Writing reports that work for victims of DV: Tools for measuring risk for DVH

Michael Sefton, Ph.D. Dangerousness assessment, Health Psychology, Human Behavior, Relationships , , , , , ,

There were times that at the end of a midnight shift in Westbrook, Maine, outside Portland, and New Braintree PD, in Massachusetts that I had reports to write for incidents I had been assigned during the shift. More than once, I snuck out of the patrol office and went home – too tired to write. And more then once, the sleep I so wanted was disturbed by the day sergeant or court officer looking for my report. Or sometimes, when I did stay, my writing was not my best effort because I was tired. Report writing is an art and is now a large part of both the academy training and field training programs. Law enforcement officers are better trained and more highly educated than ever which is essential in these times where every word is public property. The media, the citizenry, and the police hierarchy are all slicing and dicing every paragraph of today’s reports looking for your mistakes, it seems. The reason I write this is that police reports have consequences and if important statements, or officer observations, or photographs are omitted, cases may be lost. It is essential that report writing be taken seriously because, in the setting of domestic violence, lives depend on it.

Just like any report document that is to be handed out to anyone who might request it, particularly underpaid defense attorneys who swim in circles, like sharks looking to devour a poorly written report and its author. Report writing needs to be concise and laser focused. Particularly important is the reason for the call. Why did this victim call today? We know that the abuse tends to escalate successively. Sometimes, it is only when children become involved that a victim will move to stop the violence. In Vermont, a teen boy shot and killed his father when the man drunkenly waved a pistol threatening the family. And in Maine, a 13 year old boy was found to be hiding a 20 gauge shotgun and ammunition on the day he and his family were murdered by his father Steven Lake.  Our analysis of the Maine case led us to understand that the boy was likely intending to defend his mother and sister against a violent and unpredictable father.  He may have been seeking to load the weapon when his father snuck into the unlocked house and overpowered the family. 20 gauge shells were found in the child’s bed and under his pillow.

Image from Mobile ODT
When conducting assessments or forensic exams with a victim of domestic violence (DV), any reported history of strangulation places the person at a higher risk for more serious violence or homicide by the hands of their intimate partner. By recognizing signs of strangulation, healthcare providers can help to mitigate long-term damage, properly document any evidence of abuse, and provide referrals for seeking safety assistance. Sara Vehling 2019

Risk assessment tools provide quantifiable data that may be used to develop actuarial projections as to degree of risk and dangerousness. Report writing now should include assessment tools that uncover potential risk to victims. Jacqueline Campbell, RN has a valid risk assessment tool for determining whether there is high risk to potential victims that can be living in the home while officers are still on scene. Campbell’s work is readily available in the DV literature and known to most of us. The Ontario group in Canada also has a reliable tool – ODARA used by law enforcement agencies across the country. In my agency we adopted both tools after the research was complete from The Maine homicides. The national leadership includes Lenore Walker, in addition to Campbell, who both have published a good deal over 25 years on DV and its cycle. Walker believes that women and families are exposed to great harm when the abuser is out of jail only hours after terrorizing his family. It rarely mitigated the next beating. 

I propose holding the abuser until his first arraignment perhaps as long as 2 days. This allows for a cooling off period. Minutes are like hours while sitting in a municipal cell block often eating fast food 3 times a day. But the 8th Amendment of the Constitution guarantees that bail shall not be unfairly denied or excessively harsh. In truth, the modification of bail conditions in some instances must be done in real time to account for the severity of individual cases of DV and unique red flags. Experts have said that when a victims says ”I know he is going to kill me” then there is a greater likelihood that she may be correct and a protective, safety plan should be put in place. On the continuum of risk, expecting to be killed is only slightly less dangerous as physical attempt to kill or maim. In these most dangerous cases, there are tactical measures that must be written into protective orders such as GPS monitoring, forfeited bail and remand to custody for violation of protective orders, social media restriction, no contact with victim and children, no contact with victim’s family or friends, and supervised visitation, when only appropriate. It is these cases where the police officer’s report must be first rate and bullet proof.

A period of being held in custody until initial arraignment will enhance public safety and public trust in the short run. If applied to all persons arrested because of domestic abuse, then it would not unfairly impact only the poor or disenfranchised. Abuser’s should not be able to buy their way out of jail nor should they be free to wander their communities stalking their supposed loved ones. Steven Lake who killed his family and himself in Dexter, Maine posted his love for his children nightly and had piteous social media “friends” encouraging him to “fight for his children”. Little did they know he was planning the onerous events that would end the Lake family timeline forever. The Maine Law Review in 2012 reviewed changes in conditions of bail and cited our research over 12 times in its review of conditions for the release of persons in jail for domestic violence. Protective factors include the abuser having full employment and a substance free environment.

