Losing Saffie: The agony and loss of a precious little girl who was calling for ‘mum’ when mortally wounded

8-year old Saffie-Rose Roussos killed in Manchester, UK suicide attack

There are few things that I do not believe I could emotionally survive, like the loss of my spouse, employment, and physical and mental vitality. Certainly, the death of a child is among the worst of all human experience for any parent at any age. This story is a heart wrenching, story of depravity and loss. To this day, the loss of one of my children would leave me shattered, angry, and helpless. I hope these individual stories will all resonate with our humility as human beings. 

The chaos and emotion evoked in mass casualty events such as the Manchester, UK bombing, Boston Marathon bombing and the Sandy Hook, CT Elementary School mass shooting leave searing memories that take months to years to process.  We are reminded of the overwhelming sadness we feel when looking at photographs of people we know are no longer with us. The loss of a child is among the more gut wrenching experiences families can ever endure. Meanwhile, members of law enforcement face multiple victims including young children like Saffie-Rose Roussos during large scale mass casualty events that forever leave their marks. I am working with a former paramedic which was dispatched to a motor vehicle crash in 1990 where a family walking across the street was struck by a vehicle being pursued by law enforcement. The first victim he came upon was a 4 year old girl who had obvious signs of death that he cannot shake 30 years on. These next stories are similarly evocative.

 I recently came upon the story of the death of this little girl in Manchester, England. Her name was Saffie-Rose Roussos. From the sound of the description of Saffie, she was a special little girl with an enchanting wit and precocious love of life. All children are special and we recognize the curious joy through which they live each moment and we cherish every nuance. 

On the night of the bombing, Saffie was attending a music concert with her mother and sister when a suicide bomber detonated his bomb in Manchester, UK.  To see Saffie-Rose, one is compelled to ask whether or not there is a higher power? and if so, how could he allow this little girl to be in harms way? Saffie Roussos died on May 17, 2017 asking for her mum and wondering aloud if “she was going to die?” What child should ever ask this question? It evoked in me a tortuous and unthinkable picture of helplessness. But it was far worse for those emergency responders who were called upon to care for Saffie as her life came to an end that night along with the 21 other victims of the terrorist attack. No person who has ever been dispatched to a mass casualty event, like the Manchester bombing, ever comes away without a substantive chink in the veneer of their emotional core. Many in EMS and cops alike quit after mass casualty events.

The story of Saffie-Rose Roussos brings together good and evil and the ruination of one tiny life, one family, one city, one country, and illustrated the abject courage shown by the youngest of 22 victims that night in May, 2017. For this reason, I am sorry for not just the victims of the blast, like Saffie-Rose, and her family. They are devastated to this day, as I would be. But the heroic efforts of first responders who were called upon to provide life saving measures for this child and the hundreds of others wounded in the bombing. Without a doubt, all experience the deep sense of loss and failure at not being able to provide advanced trauma care for Saffie, so that she might live. “Losing a child feels like the ultimate violation of the rules of life” according to HealGrief.org an organization that guides parents through coping with the death of a child. In this case, Saffie is said to have been conscious after becoming injured but could not be saved given the resources available in the chaotic aftermath of the explosion. The protocols call for rapid triage of the scores of people needing help and this is done in the minutes to hours after the event. It is very likely, Saffie did not have the advanced life support needed to manage the hemorrhagic shock she sustained from massive loss of blood. The human body will compensate for loss of blood only until, in shock, it can no longer maintain blood pressure. Survival is measured when fluid can be replaced and loss of blood can be stanched. In children, this compensatory window is much more tenuous and short lived. 

When I worked as a LEO we were taught techniques for trauma intervention that we were told might save our own life or someone else’s life one day in the event of a shooting or massive trauma resulting in life-threatening loss of blood volume. By using a properly place tourniquet, rescuers can stanch blood loss at times of massive trauma such as from a bomb blast that took the life of 8-year old Saffie-Rose Roussos of Leyland, Lancashire in UK. Saffie was killed while attending a concert in Manchester, England in May, 2017. She was the youngest of 22 people killed on the night of May 17, 2017 when a suicide bomber Salman Abedi blew himself up in the lobby of a Manchester concert venue. Terrorism. 

