Police officer behavior

On Police Identification of the mentally abnormal

Michael Sefton, Ph.D. 12-step programs, AA, Alcoholism, crisis intervention, Health Psychology, Human Behavior, Police officer behavior, psychological relevence , , , , , , , , ,
How to recognizeWestborough, The police-mental health interaction continues to be one that neither party exhibit great confidence nor take great pride in.  Myths abound about how to treat those so afflicted – especially among law enforcement personnel. I have provided classes for LEO’s and generally they are not well attended and tend to bore the average officer. In Maine, LEO’s are required to have regular training in working with the mentally ill in order to maintain their LEO credentials. Other states in New England have similar requirements and now focus on psychological first aid and deescalation protocols.  I have presented on topics of assessment of risk and dangerousness with some success.  In- service training must be short and to the point or students will quickly lose interest.
The photograph above shows the cover of a guide book first written in 1954 that was instructional for police officers.  It was written to teach the law enforcement officers of the day to recognize signs of mental illness then defined as “abnormal people”.  It was written by 2 Louisiana State University psychologists and first used by a police agencies in the late 1950’s.  I have been trying to find a copy of this early version that was re-published in 1979 and now costs over $100.  It was written because police officers needed training and experience identifying features of psychiatric emergency. This was thought to reduce the uncertainty, fear and confusion around handling these cases by providing education including signs and symptoms.
After nearly 60 years, law enforcement is not significantly closer to understanding the mentally ill than they were in 1954. A colleague, police psychologist Leo Polizoti, Ph.D. has an original copy of this booklet although I have not seen it as yet.  Dr. Polizoti provides consultation to law enforcement, officer selection interviews, and teaches a proactive approach psychological resilience to police officers that can afford them greater career satisfaction, professionalism, and longevity. Dr. Polizoti is tasked with supporting officers who are exposed to the daily grind of violence, suicide, homelessness, and its cumulative impact on a cop’s personal narrative.  His model suggests a fundamental change in how police officers interpret their experiences over time and acceptance of what cannot change and healthy adaptation.  He is a great asset to the Central Massachusetts community and across New England and espouses a model of stress resistance through adaptation.
“In 1954, the National Association for Mental Health first issued the book “How To Recognize and Handle Abnormal People: A Manual for the Police Officer.” Included were techniques on dealing with all kinds of “abnormal persons,” from psychopaths, drug addicts, and the “mentally retarded” to civil protestors and those involved in family disturbances.”  Posted by David Pescovitz, 2015
Text from 1954 How To Recognize and Handle Abnormal People: A Manual for the Police Officer is provided below.  It points out many of the outward signs of disturbed thinking often an underlying feature of those with mental illness – in this case something called ideas of reference. These signs are common among persons with early paranoia and are sometimes missed – even by members of the immediate family. This is still a common symptom of mental illness today and is considered to be the prodrome to a more serious loss of contact with reality. Ultimately, it comes down to who is at more risk for violence?  And how can we be sure?
It takes a healthy and educated police officer to observe, understand, and control unpredictable situations. Officers are required to adapt to the demands of individual calls for service.  A colleague Dr. Leo Polizoti has identified a model for coping with the strain of police service.  He cites the importance of avoiding apathy, withdrawal and bitterness on the job.  “Understanding the 3 C’s of hardiness, Challenge / Commitment and Control will assist officers to manage stress more effectively, resulting in fewer emotional and medical problems. By viewing each new situation as a challenge, instead of a threat, you become committed to that challenge. You can readily see yourself in control and better able to deal with the situation. You will enhance your “hardiness” or resistance to stress” Polizoti, 2018.   
“He may think, for example, that announcements made over the radio have something to do with him personally. He may even hear his name mentioned. These are called ideas of reference which, of course, means that the patient thinks people are referring to him in one way or another. In the beginning, ideas of reference may occur only occasionally, but they gradually become the rule rather than the exception, and finally they may develop into definite delusions of persecution or grandeur.”
The list below are the signs of “abnormal persons” that are printed in the booklet published in 1954:
  • He shows big changes in his behavior.
  • He has strange /losses of memory, such as where he is or what day it is.
  • He thinks people are plotting against him, or has grand ideas about himself.
  • He talks to himself or hears voices.
  • He thinks people are watching him or talking about him.
  • He sees visions or smells strange odors or has peculiar tastes.
  • He has complaints of bodily ailments that are not possible.
  • He behaves in a way which is dangerous to himself or others.
Interestingly, the bullet points above remain accurate today with the understanding that too many individuals suffering with a major mental illness also have substance abuse/dependence.  It is this fact that confounds most LEO – mentally ill encounters.  “Beyond the rigors of police work, lie the demands of a personal life, specifically a wife or husband and children. Maintaining a healthy and happy family life is on its own a demanding responsibility. Add these powerful life stressors and demands to the burdens of police work and  an officer may begin to feel the weight upon his or her shoulders.” Polizotti, 2018.  Emotional and physical strength and endurance requires hardiness that comes from personal responsibility and comittment to excellence and peak performance.  Greater focus on sobriety – including opioid and alcohol dependence is essential. If this can be maintained mental illness may remit to the extent that subjects can remain in the community. Programs like A.A., N.A., and other 12-step groups are free and often afford subjects great support.  In most cities there are 12-step meetings every day morning, noon and night.  The problem is getting people to realize they have a problem.  Even airports hold A.A. meetings for travelers in need of the 12-steps. We are working on a replacement manual like the one cited in this post.
Polizoti, L. (2018) Personal Life Demands. Presentation – Direct Decision Institute.
How To Recognize and Handle Abnormal People: A Manual for the Police Officer (1954) Matthews, R. M.D. and Rowland, L. Ph.D. NATIONAL ASSOCIATION FOR MENTAL HEALTH, INC. 10 COLUMBUS CIRCLE, NEW YORK 19, N. Y.

