Officer distress in Bangkok, Thailand

“Today police morale and emotional health have hit rock bottom, he said, because of a number of factors, including botched policy-making when it comes to their career path that doesn’t take into consideration the officer’s needs and desires.” Bangkok Post December, 2019

And the year 2020 was not any better and very likely triggered added stress and tension among the working wounded in Bangkok and beyond. Shortly after I visited Bangkok, in early 2020 a member of Thai Army service in the Northern Province went off and killed his superior officer and over 20 people in his community. Very rare in the Thai history. My former Chief and I had met another commander from the Northern Province detail and liked him a lot. He smiled and seemed confident before returning to the Northern Province. Gun violence in Asia is rare and mass shootings are more rare still.

Next came the virus. Thailand got out in front of the contagion and closed things down and required both social distancing and masks. The total number of cases per 100,000 souls is much less than here and most other places.

Meanwhile, Thailand is offering a softer, gentler service to those officers who sign on to be law enforcement officers trying to accommodate the needs of the police service.

Law Enforcement – M.H. encounters – New documentary April 27, 2019 in Somerville

A new documentary featuring the law enforcement CIT model of police-mental health response is being featured as part of the 2019 Boston Independent Film Festival.  This entry won a prestigious award the SXSW in its film debut.  As I retired from police work my interest in law enforcement mental health interactions deepened.  As a result I met these officers in San Antonio was was taken for some days of first hand observation of their work.  The documentary took 2 years to complete and gives the viewer a front row seat in the model from San Antonio PD and Bexar County that works. The film debuts here in Boston at the Somerville Theater in Davis Square on Saturday April 27, 2019.  I strongly urge readers in the area to attend.

In many police agencies the call volume for mental health encounters is at or above 50 percent. That means that every other call for service requires that officers dispatched to the call have an understanding about encounters with citizens experiencing a mental health crisis. Many LEO’s lack training and are uncomfortable with these calls. Importantly, this does not mean that 50 percent of all calls involve mentally-ill citizens but those individuals experiencing some behavioral health emergency – like a job lay-off or impending divorce or financial problems. They are not mentally ill and should not be treated any differently than any other 911 call for service. Police are often called when bad things happen to normal individuals who become emotionally overwrought often made worse by chronic use of alcohol or drugs.

Training for encounters with citizen’s experience a mental illness is part of the early career academy education. Many officers are provided 40 or more hours of crisis intervention training (CIT). In-service programs are being introduced across the country because of the importance of having expertise and understanding in basic de-escalation. Agencies around the country are playing catch up in learning how best to deal with abnormal behavior. Police in Albuquerque, NM are using a monthly supervision model where the department psychiatrist case conferences specific calls and officers learn techniques for de-escalation and process details about how better to respond to future calls.

Crisis intervention training teaches law enforcement officers what to expect and allows them to practice using role playing to see for themselves how to intervene with people in crisis using de-escalation techniques. “Law enforcement officers’ attitudes about the impact of CIT on improving overall safety, accessibility of services, officer skills and techniques, and the preparedness of officers to handle calls involving persons with mental illness are positively associated with officers’ confidence in their abilities or with officers’ perceptions of overall departmental effectiveness. ” Bonfine, 2014. “When a police officer responds to a crisis involving a person with a serious mental illness who is not receiving treatment, the safety of both the person in crisis and the responding officer may be compromised especially when they feel untrained” according to Olivia, J, Morgan, R, Compton, M. (2010).


Bonfine N, Ritter C, Munetz MR. Police officer perceptions of the impact of Crisis Intervention Team (CIT) programs. Int J Law Psychiatry. 2014 Jul-Aug;37(4):341-50. doi: 10.1016/j.ijlp.2014.02.004. Epub 2014 Mar 11.PMID: 24630739

Olivia, J, Morgan, R, Compton, M. (2010) A Practical Overview of De-Escalation Skills in Law Enforcement: Helping Individuals in Crisis. Journal of Police Crisis Negotiations, 10:15–29.
While Reducing Police Liability and Injury

Police officer vulnerability previously ignored, hidden from plain site

What is currently understood as repeated exposure to trauma and its emotional impact was once thought to be a testament to toughness invoking the specter of a wall of silence. Law enforcement and first responder suicide has increased over the past several years and now exceeds the number of LEO’s killed in the line of duty. Why are cops choosing to take their lives? This is especially felt in Chicago where seven officers have taken their own lives in the last 8 months. In more than one case an officer committed suicide in the police vehicle or in the police department parking lot.

My colleague Dr. Leo Polizoti, Police Consulting Psychologist at the Direct Decision Institute, Inc. has been active in law enforcement training, fitness, and prescreening for over 40 years. He served over 30 agencies across New England and provides supportive psychotherapy as needed.

Dr Polizoti and I were recently involved in a symposium on Police Suicide in Chicago sponsored by Daninger Solutions from Daytona Beach, Florida. Among the presenters were Dr Thomas Joiner from the University of Miami, recognized expert in suicide, police sergeant Mark Debona from Orlando, Florida and Dr Daniel Hollar, Chairman in department of Behavior Science at Berthune-Cookman University in Tallahassee, Florida and CEO at Daninger Solutions.

There are many reasons why police officers have an increased levels of depression and stress.  Most are associated with repeated exposure to traumatic events like exposure to dead bodies, violence, childhood injury or death, terrorism, fatal car crashes, and more.  Most officers are able to remain professionally hearty when provided the opportunity to defuse the exposure soon after an incident. Career performance should include reducing officer depression and embitterment by building resilience starting in the academy and lasting throughout an LEO’s career.

The Mind-Body connection is well established and the role of stress in LEO career well-being is becoming a agency focus beginning in the academy.

“Not only must we as negotiators learn to take care of ourselves emotionally and physically – we must also be prepared to intervene with an actively suicidal officer. “

Dave DeMarco FOX News Kansas City

Is it any wonder officers lose hope and resilience.  There are inherent risks that LEO’s assume when they sign on like forced overtime, changing shifts, off-duty court appearances, the chance they may become injured, disabled or killed while serving the community.  There are also systemic stressors like supervisory bullying, professional jealousy, lack of opportunity to have an impact on policy, career stagnation, and paramilitary chain of command that often devalues education and innovation.  Agencies are beginning to track exposure to trauma and its correlated change police officer resilience in real time.

In Worcester, Massachusetts, LEO’s are required to attend defusing sessions following high lethality/high acuity exposure.  These sessions are kept private from members of the command staff and records are saved by the police consulting psychologist. The department has nearly 500 officers who are paid for their participation when they attend. It has been proposed that officers undergo annual “wellness checks” as a routine in some agencies such as KCMO. I have proposed a system of tracking officer call acuity and invoking mandated behavioral health assessment after a specified number of high acuity/high lethality calls for service. This is one way of reducing the stigma that officers face when they are sent for “fitness” evaluation or any sort of behavioral health care. The stigma associated with mental health may be reduced by having specified referrals following identified high profile incidents. Officers may be considered to be getting peak performance training at these defusing sessions as they are designed for enhancing officer awareness and reducing the human stress response.

Now, the KCMO department has mandated yearly wellness exams for officers in certain units like homicide and those dealing with child abuse. This was initiated to decrease the impact of traumatic events on police officer well-being. