Public Awareness Needed for Meaningful Jail Diversion

December 22, 2017December 11, 2017 Michael Sefton, Ph.D. career criminal, crisis intervention, Dangerousness assessment, domestic violence, DVH, Human Behavior, Police officer behavior addiction, domestic violence, jail diversion, mental health, Police, pre-incident red flags, Sefton, violence

teachinginprison

“If mental illness drives the violent behavior than all weapons and substance use must be carefully controlled and eliminated.” Sefton, 2017

Westborough, MA December 21, 2017 Jail diversion is a hot topic across the country even here in Massachusetts. Since July, 2017 the Massachusetts Legislature has passed sweeping changes in the Criminal Justice System. Locally and across the country, the numbers of persons incarcerated for minor offenses and drug crimes has grown in some cases exponentially. Many of these individuals have mental illness or drug abuse in addition to their criminality. The interaction between poly-substance abuse or dependence and exacerbation of underlying mental health symptoms is complex and multifactorial. The interaction of the two is sometime lethal as reported by the Globe Spotlight team It is the focus of mental health advocates and criminal justice experts nationwide as it pertains to jail diversion, alternative restitution and reduced police use of force. In Massachusetts, there is a move away from mandatory minimum sentences for all drug crimes except for those involving the sale and distribution of narcotics. Arguably, the impact on behavioral functioning when persons are gripped with co-occurring illness, such as alcoholism, is a recurrent problem for law enforcement and first responders. I have written about the impact of co-occurring illness such as alcoholism on mental and behavioral health is previously published posts here on Word press Human Behavior (Sefton, 2017). It is difficult to uncover which comes first – the addiction or the diagnosed mental illness and yet these are inextricably linked in terms of the strain on public resources and health risk to those so afflicted. Why is this important?

The importance of treatment for substance dependence and mental illness cannot be understated as violent encounters between law enforcement and the mentally ill have been regularly sensationalized. The general public is looking for greater public safety while at the same time MH advocates insist that with the proper treatment violent police encounters may be reduced and jail diversion may be achieved. The referral and treatment infrastructure needed to provide a continuum of care in this growing population is available in very few places across America.

Yet in places like Bexar County, Texas – including San Antonio and 21 other towns or cities – the county jail population has dropped by over 20 percent as a result of crisis intervention training for police officers and mobile mental health teams to intervene with those in crisis. I have seen this for myself during a visit with the San Antonio Police Department where I rode with two members of the Mental Health Unit – Officers Ernest Stevens and Joseph Smarro. These men are exemplary in their assessment and intervention skill for keeping identified subjects off radar screens and out of the revolving door of the county jail. It takes ongoing training, medical and psychiatric infrastructure, community compassion, and active engagement with members of the community to fly under the radar and effectively reduce the jail population. When necessary those most in need must have 24-hour availability for detoxification, emergency mental health, and access to basic needs such as food, clothing, and medicine. In San Antonio, they offer so much more including pre-employment training, extended housing, interview preparation including clothes, and opportunity for jobs.

The unpredictability of behavior by those who carry a “dual” diagnosis has emerged as a confounding factor in the criminal justice system raising the specter of frustration over the limitations within the system. Jail diversion programs and treatment options are needed in order to retain public safety goals and provide for needs of the mentally ill and substance dependent. In Massachusetts, cities and towns are grappling with how best to intervene with the mentally ill in terms of alternative restitution for drug-related misdemeanor crimes in lieu of mandatory jail sentences that many crimes currently require. The Massachusetts legislature has taken up Criminal Justice Reform and passed a bill in late 2017 making changes in the mandatory minimum sentencing laws. Some believe, as much as 20-40 percent of all incarcerated persons suffer with mental health diagnoses and are not getting the treatment they require. To provide a bare bones system would add billions to state and federal dollars spent on the needs of inmates at a time when measurable outcomes for in house care are limited.