“Medically trained people were with her. And she was asking for help. She knew what was happening. And she bled to death.” BBC 2021. “How do we carry on living with this information? How can we carry on breathing with this information?” asked Saffie Roussos’s father Andrew Roussos. BBC Judith Mortiz report January 17, 2021

BBC Judith Mortiz report January 17, 2021

Saffie’s father Andrew described his described his daughter as a “perfect, precious, beautiful daughter” who “melted people’s hearts” with those big brown eyes,” adding: “It’s like the best artists got together and drew her from top to toe.” according to a story in the BBC that was published during the public inquiry into the bombing last year. It is likely that the Roussos family is feeling the injustice of Saffie’s death. Anger is part of loss and healing and often is unresolved years after the traumatic loss of a child. Especially given the despicable nature of what caused Saffie to become gravely injured.

 All bereaved parents lose a part of themselves and often require months or years to understand the extent of their grief and anger.

“I did die that day, inside I’m dead. My heart is so heavy, it weighs me down” said Lisa Roussos, Saffie’s mum, now 3 years on. The Roussos family feels the loss of Saffie-Rose every day. 

Lisa Roussos

The immensity of traumatic loss was never more palpable than in 2012 when the Sandy Hook Elementary School in Newtown, CT came under attack by 20-year old Adam Lanza. Lanza first killed his mother with whom he lived and next drove to the largely unprotected elementary school and opened fire, killing 20 first-grade children and 6 adults trying to protect them.

Adam Lanza, 20, committed one of the most hideous acts of murder in history and is forever described as pure evil. Yet he was evaluated at the Yale University Child Study Center in New Haven. He was seen by a clinical psychiatrist, the report states. Ostensibly, the evaluation “purportedly to determine if Lanza had Obsessive Compulsive Disorder in the context of a putative diagnosis of Asperger Syndrome” in a piece written by Aaron Katersky and Susanna Kim in 2014 about the Newtown Massacre. Adam Lanza’s own father said “you cannot get any more evil” when talking about his son in the months after the shooting. Lanza openly wished that his son had never been born, raising an ironic specter between the loss of a child and being unable to love a child who commits unthinkable violence and died in the process. What possible conciliation may be find in his public statements months after the massacre? There is no denying that the Newtown shooting is among the most horrific and despicable violent crimes of the 21st century. No one will ever forget that December morning and the disbelief and horror it instilled. Other acts of violence toward children are documented. This is by no means a complete chronology.  

Perhaps the greatest sporting event in the United States takes place every April, ending on Boylston Street in Boston, Massachusetts. Martin Richard, 8, a child watching the Boston Marathon in 2013 was killed by a pressure cooker bomb filled with ball bearings, marbles and other shrapnel that was a homemade bomb made to kill and maim unsuspecting families watching the annual running event. Hundreds lost arms and legs in the two bomb explosions. 

Martin Richard, age 8

Martin Richard was a special child.  He is not shown in these bombing photographs. His parents have gone on to honor him with annual community events geared toward raising funds for parks and other community projects. In all, over 300 people were injured in addition to the initial 3 people who died in the bombing – including Martin. “The minute the defendant fades from our newspapers and TV screens is the minute we begin the process of rebuilding our lives and our family.” according to a Richard family statement in the Boston Globe as the Marathon bomber Dzhokhar Tsarnaev was being tried for the murder of Martin and 2 others on Patriot’s Day in 2013. For their part, the Martin family spoke out against the death penalty which was handed down to the surviving marathon bomber who was captured in Watertown, MA after a 4 day manhunt just a few miles from where they murdered MIT Police Officer Sean Collier in their effort to escape. 

We are all enormously impacted by events such as these and are left feeling sickened by the shear numbers of injuries and deaths.  Saffie-Rose Roussos, Martin Richard, and 20 kids at Sandy Hook Elementary School, 17 teens at Stoneman Douglas HS, and 32 students and faculty at Virginia Tech were all victims of violence and we should never forget these events and so many more, in human history.  The families remember the names and the horrors of the day.  The sadness of these losses makes our heart’s bleed and ache for all those who have lost a loved one to violence.  Even when you are the angry parent of a child you wish had never been born, a further violation of the rules of life.  No person who has ever been dispatched to a mass casualty event, like the Manchester bombing, ever comes away without a substantive chink in the veneer of their emotional core.

___________________________________________

AARON KATERSKY and SUSANNA KIM (2014) 5 Disturbing Things We Learned Today About Sandy Hook Shooter Adam Lanza. November 21, 2014

Family Of Martin Richard Opposed Death Penalty For Dzhokhar Tsarnaev, 2015. CBS TV Boston TV July 31, 2020.