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Profiling a package bomber

Michael Sefton, Ph.D. Austin bomber profile, career criminal, Childhood violence, Dangerousness assessment, Human Behavior, Police officer behavior, psychological relevence , , , , ,
OKC bombing
 

Alfred P. Murrah Federal Building in downtown Oklahoma City

 

WESTBOROUGH, MA March 22, 2018 The recent spate of explosive attacks on apparently random victims continues as of this blog post.  People around the world are speculating about the psychological underpinning of a person or persons who can create a bomb and deliver it to some intended victim without being caught.  The explosion at the FedEx depot is something new as compared to the first 4 blasts.  So far 2 victims have been killed by the bombs.  The initial victims were African-American and Latino raising the specter of the bombs being a hate crime.

What does the bomb say about the bomb maker? Bomb construction thought to be a characteristic of underlying ideology and may be linked to motivation.  Certainly explosive devices range in their level of technology and sophistication.  In 1995 Timothy McVeigh created a powerful bomb made out of a deadly cocktail of agricultural fertilizer, diesel fuel, and other chemicals that killed 168 people at the Murrah Federal Building in OKC including many children at a nearby pre-school.

The type of bomb in Austin, TX has not been described by police or federal agents but the frequency of the attacks is unprecedented.  It may suggest that more than one individual is working to produce the explosives and make deliveries or the devices were constructed to stockpile before deliveries were made. The bomber likely lives alone or has a shop where the devices and their components are stored for assembly. His keen interest is in making people afraid and keeping a city in lock down. McVeigh was a former munitions soldier in the Army and may have learned his technique in the process of training with the U.S. Army.

If the Austin devices are the work of a single serial bomber than the frequency and recent change in method of detonation raise the bar in terms of sophistication of delivery but the risk of being caught or making a mistake may also be accentuated.  The police chief in Austin reportedly said that by using FedEx for shipping the explosive the likelihood of capture in short order was increased. An image was obtained of a man at FedEx that eventually became a person of interest.

The person who is behind this seige is likely an angry and detached with few friends.  Being marginalized lends both to his stealth and fuels his anger and resentment.  He may be suicidal and ultimately he final blast is to be part of his exit plan. He quite likely enjoys the sadistic control and media attention he is getting.

The fact that there are so few deaths – versus a massive splash event is not quite clear.  It speaks to ambiguous planning and perhaps unclear motive and may signal the growing disorganization associated with his terminal event. Additional personality features are uncovered with each action.  These are kept from the public domain.  My analyses are conjectural.

Michael Sefton, Ph.D.

From anonymity and stigma grows resilience

Michael Sefton, Ph.D. CIT, DVH, Human Behavior, Police officer behavior, use of force continuum , , , , ,
Today there is still a great deal of stigma associated with reaching out for peer support within police departments. Officers’ fear being misunderstood and seen as weak if they acknowledge their vulnerability years into the job. The blue line bleeds each time an officer takes his or her own life yet the silence within the ranks is stunning. An officer may act heroically in their efforts to save a child who isn’t breathing and fail.  An officer may be first-in to a call for domestic violence homicide and fail.  An officer may be dispatched to a horrific motor vehicle crash and come upon an overturned minivan with a shamble of entrapped human misery and death and still feel a failing.  These events create a chink in the armor and sometimes reveal gaping personal anguish that accumulates over time. The cumulative impact of trauma adds to the layers that belie the outward calm.  As a former police officer there are calls I covered that are painful to this day. Abject failure. Exposure to subclinical, traumatic events takes a toll of both physical health and emotional wellness and can lead to PTSD, secondary traumatic stress disorder, and burn out.
Prevention of law enforcement suicide is paramount.  As recently as early November, 2018 a former police chief died by police assisted suicide killed by his former officers after charging them with a kitchen knife.  And in Baltimore County, MD, School Resource Officer Joseph Comegna, a 21-year veteran of the force, took his own life at his desk in the public school.  “And unlike line-of-duty incidents, which tend to receive a great deal of media coverage, law enforcement suicides rarely get much press, says Al Hernandez, a 35-year veteran of the Fresno Police Department (FPD) in California. Hernandez helps connect officers to mental health care.” according to Jack Crosbie writing in Men’s Health about a suicide death of an NYPD officer who died in early 2018.
The impact of stress on the lives of LEO’s is well known and can have pervasive impact on officer well-being both in and out of uniform.  Hypertension, cardiovascular disease, substance abuse, and depression are just a few of the behavioral health consequences that may result from repeated exposure. Ongoing vulnerability to traumatic events can result in anger, resentment, strong negative emotions, and reactive embitterment that can erode job satisfaction and job performance (Sadulski, 2017). Critical Incidence Stress Debriefing plays an important role for police by helping LEO’s manage their trauma and post-traumatic stress. It should be provided as part of an integrated system of peer support. Most departments have officers trained in CISD whom provide peer support to brother and sister LEO’s who are in crisis. Key among these relationships is the hand-off to mental health professionals when indicated. Peer support is not treatment and the relationship between the peer support and psychological treatment should be clearly defined.
Each of us in law enforcement has a duty to reduce suicide among the men and women in blue whenever possible. This requires a substantive understanding of the risk factors associated with LEO self-destruction. Chief among law enforcement is the camaraderie that bonds officers together during times of stress. Peer support is a key factor in reduced emotional suffering among law enforcement officers. 
Risk factors for suicide increase when the conventional need for belongingness among law enforcement officers which is thwarted by the estrangement or isolation.  This comes with individual officer discipline, e.g. suspension, or some other factor pushing him/her out that can be isolating and evoke feelings of thwarted belongingness according to Thomas Joiner (2009). Social alienation is a powerful emotional dynamic that results from the experience of being estranged from a core group of supportive friends, colleagues, and immediate family. This occurs in many ways including change in social reciprocity and reduced exposure to primary interpersonal ties resulting in powerful feelings of loss and growing belief of being a burden. This may be the result of disciplinary actions toward the officer, on-the-job injury, or departmental requisite following officer-involved use of force. 
Embitterment has large implication on LEO productivity, career satisfaction, job performance, citizen complaints, and officer health. It grows slowly as a function of career experience perceived support, and critical incident debriefing and peer support are vital to officer longevity.  Mentoring in the field and supervisory support reduce officer isolation and sometimes powerful feelings of negativity that can fester over time according to Polizoti, 2018.  Ostensibly, resilience is the opposite of embitterment. Have you ever worked with someone who rolled with the punches – literally and figuratively?  They can have felony cases dismissed in court and remain nonplussed maintaining a positive attitude and a “better luck next time” belief system.  
Lethal Self-Injury – Acquired Ability
The final risk factor involves a gradual desensitization to pain and human suffering according to Joiner (2009). Over time, exposure to repeated violence, homicide, intimate partner violence, and other “salient fearsome experiences”, the self-preservation instinct gradually disintegrates into a residual fearlessness in the face of life threatening danger and an acquired capacity to ignore the horror and humility of violence with a higher tolerance of pain and substantive capacity for suicide (Joiner, 2007).
Joiner believes that the capacity for suicide is acquired over time from the repeated exposure to trauma such that the reaction to horrific traumatic events, e.g. domestic homicide, loses the ability to evoke a normal emotional response and habituates to a decreased emotional reactivity, a higher tolerance for pain, and a fearlessness in the face of death. Given this proclivity toward feeling “numb” in the face of high levels of violence, over time researchers look for protective factors such as reducing isolation and more frequent debriefing after every critical incident rather than wait until LEO coping goes the way of attachment and perceived support. 
References
Sadulski, J. (2017). Promoting Police Resilience through Peer Support. Law Enforcement. Blog post taken November 20, 2018
Joiner, T. (2009). The Interpersonal-Psychological Theory of Suicidal Behavior: Current Empirical Status. Science Briefs, APA, June.
Polizoti, L. (2018) Critical incident resilience training. Personal correspondence, September.
 