In my practice, I see many cases of co-occurring pain syndromes with other physical debilities such as stroke or traumatic brain injury. Some of these cases are substance dependent and live lonely, chaotic lives. Generally the emotional impact of two or more diagnosed illnesses yields a greatly reduced capacity for adaptive coping and puts a great stress on the individual system. The importance of addressing co-occurring substance abuse or dependence is now well recognized and with treatment can result in healthy decision-making, growth in maturity, and greater self-awareness. If legislators have a serious desire to reduce statewide numbers of incarcerated persons a comprehensive plan must be considered for both pre-arrest and post-arrest. Programs greater understanding of addiction and added treatment options must be explored through a joint public and private initiative.

Mental and Physical Health Screening

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

Diversion Safety Plan with Mandated Revocation

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

Bail, Confinement, Mandated Treatment

There is some thinking that higher amounts of bail may lessen the proclivity of some offenders to breach the orders of protection drafted to protect victims and should result in revocation of bail and immediate incarceration when these occur. Mandated treatment may be more successful when legal charges are held as leverage where after 6 months of sober living and regular attendance at 12-step recovery meetings charges can be dismissed or modified to each individual case. This takes a complete overhaul of the front end of criminal justice system and requires buy-in by judges, district attorneys, and individual family members.

When it comes lack of compliance and repeated domestic violence, I have proposed a mandatory DV Abuse Registry that may be accessed by law enforcement to uncover the secret past of men who would control and abuse their intimate partners. This database would also include information on the number of active restraining orders and the expected offender’s response to the “stay away” order. In cases where the victim decides to drop charges there should be a mandatory waiting period of 90 days. During this waiting period the couple may cohabitate but the perpetrator must be attending a weekly program of restorative justice therapy, 12-step recovery and substance abuse education. Violations of these court ordered services are tantamount to violation of the original protection order (still in place) and victim safety plan and may result in revocation of bail. If the waiting period passes and the perpetrator has met the conditions of his bail than he may undergo an “exit” interview to determine whether or not the protection order / jail diversion plan may be extended or whether he/she has met all requirements. In any case further police encounters will be scrutinized and prior charges may be re-instated or filed as needed.

Michael Sefton

Sefton, M. (2017) Human Behavior Blogpost: https://msefton.wordpress.com/2017/03/30/police-are-building-bridges-and-throwing-life-savers/ taken December 10, 2017

Mentally ill American’s and their proclivity to act out against authority

December 16, 2017November 11, 2018 Michael Sefton, Ph.D. 12-step programs, AA, Alcoholism, crisis intervention, domestic violence, Health Psychology, Human Behavior 12-step recovery, EMS, mental health, Police, Psychiatric services, violence

The popular press is filled with ideas and criticism about what best to do with those afflicted with mental illness. The resources available to law enforcement are practically nothing in the average community. I have answered calls in west central Massachusetts where a citizen asked for referrals for counseling for a family member who was addicted to something or other. Too often I had nothing to offer. Generally speaking unless someone has money to pay for psychiatric services they are left to languish on the waiting lists of community mental health centers. In emergencies many show up or a taken by ambulance to the emergency mental health center nearest their place of residence. This usually ends up costing them thousands of dollars and hours of their time only to be told they must follow-up with a primary care physician. The entire process can be demeaning and inhumane.

In a prior post I have advocated for the use of 12-step recovery programs to help those with substance abuse and dependence. These are not psychotherapy and are often leaderless meetings. There are have daily meetings in every city and town. 12-step programs teach the understanding addiction and loss of control from addition, coping by taking one moment at a time in order to remain substance free and belief in a higher power. In many cases new members of AA or NA – or any compulsive behavior recovery group – may have a sponsor who comes forth and provide 24/hour support. I encourage family members to attend meetings with their loved one in show of support. Sobriety can begin tonight at the 7 PM meeting in Watertown, Worcester or Anytown, USA.