Harlem domestic violence homicide calls for transparent psychological autopsy

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 all the while a pandemic ravages the city in which they live. Michael Sefton, Ph.D. Direct Decision Institute, Inc.

The recent domestic violence homicide in Harlem raises the specter of an essential city worker who killed his sister-in-law while his wife called for help. The police stopped the attack resulting in the death of Ubaldo Gomez but not before he shot and stabbed a women in the head with a kitchen knife. The fact is that domestic violence has increased during the pandemic as it does at other of life’s stress points. Did the fact that the alleged murderer was an MTA employee considered to be “essential personnel” have an impact on his mental health that may have been foreseen? What role, if any, did his role as an auxiliary police officer for the NYPD have in the terminal event? A psychological autopsy would answers these questions and establish a worst case scenario of frontline exposure to trauma and possibly offer insight into underlying history that may have been anticipated and stopped. Certainly the hierarchy at 1 Police Plaza will have an interest in this case. The Corona virus has added to risk of DV and DHV.

For too many women who are abused repeatedly during times of crisis there is no place to run and no one to keep them safe. Orders of protection are ineffective and without GPS monitoring and they are nearly impossible to enforce. In a 2011 domestic violence homicide in Maine, the protective order was violated 4 times by Steven Lake who killed his wife and children in Dexter before killing himself in June 2011. That alone was grounds to hold Lake without bail. No police agency removed access to his collection of over twenty firearms. The scene diagrams illustrate how Lake was armed with two firearms and a hunting knife. He murdered his children while forcing his estranged intimate partner to watch. It was thought that he planned a murder spree and he left 9 suicide notes. The final despicable act, as police arrived, was to attempt to light the bodies on fire.

In general, there is little interest in such a comprehensive post hoc psychological examination because there is no pending prosecution. Nevertheless, a psychological autopsy conducted on Lake in the Fall of 2011 revealed a clear timeline littered with red flag warnings that were missed or ignored. The research conducted in 2011 was done pro bono. It undertook over 200 hours of interviews and presented the Domestic Violence Review Board with over 50 recommendations for reducing high rates of domestic violence homicide in Maine (Allanach et al. 2011). The medical autopsy editorialized the case in its final report:

“Despite receiving some mental health counseling it is apparent, in retrospect that the degree of violence and anger possessed by the abuser was not realized.”                                                            Chief, Maine State Medical Examiner

This latest case in point involved an estranged wife, her sister, and the building manager in Harlem. The three were having dinner when someone armed with a firearm broke into the apartment. It was the estranged husband of one of the women. He was wearing his Metropolitan Transportation Authority uniform, and he had a gun according to the NY Post reports. In the meantime we have been told that the perpetrator was an auxiliary police officer and was licensed to carry a firearm. What triggered this paroxysmal violence? If it was foreseeable, then Mr Gomez should not have had access to his firearm.The psychological autopsy will address prior history of intimate partner violence, protection orders in place, work-related stress, recent health concerns related to the corona virus and Mr Gomez trauma exposure history, and his mental health in the days before the murder. 

Police officials said the transit worker, Ubaldo Gomez, shot his sister-in-law and stabbed her in the head with a knife, while his wife reached out for help. When Gomez refused to drop a 12-inch kitchen knife and tried again to stab the man, a police sergeant opened fire, killing him. 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. A family member of Gomez suggested “he had some mental issue, something happened. He was always working day and night. He barely slept. He worked.” as quoted in the NY Post. Whether this duplicity and denial stems from cultural beliefs about the supposed “privacy” of DV, society must change the way in which law enforcement manages these cases. The buy-in from police, legislators, judges, probation, and the public-at large 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 (Sefton, 2019).

Family members who may be in the crosshairs of these insidious events often see but lack the knowledge to stop the emotional and behavioral kinetics once they start. The fear of being murdered by an intimate partner creates emotional paralysis. In a large percentage of DV occurrences, financial and self-image influences as well as outright fear of the abuser by the victim limit moves toward safety. Therefore, a continuum of interagency cooperation is needed to effectively measure risk and understand the pre-incident red flags that are common manifestations of abuse and often forecast terminal violence, all of which occurred in this case. As the totality of these red flags comes into focus it becomes incumbent upon each of us to take action to prevent domestic violence threats from becoming reality (Allanach, et al. 2011).