Resilence and management of high stress situations

Michael Sefton, Ph.D. Active shooter, CIT, Human Behavior, Police officer behavior , , , , , , , ,
 The likelihood of becoming involved in an on-the-job shooting in one’s career is generally quite low across law enforcement officers in the US and Canada. However, there is a high degree of likelihood of almost daily encounters with high stress calls involving intimate partner violence, substance abuse, children at risk, unbearable human suffering and death.  I recall being involved in a search for a middle age male who did not return home after a night of drinking.  His route typically brought him across an abandoned rail road bridge.  As you might guess he did not make it across the bridge on that cold night instead falling off and drowning. He was found partially submerged and caught on some tree branches visible only by his L.L. Bean jacket which he had bought for those cold walks back from the neighborhood watering hole.  He was known to most of the police officers – two of whom were charged with going out into the river and retrieving his remains.  The body had been in the water about 48 hours.  It was not something I had seen before. I stood by for the retrieval and was involved in the notification.  My first of many.
These kinds of calls stay with you.  Especially early in one’s career.  The response of the family to losing their 50-year old father was especially difficult as he had young children from his second wife.  But I know officers and EMS first responders who have had one
images 2
Boston Police Officers react to Marathon bombing  ABC TV – photo credit
experience after another just like this and worse. A colleague described rolling up a driveway to an open garage and bearing witness to the home owner hanging from a ceiling joist. Suicide. Imagine the psychic imprinting officers experienced responding to recent mass shootings in Las Vegas or to a small church in rural Texas where so many people are killed or maimed and to be unable to stop the bad guy before it all happened. It happens every day it seems.
Here in Boston, 3 people were killed over 300 people were badly injured after two homemade bombs were set off during the Boston Marathon setting the stage for a complete shutdown of the city while area police officers searched for the suspects.  MIT University Police Officer Sean Collier was killed by the bombers while seated in his patrol vehicle on duty 3 days after the bombing.  Within hours a firefight ensued in Watertown, MA as the bombers were found in a hijacked SUV.  The brave officers from Watertown, MA, Boston Police, MBTA Transit Police, and Harvard University PD fought it out for 8 minutes with Dzhokhar Tsarnaev and his brother Tamerlan who was killed in the gun battle and run over by his brother. MBTA officer Richard Donohue was shot during the gunfight nearly losing his life. After a year of rehabilitation he returned to duty and was promoted to sergeant but ultimately could not recover from his wounds and retired in the line of duty. It took extra days and over 1000 police officers to locate the second bomber cowering in the covered boat of a Watertown resident. His image was published in the Boston Herald depicted with the snipers red dot on his forehead.  Citizens applauded law enforcement as they left Watertown on that night.
To survive these incidents one needs to have resilience also known as the psychological resources to process the experience with all of its ugliness and to know that you did what was needed with the training and experience you bring to the job every day.
“By using alcohol to cope instead of resilient thinking one often develops other problems and this can lead ultimately to suicide. Alcohol is often related to suicidal behavior.” according to Leo Polizoti, Ph.D at the Direct Decision Institute in Massachusetts.  
After a stressful event, your body and mind must return to its baseline calm and ready state so that the officer may again activate and serve in whatever capacity is required without the baggage of the calls gone by.  As this “baggage” builds unfettered the likelihood of a decline in officer job performance grows sometimes exponentially.  There should be opportunity and on-going training to process the images in order to put them away and restore emotional equilibrium.  In some department realistic training includes use of simuntions where officers actually shoot their weapons at active shooters during training exercises.  The weapons are full sized handguns fitted with special projectiles that do not cause lethal injuries.  All training is conducted with head and face protection.  Many departments are building resilience training into their recruit academies – no only building physical strength but emotional wellness too.  “Current training teaches officers about biological awareness (bio-awareness) since psychological and physical reactions in the body arise from biological responses to the environment. Mental and physical states don’t happen independently and both must be addressed in reality-based training” Anderson, et. al., 2017.