The interaction of substance abuse and mental illness is complex. Persons with drug and alcohol addiction must be expected to become sober with the help of substance abuse treatment and family support. The risk of violence and suicide declines when sobriety can be maintained. Michael Sefton, 2017

“We have to get American police to rethink how they handle encounters with the mentally ill. Training has to change” according to Chuck Wexler, executive director of the Police Executive Research Forum, an independent research organization devoted to improving policing. People carrying a dual diagnosis are at greatest risk for self-destruction – including intimate partner violence and suicide by cop.

Sefton, M (2017) Blog post: https://msefton.wordpress.com/2017/01/16/police-as-therapist-the-inherent-risk-of-unconditional-positive-regard/ Taken 17 November 2017

Officer resilience and career success with less burnout

December 9, 2017March 24, 2018 Michael Sefton, Ph.D. CIT, crisis intervention, Human Behavior, Police officer behavior, psychological relevence Burnout, Direct Decision Institute, Leo Polizotti, mental health, Michael Sefton, Police, PTSD, Resilience

Mike Sefton photo — Michael Sefton, Ph.D. in Guangzhou, China

WESTBOROUGH, MA December 9, 2017 Resilience in police training is an added lesson designed to enhance the careers of officers-in-training. According to Leo Polizotti, Ph.D. resilience refers to professional hardiness that is protective against career burnout and raises both professionalism and job satisfaction.

It is essential to help individual officers through the tough times and enhances job satisfaction. In the case of traumatic events – officer resilience is essential for a healthy response to a critical incident. In the long run, physical health and well-being are the underpinnings of an emotionally resilient professional who will be there over and again – when called upon for those once in a lifetime calls that most of us will never have to answer.

Emotional resilience is defined as the the capacity to integrate the breadth of police training and experience with healthy, adaptive coping, optimism, mental flexibility and healthy resolution of the traumatic events. In general, resilient people are self-reliant and have positive role models from whom they have learned to handle the stressful events all police officers encounter. In its absence a police officer experiences irritability, brooding, anger and sometimes resentment toward his own agency and “the system” for all its failures. The lack of emotional resilience leads to officer burn-out.

“Your biggest risk of burnout is the near constant exposure to the “flight or fight response” inherent to the job (running code, engaging and managing the agitated, angry, and irrational, or any other of your responsibilities that can cause you to become hypervigilant). Add the very real tension of the politics and stresses inside the office and a dangerous mix is formed. The pressures and demands of your job can take a toll on your emotional wellbeing and quality of life and burnout will often follow.” Olsen & Wasilewski, 2014

It is well documented that flooding the body with stress hormones like adrenaline and cortisol play a role in police officer health and well-being. “Stress and grief are problems that are not easily detected or easily resolved. Severe depression, heart attacks, and the high rates of divorce, addiction, and suicide in the fire and EMS services proves this” according to Peggy Rainone who provides seminars in grief and surviving in EMS. (Sefton, 2013). There are various treatments for stress-related burnout including peer support, biofeedback for reduced sympathetic dysfunction, and professional psychotherapy. “Being exposed to repetitive stress leads to changes in the brain chemistry and density that affect emotional and physical health.” (Olsen, 2014) Improved training and early career support and resilience is essential for long term health of first responders including the brave men and women in blue.

Polizotti, L. (2017) Psychological Resilience: From Surviving to Thriving in a Law
Enforcement Career. Presentation. Direct Decision Institute

Olsen, A and Wasilewski, M. Police One.com (2014) Blog post: https://www.policeone.com/health-fitness/articles/7119431-6-ways-to-beat-burnout-in-a-police-officer/ Taken December 9, 2017

Rainone, P. (2013) Emergency workers at risk. (website) http://www.emsvilliage.com/articles/article.cfm?ID=176. Taken 12-1-2013

Sefton, M. Domestic Violence Homicide: What role does exposure to trauma play in terminal rage? Blog Post: https://wordpress.com/post/msefton.wordpress.com/505 Taken December 9, 2017.

