What is involved in CIT and Jail Diversion?

“The important part of crisis intervention training comes in the interdisciplinary relationships that are forged by this methodology. Trust and respect between the police and its citizens builds slowly one person at a time. “

Michael Sefton, 2017

Police officers have historically been ill prepared to deal with people exhibiting signs of mental illness or severe emotional disturbance. Many were thought to be unpredictable and therefore resistant to the typical verbal judo officer’s are trained to use. The CIT programs provided training to police officers in an attempt to bridge the gap between myths about mental illness passed down from one generation of LEO’s to the next and actual training and experience in talking with citizens experiencing a crisis in their life, learning about techniques to manage a chaotic scene, strategies for enhanced listening, understanding the most commonly encountered disorders and role playing. For one thing some person’s afflicted with mental illness have difficulty following directions such as those suspected of hearing voices, paranoia or command hallucinations but this is not always the case. Many individuals CIT trained officers will encounter are normal human beings who are experiencing a high stress, crisis such as the death of a loved one, financial loss, failed marriage or relationship, or major medical illness. This adds a layer of complexity to the CIT model that officers soon experience.

Acuity increases with encounters of mentally ill who are both substance dependent and have some co-occurring psychiatric condition. The alcohol or drugs are often veiled in the underlying “mental illness” but in truth they are not mutually exclusive. 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 M.H. advocates insist that with the proper treatment violent police encounters may be reduced and jail diversion may be achieved. 

5 Stages of Police Crisis Intervention

  1. Scene safety – Assess for presence of firearms – obtain history of address from dispatch – have back-up ready
  2. Make contact with complainant & subject – express a desire to help; listen to explanation of the problem – ascertain what is precipitating factor?
  3. Establish direct communication with subject – attempt to establish trust; support for taking steps toward change; “why now?”; identify any immediate threats – sobriety, weapons
  4. Pros and Cons for change – ascertain how willing  is subject to begin change process, i.e. sobriety, counseling, detoxification
  5. Positive expectations for change = direct movement toward change – hospital program; rewards that will come with positive change

“A crisis event can provide an opportunity, a challenge to life goals, a rapid deterioration of functioning, or a positive turning point in the quality of one’s life”

(Roberts & Dziegielewski, 1995)

There is a high degree of stress in any call involving a person in crisis. Repeated exposure to trauma is known to change the fight/flight balance we seek for emotional stability. Excessive autonomic arousal poses a threat to cardiac functioning and damaging hypertension. After high intensity/high lethality calls I suggest a defusing session take place immediately after the shift or as soon as possible. Excess adrenaline from an abnormal stress response can have significant health effects on LEO’s. Defusing or debriefing sessions can help reduce the impact of these types of calls. Full critical incident debriefing should wait until the normal effects of such calls wear off.

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

“and deliver us from evil…”

A Wolf in sheep’s clothing

Are there evil people living among us here in Boston?  I learned much about the criminal personality while attending graduate school.  I was fascinated when reading about psychopathy and its prototypic charm, lack of remorse, and proclivities toward violence. I read Norman Mailer’s The Executioner’s Song, first published in 1979 about serial killer Gary Gilmore. Gilmore was the last death row inmate to die by means of the firing squad here in the United States. It was his request to be put to death in this manner. The book was an encyclopedia of the underpinnings of psychopathy or sociopathy, used here interchangeably.  I also studied David Berkowitz, the Son of Sam killer in New York City.  Berkowitz used a Charter Arms Bulldog, a .44 caliber pistol, to kill 6 and wound 7 in 8 separate shootings in 1976.  At his trial, he claimed that a neighbor’s dog instructed him to kill young lovers whom he caught and killed while parking on lover’s lane.  He later retracted these claims and was sentenced to 6 consecutive 25 year-to-life sentences.  It is largely impossible to truly “know” someone but if you are picking up subtle signals in your brain about something someone said or did during your time together, Gavin deBecker might say that your unconscious “gut instinct” appraisal center in the amygdala and hypothalamus is giving you a warning to stay away. His book Gift of Fear was published in 1997.