“When a person encounters a threatening situation, they experience a surge of natural chemicals, such as adrenaline and cortisol. These chemicals allow the body to respond quickly. When this biological threat response is moderate, it enhances performance through more accurate vision, hearing, motor control, and response time. However, when the threat response is severe, the response can negatively affect performance by creating distortions in thinking, vision and hearing, and by increasing motor control problems, which can result in slower reaction times.” Anderson, et. al., 2017
Police in Massachusetts and throughout America are faced with the worst of all human experience.  Arguably, everything from unattended death, domestic violence, child abuse, and a fatal motor vehicle crash may show up on the call board of any dispatcher on any day or night as I posted in May, 2015. In the case of traumatic events – officer safety demands CISD and in the long run physical health and well-being are the underpinnings of a resilient professional who will be there over and again –  when called upon for those once in a lifetime calls that most of us will never have to answer (Sefton, 2015). “Psychological benefits include reducing distress, enhancing confidence in abilities and recognizing psychological responses that need the attention of a mental health professional” Anderson, et. al., 2017.  When necessary police officers undergo critical incident debriefing and peer support. Some benefit has been demonstrated using biofeedback to reduce the trending autonomic arousal through a paced breathing protocol to ameliorate the sympathetic-parasympathetic mismatch that has well described negative impact on physical health, emotional embitterment, and job satisfaction (Sefton, 2017).
“The primary goal of all modalities of biofeedback including physiologic modalities and neurofeedback is to restore the body to its “normal” state of homeostasis.  The process promotes mindfulness and paced breathing to gradually lower respiratory drive, reduce heart rate and blood pressure, and enhance other abnormal physiological readings such as skin conductance, abnormal finger temperature, and elevated electromyography.  It takes practice and understanding of its value.” Sefton Blog post 2017
Ultimately law enforcement and all first responders must be afforded support along with training to adapt to situations most human beings would never choose to confront and do so in a manner that instills personal dignity,  integrity, and continued professionalism.
Polizoti, L. (2017) Psychological Resilience: From Surviving to Thriving in a Law
Enforcement Career. Direct Decision Institute presentation.
Judith Andersen, Ph.D., Harri Gustafsberg, M.A., Peter Collins, M.D., Senior Cst. Steve Poplawski, Bsc., Emma King, M.A., Performing under stress: Evidence-based training for police resilience. RCMP Gazette Magazine Vol. 79, No. 1.
Sefton, M. (2015) Critical Incident Debriefing: The cumulative effects of stress. Blog post: https://msefton.wordpress.com/topics/dv-and-trauma/police-service/critical-incident-debriefing-the-cumulative-effects-of-stress/ Taken 12-30-17.
Sefton, M (2017) Biofeedback: Teaching the body to return to a proper homeostasis. Blog post: concussionmanagement.wordpress.com https://wordpress.com/post/concussionassessment.wordpress.com/3682, taken 12-30-2017

Public Awareness Needed for Meaningful Jail Diversion

Michael Sefton, Ph.D. career criminal, crisis intervention, Dangerousness assessment, domestic violence, DVH, Human Behavior, Police officer behavior , , , , , , ,

teachinginprison

“If mental illness drives the violent behavior than all weapons and substance use must be carefully controlled and eliminated.” Sefton, 2017

Westborough, MA December 21, 2017 Jail diversion is a hot topic across the country even here in Massachusetts. Since July, 2017 the Massachusetts Legislature has passed sweeping changes in the Criminal Justice System.  Locally and across the country, the numbers of persons incarcerated for minor offenses and drug crimes has grown in some cases exponentially. Many of these individuals have mental illness or drug abuse in addition to their criminality. The interaction between poly-substance abuse or dependence and exacerbation of underlying mental health symptoms is complex and multifactorial. The interaction of the two is sometime lethal as reported by the Globe Spotlight team It is 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. In Massachusetts, there is a move away from mandatory minimum sentences for all drug crimes except for those involving the sale and distribution of narcotics. Arguably, the impact on behavioral functioning when persons are gripped with co-occurring illness, such as alcoholism, is a recurrent problem for law enforcement and first responders. I have written about the impact of co-occurring illness such as alcoholism on mental and behavioral health is previously published posts here on Word press Human Behavior (Sefton, 2017). It is difficult to uncover which comes first – the addiction or the diagnosed mental illness and yet these are inextricably linked in terms of the strain on public resources and health risk to those so afflicted. Why is this important?

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 MH advocates insist that with the proper treatment violent police encounters may be reduced and jail diversion may be achieved. The referral and treatment infrastructure needed to provide a continuum of care in this growing population is available in very few places across America.