It would seem to be vitally important that a transparent psychological autopsy be initiated to gain an understanding of the factual behavior that was observable and measurable in the days leading up to the murder especially given the likely unintended victim. Preliminary reports described Gomez as having a pattern of pathological jealousy and victim stalking. For her part, Gomez’ wife Glorys Dominguez called for help in the weeks prior to the terminal event seeking help.

Allanach, RA, Gagan, BF, Loughlin, J, Sefton, MS, (2011). The Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide and Suicide. Presented to the Domestic Violence Review Board, November 11, 2011

Sefton, M (2019) Violence prediction: Keeping the radar sites on those who would do us harm. Blog post https://wordpress.com/block-editor/post/msefton.wordpress.com/5012 taken May 23, 2020.

Sheehan, K, Moore, T. Woods, A. NY Post May 21, 2020 https://nypost.com/2020/05/21/man-killed-in-nyc-police-involved-shooting-was-auxiliary-cop/?

Gender in peril

There are places in the world where intimate partner violence is pervasive. so pervasive that it Places the opposite gender in peril for 50% of the poor Places like Russia, Saudi Arabia, France, Egypt, and the United States have excessive rates of domestic violence and domestic violence homicide. This week in Russia, three sisters await trial for the murder of their physically and sexually abusive father. He was murdered while he slept. In spite of having first-hand audio of his abuse the three young women face over 10 years in prison for the crime

While France has a progressive reputation and pushes for women’s rights around the world, it has among the highest rates in Europe of domestic violence, in part because of poor police response to reports of abuse. Many of the women killed this year had previously sought help from police.

Violence against women is a costly and pervasive public health problem and a violation of human rights according to a 2010 paper by the Population Research Bureau. “In Egypt, a third of women are physically abused by their husbands,” according to the 2005 Egypt Demographic and Health Survey (DHS). “Most victims suffer silently and don’t seek help to prevent or stop the violence because they think it is part of life or they are embarrassed by the abuse.” 

It is like that here in the U.S. as well. Victims undergo unbearable pressure to anticipate what triggers the violence they experience. Substance abuse adds to the unpredictable nature of the perpetrators. In some rural communities in Egypt and elsewhere, honor killings remain taboo and are often minimized as a “family matter”. When a woman falls in love with a man of a different religion she may face honor killing by her father or oldest brother who feels duty bound to revenge the dishonor brought by such behaviors. This is a significant problem here in the United Stages as well. In a recent article, a man in his taxi cab ran over his wife because he had a dream she was being unfaithful to him. There are over 25 honor killings estimated annually here in the U.S.

These are not isolated incident from third world countries. While I was working in law enforcement, one victim said to me that “she was beaten by her jealous husband for taking too long in the voting booth.” It was unacceptable to him that she visit with friends and neighbors she encountered while in line to cast her vote. He called her on the cell phone three times in 30 minutes which illustrates the coercive behavior and control seeking put upon victims of intimate partner abuse.

In the French Republic, French film and TV stars joined abuse victims and activists calling for an end to “femicide.” Many held banners reading “Sick of Rape.” Like many developed countries there is an engrained denial and secrecy about spousal abuse including rape. In parts of Africa, including Kenya, Tazania, and South Africa, domestic violence may reach 50 percent of girls over age 15. These figure illustrate the problem of gender inequality in the developing countries alike.

The protest in the French capital came on the U.N.’s International Day for the Elimination of Violence Against Women and is aimed at pressuring the French government before it unveils new measures Monday to tackle the problem. A shift in egalitarian gender roles will take generations to take hold. Meanwhile, protection of girls and women should include safety planning, early intervention in public education, greater police response to physical violence, and a zero tolerance policy for violating an order of protection.

Domestic violence is a major cause of disability and death among women worldwide, and puts women at a higher risk for unintended pregnancies and sexually transmitted infections, including HIV/AIDS. An undeniable double standard exists across the world when it comes to sexual violence and male infidelity. The incidence of honor killing remains a despicable happenstance in India, Pakistan, Turkey and Egypt and 5000 innocent girls annually.

The proposed intervention measures are expected to include seizing firearms from people suspected of domestic violence and prioritizing police training so they won’t brush off women’s complaints as a private affair. In late November, Time Magazine’s Angela Charleton featured a profile of intimate partner violence that is worth the read . However, countries like France, Saudia Arabia, and Egypt have a low rate of gun ownership so further study must but undertaken to understand the secret narrative that threatens an entire gender.

“…Such are the places where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world,” said Eleanor Roosevelt.

