Violence prediction: Keeping the radar sites on those who would do us harm

crosshairsIn response to recent acts of both terrorism and recurrent gun violence by home-grown psychopaths more should be done to maintain greater control over potentially violent persons. In the Las Vegas concert venue and the more recent Texas church massacre it becomes
increasingly clear that predicting violence is practically impossible. At least this is
what we are led to believe. And yet when it comes to domestic violence
homicide the similarities in cases are almost carbon copy.
In the end, there is always at least a single person who knows what is about to happen and often does nothing to stop it. Whether this duplicity stems from cultural beliefs that what happens behind closed doors is nobody’s busy change in the way in which law enforcement manages these cases is essential. The buy in from police, legislators, judges, probation, and society needs to be fully endorsed for real change to happen and for safety plans to work. Many states across America are planning to enact “red flag” rules that will remove weapons from individuals with a known history of domestic violence e.g. choking spouse during fight. These behaviors toward a victim instill fear and point to the perilous danger that exists.
“Someone with a history, particularly a continuing history of violence, can be presumed to be dangerous.” Frederick Neuman, MD
Coercion and Control
Lenore Walker is a psychologist at the Domestic Violence Institute has published a theoretical description of the coercion and control model of DV. Victims are young and vulnerable to being emotionally and physically controlled. The Texas killer Devin Patrick Kelley had all the makings of a violent abuser from the time he was in high school and only now are people willing to talk about his darker side. Kelley was separated from his second wife who was just 19. Victims like this are often kept away from their families, not allowed to work, or when working are not permitted to handle their own funds. Some victims have to explain every cell phone call or text message they make or receive often being met with jealous fury. By robbing their sense of self keeps intimate partners emotionally isolated and insecure. They are often led to believe they could not live on their own and the children they share will be lost to them if they choose to leave. This “so called” male privilege keeps his partner marginalized and in servitude. It appears at first glance that Kelley was looking for the mother of his currently estranged wife likely enraged over steps taken to keep them apart as the divorce progressed through the courts.
Occasionally police or children’s services are called when intimidation and threats become violent. It is important to provide aftermath intervention and follow-up with families where domestic violence or chronic substance abuse occurs or families tend to disappear. Change is required to pay closer attention to those with whom law enforcement has frequent contact. Over and over
surviving family members speak of coercion and control on behalf of the abused.  Lives will be saved when society takes a closer look at red flag violence – these are the preincident indicators that violence and domestic violence homicide are possible. This is not new data nor are the stories very different.
I speak to police agencies and individual officers about DV and DVH offering detail from the psychological autopsy research we conducted on a sensational and tragic case in Dexter, Maine in which Steven Lake killed his 35-year old spouse after 10 years of marriage along with their 2 children. The Lake case was very much like the Kelley murders in terms of the cycle of abuse and its early onset. It was thought that Lake was intending to go on a killing spree but was interrupted in the act by an observant police officer. Recently a police officer participating in the statewide DV task force in Vermont asked whether there is a single most important factor or predictor to the risk of DVH? Some believe the fear of being killed by her spouse and abject cruelty toward step children raise the bar significantly and as such are worthy of crafting one’s DV report and request for orders of protection around. But keeping the victim and her abuser on the radar screen will also reduce her fear and loneliness and offer greater protection. Other risk factors include: choking and recurrent
sexual violence – although victims seldom disclose this out of guilt and fear of not being believed.
People knew what might happen
The Psychological Autopsy of Steven Lake consisted of over 200 hours of interviews with immediate family members on both sides. Steven’s aunt was quoted as saying “I never thought he would take the kids” in reference to an acknowledgment of his depression and anger at the impending divorce. She believed Lake would take his own life in front of his wife and children as a final act of punishment they would never forget. But he went far beyond that as we again saw in the small church in Texas this week. We are getting better at teaching children and families that if the see something they should say something. This is the trademark line of the Transportation Safety Administration in its fight against terrorism. The same might be taught to neighbors and friends when domestic violence is suspected or known to be occurring. If you see something then it is incumbent upon each of us to do something to help those in harms way.

Neuman, F.  (2012) Is It Possible to Predict Violent Behavior? Can a psychiatric examination predict, and prevent, a mass murder? Psychology Today. Taken May 12, 2018

Violence in the Workplace: Do people just “snap”?

WESTBOROUGH, MA June 2, 2018  Violence in the workplace is commonplace but has taken a back seat in the setting of recent school shootings. Research on the “lethal employee” is becoming more reliable in the aftermath of of workplace violence. Nevertheless people commit murder in their workplace more than ever.  What should people do if they are worried about a co-worker becoming violent.  There are signs that someone is loosing control and may be thinking of violence.  A list of potential factors is taken below from the U.S. Department of Homeland Security publication from 2008. The term “going postal” refers to a workplace shooter or act of violence.  It evolved from workplace violence in the U.S. Postal service in the 1980’s according to a report published in 2008.

“One theory was that the post office was such a high-pressure work environment that it drove people insane. In the years to come, other cases of murderous rages by mailmen cemented the idea in the public mind. “Going postal” became a synonym for flipping out under pressure.”

“An active shooter in your workplace may be a current or former employee, or an acquaintance of a current or former employee. Intuitive managers and coworkers may notice characteristics of potentially violent behavior in an employee. Alert your Human Resources Department if you believe an employee or coworker exhibits potentially violent behavior” (2008)

Indicators of Potential Violence by an Employee Employees typically do not just “snap,” but display indicators of potentially violent behavior over time. If these behaviors are recognized, they can often be managed and treated. Potentially violent behaviors by an employee may include one or more of the following (this list of behaviors is not comprehensive, nor is it intended as a mechanism for diagnosing violent tendencies):
• Increased use of alcohol and/or illegal drugs
• Unexplained increase in absenteeism; vague physical complaints
• Noticeable decrease in attention to appearance and hygiene
• Depression / withdrawal
• Resistance and overreaction to changes in policy and procedures
• Repeated violations of company policies
• Increased severe mood swings
• Noticeably unstable, emotional responses
• Explosive outbursts of anger or rage without provocation
• Suicidal; comments about “putting things in order”
• Behavior which is suspect of paranoia, (“everybody is against me”)
• Increasingly talks of problems at home
• Escalation of domestic problems into the workplace; talk of severe financial problems
• Talk of previous incidents of violence
• Empathy with individuals committing violence
• Increase in unsolicited comments about firearms, other dangerous weapons and violent crimes

U.S. Department of Homeland Security. (2008). Active Shooter – How to Respond
Bovsum, M. (2010) NY Daily News. Mailman massacre: 14 die after Patrick Sherrill ‘goes postal’ in 1986 shootings. Taken May 19, 2018

The threat raised by stereotyping

Stereotyping plays a significant role in human behavior and is known to impact police and citizen interactions. In many instances circular feedback loops operate – sometimes unconsciously – that impact the interaction between individual citizens and members of law enforcement  This was first identified when describing how school-age students respond to teacher stereotype expectations “When we use stereotypes, we take in the gender, the age, the color of the skin of the person before us, and our minds respond with messages that say hostile, stupid, slow, weak. I know this to be true having been labeled “pathetic” at age 8 by a third grade teacher.  I was active, curious, and inattentive.  But I was not pathetic yet I sometimes feel this way even now. “Those (personal) qualities aren’t out there in the environment. They don’t reflect reality.” according to John Pargh, Ph.D.  The subtle, somewhat hostile incredulity shown to me as a young child had an impact in my effort, learning style, and self-image. I learned much later in life that the teacher I describe had more than a few problems that had nothing to do with me.  But still I have lingering doubts and understand the power of stereotyping.
These signs are independent of an individuals’ guilt or danger, and rather reflect a situationally- based psychological process, called social identity threat.  Police officers undergo defensive tactics instruction throughout their formal academy training learning pre-attack danger indicators and methods of managing the threats associated with physical attack.  This post hopes to connect the pre-attack signs with the social psychological literature on stereotype threat.
“Stereotype threat refers to the concern that stereotyped group members experience when they are in a situation where they might be negatively judged by a group stereotype (Steele 1997). This psychological threat produces high levels of anxiety, physiological stress, and impaired cognitive processes, as individuals are concerned about negative treatment based on their identity (Bosson et al. 2004; Osborne 2006; Schmader and Johns 2003).”
Community policing, when implemented effectively will provide a “buffering effect” to stereotype threat. It does so by providing identity and cultural affirmation that belies an ongoing dialogue among LEO’s and neighborhood residents that are affirming and without bias and prejudice. This has a way of reducing cultural bias, perceived threat, and misinterpretation of behavior. Community policing does much to bridge a gap in social identity by building bridges.
“ST occurs when environmental cues make salient to a person the negative stereotypes associated with their group, thereby triggering physiological and psychological processes that have detrimental consequences for their performance on certain tasks, on their behavior more generally, and on their self-understanding.” Becoming aware of stereotyping and the threat it raises in those who are stereotyped can shape the behavior of police officer and culturally diverse members of the community.

Kahn, K. MacMahon, J. and Stewart, G. Misinterpreting Danger? Stereotype Threat, Pre-attack Indicators, and Police-Citizen Interactions. Journal of Police and Criminal Psychology , Volume 33, Issue 1, pp 45–54 Taken May 17, 2018

C.I.T. or M.H. Co-Response: Which model is safer for everyone?