Yet in places like Bexar County, Texas – including San Antonio and 21 other towns or cities – the county jail population has dropped by over 20 percent as a result of crisis intervention training for police officers and mobile mental health teams to intervene with those in crisis. I have seen this for myself during a visit with the San Antonio Police Department where I rode with two members of the Mental Health Unit – Officers Ernest Stevens and Joseph Smarro. These men are exemplary in their assessment and intervention skill for keeping identified subjects off radar screens and out of the revolving door of the county jail.  It takes ongoing training, medical and psychiatric infrastructure, community compassion, and active engagement with members of the community to fly under the radar and effectively reduce the jail population. When necessary those most in need must have 24-hour availability for detoxification, emergency mental health, and access to basic needs such as food, clothing, and medicine. In San Antonio, they offer so much more including pre-employment training, extended housing, interview preparation including clothes, and opportunity for jobs.

The unpredictability of behavior by those who carry a “dual” diagnosis has emerged as a confounding factor in the criminal justice system raising the specter of frustration over the limitations within the system. Jail diversion programs and treatment options are needed in order to retain public safety goals and provide for needs of the mentally ill and substance dependent. In Massachusetts, cities and towns are grappling with how best to intervene with the mentally ill in terms of alternative restitution for drug-related misdemeanor crimes in lieu of mandatory jail sentences that many crimes currently require. The Massachusetts legislature has taken up Criminal Justice Reform and passed a bill in late 2017 making changes in the mandatory minimum sentencing laws.  Some believe, as much as 20-40 percent of all incarcerated persons suffer with mental health diagnoses and are not getting the treatment they require. To provide a bare bones system would add billions to state and federal dollars spent on the needs of inmates at a time when measurable outcomes for in house care are limited.

In my practice, I see many cases of co-occurring pain syndromes with other physical debilities such as stroke or traumatic brain injury. Some of these cases are substance dependent and live lonely, chaotic lives.  Generally the emotional impact of two or more diagnosed illnesses yields a greatly reduced capacity for adaptive coping and puts a great stress on the individual system. The importance of addressing co-occurring substance abuse or dependence is now well recognized and with treatment can result in healthy decision-making, growth in maturity, and greater self-awareness. If legislators have a serious desire to reduce statewide numbers of incarcerated persons a comprehensive plan must be considered for both pre-arrest and post-arrest. Programs greater understanding of addiction and added treatment options must be explored through a joint public and private initiative.

Mental and Physical Health Screening

At time of arrest the individual must have some level of mental health assessment if mental illness is suspected or documented. When I was a police officer prior to 2015 we often asked the D.A. to provide a court clinic assessment of the suspect to rule out suicidal ideation or delusional thinking. This must also include a screening for dangerousness especially when a subject is arrested for intimate partner abuse. Next a health history questionnaire should be undertaken to screen for co-occurring illness – both physical and mental. If a diabetic suspect is held without access to his insulin he is at great risk of death from stroke. Similarly, a person arrested for assault who suffers from paranoid ideation is at greater risk of acting violently without access to psychiatric medication. Finally, an alcoholic brought to the jail with a blood alcohol level greater than 250 is at great risk for seizures and cardiac arrhythmias when delirium tremens begin 6-8 hours after his last drink. The risk to personal health in each of the scenarios above must be taken seriously and the obtained data should be factually corroborated. Police departments across the United States are pairing up with private agencies to provide in-house evaluation and follow-up of individuals who fall on the borderline and may not be easily assessed by the officer in the field.

Diversion Safety Plan with Mandated Revocation

Next, the probation and parole department must obtain an accurate legal history prior to consideration for bail. A nationwide screen for warrants and criminal history based on previous addresses is essential. In many places these are being done routinely. In the case of someone being arrested for domestic violence he may have no convictions thus no finding of criminal history. For these individuals the dangerousness assessment may bring forth red flag data needed for greater public safety resulting in protection from abuse orders, mandated psychotherapy, and in some cases, no bail confinement when indicated. Releasing the person arrested for domestic violence without a viable safety plan increases the risk to the victim and her family, as well as the general public – including members of law enforcement.

Bail, Confinement, Mandated Treatment

There is some thinking that higher amounts of bail may lessen the proclivity of some offenders to breach the orders of protection drafted to protect victims and should result in revocation of bail and immediate incarceration when these occur. Mandated treatment may be more successful when legal charges are held as leverage where after 6 months of sober living and regular attendance at 12-step recovery meetings charges can be dismissed or modified to each individual case.  This takes a complete overhaul of the front end of criminal justice system and requires buy-in by judges, district attorneys, and individual family members.

When it comes lack of compliance and repeated domestic violence, I have proposed a mandatory DV Abuse Registry that may be accessed by law enforcement to uncover the secret past of men who would control and abuse their intimate partners. This database would also include information on the number of active restraining orders and the expected offender’s response to the “stay away” order. In cases where the victim decides to drop charges there should be a mandatory waiting period of 90 days. During this waiting period the couple may cohabitate but the perpetrator must be attending a weekly program of restorative justice therapy, 12-step recovery and substance abuse education. Violations of these court ordered services are tantamount to violation of the original protection order (still in place) and victim safety plan and may result in revocation of bail. If the waiting period passes and the perpetrator has met the conditions of his bail than he may undergo an “exit” interview to determine whether or not the protection order / jail diversion plan may be extended or whether he/she has met all requirements.  In any case further police encounters will be scrutinized and prior charges may be re-instated or filed as needed.

Michael Sefton

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

Officer resilience and career success with less burnout

Michael Sefton, Ph.D. CIT, crisis intervention, Human Behavior, Police officer behavior, psychological relevence , , , , , , ,

Mike Sefton photo
Michael Sefton, Ph.D. in Guangzhou, China

WESTBOROUGH, MA December 9, 2017 Resilience in police training is an added lesson designed to enhance the careers of officers-in-training. According to Leo Polizotti, Ph.D. resilience refers to professional hardiness that is protective against career burnout and raises both professionalism and job satisfaction.