More than ever women around the globe are now shouting out in private and public spaces, regardless of the possible backlash, “I am equal!”

“The term femicide was first coined in the 1970s to refer to gender-related killings. Femicide is not recognized in the French criminal code, but Marlène Schiappa, the junior minister for gender equality, said the recognition would be discussed in the coming weeks” described Laura Fourquet in a September 2019 NY Times article on the topic

PRB. (2010). Domestic Violence High in Egypt, Affecting Women’s Reproductive Health taken November 25,2019.

Investigating domestic violence, predicting danger, and containing the anger

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Domestic violence homicide results when victims decide to move on with their lives and inform a jealous, insecure spouse that they no longer want a relationship. October is Domestic Violence Awareness month. The risk is greatest when victims decide to leave. At first glance one might say “Lots of people break up and do not murder their spouse and family” according to Michael Sefton shown in the photo on the left. That is a fair statement but it happens enough in the United States and elsewhere that it must be considered. Last week in Massachusetts a family was murdered because one spouse asked to be let go and people were stunned that they saw nothing to warn them of what was brewing.

“Domestic violence is not random and unpredictable. There are red flags that trigger an emotional undulation that bears energy like the movement of tectonic plates beneath the sea.” according to Michael Sefton (2016).

At what point does a potential begin to wonder whether she and her children are safe? We are lead to believe that abusive intimate partners cannot be held in jail unless they are in violation of an order of protection, AKA: restraining order. Time and again, violent and abusive partners stalk and ignore orders of protection – especially using social media tracking software and trolling social media sites like Facebook, Instagram, and What’sAp. It is all about control and instilling fear.

Restraining order’s are authorized by a district court judge who is on call night and day. They are not authorized unless substantial threat to the victim exists.  These orders are carefully crafted by investigating police officers whose reports highlight the exact nature of the violence and the reason the victim needs protection. “Protection orders are offered to the victim after the first sign of physical violence. It has been espoused that the police are not called until after the 6th or 7th episode of domestic violence” according to Sefton, 2016.  DV is a secret affair between members of a family who are often ashamed or embarrassed to come forward for help often until things gradually get worse – sometimes years into a pattern of violent dysfunction.

Research is clear that separating spouses for the night does not positively impact the level aggression and risk in the household as much as the formal arrest of the aggressor.  What usually happens is the police break up the fighting couple by sending the aggressor off to the home of a friend or family member – less often to jail unless there are obvious signs of abuse. Arrest is mandated by law when physical signs of abuse are apparent. It has become all too often the case that hindsight – taken seriously – may have saved a life. It is when they are attempting to leave that abuse victims are at greatest risk of death due to domestic violence as in the case of Amy Lake, a victim of domestic violence homicide whose case was carefully studied in the Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide (Allanach, et. al. 2011) that occurred in June 2011. Lake’s husband and murderer was heard to state that “if you ever try to leave me I will kill you”. 

In research conducted by this author and colleagues we learned that as soon as police leave the scene the risk for violence is increased. We interviewed a man who served 18 years for the murder of his wife and he described in vivid detail how he used nonverbal coercion to manipulate his wife while being interviewed by sheriff’s deputies in Maine. He admitted that as soon as the police were out of the driveway he strangled and drowned his wife for calling them.

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 unwitting duplicity stems from the cultural belief that what happens behind closed doors is “nobody’s business” or the conscious result of intimidation should not change the law enforcement intervention in these cases. Early incarceration provides access to a viable safety plan for potential victims and in some cases, will instill a desire for change in the violent partner. In the meantime, substantive 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 and violent partners to be contained. 


Allanach, RA, Gagan, BF, Loughlin, J, Sefton, MS, (2011). The Psychological Autopsy of the Dexter, Maine Domestic Violence Homicide and Suicide. Presented to the Domestic Violence Review Board, November 11, 2011
Sefton, M (2016). https://msefton.wordpress.com/2016/07/20/the-psychology-of-bail-and-alternatives-to-incarceration/ Blog post: Taken October 9, 2019

Domestic Violence Awareness October 2019

Today, as we read about another family destroyed in domestic conflict here in the Boston area, I can imagine the images seared into the eyes of those who responded to the call finding 3 children dead along with their parents.  The Abington, MA police chief described the death scene in the Boston Globe as “something unimaginable”.  Some people are better equipped to handle horrific cases where death is on public display – perhaps even today’s horrific domestic terror attack here in Massachusetts. Others become impacted by the recurring images and how they are all the same after a while. Too many calls resonate with the officer’s personal well-being and safety leaving him or her constantly on guard. But over time – even the neurosurgeon – will become harmed by embitterment when his learned craft can do nothing to fix a leaking brain and his patient dies. Perhaps he feels that with updated equipment and training he may have been able to save the life?