As the reader begins to understand report writing requires a visceral response and poignant understanding of this hidden social maelstrom. There are legitimate reasons for seeking “no bail” holds on some people arrested for domestic violence when high acuity and high risk exist together. These have been posted by me in the Human Behavior blog.

Campbell, J. (1995). Assessing dangerousness. Newbury Park: Sage. Nicole R.

Bissonnette, Domestic Violence and Enforcement of Protection from Abuse Orders: Simple Fixes to Help Prevent Intra-Family Homicide, 65 Me. L. Rev. 287 (2012). Available at: https://digitalcommons.mainelaw.maine.edu/mlr/vol65/iss1/12

Ronald Allanach 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.

Vehling, S. (2019) Taking your breath away – why strangulation in domestic violence is a huge red flag. Blog post https://www.mobileodt.com/blog/taking-your-breath-away-why-strangulation-in-domestic-violence-is-a-huge-red-flag/ taken March 15, 2022

Mac Walton. (2019) Bail Reform and Intimate Partner Violence in Maine, 71 Me. L. Rev. 139. Available at: https://digitalcommons.mainelaw.maine.edu/mlr/vol71/iss1/62

Domestic Violence Homicide: crafting protective orders with teeth and laws to support victims in fear of being murdered

Michael Sefton, Ph.D. Dangerousness assessment, domestic violence, domestic violence homicide, Human Behavior, Relationships , , , , , ,
Domestic violence homicide shares common red flag warnings that are discernible when prosecutors take time to connect the dots.

In Maine, Texas, and across America, the criminal justice system – including prosecutors, too often fail to protect victims of domestic and family violence from their abusers — even when the “red flag” warning signs are obvious as they were in both these cases. In this post, and the March 15 post, I talk about the importance of report writing and truly  understanding DV on a visceral or gut level. To truly understand what is going to happen requires a realization that just below the surface may lie a wolf in sheep’s clothing. 

In early 2021, the police in Austin,Texas were beset by a horrific case of domestic violence homicide. On April 18, 2021, a former police officer killed the family while picking up his son for a monthly supervised visit. The child’s mother encouraged these visits as important to the boy’s development and relationship with his violent and sadistic father. While exchanging pleasantries, the child’s father shot and killed his former wife and step-daughter.  And he killed his daughter’s young boy friend and immediately fled. Detective Broderick was captured 20 hours later and is being held. Yes, the abused was a former law enforcement officer. 

Common sense look at facts

Police need broad discretionary authority in dealing with any violation of orders of protection including no bail holds and danger risk assessment

Following the 2020 arrest for sexual assault of a child, Broderick resigned from the Travis County Sheriff’s Department. He was initially held on $100,000 bond. A family friend remarked, “I kind of had a feeling that this is where he was going, because he was lost,” she explained. “He lost everything. He lost his family. There was a protective order for a reason.” He was lost?  That gives him the right to violently kill his former wife, adopted daughter, and her male friend? Many in our society are lost and do not go on to commit violent homicide.

The 16-year old child, who was among the victims, begged for a more restrictive supervision of her step-father who had been released from jail and was not required to wear an ankle bracelet after only a period of 3 months. An order of protection was brought against former police detective. There was a protection order in place but even the teen knew that orders of protection were “not worth the paper they were written on.” 

“Because Mr. Broderick committed this heinous crime after he paid a money bond to be released on charges related to sexual assault against a child, Texas law permits his detention without bail.” Wes Wilson, KXAN television Austin, TX

There is a case to be made for careful analysis of behavioral health functioning of abusers. That seems to be common sense right? But this sometimes does not occur. As a law enforcement officer in Massachusetts, I made an effort to introduce risk assessment tools to quantify a subject’s dangerousness. This is important but is not yet universally adopted here in Massachusetts. Nearly 10 years on, the psychological autopsy conducted in 2011, looked at the red flag warnings that are common to DVH everywhere – including the case in Austin. What brought my attention to the case in Maine was the purported prosecutorial impotence argued by Christopher Almy, the county district attorney, that there was “nothing that could be done to protect the victim, Amy Lake and her two children, from her estranged husband Stephen Lake. That statement was inspiring. Imagine if you and your family were depending upon the police to protect you as Amy Lake was? Everything that could be done was in place. But the protection order had no teeth. So Steven Lake snuck into the Amy’s home at 5 AM and staged a despicable murder scene, ultimately killing the children he claimed to love while Amy was forced to watch. Ending with her shotgun murder and is own death by suicide. 