It is essential to help individual officers through the tough times and enhances job satisfaction.  In the case of traumatic events – officer resilience is essential for a healthy response to a critical incident.  In the long run, physical health and well-being are the underpinnings of an emotionally resilient professional who will be there over and again – when called upon for those once in a lifetime calls that most of us will never have to answer.

Emotional resilience is defined as the the capacity to integrate the breadth of police training and experience with healthy, adaptive coping, optimism, mental flexibility and healthy resolution of the traumatic events. In general, resilient people are self-reliant and have positive role models from whom they have learned to handle the stressful events all police officers encounter. In its absence a police officer experiences irritability, brooding, anger and sometimes resentment toward his own agency and “the system” for all its failures.  The lack of emotional resilience leads to officer burn-out.

“Your biggest risk of burnout is the near constant exposure to the “flight or fight response” inherent to the job (running code, engaging and managing the agitated, angry, and irrational, or any other of your responsibilities that can cause you to become hypervigilant). Add the very real tension of the politics and stresses inside the office and a dangerous mix is formed. The pressures and demands of your job can take a toll on your emotional wellbeing and quality of life and burnout will often follow.” Olsen & Wasilewski, 2014

It is well documented that flooding the body with stress hormones like adrenaline and cortisol play a role in police officer health and well-being. “Stress and grief are problems that are not easily detected or easily resolved. Severe depression, heart attacks, and the high rates of divorce, addiction, and suicide in the fire and EMS services proves this” according to Peggy Rainone who provides seminars in grief and surviving in EMS. (Sefton, 2013). There are various treatments for stress-related burnout including peer support, biofeedback for reduced sympathetic dysfunction, and professional psychotherapy. “Being exposed to repetitive stress leads to changes in the brain chemistry and density that affect emotional and physical health.” (Olsen, 2014)  Improved training and early career support and resilience is essential for long term health of first responders including the brave men and women in blue.

Polizotti, L. (2017) Psychological Resilience: From Surviving to Thriving in a Law
Enforcement Career. Presentation. Direct Decision Institute

Olsen, A and Wasilewski, M. Police One.com (2014) Blog post: https://www.policeone.com/health-fitness/articles/7119431-6-ways-to-beat-burnout-in-a-police-officer/ Taken December 9, 2017

Rainone, P. (2013) Emergency workers at risk. (website) http://www.emsvilliage.com/articles/article.cfm?ID=176. Taken 12-1-2013

Sefton, M. Domestic Violence Homicide: What role does exposure to trauma play in terminal rage? Blog Post: https://wordpress.com/post/msefton.wordpress.com/505 Taken December 9, 2017.

Discretion, Treatment and Alternatives to Jail

Michael Sefton, Ph.D. CIT, crisis intervention, Human Behavior, Police officer behavior, psychological relevence, Suicide by cop , , , , , , ,

WESTBOROUGH, MA July 16, 2017 In last weeks publication I introduced the problem of mental health and co-occurring substance abuse with some ideas about alternative restitution and treatment. These involve greater discretionary awareness among police officers.  More importantly options to jail require viable alternatives that will end the revolving door of minor criminality coupled with treatment for the breadth of addiction seen on a daily basis by law enforcement.

Mental and Physical Health Screening

At time of arrest the individual must have some level of mental health assessment if mental illness is suspected or documented. When I was a police officer prior to 2015 we often asked the D.A. to provide a court clinic assessment of the suspect to rule out suicidal ideation or delusional thinking. This must also include a screening for dangerousness especially when a subject is arrested for intimate partner abuse. Next a health history questionnaire should be undertaken to screen for co-occurring illness – both physical and mental. If a diabetic suspect is held without access to his insulin he is at great risk of death from stroke. Similarly, a person arrested for assault who suffers from paranoid ideation is at greater risk of acting violently without access to psychiatric medication. Finally, an alcoholic brought to the jail with a blood alcohol level greater than 250 is at great risk for seizures and cardiac arrhythmias when delirium tremens begin 6-8 hours after his last drink. The risk to personal health in each of the scenarios above must be taken seriously and the obtained data should be factually corroborated. Police departments across the United States are pairing up with private agencies to provide in-house evaluation and follow-up of individuals who fall on the borderline and may not be easily discerned by the officer in the field.

Diversion Safety Plan

Next, the probation and parole department must obtain an accurate legal history prior to consideration for bail. A nationwide screen for warrants and criminal history based on previous addresses is essential. In many places these are being done routinely. In the case of someone being arrested for domestic violence he may have no convictions thus no finding of criminal history. For these individuals the dangerousness assessment may bring forth red flag data needed for greater public safety resulting in protection from abuse orders, mandated psychotherapy, and in some cases, no bail confinement when indicated. Releasing the person arrested for domestic violence without a viable safety plan increases the risk to the victim and her family, as well as the general public – including members of law enforcement.

Bail, Confinement, Mandated Treatment

There is some thinking that higher amounts of bail may lessen the proclivity of some offenders to breach the orders of protection drafted to protect victims and should result in revocation of bail and immediate incarceration when these occur. I have proposed a mandatory DV Abuse Registry that may be accessed by law enforcement to uncover the secret past of men who would control and abuse their intimate partners. This database would also include information on the number of active restraining orders and the expected offender’s response to the “stay away” order. In cases where the victim decides to drop charges there should be a mandatory waiting period of 90 days. During this waiting period the couple may cohabitate but the perpetrator must be attending a weekly program of restorative justice therapy and substance abuse education. Violations of these court ordered services are tantamount to violation of the original protection order (still in place) and victim safety plan and may result in revocation of bail. If the waiting period passes and the perpetrator has met the conditions of his bail than he may undergo an “exit” interview to determine whether or not the protection order / jail diversion plan may be extended.