This is what LEO’s face.  A loss of purpose in life and the unmitigated stench of a decomposing society over which they have no control and, too often, a internal command structure who does not know what it is like to be in a lonely barn at 2 AM and see the hanged remains of someone who, after 5 hours, would leave even the most hardened of us on our knees and wanting out.

October is Domestic Violence Awareness month. Cases such as today’s Abington murders often leave emotional tracers that can grow a database which LEO’s can utilize when investigating calls for service. Lives will be saved when society takes a closer look at red flag violence – these are the pre-incident indicators that violence and domestic violence homicide are at highest risk (Sefton 2018). Some behaviors are secretly guarded among intimate partners – as “nobody’s business”. Police officers must inquire and listen carefully to the victim who firmly believes her spouse intends to kill her. The underpinnings of her fear are generally spot on as in the case I that investigated in Maine using the psychological autopsy in 2012. For the cases with high likelihood of domestic violence homicide, greater care for victims must be initiated from the beginning before it is too late. It can be a hard sell, I know, but the reports we write must also be “spot on” when it comes to dangerousness, risk, and containment.

Sefton, M (2018) Violence prediction: Keeping the radar sites on those who would do us harm. Blog post: https://msefton.wordpress.com/2018/05/20/violence-prediction-keeping-the-radar-sites-on-those-who-would-do-us-harm/ Taken October 8, 2019

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

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

Orders of Protection – Underpinning the Good Safety Plan

Many cases of domestic violence (DV) result in an order of protection being issued.  The protection order is based upon the personal report of the victim which is substantiated by police report and perceived risk and may be implemented 24 hours a day. The approval of a court judge or magistrate  is generally required for its issuance. This order requires that the abuser “stay away” from the victim and is based on the totality of circumstances presented to a district or family court judge at the time of arrest.  Police officers use report narratives to construct the details of the protection from abuse (PFA) or restraining order (RO).  Different states utilize differing nomenclature to define what is the substantive court directive that provides the underpinning of a victim safety plan. They are granted on an emergency basis for 24-48 hours and are sustained for up to 6-12 months following a review by the court.
What happens between the time the initial PFA is granted and when the victim is expected in court to chronicle his or her intimate partner violence is often a mystery.  Victims often fail to show for the initial hearing that allows the initial PFO to go away.  Why? In some cases they become intimidated by their violent spouse who has made promises to straighten up and fly right. This is the core dynamic of intimate partner violence and it is well-described in these pages and elsewhere.
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“Domestic violence is not random and unpredictable. There are red flags that trigger an emotional undulation that bears energy like the movement of tectonic plates beneath the sea.” according to Michael Sefton (2016).
In all states a protection order requires that no contact be made via telephone, through acquaintances, text messaging, or in person.  By violating a PFO requires that law enforcement make an arrest of the person in violation. This information becomes the grist of the underlying risk to the victim.  The marginalized abuser sometimes becomes obsessed with his loss of control and may take to cyber stalking in order to keep tabs on his partner.  As just mentioned any violation of the protection order renders the abuser subject to arrest and should require a high amount of bail before he is released from jail.  This is rarely the circumstance as violators easily make bail ironically blaming the victim as the root cause of the marital strain. These are the hubristic remarks of building tension and frustration described in the cycle of violence.
It is important to note that social media has given abusers extra means to “creep” into the privacy of estranged spouses without detection.  It played a significant role in the domestic violence homicide according to the psychological autopsy report of the Dexter, Maine homicide/suicide in 2011 (Allanach, R. et al., 2011).  Social media may also be used to intimidate and unfairly influence friends and family.
Bail amounts differ from state to state and sometimes even from county to county within a single state. The amount of bail should be high enough to inconvenience and deter the abuser from being tempted to coerce and manipulate his victim and family.  Most often the bail amount is low and inconsequential to the abuser who often has no criminal record.  However, changes in bail conditions and risk assessment must be integrated into orders of protection – especially when a single abuser has had more than one PFO filed against him. This sets the stage for measuring the degree of violence one might expect as the abuser becomes further marginalized and feels his control over the victim begin to collapse.  “Someone with a history, particularly a continuing history of violence, can be presumed to be dangerous.” according to Frederick Neuman, MD.
The order of protection belies the fundamental safety plan that is crafted by police and domestic violence experts and is designed to prevent further victim injury or death.

