Month: October 2024

How Legal System Shortcomings Fail Domestic Violence Victims and what we may learn from these failings

Michael Sefton, Ph.D. Bullying, crisis intervention, Dangerousness assessment, domestic violence, domestic violence homicide, DVH, Health Psychology, Human Behavior, Massachusetts domestic violence, Police officer behavior, Relationships, terminal rage

WESTBOROUGH, MA – October 31, 2024 – I am writing in the aftermath of another murder suicide here in Massachusetts. It happened 3 months ago at the end of the school year. An adolescent girl was walking home from school and was abducted by her former step-father who is charged with raping her when she was 13. He was wearing an ankle bracelet designed to provide police with GPS coordinates when he deviated from going to and from his work place or if he deviated anywhere near the victim from whom he had a stay away order. Technically, as soon as he drove near the childs school or home the police should have been notified. But this did not happen and now the girl and the former step-father are dead. I have written to the Middlesex County district attorney here in Massachusetts about this case with ideas I have about domestic violence homicide and best practices, but so far, I have heard nothing back. I presume they have all the expertise and advice they require to help keep people safe from trolls and jealous spouses with outstanding orders of protection.

I am a former police sergeant and have looked at several cases each year that are compelling and I try to report these. I asked the local chief of police for the police reports on this case but was sent only the press release. My interest started both from my experience in law enforcement and also out of a response to the abject horror the so many of these cases, like this one. People living in fear, month after month, or in some cases years of fear. This case was delayed over and over. A common tactic used by defense attorneys to avoid going to trial at all. They are banking on the victim being too frightened to testify or better yet, the victim moves away and cannot be found. Victim witness advocates will tell you that teenaged children carry a great deal of shame with them after being victimized. Every delay or change in court dates can trigger fear and often self-doubt. Many know the protection orders have very little that prevents a stalking step-parent from wreaking terror on his victim and her family. In this case, the restraining order failed the victim in spite of the best efforts of law enforcement with things like old technology GPS monitoring.

This case flew under the radar because the criminal trial of the accused was re-scheduled 3-4 times over several years. It was finally headed toward the court room and it is a fact, that as this occurs the risk to potential victims increases as domestic violence cases plod toward a trial. Every change in court date is enough to put a frightened victim into crisis. Many if not most, victims of DV change their minds and do not prosecute. They often blame themselves for breaking up the family by coming forth with sometimes horrific accusations as in this case. In the long run, this impacts their emotional development and victims should be afforded all the support they require to be capable of going to trial. They often are too afraid to stand up and admit what was done to them. They feel shame and deeply frightened.

As I said, I am a former police officer and currently MA licensed psychologist working in here in Massachusetts. When I patrolled the town, I frequently stopped at houses known to us for domestic violence calls in the days afterward. I sometimes had one of our community policing officers with me in the aftermath of the call. When everything was settled down and the dust had cleared, I would stop and try to connect with the couple. Follow-up on recommendations I may have offered – like family or couples therapy and other local resources. And let them know help is available. I was surprised at how many families moved away soon after being involved in a family fight. Off my radar right? My understanding of domestic violence is that it cycles from guilt and shame to honeymoon and a family love fest. The cycling of coercive, violent behavior ramps up one a trial nears or some other dramatic change like divorce. These are the most dangerous times and any violations once the GPS monitor is in place should require arrest with no bail. While in containment, the psychological assessment must be initiated and presented to the court.

The double dose of the stigma of both suicide and intimate partner violence (IPV) leaves the details of many of these traumatic experiences untold. 
Everytown Research and Policy, 2024

“These tragedies often include children, family members, and friends.” Despite the devastation and immeasurable impact, these events garner little public attention and recognition as a frequent form of gun violence.” according to a story published on 8-8-2024. More needs to be done to protect child victims from known violent perpetrators such as Juliano Santana, who killed a 16-year-old girl a few weeks ago in Acton, Massachusetts. Child victims like the 13-year-old victim in this case often blame themselves for being physically assaulted or being groomed for sexual assault. They lack the developmental and emotional maturity to fully understand what has happened to them and often live in recurring fear that the rapist is going to come back and hurt them again or kill them next time. The media portrayal of these horrific events failed to ask the important question how did the perpetrator avoid being captured before he got to his one-time stepdaughter? He was attached to a GPS device, right? And where did he get the firearm used to kill the teen and turn it on himself? Well, it sounds as though the police have determined that the GPS may be partially to blame. As soon as they queried the device, they knew Santana was on the move and the victim was grave danger. And where did the deadly firearm come from?