Guardianship

In many jurisdictions the mentally ill cannot be forced to take medication nor can they be forced into treatment. Adherents to this belief advocate on the behalf of the chronically mentally ill for the right to make these individual choices – treatment or no treatment. Ostensibly advocates seem unconcerned for the public health risks associated with ongoing drug addiction and major mental illness. There needs to be an active system in place to provide guardianship to individuals with repeated failed treatment that mandates treatment for those who cannot remain in a program of sobriety and psychotherapy in lieu of incarceration. In many cases a family member may be appointed temporary guardian for up to 180 days that allows decisions to be made about patient care up to the guardian not the patient himself who may be unable to stay on track.

 

 

Jail Diversion: Reduced costs by spending more on mental health

Michael Sefton, Ph.D. career criminal, CIT, crisis intervention, Human Behavior, Police officer behavior, psychological relevence , , , , , , , , ,

PART 1

WESTBOROUGH, MA July 6, 2017 Jail diversion is a hot topic across the country. The numbers of persons incarcerated for minor offenses and drug crimes has grown. Many of these individuals have mental illness or drug abuse in addition to their criminality. The interaction between poly-substance abuse or dependence and exacerbation of underlying mental health symptoms is complex. It is the focus of mental health advocates and criminal justice experts nationwide as it pertains to jail diversion and reduced use of force among law enforcement.  In Massachusetts, there is a move away from mandatory minimum sentences for all drug crimes except for those involving the distribution of narcotics. Arguably, the impact on behavioral functioning when persons are gripped with co-occurring illness is a recurrent problem for law enforcement and first responders. I have written about the impact of co-occurring illness such as alcoholism on mental and behavioral health is previously published posts here on Word press Human Behavior (Sefton, 2017). It is difficult to uncover which comes first – the addiction or the diagnosed mental illness and yet they are inextricably linked in terms of the strain on public resources and health risk to those so afflicted. Why is this important?

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 MH advocates insist that with the proper treatment violent police encounters may be reduced and jail diversion may be achieved. The referral infrastructure to provide a continuum of care in this growing population is available in very few places across America.

Models of Care

Yet in places like Bexar County, Texas the county jail population has dropped by over 20 percent as a result of crisis intervention training for police officers and mobile mental health teams to intervene with those in crisis. I have seen this for myself during a visit with the San Antonio Police Department where I rode with two members of the Mental Health Unit – Officers Ernest Stevens and Joseph Smarro. It takes training, medical and psychiatric infrastructure, community compassion, and active engagement with members of the community often left to fly under the radar to effectively reduce the jail population. When necessary those most in need must have 24-hour availability for detoxification, emergency mental health, and access to basic needs such as food, clothing, and medicine. In San Antonio they offer so much more including pre-employment training, extended housing, interview preparation including clothes, and opportunity for jobs.

Behavioral Analysis and Law Enforcement

The unpredictability of behavior in those who carry a “dual” diagnosis has emerged in the criminal justice system when jail diversion programs and treatment options are brought forth raising the specter of frustration over the limitations within the system. Cities everywhere are grappling with how best to intervene with the mentally ill in terms of alternative restitution for drug-related misdemeanor crimes in lieu of mandatory jail sentences that many crimes currently require. Some believe, as much as 20-40 percent of all incarcerated persons suffer with mental health diagnoses and are not getting the treatment they require. To provide a bare bones system would add billions to state and federal dollars spent on the needs of inmates at a time when measurable outcomes for in house care are limited.

In my practice I see many cases of co-occurring pain syndromes with other physical debility such as stroke or traumatic brain injury. Generally the emotional impact of two or more diagnosed illnesses yields a greatly reduced capacity for adaptive coping and puts a great stress on the individual system. The importance of addressing co-occurring substance abuse or dependence is now well recognized and with treatment can result in healthy decision-making, growth in maturity, and greater self-awareness. If legislators have a serious desire to reduce statewide numbers of incarcerated persons a comprehensive plan must be considered for both pre-arrest and post-arrest. Infrastructure for enhanced understanding of addiction and greater treatment options must be explored through a joint public and private initiative.

PROPOSED JAIL DIVERSION INITIATIVE

PRE-ARREST JAIL DIVERSION – No crime committed

If police encounter subjects with a known history of mental illness through their community policing efforts they should return the subject to his family or primary psychiatric caregiver – this might be a physician, physician’s assistant (PA), a nurse practitioner (NP), even a psychologist for immediate crisis intervention. Depending upon the nature of the police encounter such as during the nighttime hours the subject may be transported to a local emergency department for psychiatric evaluation. This model has grown less popular because of the growing wait times in local hospital emergency departments – especially for those suspected of mental illness and tends to make them increasingly agitated. Persons with mental illness are often homeless and come into police contact simply on the basis of panhandling or looking suspicious and out of place in the neighborhood. Often they are reported to police because they are talking to themselves, suspicious, and menacing toward pedestrians making them afraid.

The hospital alternative might be to establish regional psychiatric emergency intake centers available 24-hours daily. At one point states had regional hospitals that have been closed down releasing thousands of institutionalized patients into the community. The plan for de-institutionalization was to provide a neighborhood center at which the patient could continue his or her treatment and receive their needed medication to keep them symptom free.

Minor crime committed

When a crime is committed by someone with known or suspected mental illness such as simple assault, disorderly conduct, or shoplifting the responding police officer’s will have discretion whether to bring forth charges or not in exchange for an alternative disposition that would defer jail time. These are not new concepts. Law enforcement has always had the discretion to arrest or not arrest for many minor offenses. The choice often comes down to the subject demeanor and his response to police officer directives at the time of the encounter. In some cases an officer must arrest such as in the setting of domestic violence, child abuse, or as a result of a felony being committed.