When citizens de-escalate the police: Let’s end the verbal judo once and for all

November 9, 2017November 9, 2017 Michael Sefton, Ph.D. Human Behavior

images — Police Athletic League – the earliest beginning of *community* policing

WESTBOROUGH, MA October 27, 2017 I spent some time with a close friend tonight and the topic of my police consultation came up. He asked “why police officers need de-escalation training when it is often the citizen who does the de-escalating of police officer behavior”. I thought for a minute and replied sharply that he misunderstood what I was describing as police “de-escalation”. Unfortunately the sample of behavior he described was embarrassing for police officers everywhere. When officers feel threatened or believe a situation is getting out of control he or she often uses verbal judo to redirect citizen behavior as a tactical control technique. The officer takes on an authoritative tone of voice. You might notice an officer speaking loudly or shouting directives as a way of demonstrating his control of a situation. Some academy training officers suggest that by using an authoritative speaking voice people will respect and comply with their directives. Sometimes the person speaking the loudest may be attempting to maintain control of a chaotic situation out of insecurity, fear and lack of understanding of the true meaning of verbal judo. Living in the Boston area, I often see BPD officers playing hoops with neighborhood children or standing on the corner talking to regular citizens. That is community policing and more of it needs to get initiated across the state and the country. Here is a personal anecdote of what can go wrong when verbal judo takes on a life of its own.

While talking with a friend…

I was suddenly reminded of the time when my children and 2 friends went to a skate park in the neighboring town. School was closed for my children but kids in the next town were supposed to be in class. The boys were aged 9-12 and wanted to try their skateboarding skill at the new skate part nearby. Because it appeared as though they may have been skipping school a police officer on patrol stopped and interviewed the boys. When he determined that the boys were legitimately on a day off from school he politely asked them to leave the park and return after 3:00 PM when the local school was dismissed. On the one hand, the officer’s directive made sense, but when you consider that the park was a public place and the boy’s using the park were breaking no laws and had not skipped school, then in all likelihood there was no reason for the officer to limit access to the facility. Given their ages, the likelihood of them creating a disturbance, using drugs or alcohol, or leaving trash or grafitti upon their departure was quite low. But they did as they were told and left the area and called home to be picked up by my wife. In the meantime as the 3:00 hour neared they returned to the skate park which happened to be within 500 yards of the police station. At the shift change, the officer who had spoken to my children only an hour earlier witnessed them enter the park – perhaps one of them was actually on his skateboard in direct violation of his orders. Here is where the problem starts but not with the insubordinate juveniles (ages 9-12) but with the acerbic, bellicose young man who wore the badge on that day. What he failed to realize was that his own behavior escalated to the degree that he failed to protect and serve the public.

At the time this occurred I was a sworn police officer in a nearby community. I served as a field training officer and was responsible for young men and woman who were entering the field of law enforcement. What happened next was in sharp contrast to what I taught new patrol officers and defies common sense. The officer confronted the children indicating harshly that he had given them instructions not to return to the park until 3:00 PM when the local schools were let out. My children grew up around police officers and had great respect for both the law of the land and adult expectations for behavior. They did what they were told to do and were not trying to challenge the officer’s authority – merely they were awaiting my wife to pick them up and return them to their own side of the town line. The boys told the officer that their ride would arrive at 2:45. What happened next is the subject of some debate. The boys felt as though the officer became very angry at them and began yelling at them indicating that they were trespassing (based upon his prior decision to send them away until 3:00 PM). The words “trespassing” and “possibility of arrest” were threatening – leaving one of the boys in tears. Afraid and understandably confused.

Fortunately my wife arrived at that moment and observed one of the boys in obvious distress. She quickly surmised that one of them may have been injured asked the officer “if there was a problem?” He quickly responded “you are my problem” in a tone and volume that were unexpected and unnecessary for a first encounter with the parent of 4 boys who wanted to try out the new skate park on their day off from school. My wife was nonplussed and gathered the 4 boys for the ride home – the lesson being that all police officers do not react this way to middle school kids. The officer correctly asked the boys to leave – if the town’s ordinance did not allow for skating on days when school was in session – but in doing so he failed the community policing litmus test. The next day I had a talk with his chief who agreed with me and agreed to take it up with the officer personally.