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

In an article on the 8th Amendment regarding bail in cases of domestic violence, the Maine Law Review, first in 2012 and an updated second publication in 2017, cited the importance of carefully crafted conditions of bail especially among men who are found to have violated the conditions often by stalking and using social media to intimidate and contact potential victims also by trolling family members in an effort to locate estranged spouse and her children who may be in hiding. Both Amy Lake and Austin, TX mother of 3 expressed an interest in having children remain in contact with extended family in spite of pending serious criminal charges. This opened up access to the perpetrator to information about current living arrangements, employment, after school activities, and other potential clues that raised the risk of further domestic violence and ultimately DVH. In Austin, the victim expressed a wish to allow her estranged husband to have contact with the little boy – his son in spite of pending felony charges brought forth by the 16-year old step-daughter who rightfully feared for her life. Why was her fear ignored or minimized given her history of having been sexually assaulted by her adoptive father and his animosity toward her for reporting the abuse to law enforcement. He blamed her for his loss of career and status as a local detective with the Travis County Sheriff’s Department.

Firearms are a major cause of DVH and in every state are required to be taken from men with active protection orders in place. This was the default expectation in the two cases described here but in the case of Stephen Lake his arsenal of 22 firearms were not removed from his possession in spite of court orders.  Similarly, the Austin killer was left with at least one firearm used to kill his family.  Lake left 9 suicide notes many of which were rambling, angry tirades toward his wife and in laws.  The Austin killer did not take his own life and was captured. This is atypical especially among law enforcement officers raising the specter of possible psychological analysis of his motives. This make the two cases in this post very different at this level. To what extent Texas authorities will endeavor to understand the events that preceded the murders remains unclear although, like the Aurora theater shooting, having a bad guy to study is rare. This means nothing, aside from an opportunity for personality and psyhopathology to be brought up at trial perhaps allowing Mr Broderick to avoid death row.  There is not much in the public media since the crime and his capture. However, gaining a comprehensive understanding of the red flag warnings in this case is recommended and will add to the body of literature on domestic violence. Why he chose not to kill himself is itself a mystery. 

Domestic violence homicide risk factors

  1. Threatens to kill spouse if she leaves him – pathological jealousy
  2. Actual use of firearm or other weapon anytime during domestic violence incident
  3. Access to firearms even if he never used them – veiled threats
  4. Attempt at strangulation ever during fight
  5. Forced sex anytime during relationship
  6. Unemployment of perpetrator
  7. Stalking via social media – one or both spouse use social media to intimidate or garner support
  8. Presence of unrelated “step” child in home
  9. Spouse finds new relationship soon after separating
  10. Low bail release from custody – high bail holds are essential in DVH mitigation

Conditions of bail and 8th amendment freedoms – reflections on domestic violence homicide

Michael Sefton, Ph.D. Dangerousness assessment, domestic violence homicide, DVH, Human Behavior, Police officer behavior, psychological relevence , , , , , , , ,

The 8th Amendment guarantees that people will not be faced with unfair conditions while in custody nor should they have undue hardship following adjudication. But when victim safety requires it then some modification of this rule must be considered. Dangerousness to possible victims requires some abusive subjects (usually men) be held without opportunity for bail at least as long as it takes to confirm that there is no immediate danger to possible family members. This evaluation sometimes takes hours to days to complete. In Massachusetts, here in the US, some courts have court clinics that can assess persons in custody for risk of suicide and dangerousness. The pandemic has reduced this option significantly and arraignments were conducted virtually for months. Many district courts work with domestic violence agencies on a regular basis sometimes in the court buildings near court rooms.

Maine Law Review

Not much has changed since the Maine Law Review cited our work in its 2012 in Nicole Bissonnette’s review of bail conditions following domestic violence. Ms. Bissonnette published second paper in 2017, in the same MAINE Law Review that gives some quick and easy fixes for the 8th Amendment conundrum as it pertains to domestic violence. It is a fact that victims generally do not call police when the abuse first begins. It is also a fact that if a victim has been threatened with death if she “leaves” or “asks for a divorce” then her risk is substantially elevated and a safety plan must be provided including an order of protection.