In these cases charges may be brought and held as long as the subject entered treatment or remained abstinent from use of drugs or alcohol – the jail diversion plan. If they failed to follow the terms of their diversion plan the charges would be re-instated and sent to district attorney for prosecution.  The alternative is a revolving door of addiction and petty crime that, at times, will escalate into violent crime. As a society more can be done to reduce criminality and jail diversion through empathic, sensitive treatment options.

Forensic Mental Health: Contemporary Issues and Interactions Involving Justice-Involved Persons with Mental Illness

Michael Sefton, Ph.D. Dangerousness assessment, domestic violence homicide, DVH, Human Behavior, Police officer behavior, Suicide by cop, use of force continuum , , , , , ,

neacjs-logo-US-left-colorv21-300x251WESTBOROUGH, MA April 30, 2017 The Northeastern Association of Criminal Justice Sciences has announced the date for its upcoming annual conference to be held in Rhode Island at Roger Williams University in Bristol.  The conference will be held on June 7-10 2017.

The topic this year is Forensic Mental Health: Contemporary Issues and Interactions Involving Justice-Involved Persons with Mental Illness that has been in the news when it comes to police encounters with those so afflicted.  In Massachusetts alone over 120 people thought to suffer with mental illness have been involved in lethal force situations with law enforcement between 2008-2016.  The program is still being drafted but I have been invited to present the Psychological Autopsy as a Forensic Tool along with my colleague Brian Gagan and co-author of the Psychological Autopsy of Steven Lake – Dexter,

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Dr. Sefton discussing psychological autopsy of Steven Lake with coauthor Brian Gagan (left)

Maine Homicide-Suicide in 2011.

Police are building bridges and throwing life savers

Michael Sefton, Ph.D. CIT, crisis intervention, Dangerousness assessment, domestic violence, Human Behavior, Police officer behavior, SAPD, use of force continuum , , , , , , ,

WESTBOROUGH, MA  – March 30, 2017  Police officers are being trained in crisis intervention techniques across the country and Canada. This training offers plenty of practice role-playing scenarios that come directly off of the call sheets affording a reality-based training opportunity. I recently spent time riding with members of the San Antonio PD mental health unit and have the greatest respect for the officers with whom I rode.  In contrast, some departments regularly have highly trained clinicians riding with officers bringing expertise in mental illness and abnormal behavior across the thin blue line.  It is thought that by sharing knowledge at working with unpredictable, drugged out, psychotic and delusional and angry who police encounter on a daily basis better outcomes may be achieved. No single model is best and all are still in the growing stages of establishing protocols for bringing those most disturbed individuals in from the margins. More and more officers are receiving CIT training every year.

The important part of crisis intervention training comes in the interdisciplinary relationships that are forged in by this methodology. Trust and respect between the police and its citizens builds slowly one person at a time.  Community policing is not a new concept but fiscal priorities often prevent its full implementation.  Just the same, there must be trust and respect between the police and the purveyors of crisis intervention and mental health risk assessment including doctors, nurses, and health care practitioners. This also takes time and training and the shared belief in the model.

“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,” according to Grace Gatpandan, spokesperson for the San Francisco Police Department

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Michael Sefton, Ph.D. in 2017 photograph

The use of force continuum belies each officer contact and guides the process when police are called upon to defuse a dangerous encounter. It is best that a mental health contact be made long before violent threats are made – long before terminal rage erodes personal judgment. The community policing doctrine affords this front end contact and encourages officers to know the people living on the beat.

POLICE ENCOUNTERS WITH MENTALLY ILL CITIZENS

The Boston Globe Spotlight series on police encounters with the mentally ill cites one distraught parent who was quoted “I only wanted the police to disarm him not shoot him dead.” Unfortunately for this family, when faced with lethal violence it is the behavior of the subject that drives the ship in terms of what will or will not happen.  “When faced with a deadly situation, when there is a gun pointed at a cop, there is no time to go into mental health measures”. All too often people fail to see the cause – effect relationship between citizens with guns or other lethal weapons and the police officer response.  The use of force continuum follows the principle of causation by guiding police decision making based on the level of threat.

What came first the threat or the police action?  It is the primary action of the citizen the evokes the lethal response by police.  If citizens dropped weapons and listened to police officer directives during these high energy and chaotic events there would be fewer deaths.  To say they lack training in mental health is preposterous.  Almost as preposterous as saying if they were better parents the mentally ill subject might not aim his gun at police or threaten his mother with a knife.  No, the responsibility lies with the mental decision-making and subsequent behavior of the subject himself.  If mental illness drives the violent behavior than all weapons and substance use must be carefully controlled and eliminated.  When people attend psychotherapy sessions and 12-step recovery programs the proclivity for violence is greatly reduced.  Inevitably, drug abuse is a co-morbid factor that alters perception and fuels underlying anger and violent tendencies.  Who is responsible for this? When drug addition or alcoholism begin – all emotional growth including adult “problem solving” begins to fail until it is fraught with uncontrolled, impulsive violence. Rather than placing blame, greater emphasis on sobriety, counseling and developing emotional resiliency should be encouraged.

Lowery, W. (2015) DISTRAUGHT PEOPLE, DEADLY RESULTS: Officers often lack the training to approach the mentally unstable, experts say. http://www.washingtonpost.com/sf/investigative/2015/06/30/distraught-people-deadly-results/?utm_term=.86e44d33dfab Taken March 5, 2017