C_6B2o6XkAEPuRV — Boston police officer on the foot beat – meeting with children (BPD photo credit)

Police response to Domestic Violence

July 24, 2017July 7, 2017 Michael Sefton, Ph.D. CIT, crisis intervention, domestic violence, domestic violence homicide, Human Behavior domestic violence, extended family, mental health, Michael Sefton, Police, police officer, toxic relationships, violence

Police officers are regarded as the front line first responders to family conflict and domestic violence. For better or worse, the police have an opportunity to effect change whenever they enter into the domestic foray – whether an arrest is made or not. This affords them a window into the chaos within the effected family system and the opportunity to bring calm to crisis. In many cases, the correct response to intimate partner violence should include aftermath intervention when the dust has settled from the crisis that brought police to this threshold. At these times the communication between family and police may be operationalized, improved and redefined. When this is done it establishes a baseline of trust, empathy, and resilience.

Discretion, Treatment and Alternatives to Jail

July 14, 2017December 10, 2017 Michael Sefton, Ph.D. CIT, crisis intervention, Human Behavior, Police officer behavior, psychological relevence, Suicide by cop Addiction treatment, intimate partner violence, mental health, Police, police officer, PTSD, Social skills, violence

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

Mental and Physical Health Screening

Diversion Safety Plan

Bail, Confinement, Mandated Treatment

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

Guardianship

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

Jail Diversion: Reduced costs by spending more on mental health

July 6, 2017July 7, 2017 Michael Sefton, Ph.D. career criminal, CIT, crisis intervention, Human Behavior, Police officer behavior, psychological relevence addiction, Ernest Stevens, jail diversion, Joseph Smarro, mental health, Personality, Police, rehabilitation, SAPD, Social skills

PART 1

WESTBOROUGH, MA July 6, 2017 Jail diversion is a hot topic across the country. The numbers of persons incarcerated for minor offenses and drug crimes has grown. Many of these individuals have mental illness or drug abuse in addition to their criminality. The interaction between poly-substance abuse or dependence and exacerbation of underlying mental health symptoms is complex. It is the focus of mental health advocates and criminal justice experts nationwide as it pertains to jail diversion and reduced use of force among law enforcement. In Massachusetts, there is a move away from mandatory minimum sentences for all drug crimes except for those involving the distribution of narcotics. Arguably, the impact on behavioral functioning when persons are gripped with co-occurring illness is a recurrent problem for law enforcement and first responders. I have written about the impact of co-occurring illness such as alcoholism on mental and behavioral health is previously published posts here on Word press Human Behavior (Sefton, 2017). It is difficult to uncover which comes first – the addiction or the diagnosed mental illness and yet they are inextricably linked in terms of the strain on public resources and health risk to those so afflicted. Why is this important?

The importance of treatment for substance dependence and mental illness cannot be understated as violent encounters between law enforcement and the mentally ill have been regularly sensationalized. The general public is looking for greater public safety while at the same time MH advocates insist that with the proper treatment violent police encounters may be reduced and jail diversion may be achieved. The referral infrastructure to provide a continuum of care in this growing population is available in very few places across America.

Models of Care

Yet in places like Bexar County, Texas the county jail population has dropped by over 20 percent as a result of crisis intervention training for police officers and mobile mental health teams to intervene with those in crisis. I have seen this for myself during a visit with the San Antonio Police Department where I rode with two members of the Mental Health Unit – Officers Ernest Stevens and Joseph Smarro. It takes training, medical and psychiatric infrastructure, community compassion, and active engagement with members of the community often left to fly under the radar to effectively reduce the jail population. When necessary those most in need must have 24-hour availability for detoxification, emergency mental health, and access to basic needs such as food, clothing, and medicine. In San Antonio they offer so much more including pre-employment training, extended housing, interview preparation including clothes, and opportunity for jobs.