The 8th amendment guarantees that excessive bail nor excessive fines shall not be required when someone is in custody and when found guilty of a crime. In many cases of domestic violence assault, abusive spouses are released on personal recognizance – essentially no bail is taken. Abusers are required to show-up on the next court day (usually Monday morning) and answer to charges of assault, domestic abuse, or whatever the evidence shows. The 8th Amendment also specifies that punishment for crimes shall not be excessive, overly punitive or harsh. It is frequent that abusers may have no criminal record whatsoever. Given that fact, it is hard to argue for high bail in a case where the defendant is unlikely to skip out on an initial hearing. This is precisely the reason why officer reports must include detailed statements from victims and witnesses – especially children.

I agree in principle that bail should not be punitive but neither should a family be faced with constant fear and danger because of the arrogant defiance of an abusive spouse. People without means do not have money for bail and some individuals are unfairly kept in jail simply because they or their families do not have cash for release from custody. So, a person who may be unemployed and was picked up for shoplifting and has 2 prior arrests may have an artificially high bail so he sits for weeks in a county jail awaiting trial. There are times when dangerous supersedes the right to be released from custody. This requires close scrutiny for making bail conditions that reflect risk to community and red flags for individual families.

In the 2017 Maine Law Review, Nicole Bissonnette restated her 2012 premise that bail conditions must be considered carefully when it comes to letting violent intimate partners out of custody. Ms.Bissonnette smartly cited the work done by this author and colleagues that brought these issues into sharp focus (Allanach et al. 2012). The importance of orders of protection cannot be understated in preventing domestic violence homicide. “The purpose of this follow-up comment is to evaluate the existing (PFA) system and assess methods of improving outcomes while avoiding prohibitive fiscal impacts” according to Ms. Bissonnete, 2017. The process, structure and failings of the existing system will be illustrated by the tragic deaths of Amy Lake and her two children, who were murdered by Steven Lake, despite the PFA in effect at the time. It was this case that brought domestic violence homicide into national prominence and provided substantive recommendations for mitigating DVH. Information is often unavailable to bail clerks or even judges when PFA’s are needed most. Information such as whether the defendant has previously violated conditions of release, probation or other orders, including, but not limited to, violating protection from abuse orders according to Jennifer Thompson, 2004. When these factors are affirmed then bail conditions must be revised in real time accordingly. Substantial bail for violation of protective orders is but one of them. Some believe that having non-refundable, very high bail is the only sanction to prevent recurring violations of the PFA. The 8th Amendment informs that bail may not unfairly impact people without employment and those who do not have financial means to buy there way out of jail.

There are cases, as recently as 2021 where a protection order was denied and domestic violence escalated into death of the New Hampshire suspect and critical injuries to intimate partner who became the victim. A judge did not think a protective order was warranted. Similarly, in Austin, TX, a disgraced police officer shot and killed his step-daughter, the teen’s boyfriend and his former wife in April 2021, even after the teenage girl begged for a protective order with the option to hold the abuser in jail. Her fear was palpable. The shooter was required to wear an ankle bracelet for 90 days after which he was free to stalk his former family who were trying to move on. There were several flaws in the safety plan in this case that ultimately triggered the terminal event such as coming together for planned visitation so the former police officer could visit his son who was not murdered. In New Hampshire, a judge denied a protective order on the basis that the abuser had not been violent since 2016 although acknowledged that the man was coercive and controlling. The victim, Lindsay Smith, was shot and critically wounded in Salem, MA in November 2021. Her former boyfriend, who had stalked the victim for the years since the break-up reportedly said he intended to forever “turn her life upside down” died from a self-inflicted gunshot wound. This may have been avoided if the temporary restraining that had expired had been approved to become a permanent restraining order as the victim had petitioned.

The desire to mitigate police discretion in domestic violence cases stems, in part, from problems relating to “the inherent ambiguity of the police-citizen encounter in the context of domestic violence.”

Jennifer Thompson, 2004 Maine Law Review

The domestic violence literature suggests that after 5-7 beatings victims will reluctantly summon police – especially if they fear either they or their children are about to be murdered. The details Calais, ME case of domestic violence are being carefully guarded even today. It is known that Daniel Phinney, 26 was out on bail after being arrested and charged with domestic violence and criminal threatening in May 2013. At that point he must have both physically assaulted his significant other and threatened to kill or maim his family resulting in the charge of criminal threatening. Police are quick to say that Phinney had “no prior criminal history” perhaps in an effort to obfuscate public outrage evoked by the system of bail in Maine that releases violent abusers over and over again on low bail. Had anyone made an effort to determine the degree of risk posed by Daniel Phinney prior to his release? Had anyone registered safety concerns based on the defendant’s behavior and history? If there had been routine aftermath follow-up then this may have been a known fact. A psychological assessment of Phinney may have provided important details about his impulse control, substance use, coping skill, and proclivity toward violence and had been charged previously with domestic violence. Phinney was killed by police in a stand-off in Calais, Maine shortly after being released from custody.