“Access to a gun is the centerpiece of the dual tragedies of intimate partner homicide and suicide.” 

The GPS ankle monitor system did not protect the victim because it was not the type of monitor that would alert law enforcement when a suspect diverts from his programmed daily route or if he drove near the school or apartment complex where the victim lived. So, after 3 years the trial was set to begin in July 2024. That is usually a red flag and signals growing anxiety in both the victim and the suspect. Under state law, prosecutors cannot request a hearing to determine if someone is dangerous or whether he should be held in cases involving egregious cases of child rape. The rape of a child is de facto evidence of dangerousness in most circles.

As a former law enforcement officer and a now licensed psychologist here in Massachusetts and I have looked at DVH. I find it necessary to draft reports that highlight the murderer’s unpredictable violence. Certainly, the probation department looks at the perpetrator’s prior criminal history in making recommendations for bail. It is likely that Mr. Santana had no criminal history although we have not been told this fact. Juliano Santana drove to Acton with one thing in mind – to shoot and kill the 16-year-old girl whom he first violated 3 years prior when she was just 13. He should have been in a holding cell until he received a dangerousness assessment.

“Law enforcement agencies should implement a lethality risk assessment protocol in domestic violence cases that includes instructing officers to ask about the presence of firearms and other known risk factors for lethal violence.”

There is nothing more frightening than to be the person who asks for a restraining order for protection from a monster that allegedly raped her as a 13-year-old girl. She was not his biological daughter. How is it possible that someone who has demonstrated such violent and dangerous behavior cannot be held until his dangerousness can be assessed? Here in Massachusetts conditions of bail have no bearing on criminal behavior once released. Bail does not stop secondary criminality. The likelihood of terminal violence such as this, is extremely high as the court begins to move on the case.  Santana skidded through the pervious gauntlet and killed his victim and then himself. Rather than say that there were many things in place to protect the victim, there needs to be an investigation as to how the protection order failed? This case is an abject failure.

More needs to be done to protect child victims from known violent perpetrators. News reports say there were things being done to protect the victim. Not enough was done. The county court probation system failed this victim releasing Juliano Santana on three thousand dollars cash bail – thirty thousand surety bond. In all orders of protection, the perpetrator is required to forfeit all firearms. The fact that Juliano Santana had a firearm needs to be investigated. Did he have a license to carry the firearm he used in the killing? If so, this should have been taken away from him immediately upon the order by the judge on the day the victim went to police in Malden. Someone provided the gun, and someone knew that he had plans for using the weapon. The psychological autopsy can develop facts that shed light on these truths. The facts gleaned in the PA will directly help other cases like this one. The question always comes up as to how the guns were acquired or how the guns were not removed as mandated by law?

“The psychological autopsy is an individually designed case study that elicits a broad range of factual data regarding the behaviors of a decedent in the immediate day or days leading up to domestic violence homicide. The study is especially important when first responders and essential workers are involved. In all likelihood the girl lived in fear and terror” according to Michael Sefton, Ph.D. at a police psychology program in Worcester. This after incident examination can provide a good deal of information and warning signs that extreme risk for violence exists. These studies may add to the collective understanding of DVH – especially when family annihalation results.

We conducted a psychological autopsy on a man in Maine who murdered his wife and two children. This occurred just days before his divorce was to be finalized and two weeks before he was to be tried for criminal threatening. Steven Lake was known to be violent toward his wife and daughter. He violated the order of protection over five times with impunity. His firearms were not taken from him. He had over twenty to choose from when he made his move. This is what happens in systems where defense lawyer argues about eighth amendment rights to “reasonable” bail in lieu of consideration for the traumatized victim and her family. What modern society leaves its children at considerable risk for death in crimes like these? There were most certainly red flags that the perpetrator waved in the days and hours before this kidnapping and murder.  His anger was likely extremely high as the trial date neared. He would not allow the victim to take control of his life by sending him to prison where he belonged.

Someone knew that this was going to happen and said nothing. Maybe a family member or co-worker. He may have contacted the victim wanting to apologize or threaten her against telling the truth. Or her family was threatened?  But it is quite likely the unnamed 16-year-old lived in fear that her tormentor may strike and take her again. Just as he did on Thursday in late June as she walked to her home.  It is vital to future cases of domestic violence that common red flags do not become holes in the safety plan of victims seeking safety and protection. The results of the psychological autopsy of Steven Lake were presented to the Maine Attorney General’s DV Homicide Review Board. The document is 75 pages long and offers over 50 recommendations for lowering risk and lowering deaths by DV.

Governor Charlie Baker had the right idea and proposed it to the legislature that allows the court to require a dangerousness evaluation in the case of rape and other crimes. We learned that this failed in 2022 as too expansive a mandate with too few resources to hold perpetrators accountable.  Why? The Middlesex County D.A. should bring this to life and use the event to highlight the imbalance in domestic violence prosecution and the protections it gives to perpetrators from (low bail) and the fear it drowns its victims who feel unprotected. Even having an ankle monitor did not work until it was too late and provided no “real time” monitoring. If it had, then Santana could have been tracked when he diverted from his given route and came to Acton to murder his stepdaughter.  

Everytown Research & Policy is a program of Everytown for Gun Safety Support Fund, an independent, non-partisan organization dedicated to understanding and reducing gun violence.

Career Burnout: The overwhelming impact of stress and understanding the cost to Human Capital

Michael Sefton, Ph.D. Corona virus, Health Psychology, Human Behavior, Leadership, psychological relevence, PTSD, Stress , , , , , , , , , , , ,

WESTBOROUGH, MA October 17, 2024 When we talk about career burn-out, we are looking at the impact of chronic and sometimes overwhelming stress on work efficiency and job satisfaction. As a clinical psychologist, I espouse the risk of stress and its associated malignancy to everyone I meet. Stress adds costs to workforce management because as workers become overwhelmed they start to look for better jobs. Surprisingly, it is often not the compensation that makes workers want to switch jobs – but the work ecology, those subtle factors most of us seek in the relationship between us and the company. Replacing intelligent and career oriented nurses and doctors is very expensive and disruptive to everyone. It means that supervisors are always interviewing and floor nurses are always orienting someone to the idiosyncrasies of the role.

It has been suggested that employees who are under chronic stress are at greater risk for making medical errors and other mistakes. Shortages in staff trickle down to patient care too. Hardly a day goes by when I do not hear someone say “I had to wait 30 minutes for someone to come and help me get back into bed.” When it comes to healthcare, people are not concerned with staff shortages when a loved one is hospitalized. Customer satisfaction is key to good medicine and community policing alike. And like police officers, a nurse or doctor who is on the last hours of a 12-hour shift is more likely to be ill-tempered and out of sorts. And like police officers, healthcare workers experience stress from long hours, shift work, and the nerver ending number of patients. Just ask any nurse or physician working in the emregency department and they will tell you it goes on and on round the clock. It is a mystery how some can stay in one job for any length of time given the current model of corporate medicine and the megagroup practice devouring one sole practitioner after another.

“The prolonged elevated cortisol levels that come with chronic stress and post-traumatic stress disorder (PTSD) can interfere with and damage the brain’s hippocampus” Wendy Suzuki author of Good Anxiety: Harnessing the Power of the Most Misunderstood Emotion.

The brain and body experience stress like a jolt of toxic hormones that have the power to gradually reduce the ability to relax and quiet the body. I am tasked with assessing employees following high acuity/high lethality calls for service who find themselves in an unsustainable state of physical tension and mental fatigue. I teach mindfullness and biofeedback strategies for people suffering with the effects of chronic exposure to high stress situations and the physical impact of these. When working with a group of medical providers stress may become overwhelming after a particularly stressful shift, like many hospitals experienced during the coronavirus pandemic.

I presented a conference on Stress and Healthcare providers: Caring for the Caregivers shortly after our emergence from the nationwide pandemic response in 2022. On that night, I wanted to bring some examples of current stress the frontline healthcare workers experience – especially with the pandemic now in the rear view mirror. In doing so I realized that even preparing for this 90 minute presentation was as much as I could handle with so much on my plate. I needed to remind myself, I am not a superman, I am not a warrior. I must take time for myself and cleanse my psyche of the evil spirits floating around in my unconscious mind. I am aware of the impact of stress on my thinking and my intimate life.