Behavioral Analysis and Law Enforcement

The unpredictability of behavior in those who carry a “dual” diagnosis has emerged in the criminal justice system when jail diversion programs and treatment options are brought forth raising the specter of frustration over the limitations within the system. Cities everywhere are grappling with how best to intervene with the mentally ill in terms of alternative restitution for drug-related misdemeanor crimes in lieu of mandatory jail sentences that many crimes currently require. Some believe, as much as 20-40 percent of all incarcerated persons suffer with mental health diagnoses and are not getting the treatment they require. To provide a bare bones system would add billions to state and federal dollars spent on the needs of inmates at a time when measurable outcomes for in house care are limited.

In my practice I see many cases of co-occurring pain syndromes with other physical debility such as stroke or traumatic brain injury. Generally the emotional impact of two or more diagnosed illnesses yields a greatly reduced capacity for adaptive coping and puts a great stress on the individual system. The importance of addressing co-occurring substance abuse or dependence is now well recognized and with treatment can result in healthy decision-making, growth in maturity, and greater self-awareness. If legislators have a serious desire to reduce statewide numbers of incarcerated persons a comprehensive plan must be considered for both pre-arrest and post-arrest. Infrastructure for enhanced understanding of addiction and greater treatment options must be explored through a joint public and private initiative.

PROPOSED JAIL DIVERSION INITIATIVE

PRE-ARREST JAIL DIVERSION – No crime committed

If police encounter subjects with a known history of mental illness through their community policing efforts they should return the subject to his family or primary psychiatric caregiver – this might be a physician, physician’s assistant (PA), a nurse practitioner (NP), even a psychologist for immediate crisis intervention. Depending upon the nature of the police encounter such as during the nighttime hours the subject may be transported to a local emergency department for psychiatric evaluation. This model has grown less popular because of the growing wait times in local hospital emergency departments – especially for those suspected of mental illness and tends to make them increasingly agitated. Persons with mental illness are often homeless and come into police contact simply on the basis of panhandling or looking suspicious and out of place in the neighborhood. Often they are reported to police because they are talking to themselves, suspicious, and menacing toward pedestrians making them afraid.

The hospital alternative might be to establish regional psychiatric emergency intake centers available 24-hours daily. At one point states had regional hospitals that have been closed down releasing thousands of institutionalized patients into the community. The plan for de-institutionalization was to provide a neighborhood center at which the patient could continue his or her treatment and receive their needed medication to keep them symptom free.

Minor crime committed

When a crime is committed by someone with known or suspected mental illness such as simple assault, disorderly conduct, or shoplifting the responding police officer’s will have discretion whether to bring forth charges or not in exchange for an alternative disposition that would defer jail time. These are not new concepts. Law enforcement has always had the discretion to arrest or not arrest for many minor offenses. The choice often comes down to the subject demeanor and his response to police officer directives at the time of the encounter. In some cases an officer must arrest such as in the setting of domestic violence, child abuse, or as a result of a felony being committed.

In these cases charges may be brought and held as long as the subject entered treatment or remained abstinent from use of drugs or alcohol – the jail diversion plan. If they failed to follow the terms of their diversion plan the charges would be re-instated and sent to district attorney for prosecution. The alternative is a revolving door of addiction and petty crime that, at times, will escalate into violent crime. As a society more can be done to reduce criminality and jail diversion through empathic, sensitive treatment options.

