“Ernie and Joe” – 2019 Jury Award winner for Empathy and Craft documentary at IFF Boston

I was happy to spent time with Ernest Stevens (left) and Joseph Smarro (right), here in Boston.  The officers are member of the San Antonio PD Mental Health Unit. On Saturday 4-27-19 the New England premier of “Ernie and Joe” Directed by Jenifer McShane was shown as part of the Boston Independent Film Festival. The film was well directed and edited with precision. The sound and images captured the intensity of their work and the exquisite sensitivity these officers exude. Jen McShane captures moment after moment of the important work being done in San Antonio, Bexar County, TX and the intimacy of this friendship.  The program is being adapted for law enforcement agencies across the country. “Ernie and Joe” is headed for Washington DC in June.  Congratulations I enjoyed every moment of the film.      Michael Sefton

Law Enforcement – M.H. encounters – New documentary April 27, 2019 in Somerville

A new documentary featuring the law enforcement CIT model of police-mental health response is being featured as part of the 2019 Boston Independent Film Festival.  This entry won a prestigious award the SXSW in its film debut.  As I retired from police work my interest in law enforcement mental health interactions deepened.  As a result I met these officers in San Antonio was was taken for some days of first hand observation of their work.  The documentary took 2 years to complete and gives the viewer a front row seat in the model from San Antonio PD and Bexar County that works. The film debuts here in Boston at the Somerville Theater in Davis Square on Saturday April 27, 2019.  I strongly urge readers in the area to attend.

In many police agencies the call volume for mental health encounters is at or above 50 percent. That means that every other call for service requires that officers dispatched to the call have an understanding about encounters with citizens experiencing a mental health crisis. Many LEO’s lack training and are uncomfortable with these calls. Importantly, this does not mean that 50 percent of all calls involve mentally-ill citizens but those individuals experiencing some behavioral health emergency – like a job lay-off or impending divorce or financial problems. They are not mentally ill and should not be treated any differently than any other 911 call for service. Police are often called when bad things happen to normal individuals who become emotionally overwrought often made worse by chronic use of alcohol or drugs.

Training for encounters with citizen’s experience a mental illness is part of the early career academy education. Many officers are provided 40 or more hours of crisis intervention training (CIT). In-service programs are being introduced across the country because of the importance of having expertise and understanding in basic de-escalation. Agencies around the country are playing catch up in learning how best to deal with abnormal behavior. Police in Albuquerque, NM are using a monthly supervision model where the department psychiatrist case conferences specific calls and officers learn techniques for de-escalation and process details about how better to respond to future calls.

Crisis intervention training teaches law enforcement officers what to expect and allows them to practice using role playing to see for themselves how to intervene with people in crisis using de-escalation techniques. “Law enforcement officers’ attitudes about the impact of CIT on improving overall safety, accessibility of services, officer skills and techniques, and the preparedness of officers to handle calls involving persons with mental illness are positively associated with officers’ confidence in their abilities or with officers’ perceptions of overall departmental effectiveness. ” Bonfine, 2014. “When a police officer responds to a crisis involving a person with a serious mental illness who is not receiving treatment, the safety of both the person in crisis and the responding officer may be compromised especially when they feel untrained” according to Olivia, J, Morgan, R, Compton, M. (2010).


Bonfine N, Ritter C, Munetz MR. Police officer perceptions of the impact of Crisis Intervention Team (CIT) programs. Int J Law Psychiatry. 2014 Jul-Aug;37(4):341-50. doi: 10.1016/j.ijlp.2014.02.004. Epub 2014 Mar 11.PMID: 24630739

Olivia, J, Morgan, R, Compton, M. (2010) A Practical Overview of De-Escalation Skills in Law Enforcement: Helping Individuals in Crisis. Journal of Police Crisis Negotiations, 10:15–29.
While Reducing Police Liability and Injury

Points of entry to Peer Support – Stress Intervention Continuum

When law enforcement agencies recognize the human effect of 
SURVIVORS
Stress exposure is a regular occurrence
stress on its officers then the stigma associated with routine interaction with behavioral health specialists will diminish or become nonexistent. Agencies having a Stress Intervention Continuum (SIT) such as this one are more apt to address law enforcement officer (LEO) behavior before it becomes career or life threatening. The model involves specific events that would regularly trigger a referral to peer support or behavioral health. This need not be an official “fitness” evaluation but more of a check-in with peer support, behavioral health, or consulting psychology service. The level of intervention is related to officer history and may be linked to identified deviation from “typical” annual reviews such as when an officer suddenly exhibits a change in regular habits or on-duty comportment.  Cumulative exposure to high stress events should also trigger a routine screening for all officers involved e.g. death of a child or serious injury to fellow officer.   Agencies are getting more adept at tracking call volume and specific events of high community interest. Known events of high acuity/high lethality such as a mass casualty incidents or other high profile/high stress incidents should be cause for officer defusing sessions that might include a group of officers not just a single officer. These sessions should be scheduled soon after the incident occurs. They should include supervisory staff in addition to police officers who participated in the call.  Some agencies are calling for annual stress reviews to include screening by a behavioral health specialist or police consulting psychologist.
When officers are identified there needs to be a planned response using a peer support infrastructure that provides for a continuum of service depending upon the individual needs of the LEO and the supports available including behavioral health specialists. In many agencies, especially smaller departments lacking resources, officers’ languish and sometimes spiral downward without support and without somewhere to turn. 
                                                                                                                         Michael Sefton, 2018
SIT – Points of Entry
  • Exposure to highly stressful events in close sequence e.g. multiple suicides or fatal car crashes, homicide, repeated domestic violence calls involving violence and children, etc.
  • Change in work assignment, district/station, deployment plain clothes undercover or return from deployment to uniform patrol
  • Increased absenteeism – over use of sick leave
  • Increased use/abuse of substances – impacting job functioning, on-the-job injury, vehicle operation
  • Off the job criminality or citizen complaints or neighborhood disputes
  • Community – on-duty citizen complaint(s) for verbal abuse, dereliction of duty, LEO vehicle crash
  • Citizen complaints of excessive force during arrest, new supervisory or peer conflict, or direct departmental insubordination.
  • Use/Abuse of force such as using baton, taser or firearm, recurrent officer involved use of force. Officers are sometimes strongly embittered and angry at this point in their career due to perceived lack of support and powerful feelings career disappointment and alienation.

