Shoot – Don’t Shoot: Mental Illness and the Use of Force

Police agencies expend a great deal of LEO resources dealing with citizens with mental illness. The Washington Post (2015) and the Boston Globe (2017) both did large feature stories on police use of force against mentally ill persons. The profiles were gut wrenching but only one example illustrated the emotional toll on law enforcement officers who are involved in fatal use of force situations. The Boston Globe Spotlight Series entitled The Desperate and the Dead was published in 2016. I have written about officer involved use of force for over 5 years now. The interaction between poly-substance abuse or dependence and exacerbation of underlying mental health symptoms is complex. The interaction of the two is sometime lethal as reported by the Globe Spotlight team. 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. Lethal force results as a function of the behavior of the subject and his capacity to listen and follow directions when he is confronted by law enforcement. It is impossible to utilize de-escalation techniques in all cases of police-mental illness encounters.

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

“When officers are faced with a deadly situation, when there is a gun pointed at a cop, there is no time to go into mental health measures,” SFPD Chief Grace Gatpandan said in 2015. 

Washington Post (2015) Lowery, W. et al. DISTRAUGHT PEOPLE, DEADLY RESULTS: Officers often lack the training to approach the mentally unstable, experts say

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

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

Boston Globe Spotlight Team 2016

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

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

What are protective factors in law enforcement: Ballistic vests notwithstanding

vest.jpg
Officer wearing ballistic vest

A new paper was just published in the Journal of Police and Criminal Psychology that has to do with high rates of depression in some police officers. It is written by Emily Jenkins (2019) who is a biostatistician and epidemiologist at the National Institute for Safety and Occupational Health in Morgantown, WV.  Her co-authors include John Violante who himself is an epidemiologist and former New York State Trooper now researching police officer health and suicide.  Basically, the authors say there are factors in personality and behavior that serve to reduce the new incidence of depression in LEO’s and to reduce the associated physical debility that may be co-occurring in cases where a history of depression was previously reported. One might see this protection as a ballistic vest for emotional health and career hardiness. High resilience leads to career success, satisfaction, and reduced likelihood of developing depression. Resilience refers to adaptability and flexibility in dealing with stressful situations.  Resilience officers are able to tolerate highly stressful situations without becoming debilitated by stress and negativity.

I find the study interesting but it doesn’t connect with the troops in the field. For example, one feature listed as helpful against depression is “active coping” that includes things like agreeableness, conscientiousness, and having social support. Understanding protective factors leads to understanding who is most at risk of developing depression.  The goal is to reduce depression among LEO’s and lessen the long-term impact of depression once it has been diagnosed.  The paper cites links to depression and poor coping skills to personality features such a high neuroticism and low conscientiousness and low extraversion.  These variables may lead to higher risk for substance abuse, reduced hardiness, and a host of physical signs and symptoms.  These personality features are the biomarkers of chronic stress and its harsh consequences. They make sense to me but I rarely encounter a police officer, or anyone else for that matter that actively thinks about the core set of personality features that have defined them throughout life.

Officers across the country are being trained in peer support and crisis intervention training. At the Direct Decision Institute we are providing a variety of training programs designed for this same issue – increased officer hardiness and reduced risk of burnout, depression, and suicide. These are intuitive concepts and when talking with active duty LEO’s, I feel like the rank and file understand the words they hear but rarely will an officer offer up a personal example of times he or she may have had behavioral health issues. I have heard officers become very emotional when telling the stories of friends who have suffered with mental illness but rarely a personal story.

Two recent exceptions to this notion are Sergeant Mark DiBona, a recently retired sheriff’s department officer from Florida and Joe Smarro, an officer from Texas who is recently featured in an outstanding documentary entitled Ernie and Joe released in May, 2019 with great acclaim.  It should not be this way and there is still great secrecy behind the veil of police service.  It takes great courage to share personal struggles and one’s private experience.  Police officers are most uncomfortable with this. Officers who are signing up for CIT and peer support courses are carefully chosen and may be more open to personal self-disclosure exhibiting greater positive coping skills, hardiness, extroversion and emotional resilience.

In order to reduce stigma associated with law enforcement behavioral health issues all members of the police service need greater self-awareness, openness to self-disclosure, and understanding of the effects of repeated exposure to violence and its broad ranging vicissitudes. This is nothing new and is being taught in academy training. Police psychologists who provide pre-employment screening should analyze the test data carefully and avoid selecting men and women who are most at risk of developing depression and who are outgoing, confident, and emotionally sturdy.