The case is reminiscent of the 2011 Steven Lake homicide in Dexter. Lake had twice been released on bail before murdering his family.  The medical autopsy concluded that “in spite of psychological counseling (the state) failed to appreciate the degree of anger and violence in Steven Lake”.  He had also been charged with criminal threatening after holding his family at gunpoint as he drove home the point about how much he loved them but he could not let Amy move on. 

Using a firearm in the commission of a domestic violence incident is defacto evidence of dangerousness and no bail shall be considered until such time as all firearms are collected and a viable safety plan is in place for potential victims including police protection. Michael Sefton, Ph.D. 2021

I was a member of a team that conducted a psychological autopsy on Steven Lake that resulted in over 50 recommendations to the esteemed Maine Attorney General’s Homicide Review panel in November 2012. At first glance there appears to be brash indifference toward the court protection order and the failure to remove firearms held by the defendant. It is now important to study the case of Daniel Phinney and others, so we ma learn from the many red flags exhibited in the weeks prior to his death. These red flag events must lead to stopping and containments points in future cases of domestic violence and domestic violence homicide. No family should be kept in fear by a spouse whose loathsome behavior derails all human spirit and sense of dignity.

At what point does the well-being of victims and potential victims rise above the abuser’s right to bail?

Michael Sefton, 2014 on the 8th Amendment and PFA orders

Allanach, R et al., 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.

Bissonnette, NR (2012). Domestic Violence and Enforcement of Protection from Abuse Orders: Simple Fixes to Help Prevent Intra-Family Homicide, 65 Me. L. Rev. 287. Available at: https://digitalcommons.mainelaw.maine.edu/mlr/vol65/iss1/12

Thompson, J (2004). Who’s Afraid of Judicial Activism? Reconceptualizing a Traditional Paradigm in the Context of Specialized Domestic Violence Court Programs, 56 Me. L. Rev. 407.

Sefton, M. (2021) Domestic violence and the importance of red flag warnings for preventing homicide. WordPress Blogpost. https://msefton.blog/2021/04/24/domestic-violence-and-the-importance-of-red-flag-warnings-for-preventing-homicide/ taken 2-25-2021

Get rid of stigma once and for all

Michael Sefton, Ph.D. Health Psychology, Human Behavior, Police officer behavior, PTSD

youtube.com/watch

This video is about an introduction to a post that will be forthcoming in a short while it is reference to law enforcement officers and the suicide death of officers who carry trauma.

The NYPD is making use of psychological autopsies, a research-based approach that attempts to better understand why someone took his or her life. 

The fight/flight mechanism that keeps us on guard plays a primary role on how people feel after episodes of high stress.  Feelings of frustration, lack of focus, chronic fatigue, and even depression can result from an over reliance social media stimuli like an unfed addiction.  

Chicago PD: suicide strategy session

Michael Sefton, Ph.D. Human Behavior

Dr. Leo Polizoti (right) and Dr. Michael Sefton (second right) were invited to Chicago to discuss the impact of police suicide on officers and family. Our work with Dr. Thomas Joiner brought to light some of the important factors that contribute to LEO death by suicide. A return consultation was interrupted by the pandemic in 2020. The event was hosted by Dr. Daniel Holler of Daninger Solutions of Fort Lauderdale, FL.

Members of Direct Decision Institute in Chicago (right)

The multiple deaths by suicide have renewed attention on another troubling and often hidden issue: Police officers die by their own hands at rates greater than people in other occupations, according to a report compiled by the Police Executive Research Forum (PERF) in 2019, after at least nine New York City police officers died by suicide that year. I was involved in the April 2019 presentation at 1 Police Plaza on the impact of LEO suicide as it related to the high incidence of police officer death by suicide according to Sefton in 2022. 

Law Enforcement and the “window” of attack against domestic violence

Michael Sefton, Ph.D. Dangerousness assessment, domestic violence, domestic violence homicide, Human Behavior , , , , , ,

Human Behavior blog

In Iceland, the first 24 hours after a report of domestic violence, the window of opportunity is open. During this window there is multidisciplinary response from police, social work, legal experts, and from the child protective service that establishes a safety plan and targets supporting the victim from her household, and sometimes away from the dangerous intimate partner.The first 24 hours after the report comes in is critical. Victims are more likely to accept help if definitive, comprehensive assistance can be offered right away. Within the window of emotional opportunity.