Sefton, M (2018) Blog post: https://msefton.wordpress.com/2018/11/19/police-stress-intervention-continuum-an-introduction-for-leos-and-command-staff-to-reduce-officer-suicide/ Taken April 24, 2019
Copyright Michael Sefton, 2019

Police officer vulnerability previously ignored, hidden from plain site

What is currently understood as repeated exposure to trauma and its emotional impact was once thought to be a testament to toughness invoking the specter of a wall of silence. Law enforcement and first responder suicide has increased over the past several years and now exceeds the number of LEO’s killed in the line of duty. Why are cops choosing to take their lives? This is especially felt in Chicago where seven officers have taken their own lives in the last 8 months. In more than one case an officer committed suicide in the police vehicle or in the police department parking lot.

My colleague Dr. Leo Polizoti, Police Consulting Psychologist at the Direct Decision Institute, Inc. has been active in law enforcement training, fitness, and prescreening for over 40 years. He served over 30 agencies across New England and provides supportive psychotherapy as needed.

Dr Polizoti and I were recently involved in a symposium on Police Suicide in Chicago sponsored by Daninger Solutions from Daytona Beach, Florida. Among the presenters were Dr Thomas Joiner from the University of Miami, recognized expert in suicide, police sergeant Mark Debona from Orlando, Florida and Dr Daniel Hollar, Chairman in department of Behavior Science at Berthune-Cookman University in Tallahassee, Florida and CEO at Daninger Solutions.

There are many reasons why police officers have an increased levels of depression and stress.  Most are associated with repeated exposure to traumatic events like exposure to dead bodies, violence, childhood injury or death, terrorism, fatal car crashes, and more.  Most officers are able to remain professionally hearty when provided the opportunity to defuse the exposure soon after an incident. Career performance should include reducing officer depression and embitterment by building resilience starting in the academy and lasting throughout an LEO’s career.

The Mind-Body connection is well established and the role of stress in LEO career well-being is becoming a agency focus beginning in the academy.

“Not only must we as negotiators learn to take care of ourselves emotionally and physically – we must also be prepared to intervene with an actively suicidal officer. “

Dave DeMarco FOX News Kansas City

Is it any wonder officers lose hope and resilience.  There are inherent risks that LEO’s assume when they sign on like forced overtime, changing shifts, off-duty court appearances, the chance they may become injured, disabled or killed while serving the community.  There are also systemic stressors like supervisory bullying, professional jealousy, lack of opportunity to have an impact on policy, career stagnation, and paramilitary chain of command that often devalues education and innovation.  Agencies are beginning to track exposure to trauma and its correlated change police officer resilience in real time.

In Worcester, Massachusetts, LEO’s are required to attend defusing sessions following high lethality/high acuity exposure.  These sessions are kept private from members of the command staff and records are saved by the police consulting psychologist. The department has nearly 500 officers who are paid for their participation when they attend. It has been proposed that officers undergo annual “wellness checks” as a routine in some agencies such as KCMO. I have proposed a system of tracking officer call acuity and invoking mandated behavioral health assessment after a specified number of high acuity/high lethality calls for service. This is one way of reducing the stigma that officers face when they are sent for “fitness” evaluation or any sort of behavioral health care. The stigma associated with mental health may be reduced by having specified referrals following identified high profile incidents. Officers may be considered to be getting peak performance training at these defusing sessions as they are designed for enhancing officer awareness and reducing the human stress response.

Now, the KCMO department has mandated yearly wellness exams for officers in certain units like homicide and those dealing with child abuse. This was initiated to decrease the impact of traumatic events on police officer well-being. Officers at KCMO can also get up to six free anonymous visits to a mental health clinician each year, and the department has a peer support team.  Mental health clinicians must have experience working with law enforcement officers for best results.  Training for clinicians should be provided to best work with LEO’s and first responders. This is especially true for officers who self-refer.  Clinical hours should be supervised by the police consulting psychologist.