Violence and psychotic people

Among the most dramatic and menacing forms of mental illness are the psychotic disorders. These include people who have uncontrolled paranoid schizophrenia, bipolar disorder, depression with psychotic features, substance intoxication, and perhaps intermittent explosive disorder. Violence is not associated with mental illness per se.  There are factors that increase violent behavior among those who are mentally ill including persecutory ideation like suspiciousness and fear, and co-occurring alcohol dependence.  The most important way in which to reduce violence among citizens who are mentally ill is to provide some form of treatment to them.  Those who go without substantive treatment including psychotherapy are at greatest risk for becoming aggressive or violent according to Coid et al. (2016). These are the citizens who fly above the radar and are seen pacing the street corners in cities everywhere reciting from some unwritten preamble.  People walking avoid eye contact further pushing them to the margins of civility.  Eventually, the bottom falls out and the preamble comes to an incoherent end.  Either they move on or they are picked up for evaluation.

There are even greater numbers of psychotic people living under the radar.  Making their way in society, flying by the seat of their pants.  These people are often cared for by family members including elderly parents. When they relapse or “go off the rails”, caregivers often need the help of police to gain compliance with their loved ones.  Sometimes the police are called to restore the peace and compel the emotionally disturbed person into treatment.  For those individuals who relapse and are substance dependent i.e. alcoholic, the risk for violence is elevated.  These people require special understanding and sensitivity in order to establish a trust and to help them see their behavior patterns and risk taking behavior for themselves.  No easy task.

More recently, meta-analyses and case register studies concluded that psychiatric disorders are associated with violence, but that the relationship is largely or entirely explained by comorbid substance misuse. Fazel et al. (2009)


Fazel S, Gulati G, Linsell, L, Geddes, JR, Grann, M. (2009) Schizophrenia and violence: systematic review and meta-analysis. PLoS Med. 6: e1000120.
Coid, JW,  Ullrich, SP, Bebbington S, Fazel, R,  Keers, R (2016). Schizophrenia Bulletin, Volume 42, Issue 4, Pages 907–915, https://doi.org/10.1093/schbul/sbw006 taken May 9, 2019

The Field Training Officer: Important things they may not know

Most departments has active field training protocols that recruits must pass after leaving the academy.  This means they ride along with the FTO until they are ready to function independently as LEO’s.  The specific time line for this depends on FTO daily observation reports during the phases of field training.  These begin with close supervision where the trainee does little of the daily work. In the latter phase of training the FTO may pull back and provide intervention only if needed by allowing the trainee to be the lead on all calls.

Officer resilience depends upon solid field training with adequate preparation for tactical encounters, legal and moral dilemmas, and mentoring for long-term physical and mental health.  Michael Sefton, Ph.D. 2018

Law enforcement officers begin their careers with all the piss and vinegar of a first round draft pick.  This needs to be shaped by supervised field training and inevitably will be effected by the calls for service each officer takes during his nightly tour of duty. Much like competitive athletes, law enforcement officers at all levels exhibit “raw” talents, including leadership abilities and the cognitive skills to go along with them.  Moreover, like competitive athletes, these raw abilities have to be honed, refined and advanced through a combination of modeling, coaching and experience in order for the officer to develop the skills needed to improve performance, as well as prepare them for career advancement according to Mike Walker.  This important task falls upon the field training officer (FTO) and is a critical phase in probationary police officer’s development.  “The FTO is a powerful figure in the learning process of behavior among newly minted police officers and it is likely that this process has consequences not only for the trainee but for future generations of police officers” according to Caldero and Crank (2011).  In 1931 the Wickersham Commission found over 80 percent of law enforcement agencies had no formal field training protocols for new officers entering the field of police work described by McCampbell (1987). In 1972, formalized field training protocols were introduced by the San Jose, CA police department that became a national model for post academy probationary field training.

Just before I was promoted to sergeant while working for a law enforcement agency, USCG Vice Admiral John Currier, a friend of mine said to me: “Michael, move up or move out”.  I wasn’t sure what he meant by that but given my 9 years as a patrolman, I started to lobby for a promotion to sergeant.  The agency at which I worked had little turnover in the middle ranks so I was never sure I would get a chance for promotion.

All law enforcement officers should have a career path when they graduate the academy that lays out a career path based on officer interest, career improvement goals, on-going training interests, and agency needs.  Training opportunities offer new officers the chance to gain experience in anything from specialized investigations i.e. sexual assault and child abuse, firearms instructor, domestic violence risk assessment to bike patrol and search and rescue.  Our chief believed strongly in incident command, active shooter response, and emergency medical technician training.  I went on to take the paramedic technician course at a local college in 2011-2012. In many ways my former agency was well ahead of the curve in training opportunities and tactics including use of body worn video cameras, taser training, stop sticks, and individually deployed patrol rifles.  I was encouraged by my chief to participate in a research opportunity I was offered in domestic violence homicide from a case in northern Maine, a community much like the one I served. From this research we introduced a risk assessment instrument developed by  Jacquelyn Campbell.