Sefton, M. (2016) Blog post: DVH in MA: 4 year old child begs his father.  https://msefton.wordpress.com/2016/10/02/dvh-in-ma-4-year-old-child-begs-father-not-to-murder-his-mother/. Taken 8-20-2018

Allanach R. et al., (2011). Psychological Autopsy of June 13, 2011, Dexter, Maine Domestic Violence Homicides and Suicide: Final Report 39 (Nov. 28, 2011), http://pinetreewatchdog.org/files/2011/12/Dexter-DVH-Psychological-Autopsy-Final-Report-112811-111.pdf.

Neuman, F. (2012) Is it possible to predict violent behavior? https://www.psychologytoday.com/au/blog/fighting-fear/201212/is-it-possible-predict-violent-behavior?collection=113345

The Agony of Releasing a Murderer

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Albert Flick is led out of the courtroom following his initial appearance in the Androscoggin County Court house in Auburn Wednesday morning. (Russ Dillingham/Sun Journal)
 
There is no pleasure when a parole board must decide on whether to release or not a man who violently murdered his wife. Especially the case of Albert Flick – arrested in Westbrook, Maine in 1979 and convicted of the brutal murder of his wife. Mr. Flick asked not to be released perhaps out of some inner sense of foreboding and primal instinct of things to come – if such a thing exists among killers. He is a wolf in sheep’s clothing -underneath he is ravenous.
Fast forward to Sunday July 15, 2018 Albert Flick who had been released from jail for committing the violent murder of his wife again killed a woman with whom he had an infatuation. He had been stalking her for weeks prior to her murder.  He followed she and her two little boys from place to place in Lewiston, Maine.  She had an inner sense that he was dangerous but was fearful of going to the police at the time of her death. Yet she had spoken to friends about her worries. What may have prevented the victim from calling police when she first noticed Mr. Flick was stalking her? Why was she fearful of the very people charged with preventing violence? What may have happened if she had notified the officer on her beat? Or a police officer walking in her neighborhood?
The answer is that Mr. Flick would have had a visitor that in all likelihood would derail his infatuating behavior. If not, he would have had is parole revoked as it should have rightfully been done.  I was a police officer in Westbrook, Maine when Flick murdered his wife in 1979. I was on duty when the call came in to the station but as a junior officer was not dispatched to the scene. The scene was horrific even by todays standards of violence. Nevertheless, the case is well know to me as I later worked closely with the arresting investigator Ron Allanach and his partner Wayne Syphers – both exemplary career law enforcement officers.  Ron went on to earn his doctorate in counseling and was Chief of Police for 8 years at the end of his career in Westbrook. Both men were instrumental at convicting Albert Flick.  Flick is shown in the 1979 photograph below being taken to court in Portland by Detective Syphers who made a heroic effort to save the life of the victim. The female victim ultimately died in his arms in 1979.  Albert Flick should have remained in jail for life and many in law enforcement who remember the case are agonizing over  his release after serving 20 years.
“Clearly, probation is not working. … At this point, I just don’t know what else to do. I think there’s a huge safety risk to women and society when it comes to Mr. Flick.” Prosecutor Katherine Tierney, 2010
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Albert Flick with Det. Wayne Syphers (right) at Cumberland County, Maine trial in 1979
Flick was known for a proclivity for violence against women. After being released from his murder conviction Flick was arrested for chasing an intimate partner with a screw driver with intent to due harm. There would be other charges and other arrests that were red flags for the underlying anger he felt toward woman.  A group of us will reach out to Mr. Flick in the coming months for a sit down.
The female victim, Kimberly Dobbie, in this 2018 Lewiston, Maine case had felt threatened by Flick. Her instincts were keen as it related to his potential for violence against her. But she told only her friend and no one else.  She was 30 years his junior and had spurned his love interest. She had twin children who were present during the despicable killing and are traumatized having witnessed their mother’s death. In his book “The Gift of Fear“, Gavin deBecker espoused the value of trusting our primal instincts as they pertain to our personal safety.
Flick had been in and out of prison for crimes involving intimate partner violence and intimidating female witness who were courageous in coming forward against Flick. At some point he himself reported asked to be kept in custody.
“You can’t say that nothing can be done, because nothing will be done,” said Michael Sefton, a former Westbrook police officer who now works in Massachusetts for the New Braintree Police Department.
Keep Me Current, 2011
The judge who authorized Flick’s release is retired from the bench but his stated opinion for releasing Flick was that “he had aged-out and was no longer criminally inclined” yet he himself asked to remain behind bars.  Why?
Technically this was true, Flick no longer fit the stereotypic picture of a repeat murderer.  He was older and physically growing infirm.  Most men who commit domestic violence homicide do not recidivate once released from prison especially those over the age of 70.  While researching a case of family murder-suicide, I have spoken to a man who served 18 years for strangling his wife who was released and became a model citizen and amateur photographer. He published a book of his photographs that were quite good – even sensitive.  This man was not a risk and was somewhat younger than Flick.  So by all reasonable judicial standards Flick was considered a low-risk release. Probation would keep him in line.  Not so fast, information was available from his first release that included repeated violence against women raising a red flag of potential violence in the future.  Plus the horrific nature of the stabbing murder in 1979 was not a factor in the release conditions once he had served his time. Finally, there is also information that suggested that Mr. Flick did not seek his own release as reported above. He may have been institutionalized with the simmering anger he himself expected would again leach from his despicable soul.