“Beware of false prophets who come to you in sheep’s clothing, but underneath are ravenous wolves”.  Mt 7 15-20

While these publications are not specifically about criminal personality or the neurobiology of antisocial behavior, it struck me during the Spring semester class that a neurobiology of rage, and a neurobiology of moral development, and the neurobiology of emotions are very real. Professor Sabena Berretta, M.D., a physician studying brain disease at McLean Hospital in Belmont, Massachusetts carefully laid out the ground work for this.  It is written, in the same way a good tree cannot bear bad fruit nor can a bad tree bear good fruit.

Dr. Berretta described the case of Theodore Bundy who may have killed and mutilated over 30 female college students – even females as young as 12 year of age.  Mr. Bundy was intelligent and charming and disarmed his victims slowly.  He earned the trust of many of his victims only to use his cunning to undue that trust by sexual torturing and mutilating his captives often while still alive.  These members of society have callousness, lack of remorse, egocentricity, manipulativeness, superficial charm and shallow affect (Berretta, 2019). They are able to act witty and charming in a callously, predatory manner. Ostensibly, predation is a biological phenomena over which one might argue Bundy had no control. 

This is a hard sell for me. I was always of the belief that psychopathy represented something of an anomaly in human behavior and it was for them that death row was made.  I began to see for myself when I heard the predator analogy – see Great White shark, Alaska Brown bear, and the pride of lions – all hunter killers.

After some degree of give and take Dr. Berretta made a compelling case for mental illness as the cause of these horrific events committed by people I believe to be fully culpable for their crimes. The mutual understanding Dr. Berretta and I came to accept was based on our knowledge of the center for emotional regulation in the brain – the amygdala and hypothalamus and prefrontal brain coupled with a lack of social and moral development and disinhibited sexual drive and unregulated anger were the multifactorial underpinnings of his serial killing.  These are all functions regulated by circuits in the brain.  Ted Bundy did not affiliate with others and had no interest in anyone but himself and meeting his primal drives highlighting the hypothalamic and pituitary absence of oxytocin – a hormone that when present at normal levels produces affiliative, pro-social behavior AKA “the love hormone”.

Bundy was, by definition, a career criminal and was put to death in 1989 – a bonafide wolf in sheep’s clothing.  No one should lose sleep over his departure from this world.  

It can be unsettling when career criminals go free.  In another case in point, in July 2018, Albert Flick was released from prison in Maine after serving 30 years for the violent murder of his wife.  This was committed in front of her two children and was by all accounts a gruesome murder.  The crime occurred in Westbrook, ME in a city police agency where I served as a patrolman.  Soon after Mr. Flick was released he began stalking a woman and her two children near Auburn, Maine.  Within a few months his fixation grew and he started to follow her.  She knew he was around.  Always around.  Something in her brain triggered an early warning of danger.  Shortly after this the victim told friends that he worried her although he was 72-years old and appeared somewhat frail. She should have listened to that primitive signal. Gavin deBecker described the fear instinct as a gift to be recognized when in the presence of evil.  Dr. Berretta linked this early warning to a primitive survival instinct seen in all animals.  It drives the fight-flight response in the autonomic nervous system and keeps us on guard.  Long before there is conscious awareness of danger the amygdala signals that a threat exists.

Within a few days of disclosing this she was dead.  She had a strange feeling about Albert Flick that she shared with her friends.  She was stabbed to death, again in front of her two small children.  Flick stabbed both women, his wife – 30 years earlier, and a relative stranger with whom he had an infatuation, both occasions in the presence of small children. 

Flick is once again in prison where he belongs.