In the short term, our bodies need the adrenaline and cortisol to quickly activate our brains and other organs to react when a threat exists such as when a patient unexpectedly goes south. Since we were being chased my sabertooth tigers we have relied upon the “threat response” to keep us alive. In any environment our bodies need this fight-flight system to modulate and guide our behavior including when to run, fight, or freeze. It comes down to using our sensory system to be on guard for us and when we are exposed to something threatening, like a crash in our patient’s blood pressure or looking through a darkened building trying to find a burglar.

“If you exercise regularly, get good-quality sleep and take steps to reduce and/or manage your stress, “you can reduce stress activity in the brain, systemic inflammation and your risk of developing cardiovascular disease,” reported Ahmed Tawakol, a Massachusetts General Hospital physician quoted in Washington Post article on Stress published in 2022.

Chronic stress is hard on the human body. Most people who seek out a blog like this one are well aware of the toxic impact of an abnormal stress response. “The prolonged elevated cortisol levels that come with chronic stress and post-traumatic stress disorder (PTSD) can interfere with and damage the brain’s hippocampus, which is critical for long-term memory function,” Wendy Suzuki said in a Washinton Post article (2022). The hippocampus and amygdala are a constant filter for danger and threats to safety. Abnormal activation or damage to these organs leave a person struggling with constant activation of the fight-flight response that we know is unsustainable. Or even worse, we are left somewhat helpless without this cueing mechanism. When it starts to rain upon us and we do nothing to initiate staying dry or move away from the lightning. Long-term increases in cortisol can also damage the brain’s prefrontal cortex and its interconnective pathways. These are essential for focused attention and concentration, as well as the functioning of the higher order executive system needed for problem solving and other cognitive tasks we often take for granted. That is until they are corrupted by stress hormones running amock.

What are the signs of burnout? First, there are many nurses who have become numb and disinterested. Some career nurses pull the plug on their roles leaving to become a home health nurse or perhaps off to the nursing home nearest to their homes. Many experience caregiver fatigue and waning empathy from hours of high stress patient care and management. During the relentless pandemic Many want to go back to the “old way” of taking care of patients by using the primary nurse model which divides high acuity patient among the senior nurses on a shift. The primary nurse is usually repsonsible for attending team meetings designed to update physicians and consultants as to how treatment goals are being met.

Secondly, burnout can leave people exhausted, unmotivated, and cynical – the consequences of which can be catastrophic in many professions. As well as impacting professional growth, research suggests that these extreme stress levels can impair social skills, overwhelm cognitive ability, and eventually lead to changes in brain function and damaging physical disease and inflammation in vital organs leading to premature aging.

The stress of this is often overlooked. “During the pandemic began, newly minted residents who normally wouldn’t take care of patients with severe respiratory illnesses, such as those training to be psychiatrists, podiatrists, or orthopedic surgeons, have been asked to volunteer to work in COVID-19 wards” across the country according to a report by Deanna Pan in the Boston Globe on May 9, 2020. Professionals including residents in training, who ride a high stress career need time to process the trauma they face each day. That is not always possible. As a result, the cumulative impact can abbreviate even the most stalwart among us. Supportive supervision can assist young professionals to mitigate the impact of trauma and stress. Time for resilience should not be put off because of staffing shortages.

Working on the front lines with patients who are dying is horrific. This is especially painful when there is seemingly nothing that can be done to help them. First responders and frontline hospital workers are trained to provide emergency care. When their training is not effective, than feelings of helplessness will grow (Sefton, 2020). These feelings can be overwhelming. The cost has been great with increased rates of suicide since the shutdown began in March including those on the frontlines where the decisions they made both right and wrong may have been impacted by the unending stress of patient care.

On April 27, 2020 Lorna Breen, a physician specialist in emergency medicine took her own life after being witness to dozens of patient deaths during the peak of the coronavirus and contracting the virus herself and surviving it. Dr. Breen was a professional and emergency service medical director of NewYork-Presbyterian Allen Hospital and had no history of depression or mental health diagnoses. 

More should be done for employees to assist them in remaining emotionally hardy and resilient for long-term career satisfaction. We know that days of stress from never ending patient flow can undermine career-oriented nurses and shorten their work life – something that no employer wants to see. The same as in law enforcement, finding replacements for nurses, doctors, and other caregivers is not easy. It is important to get ahead of career paths and lower the chances of losing the best and brightest because they are pushed too hard by a hallow system that does not care for its employees. Its human capital is the source of all business success. The loss of its human capital is the actual cost of stress and should be better addressed with thoughtful awareness, firm compassion, and kindness.