Desperate Victim’s plea for help

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Victim passed this note to Veterinarian staff – Photo VCSD

WESTBOROUGH, MA  June 6, 2018 A case of domestic violence unfolded on Memorial Day weekend in Volusia County, Florida when a female victim was being held by her live-in boyfriend. The note implores staff members of the DeLand Animal Hospital to call police because her partner was threatening her and had a gun.  These kinds of desperate measures occur occasionally and are dramatic and newsworthy. The staff at the DeLand Animal Hospital are to be commended.  But there are intimate partners everywhere who live in fear just as the indomitable victim who passed this note had been living.

“From coast to coast LEO’s are caught in this moth eaten, patchwork system that lacks resources for both the mentally ill and those addicted to alcohol and drugs.” Michael Sefton, Ph.D. 2018

As the story goes, her boyfriend had beaten her and was refusing to allow her to leave the couple’s home.  To her credit (perhaps life saving) she convinced the man that she needed to bring the dog to the veterinarian.  He agreed but would not allow her to go without him. Upon arrival this note was passed to a member of the hospital staff who knew just what to do.  The man is now behind bars being held without bail – manning his defense.

There is a consensus among experts in domestic violence that victims are abused multiple times – often threatened with death – before they call police for help.

As a society, more needs to be done to fill-in the holes in the system designed to keep families safe.  Safety plans and orders of protection are not enough.  From coast to coast LEO’s are caught in this moth eaten, patchwork system that lacks resources for both the mentally ill and those addicted to alcohol and drugs. The holes in the system allow for violence prone individuals to allude police and coerce victims into silence.  But every once in a while, a silent victim writes a life saving note and gives it to the right person.

Domestic violence happens in family systems that are secretive, chaotic, and dysfunctional.  This lifestyle pushes them into the margins of society – often detached from the communities in which they live.

The abusive spouse makes his efforts known within the system by his barbaric authoritarian demands.  He keeps his spouse isolated as a way of controlling and manipulating whatever truth exists among these disparate family members.  The consequence of this isolation leaves women without a sense of “self” – alone an emotional orphan vulnerable to his threat of abandonment and annihilation.

Successful intervention for these families must slowly bring them back from the margins into the social milieu. Arguably, the resistance to this is so intense that the violent spouse will pull up stakes and move his family at the first sign of public scrutiny.

Police officers are regarded as the front line first responders to family conflict and DV.  For better or worse, the police have an opportunity to effect change whenever they enter into the domestic foray.  This affords them a window into the chaos and the opportunity to bring calm to crisis.  In many cases, the correct response to intimate partner violence should include aftermath intervention when the dust has settled from the crisis that brought police to this threshold.  When this is done it establishes a baseline of trust, empathy, and resilience.

Community policing has long espoused the partnership between police and citizens.  The positive benefits to this create bridges between the two that may benefit officers at times of need – including the de facto extra set of eyes when serious crimes are reported.  But the model goes two ways and requires that police return to their calls and establish protocols for defusing future events meanwhile processing and understanding the current actions of recent police encounters. When done effectively the most difficult families may be kept off the police radar screens for longer periods of time that can be a good thing when it comes to manpower deployment and officer safety.