Dr M. Sefton (left) Officers Ernest Stevens and Joe Smarro of SAPD Mental Health Unit


WESTBOROUGH, MA May 5, 2018 When people are in crisis law enforcement officers respond to the call for help. Because of a spate of police officer involved shootings there is a call for less police violence.  Yet in fact, it is the primary action of the citizen the evokes the lethal response by police. Those who call for “more police training in mental health counseling and less training in the use of firearms” have never been faced with the life or death conundrum – kill or be killed. Meanwhile, police officers are being called upon to de-escalate hazardous encounters daily using skills taught to them in the academy or in-service training. A detective in an urban department recently told me that the majority of their calls for service are for people exhibiting signs of mental illness.
The Department of Justice published a BJA Spotlight on Safety article entitled Defusing Difficult Encounters that essentially teaches officers to slow down the scene by projecting calmness and establish rapport. This is done by asking open-ended questions, e.g. “tell me what happened today”? Constantly assess the dynamic, changing threat by using communication strategies, defusing strategies, and mindfullness. Finally, take action using the minimum about of force needed to bring about a peaceful outcome.  Taking action does not necessarily mean the subject is arrested or goes to hospital.  In my experience if family members are actively engaged in the person’s life they may assist with aftermath intervention such as detox, rehabilitation, or hospitalization, if needed.  Ultimately, the use of force continuum follows the principle of causation by guiding police decision making based on the level of threat in any police encounter.
There are two dominant approaches to encounters of police and persons with mental illness. The first involves having mental health clinicians either ride along with patrol officers (or detectives) and roll on calls that involve someone exhibiting signs of mental illness. In some cases clinicians are housed at police facilities and interview subjects once they are brought in for determination of needs – rather than simply sending the person to the local emergency department.  The second method of police-mentally ill interaction teaches LEO’s to directly engage the person using skills they are taught such as empathic listening, establishing rapport, defusing emotional crises, and initiating treatment options e.g. hospitalization, medication management, return to psychotherapy, detoxification, 12-step AA or NA meetings.  Family members are encouraged to facilitate some treatments and I believe play a large role in keeping family members sober.  The drug or alcohol abuse often makes the mental illness more unpredictable and unstable.  Significant threats to public safety and direct risk to police officers can be mitigated if the abuse of drugs and alcohol can be managed by members of the immediate family.
Crisis Intervention Training (CIT) for police officers is an expensive and ambitious program that teaches first responders how to recognize and engage citizens exhibiting signs of mental illness.  I have seen this for myself work smoothly in San Antonio, Texas in 2017.  The SAPD is using a program developed by police and mental health professionals in Memphis, TN in the early 2000’s and adopted by SAPD in 2003.  I was fortunate enough to ride with two of the department trainers Officer Ernest Stevens and Officer Joseph Smarro.  I was shown the MH intake facility and met Roberto Jimenez, M.D, the program medical director who began his career at Boston City Hospital as I did. I visited the entire continuum of services including Bexar County sponsored housing and career development programs.  It was quite an experience and I remain in contact with the unit to this day.  Some believe that this “sensitivity training” will reduce the number of officer involved shootings with those who are known to be mentally ill. CIT training offers plenty of practice role-playing scenarios that come directly off of the call sheets affording a reality-based training opportunity.
In something of a contrast many department utilize the service of a mental health expert – usually a clinical social worker or licensed mental health counselor, to provide the de-escalation intervention, dialogue and liaison with mental health services to reduce the need for jail and the risk to everyone involved from escalating behavior and missed understanding. I have spoken to police officers accustomed to this method who believe it works well.  They develop a rapport and trust in the mental health clinician who comes on the scene only when it is safe to do so to begin their assessment. This too is designed to reduce the risk of unintended consequences and divert individuals away from jail and into treatment programs. Given the speed at which violent encounters take place I believe there are risks to everyone involved using this model of de-escalation. When an officer has one instant of hesitation he or someone else may be victimized in the time it takes to make contact, size up the call, and gain compliance.
The NYPD uses a clinician model that tracks hospital discharges and uses a preemptive strategy meeting with mentally ill persons prior to any growing crisis.  Their belief is that by keeping them off the police radar they reduce the likelihood of an acute crisis and divert potentially lethal encounters.
“Steve Coe, the CEO of Community Access, an organization that advocates for the mentally ill and works with the NYPD training officers on how to treat that community, said he hopes the task force focuses on creating a system that also would dispatch social workers to emergencies involving the mentally ill.” according to a report in the Wall Street Journal – April 21, 2018
Crisis Intervention Team training (CIT), is a progressive first-responder collaborative effort that works closely with community stakeholders, health care organizations , and various advocacy groups. The CIT model was first developed in Memphis and has spread throughout the country. The San Antonio Police Department adopted this model in 2003 and it has continued to grow immensely year after year. 40-hour CIT training allows law enforcement officers to respond with a new skill set which has a myriad of benefits both data specific and anecdotally. Additionally, CIT in San Antonio directly benefits individuals with a mental illness, while improving the safety of patrol officers, mental health consumers, family members, and citizens within the community. Because CIT is a collaborative program, it provides the foundation necessary to promote community and statewide solutions to assist individuals with a mental illness.
The 40-hour CIT model aims to reduce both stigma, and the need for further involvement with the criminal justice system through jail diversion programs. CIT provides an opportunity for effective problem solving regarding the interaction between the criminal justice and mental health care system. San Antonio Police Chief William McManus has mandated the 40-hour CIT training to all cadets and peace officers on the department. The San Antonio Police Department has fully embraced CIT by allowing a full-time Mental Health Detail to grow from two-officers to 10-officers, according to a SAPD spokesperson with knowledge of the SAPD program.
Dual Diagnosis – Mental Illness and Substance Abuse/Dependence
Arguably, when the police are called to keep the peace or investigate a violent person call they are required to meet the threat with heightened awareness for their personal and the safety of the immediate family and others.  If the violent person is actively aggressive or menacing with threat of lethal injury to the police or others than there is unlikely going to be any de-escalation until the threat of lethal force is eliminated. More often than not the person of interest is intoxicated or under the influence of drugs as well as suffering from some form of mental illness like depression or paranoia.  In the time it takes to find just the right words to engage a threatening subject who is waving a firearm or machete or baseball bat people may die – including members of the police who are trained and responsible for calls like this. When people attend psychotherapy sessions and 12-step recovery programs the proclivity for violence is greatly reduced.
No single model is best and all are still in the growing stages of establishing protocols for bringing those most disturbed individuals in from the margins. More and more officers are receiving CIT training every year according to Sefton in 2017.  Inevitably, drug abuse is a co-morbid factor that alters perception and fuels underlying anger and violent tendencies. On the other hand, if the violent person responds to officer directives to cease and desist all violent action and submit to being taken into protective custody or arrest – only then can mental health assessment be initiated.