At the same time I am studying the underpinnings of psychopathy.  Psychopathy is a term ostensibly used interchangeably with sociopathy and refers to a pattern of criminality. The neurobiological underpinnings of which come from a lack of empathy, sensation seeking, and superficial exploitation of others. These features are derived from a primitive drive state of predation, stalking, and killing or injuring without conscience. In animals these are survival instincts and as human beings, we sometimes naively believe in a higher order sense of right and wrong.

There are people who are drawn to committing violence and would like nothing more than to steal our lives if we let them. But these citizens lack the internal moral development needed to affiliate with others and are often transient.  Some families seem to contain far more than their share of criminal family members across several generations. This familial concentration of crime has been confirmed as a characteristic of the general population. 

As a society we need to identify these sociopaths before they become active. They seek out violence and are rewarded by the release of brain chemicals when locked in or on the chase. That brings excitement and often erotic pleasure. They are predators and they live among us.  Their brains are wired differently than most of us and they live without moral contemplation or regard for the feelings of others.  These members of society have callousness, lack of remorse, egocentricity, manipulativeness, superficial charm and shallow affect (Berretta, 2019). They are able to act witty and charming in a callously, predatory manner all the while planning the snare looking very wolfish and bearing their teeth.  

 
Albert Flick is led out of the courtroom following his initial appearance in the Androscoggin County Courthhouse in Auburn Wednesday morning. (Russ Dillingham/Sun Journal)

Job satisfaction: Attrition and “exodus” in Seattle

I just finished a grant proposal looking at the effects of biofeedback on depression and embittered in early and mid-career law enforcement officers. A common complaint with retiring officers and many who leave is not being supported by the agency leadership. Embitterment and attrition go hand in hand but a “mass exodus” bespeaks trouble in paradise. I would like to study the effects of physiological biofeedback on LEO depression and emotional embitterment with a goal of reducing suicide with the goal of enhanced officer well-being. This study will not do much to explain the increase of resignations in Seattle but the data speaks for itself. The Emerald City has lost some luster and the trust of its troops.

Police chiefs frequently ask what can we do about officers who are trained and then leave the department after 1-3 years of service? This is a large problem in small and medium-sized departments. A study was published looking at the exit interview data from departing officers in the Seattle PD and what factors contributed to their decision to leave. According to Jason Randz who has a radio show at KTTH in Seattle, the mass exodus is linked to disgust at the city leadership including aggressive city council over site.

Copy of scathing response to exit inquiry

“There are lots of people walking out the door,” an officer explained. “This is a mass exodus. We’re losing people left and right. Why stick around when the City Council doesn’t appreciate you? [These officers are] fleeing the ‘Seattle mentality.’”

It is unlikely that a true mass exodus is taking place as some believe in the great Northwest. All large departments have officer turnover that can cause difficulty for recruiting efforts. In 2019, it has become more difficult to recruit men and women for the police service across the country. The Seattle story cites over three dozen officers who have left or are planning to leave the SPD because of feelings of unhappiness with the city. A true copy of one exit interview is shown above “New strategies will be essential to fill not only the recruitment gaps, but also the tremendous loss of organizational knowledge that will accompany the impending mass retirements. Few would argue that a department full of rookies at every level is what the profession needs, especially if those rookies are from a generation that craves immediate approval and recognition” as described in a paper published in Police Chief Magazine entitled A Crisis Facing Law Enforcement: Recruiting in the 21st Century.

According to Chief Sid Smith, “with the growing public concern over police use of deadly force, this mental health issue presents another challenge for the recruiters and places an added burden upon the mental health professionals retained to more carefully screen all applicants, including military veterans”. In a prior post the topic of protective factors for success in law enforcement are listed but a substantial factor impacting job satisfaction and career hardiness is perceived support from management and city government including members of city council and in some cases strong mayors. In 2014, the Seattle Police Department appointed Kathleen O’Toole, a former Boston Police Commissioner, to lead the agency which was under federal consent decree for cases of alleged excessive force. She resigned in 2017 for personal reasons.