the case in school violence whereas the perpetrator of the action was deceased at the conclusion of the incident.  In these cases an effort must be made to uncover substantive causal factors in the perpetrator’s terminal actions.
The true incidence of violence among people diagnosed with a nervous and mental disorder is quite low. It is a common misconception that whenever something hideous occurs it must be mental illness that is the driving force behind its fury. In most cases this is neither the reality nor the underlying cause of terminal rage. In light of the information being uncovered about the Newtown, CT mass murderer, the specter of mental illness insures a convenient scapegoat. Updated information from Newtown recently confirmed that Adam Lanza had studied the media stories of prior mass killings as he planned for his despicable final melt down. In retrospect, I wonder what “red flags” have been uncovered that offer insight into his substantive motivation. People will speculate about random causes of Lanza’s behavior with uncertainty unless it can be studied scientifically.
There are some instances when mental illness has be associated with serial homicide such as the Son of Sam killer who plied his murderous delusions in NYC during the 1970’s using a Charter Arm’s Bulldog .44 caliber revolver. David Berkowitz used that weapon to kill 6 and wound 7 during his spree. He claimed to have been commanded to kill random couples he saw in cars by a dog he believed possessed by the demon. After spending time in a mental institution following his conviction he was transferred to the state prison at Sing Sing and finally Attica to serve 6 life sentences. When he was on trial Berkowitz plead not guilty by reason of insanity – the delusions he had about communicating with demons. In the end, it was determined that Berkowitz was not mentally ill. The Columbine, CO high school killers, Klebold and Harris were methodical in their planning of the attacks on the school and its students. They built explosive devices and practiced their attack in the weeks before the assault on the school. By outward appearances these two were from middle class families with involved parents. Many believe Klebold and Harris were the victim of bullies.
Psychological experts believe mentally ill persons lack the higher order planning to execute the complex steps necessary for these types of crimes. Neither Dan Klebold nor Eric Harris was mentally ill. The Virginia Tech killer Seung-Hui Cho murdered 31 students and faculty in 2007 after a period of decompensating rage. He wrote a profanity laden manifesto blaming everyone for their maltreatment of him that sounded paranoid and vindictive yet was able to send the videotaped diatribe to a news agency. Cho had been held in a psychiatric hospital 2 years prior to his rampage after becoming marginalized. Cho was able to organize his crime preparation and sequence the needed steps to meet his murderous goal. Was he mentally ill?
The Psychological Autopsy is a clinical assessment of the time line and antemortem behavior and emotional comportment of the perpetrator of compelling and despicable events. These types of case studies explore changes in cognitive and behavioral functioning immediately before a terminal event of homicide. An extensive review of a case from 2010 that was published in 2011 generated over 50 recommendations about DV and factors to consider when victims are at greatest risk (Allanach, R., 2011). The cost of these interviews and substantive case review is the primary reason they are not regularly conducted.  It is also less compelling when the perpetrator has killed himself and survivors want to turn the page.
Recently, at least 2 shooters have survived mass killings or have been captured after their alleged attacks.  In 2012 in Aurora, CO movie theater James Holmes was arrested and charged with multiple counts of murder.  He has pleaded not guilty by reason of insanity.  In 2011, Jared Lee Loughner was arrested at an outdoor political event in Tuscon, AZ after the shooting of U.S. Representative Gabrielle Giffords and killing 6 others. Loughner plead guilty after being found that he was capable of standing trial.He is serving 140 years in prison.  The Aurora case remains open.
It is hoped that important information may be gleaned from the rigorous study of motives, personal history, and triggers to their rage.
REFERENCES
Ronald Allanach et al., Psychological Autopsy of June 13, 2011, Dexter, Maine Domestic Violence Homicides and Suicide: Final Report 39 (Nov.28,2011), http://pinetreewatchdog.org/files/2011/12/Dexter-DVH-Psychological-Autopsy-Final-Report-112811-111.pdf.
Sefton, M. (2011) The Psychological Autopsy: Provides a host of pre-incident indicators. Blog:  http://www.enddvh.blogspot.com/2011/11/psychological-autopsy.htm, taken May 26, 2014.
Sefton, M (2013) Asperger’s Disorder: Not linked to violence. https://msefton.wordpress.com/category/active-shooter/ Taken March 2, 2015
Michael Sefton, Ph.D.
Read more at: http://www.msefton.wordpress.com

The cumulative impact of dementia on caregivers

Michael Sefton, Ph.D. aging and memory, Alzheimer's disease, Health Psychology, Human Behavior, Relationships , , ,

WESTBOROUGH, MA January 20, 2015  Dementia is a life changing affliction for both the patient suffering with the neurocognitive decline and spouse and family members alike. Caregivers have a particular cross to bear – especially those without support. It is a highly stressful role for any spouse that requires both education and support. They are at high risk for burnout otherwise known as caregiver fatigue. For anyone who has had a loved one suffer with this disease “it is like seeing a family member die slowly, daily, withering away into an empty vessel” according to Michael Sefton, Ph.D., Director of Neuropsychology at Whittier Rehabilitation Hospital in Westborough, MA.  “It is very important to obtain a careful and sound neuropsychological assessment of patients’ suspected of having dementia because so many conditions mimic dementia and may be treatable” according to Sefton.

When a caregiver is overwhelmed something must be done to provide emotional respite for the spouse or family member. Caregiving spouses frequently have powerful feelings of guilt, anger, and sadness as a result of seeing a loved one become forgetful, detached, and confused. They can be extremely difficult to managed in the home setting and sometimes require specialized day treatment.  The decision to hospitalize or seek nursing home admission for a family member is an individual one. It is critical to look at the functional change in the afflicted family member and see what placement options make the most sense.  Caregiver fatigue places afflicted patients at greater risk for neglect, battery and abuse than other medically complex cases. It places caregivers at risk for health problems of their own.

Throughout America, physicians and psychologist alike are mandated reporters for cases of suspected abuse – regardless of whether the caregiver is experiencing caregiver fatigue or not. Family members are strongly encouraged to support parents, e.g. respite care for afflicted parent, whenever one is suffering from a severe illness like dementia. Read the post at link below.

The cumulative impact of dementia on caregivers.