Forensic Mental Health: Contemporary Issues and Interactions Involving Justice-Involved Persons with Mental Illness

May 3, 2017May 28, 2017 Michael Sefton, Ph.D. Dangerousness assessment, domestic violence homicide, DVH, Human Behavior, Police officer behavior, Suicide by cop, use of force continuum Brian Gagan, DV, mental health, Michael Sefton, NEACJS, Northeastern Association of Criminal Justice Sciences, Police

WESTBOROUGH, MA April 30, 2017 The Northeastern Association of Criminal Justice Sciences has announced the date for its upcoming annual conference to be held in Rhode Island at Roger Williams University in Bristol. The conference will be held on June 7-10 2017.

The topic this year is Forensic Mental Health: Contemporary Issues and Interactions Involving Justice-Involved Persons with Mental Illness that has been in the news when it comes to police encounters with those so afflicted. In Massachusetts alone over 120 people thought to suffer with mental illness have been involved in lethal force situations with law enforcement between 2008-2016. The program is still being drafted but I have been invited to present the Psychological Autopsy as a Forensic Tool along with my colleague Brian Gagan and co-author of the Psychological Autopsy of Steven Lake – Dexter,

lakefoll0916_kc01-250x250 — Dr. Sefton discussing psychological autopsy of Steven Lake with coauthor Brian Gagan (left)

Maine Homicide-Suicide in 2011.

Co-occurring Illness: Effecting change at times of crisis

April 20, 2017May 1, 2017 Michael Sefton, Ph.D. CIT, domestic violence, DVH, Health Psychology, Human Behavior, Suicide by cop Bail conditions in domestic violence, Community Policing, Michael Sefton, psychological autopsy, Sefton Blog

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Google images

WESTBOROUGH, MA – April 24, 2017 There is no magic solution for de-escalating someone who is in “crisis” or emotionally distraught. The loss of control may signal a failure of reality testing that can signal a diminished capacity to appreciate the consequence of their behavior. This occurs frequently when people who have mental illness have co-occurring drug and alcohol addiction. It is true that the correctional system has more than its share of mentally ill prisoners but for many being in jail is the only way to stay sober. The full capability to provide mental health services in the correctional system here in Massachusetts has not been realized. The courts are reluctant to require that someone receive treatment for mental illness and/or substance abuse in lieu of going to jail.

Criminality and mental illness are not mutually exclusive so there will always be a high number of incarcerated persons with chronic underlying psychiatric diagnoses. The prevalence of mental illness in the general population may range from 5-15 percent. The degree of mental illness in the correctional system may be as high as 40 percent by some accounting but the number is misleading. One needs to consider treating mental illness when it becomes a barrier to functioning such as in schizophrenia or bipolar depression where the symptom profile interferes with reality testing. Only then may a contract for treatment may be constructed to include medication and psychotherapy depending upon the diagnosis. In cases where mental illness and co-occurring substance abuse exist a determination about primary diagnoses and treatment options must be considered.

“The consequences of dual diagnosis include poor medication compliance, physical comorbidities, poor health, poor self-care, increased risk of suicide or risky behavior, and even possible incarceration” according to Buckley and Brown, 2006

In many cases of emotional crisis those in need can be diffused with recognition of their struggle – such as death of family member or loss of employment. By showing empathy for their emotional burden police officers and mental health providers can intervene and make a real difference. But effecting change takes time and a consistent message that personal responsibility begins at home. Instead of placing blame on a “system” that is filled with holes individuals need resilience and family support to get the help they require. teachinginprison Before I am criticized for being insensitive, I point to the 12-step programs in alcohol and drug recovery. They are free and in many cases provide 24-hour support and mentoring at times of crisis. I strongly believe that if people can remain clean and sober than the need for crisis intervention will decrease. Ostensibly, this is a perfect first step toward recovery and will bring forth a palpable reduction in emotion and reduce the potential for violence. When substance abuse is stopped emotional growth is more able to take hold. Healthy, more effective problem solving may result from prospering emotional maturity allowing for resilience and enhanced coping.

Stress can engulf individuals and families for a variety of reasons and should not be judged. People cope with stress differently and in many cases achieve emotional relief by having someone to talk to. Some clinicians believe great personal change may be possible when coping skills are most frail. But in too many instances, drug and alcohol abuse present a confounding variable when working with person’s diagnosed with mental illness. At the same time this raises the risk to law enforcement exponentially. Why?