The Iceland Project puts together the package needed to bring charges by having a team of social service and law enforcement investigators who work together during the “call out”. One reason cases of domestic abuse seldom make it to court is because days and days go by before investigators can interview the victims. Some go to work, and some do not make themselves available to officers. “In Iceland, twice as many women are reporting incidents of domestic violence to the police than they were two years ago. This is due to an ongoing police initiative to provide women with better-timed and better-located assistance, which is bringing the problem out of the shadows” as reported in apolitical in 2017. I have called for regular aftermath follow-up in cases of domestic violence as a form of community policing. Officers work in pairs and stop during the next day to complete a check-in. Victims are contacted by their abusers or the family of the abuser or may be harassed via social media and made to feel like it is their fault this occurred. I had one victim tell me she was beaten up by her husband because the dinner she had prepared was late and unsatisfactory. I stayed in contact with her until the family quickly sold their home and moved from the area. That is pretty typical whereas the abusive partner wants to keep his wife under control. As soon as she makes friends he moves her somewhere else. Even if he takes a different job. Cases of domestic violence here in the United States skyrocketed during the pandemic quarantine that also gave birth to new higher rates of substance abuse and changes in behavioral health and well-being.

Police in Reykjavik, Iceland believe that detectives or senior police officers must intervene within the window – 24 hours from start of a call out, to put together a strong case and collect evidence. They work in teams of 4 or 5. The former protocol was often several days after the call and coincided with the honeymoon period. Bail conditions frequently fail DV victims as the abuser is often bailed out within 1-2 hours. Egregious cases of DV should be held without bail until a dangerousness hearing may be initiated. The result of this usually resulted in cases being dropped and victims staying in dangerous relationships. In theory, victims are more likely to accept support and provide meaningful evidence in the first 24 hours after their abuse. The window program is designed to link victims with programs such as housing, psychotherapy, job assistance, and financial means for a new start.

The Iceland Window Project also offers perpetrators the same assistance and supports that victims receive. Charges against perpetrators of abuse have gone from approximately 24 percent of cases to approximately 30 percent of cases. This is a modest improvement at best, according to the BBC podcast People Fixing the World who report that caseloads have increased dramatically since 2014. In spite of modest changes in prosecution numbers the Window Project’s fundamental aim is to reduce intimate partner abuse. It is a well designed project to support victims and keep them focused on the problem. Many practitioners believe that when a family is in crisis, such as when police are called to the residence, that great change is possible. There has been some movement toward prosecuting abusers even when the victim changes her mind. This is a primary reason for the Window Project’s success. By getting statements, photos, and other evidence there is greater likelihood that cases can go to court even when the victim chooses not to prosecute police are now doing this on behalf of bullied partner/victims. Children who are exposed to severe domestic violence are more likely to go on and become victims going forward. Or worse, they grow up and do exactly what their abuser did.

Here in the United States victims of domestic abuse are at great risk. Especially as they prepare to leave their abusive partners. Law enforcement is required to arrest perpetrators of DV whenever signs of physical trauma. That is generally understood by the police and the abusive spouses. But what happens just as frequently, law enforcement officers send the abuser away for the night or weekend. This makes things worse for victims and children.

Use of Force continuum – Shoot – Don’t Shoot: Mental Illness and the Use of Force – Officer confronts man with non lethal gun

Michael Sefton, Ph.D. Human Behavior , , , , , , ,

Police agencies expend a great deal of LEO resources dealing with citizens with mental illness. The Washington Post (2015) and the Boston Globe (2017) both did large feature stories on police use of force against mentally ill persons. The profiles were gut wrenching but only one example illustrated the emotional toll on law enforcement officers who are involved in fatal use of force situations. This fact fails to illustrate the emotional toll officer involved shootings has on member of law enforcement. The Boston Globe Spotlight Series entitled The Desperate and the Dead was published in 2016. I have written about officer involved use of force for over 5 years now.

The interaction between poly-substance abuse or dependence and exacerbation of underlying mental health symptoms is complex. It must be studied. The interaction of the two is sometimes lethal as reported by the Globe Spotlight team. The focus of mental health advocates and criminal justice experts nationwide is to provide options for jail diversion. Programs like alternative restitution have reduced sentencing and have not reduced the police use of force. Lethal force results as a function of the behavior of the subject. His capacity to listen and follow directions guides the force that will be used against him when confronted by law enforcement. It is impossible to utilize de-escalation techniques in all cases of police-mental illness encounters.