San Antonio Mental Health Unit (2018) Personal correspondence on Crisis Intervention Team – Mental Health Unit.
Sefton, M. (2017). Police are building bridges and throwing life savers.  Blog post Taken April 21, 2018

Maine to Consider “Red Flag Law”

WESTBOROUGH, MA April 25, 2018  Maine is the latest state to consider a so-called red flag law. It would let family members or law enforcement officers petition a judge to take away a “high risk” person’s firearms temporarily, if the judge determines the person poses an imminent risk. In a recent post I describe the updated terminology for individuals who are a potential threat called Gun Violence Restraining Orders.  The proposed action would allow law enforcement to remove the firearms of people who are known to be threatening or physically violent toward intimate partners.  “Felons, the dangerously mentally ill, perpetrators of domestic violence – these people have demonstrated their unfitness to own a firearm” said David French, 2018.  In cases such as these police have reasonable cause to disallow gun ownership based not on prior conviction but on the elevated risk to potential victims.
Here in Massachusetts, in August 2013 I published a blog after the death of Jennifer Martell who was murdered in front of her 4-year old daughter by Jared Remy, son of Red Sox broadcaster and former player Jerry Remy.  The younger Remy had received one break after another some say linked to his celebrity father’s influence.  He was never held until a dangerousness hearing could be undertaken.  Had this been done Ms. Martell may be alive today. In 2011, Stephen Lake murdered his wife and children after he was kept from attending his son’s 8th grade graduation.  Lake had exhibited several red flag warnings prior to the murders.  In spite of these he was not held nor were his firearms removed from his control Allanach, et al. 2011.
Several states have debated similar red flag laws in the wake of the school shooting in Parkland, Florida. Supporters argue a red flag law could have prevented the Parkland shooter, but some gun owners say it’s an overreach that threatens their 2nd Amendment rights.
Like many states in the U.S. Maine has more than its share of calls for domestic violence and domestic violence homicide.  “All law enforcement personnel who respond to incidents in which an individual’s mental illness appears to be a factor receive training to prepare for these encounters; those in specialized assignments receive more comprehensive training. Dispatchers, call takers, and other individuals in a support role receive training tailored to their needs.” Communication between members of a response team with awareness and understanding of red flag warnings will reduce the impact of coercion and control that belies the secretive relationships between intimate partners.  It will also bring to light the need for danger assessment and containment of people who are high risk for violence as in the case of Jared Remy in Massachusetts and Stephen Lake in Dexter, Maine.

Red Flag Warnings (2018) Taken 4-4-18
Allanach, R.A., Gagan, B.F., Loughlin, J., Sefton, M.S., (2011) The Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide and Suicide. Presented to the Domestic Violence Review Board, November 11, 2011