One response to stress is the increase in substance use and with that increase there is often a worsening of any underlying mental health disorder such as depression and anxiety. “There could be a common factor that accounts for both, primary psychiatric disorder causing secondary substance abuse, primary substance abuse causing secondary psychiatric disorder, or a bidirectional problem, where each contributes to the other.” (Buckley and Brown, 2006) Unemployment, early childhood trauma, financial burdens, and random emotional baggage result in a range of actions that foreshadow regression and failure of coping mechanisms that put us all at risk. Some people are able to endure extreme levels of stress with little to no outward sign of distress while others boil over at the first sign of conflict or emotional ripple.

JAIL DIVERSION

There is a growing push toward alternative restitution and jail diversion for those with mental health and substance abuse problems. In San Antonio, TX, the Bexar County jail had been filled to capacity for many years. As a jail diversion and mental health program evolved the population dropped by 20-25 percent from 5000 inmates to 3800. Data suggests that over one quarter of all prisoners may experience mental illness or substance dependence/abuse and are not receiving treatment. But here in Massachusetts the systems are not available to make this innovation an effective reality in any scale. Many departments are using jail diversion options such as drug treatment and counseling but here in Massachusetts psychiatric treatment cannot be court mandated. Arrest may not be indicated simply because a person is in crisis but those in crisis may be involved in some type of criminality such as assault, criminal threatening, domestic violence and property crimes. So what options are available? The drop out rate for patients suffering from major mental illness is quite high. They often stop taking prescribed medication and do not attend counseling sessions.

MENTAL ILLNESS, CRIMINALITY AND RESTORATIVE JUSTICE

bigstock-Mental-illness-in-word-collage-072313 As a police officer I found jail diversion a discretionary tool that was used a great deal. Nevertheless there are times when arrest is the proper course of action but jail diversion remains a possible negotiating point for those charged with some crimes. The correct response to intimate partner violence should include aftermath follow-up and intervention when the immediate crisis has settled from the events that brought police to this dangerous threshold. Arrest is mandated by state statute when one spouse has visible injuries. Whenever possible using a restorative justice model – often limited to incarcerated individuals – may allow those arrested for crimes against persons to reconstruct their encounters with police and gain concrete understanding of events and the impact substance abuse may have had on the actions taken by themselves and law enforcement. Some never attain empathy for victims, family members including action taken by police and wind up behind bars. Police encounters with persons having co-occurring mental health and substance abuse are frequently violent and often result in charges for assault on a police officer and more. In the aftermath of these encounters offenders may be sent to treatment in lieu of formal charges with the understanding that sobriety and psychotherapy are indicated. In cases of treatment avoidance police have the option to file charges later on.

Techniques for understanding mental illness may facilitate mutual understanding and establish the needed bridge to facilitate treatment as published in 2015 (Sefton, 2015). Those seeking diversion from incarceration must demonstrate the willingness to change and take responsibility for their actions. The relationship between law enforcement and community agencies is one that requires a strong foundation and mutual understanding of the framework for reducing recidivism, criminality, and managing mental illness.

Buckley, P. F., & Brown, E. S. (2006). Prevalence and consequences of dual diagnosis. The Journal of clinical psychiatry, 67(7), e01-e01.

Sefton, M. (2015) Emotionally distraught – nearly one-quarter of all officer-involved shootings go fatal. https://msefton.wordpress.com/2015/07/01/emotionally-distraught-nearly-one-quarter-of-all-officer-involved-shootings-that-go-fatal/. Taken March 5, 2017.

The use of force continuum follows the principle of causation by guiding police decision making based on the level of threat

April 4, 2017March 31, 2017 Michael Sefton, Ph.D. Human Behavior

“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 here in Massachusetts they are not”

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Year: 2017