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

“When officers are faced with a deadly situation, when there is a gun pointed at a cop, there is no time to go into mental health measures,” SFPD Chief Grace Gatpandan said in 2015.  Washington Post (2015) Lowery, W. et al. DISTRAUGHT PEOPLE, DEADLY RESULTS: Officers often lack the training to approach the mentally unstable, experts say

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

“I called 911 so they could disarm him, not kill him,” Joan Hart told a reporter in 2007 after her suicidal husband, James, 65, was fatally shot by Quincy police in their backyard after charging officers with a knife. Boston Globe Spotlight Team 2016

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

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

Loneliness, loss, and fading resilience in the tarnished golden years: languishing with loss of purpose

Michael Sefton, Ph.D. Health Psychology, Human Behavior, Relationships, Stress , , ,
The isolation felt by people in quarantine can leave the average person feeling numb and emotionally languished. Recently, I provided a zoom conference on the psychological impact of the coronavirus in November 2021 from my office at Whittier Rehabilitation Hospital in Westborough, MA. It was well attended, largely by people who are psychologically minded and aware of the points I endeavored to make. My target audience was the people who were struggling and vulnerable to decreased coping during covid-19 recovery. I am unsure we hit the mark I was hoping for with the target audience.  The fallout in mental health from the coronavirus is real and it is now recognized as a public health menace among recovering adults. It is now being seen in children and adolescents with growing concern. Just like younger patients, loneliness and social isolation in older Americans are serious public health concerns putting them at risk for dementia and other serious health conditions including failure to thrive, sepsis, malnutrition, addiction, and mental illness according to a CDC report. For many individuals in quarantine, the nightly happy hour started earlier and earlier raising the specter of worsening substance abuse and addiction. The liquor stores were soon to be considered essential services and package delivery became a common source of re-supply. The impact of isolation, emotional loss, and social detachment undermines public and behavioral well-being across the life span. It is a co-occuring illness among illnesses afflicting millions. I see it in my own family as nerves are frayed now almost 2 years in – first noted in the blog post published in May, 2020 (Sefton, M.). In this fourth wave of the virus called the Omicron variant, people are tired of hearing about social distancing, mask mandates, and rising infection numbers. I see it every day.

I have worked with older clients for over 25 years first as a post doctoral fellow at Boston City Hospital – now BUMC. Long before the pandemic, my work at Whittier Rehabilitation Hospital has been to provide support and direct service to patients’ suffering from debility associated with decline in physical health along with the psychosocial needs and changes. All too often, this includes feelings of loss of control and sadness that is palpable in our short conversations. Many seniors feel invisible and the virus exacerbates these feelings. Declining health further instills the loss of purpose and amplifies the stigma of being seemingly infirm. The lack of purpose germinates from the passing of a spouse, close friends who move or have died, food and financial insecurity. It precedes a death wish and it’s associated demoralization. My mother was infected with the coronavirus in mid-April 2020 before the vaccine was introduced. She lived in the same nursing facility where I lost my 93-year old aunt in the first wave of the virus in May, 2020. My mother survived the virus but it has taken a significant toll on her physical and cognitive well-being. We were not permitted to see my mother during her illness and my aunt was alone on May 1 when she succumbed to the virus.

Trauma informed therapy refers to the critical understanding of one’s emotional history and supports the model of early traumatic experience being one underpinning of many mental health outcomes and threatened resilience later in life. These kinds of experiences have an impact on people who have had loved ones die while in lock down across the country and can engender guilt and helplessness. Often, singular front line medical staff are alone with patients who succumbed to the virus – sometimes holding the fading grip of another disappearing life. This heroic act of empathy happens without fanfare or even a moment to process its importance and acknowledgment of the person’s passing.

Hurry up: you are called to help save lives but are told to do nothing!

Aside Michael Sefton, Ph.D. Health Psychology, Stress , , ,

The man stopped breathing.His color signaled that he had only moments to live. His nurse called the code. This brought a hospital team of 

nearly 20 staff members assigned to the code blue team. Their job was to provide intervention for advanced cardiac care to return circulation and restore breathing. Every member of this team had a job to do. Starting with the scribe who kept track of everything. “Is somebody writing”? Inquired the maestro. Things like the minutes since the heart stopped and when he first received medication, when IV access was achieved, or the time he received the lifesaving shock to his heart, known as defibrillation. Her voice was sometimes shrill as she tried in vain to speak above the calamitous scene by tracking time since last dose of epinephrine, adenosine, or vasopressin or changing vital signs. Her job was essential and had to be accurate. These are high stress low frequency events that nobody enjoys. 