The chrysalis for me came in August, 2012 when I was appointed by the Select Board to sergeant at the recommendation of my chief.  Before this could occur, I had put in a significant amount of time developing a field training program, domestic violence awareness and lethality assessment protocols, and police-mental health encounter training. I learned the hard way that most police officers do not like working with citizens with mental illness and hate attending training classes on mental health awareness and crisis intervention training. I realized that I needed to become a leader and in order to do so I needed to become better in communicating with the troops and with those up the chain of command. In order to develop leadership I was sent to sergeants school but what I learned was the importance of being a role model for those in training and to teach by doing, teach by example. I also learned that field training is demanding, exhausting work if done with the precision needed to fully socialize the trainee and provide needed modeling while gradually offering greater independence for the trainee.

cropped-images.jpgField training involves months of practicing ‘what if‘ scenarios, learning the ropes of the police service, use of force, and writing reports. Early in the phase of training the tough discretionary decisions faced by a probationary officer are made by the senior training officer based on prior judgement, experience and what is most prudent for the specific incident and conditions on the ground.  “Agencies should thus maintain a greater degree of FTO supervision, not just trainee supervision. Such an effort would go a long way toward improving FTO programming and better informing the needed research base” Getty et al. (2014, pg. 16). Field training is often time limited with special consideration for officers who need additional training in specific skills or personal areas of concern. Some officers are put on career improvement plans and extended field training, when needed, and some probationers are discharged from the agency because of skills or behavior that are not compatible with police work. Law enforcement agencies want active police officers who represent the core beliefs of the agency and individual community needs.

Field training has perhaps the most potential to influence officer behavior because of its proximity to the “real” job according to Getty, Worrall, and Morris (2014).

Probationary officers can be taught the how and when of effecting an arrest but the intangible discretionary education comes from FTO guidance and socialization that takes place during the FTO training period.  Research has revealed that officers’ occupational outlooks and working styles are affected more by their FTOs than formal “book” training, Fielding, 1988.  The selection of who becomes an FTO is not well defined.  In a study at Dallas PD probationary trainees were exposed to multiple FTOs over 4 phases (Getty et al. 2014).  The study revealed a correlation between new officer behavior – in the 24 months after supervision, as measured by citizen complaints and the FTO group to whom they were assigned. It is conceivable that the results in the study may be due to the relative brevity of training at each phase may have stopped short of instilling good habits or extinguishing bad habits in many new police officers. I have worked in agencies where only the sergeants were the FTO’s by virtue of rank and supervisory acumen long before systematic field training programs were introduced.  In Dallas, results showing officer misconduct via high citizen complaints may too have been associated with unprepared FTO’s who were drafted to supervise the trainee and who were not prepared for that role.

“Bad apple” and/or poorly trained FTOs may thus have a harmful influence on their trainees. Getty et al. (2014)

Choosing successful FTO’s is of critical importance for new officer development and for future generations of law enforcement officers. The values espoused by the FTO have enormous impact on the behavior, habits, and professionalism of new police officers. It has been shown that the quality of this training belies post-supervision job behavior and success.  Haberfeld (2013) has offered a supportive assessment of the assessment center approach to FTO selection suggesting there are qualities that may be quantified in the selection process. This may be helpful in the selection of FTO’s who are professionally resilient and emotionally hardy as they lead the new probationary officer into his career. If officers are randomly assigned to provide field training without forewarning or preparation this may staunch career growth in the probationary LEO.  If this becomes the norm then FTO’s may have provide more of what probationary officers need such as correct values, discretionary wisdom, and perhaps less negative socialization that can lead to embitterment, misconduct, and citizen complaints.

At times of high officer stress when high lethality/high acuity calls are taken the probationary LEO is apt to require greater support and guidance from the FTO. It is during these critical incidents that post hoc peer support and defusing may take place.  Training LEO’s should be permitted to openly discuss and express the impressions they experience to calls that may be more violent, and outside of the daily norm for what he or she has been doing.  In doing so, the impact of these high stress exposures may be mitigated and emotional resilience may germinate. The responsibility of FTO’s to reassure and invigorate trainee coping skill and mindful processing of critical incidents cannot be under emphasized.  FTO’s understand that healthy police officers must be permitted to express horror when something is horrible and feel sadness when something leaves a mark. They will become better equipped in the long run if allowed to fully appreciate the emotional impact that calls for service will elicit in them.  The stigma of high reactive emotions from high stress incidents, i.e. homicide or suicide, is reduced when officer share the call narrative and its allow for its normal human response.

Michael Sefton, Ph.D.
2019

REFERENCES
Caldero, M. A., & Crank, J. P. (2011). Police ethics: The corruption of noble cause (3rd ed.). Burlington, MA: Anderson.
Fielding, N. G. (1988). Competence and culture in the police. Sociology, 22, 45-64.
Getty, R, Worrall, J, Morris, R. (2014) How Far From the Tree Does the Apple Fall? Field Training Officers, Their Trainees, and Allegations of Misconduct. Crime and Delinquency, DOI: 10.1177/0011128714545829, 1-19.
Haberfeld, M. R. (2013). Critical issues in police training (3rd ed.). Upper Saddle River, NJ: Pearson.
McCambell, M. Field Training for Police Officers: The State of the Art (1987). DOJ: NIJ, April.