The code team works like an orchestra led by the maestro – sometimes a senior nurse. The maestro must be laser focused and have full knowledge of the patient’s recent medical history and all possible causes leading to this event. Maestro follows an ACLS protocol that guides the decision tree. The team had assigned jobs for CPR and back-up to the person assigned to be first on chest compressions. And there was the rescue breather, respiratory therapist, IV nurse, the runner for blood and other equipment, pharmacist, and physician – usually the maestro. For many team members, there is an intangible calling that underlies a doting sense of purpose which brings them into nursing.The less experienced team members may be second chair in this orchestra but all feel cheated when outcomes are bad. 

The man in question wanted no heroic measures taken and did not wish to be transferred to the trauma center if his heart were to stop beating. It was his advanced directive. 

 On this particular day, the nursing staff on duty watched the patient closely. His heart was being monitored for rate and rhythm. His breathing sounded scary in the early morning hours on the Saturday after Thanksgiving. The family had not been able to see the man who had been diagnosed with covid-19 following a stroke. By all reports his viral load was mild. He seemed to be getting better leaving most of us to believe he would slowly improve and one day make it home. I spent time with him that Friday assessing his language. It too had improved during his time in the unit.

 The physician on the day shift was not on the unit yet on the Saturday morning. It would be the man’s last day. He was running a low grade fever perhaps 99.8 degrees. This was lower than it had been the days prior. The man had started to show signs of improvement after being diagnosed with coronavirus shortly after being admitted to the rehabilitation hospital. He was fully vaccinated. So what happened? He went from being on the mend to not breathing in a matter of hours. This is what front line ICU nurses and doctors have been dealing with for 18 months during this pandemic. We saw very few cases of this type at our hospital. Afterall, he was in our hospital to rehab from his CVA.

 These events take a human toll and put a chink in the armour. Outcomes whittle away at job satisfaction, personal efficacy, and professional.purpose. The coronavirus was making its fourth appearance with a growing wave of breakthrough cases which had us all on edge. The man in this case was sick well before my breakthrough surprise. I became infected in mid-December and was sent home for quarantine. 

 The man was transferred to us following a significant left hemisphere stroke. He was sent for retraining to advance the  functionality of his language so he might return home. He had global aphasia but was getting better with using words and helping himself. Slowly, his receptive language was starting to make connections again. He started to understand nuance and gesture. He could make his point using the tools he was learning during therapy sessions. These are good signs in early stroke recovery and represent the plasticity in the human brain. He had become able to follow some perfunctory directions and express his basic needs, still sometimes missing the point by using jargon. This is known as the language of confusion in speech pathology circles. We have excellent speech pathology services at Whittier and I especially respect their efforts and expertise. 

He was not depressed and was working with his therapy team as much as he could. For their part, the staff is passionate when it comes to helping patients gain function. By standing, speaking, and eventually, directing their own care. 

When he was admitted, the man and his family decided that they wanted no heroic measures taken should his heart stop beating. No CPR, no intubation or breathing tube, no transport to a higher level of care such as the nearby trauma center. He was not a young man and believed he had lived a good life. His wishes. 

Remember, his breathing and respiratory drive took a rapid turn for the worse. Quickly, he went from looking bad to looking better, to looking worse. In a matter of a few hours his breathing had become more shallow. Agonal in quality. His nurse called the code. 

Agonal breathing usually signals a cardiac arrest. Nurses are trained to respond with the code cart and a dozen or more advanced cardiac rescue interventions geared toward restarting the heart and saving a life. Not the outcome last Saturday morning. His choice was very clear – no heroic measures. So staff were instructed to stand down and watch. Some staff became emotional and were consoled by senior nurses.They could do nothing but sit on their hands. 

The younger staff felt traumatized, as this was not supposed to happen. Even support personnel were watching as team members slowly backed away to hear witness. 

 His family was called and the sad news was shared. They had not said goodbye because of the mandated virus protocols. He did not yet receive the Sacrament of the Sick, as he had wanted. He was not alone and in the end, the group came together to recognize this man for the good fight he brought forth at rehab and for having the courage to know what he did not want, and for those few things he did. He died at 8:12 as he wished, without fanfare. The maestro on this day, reminded them all of this and that he lived a full life, and the scribe recorded the time.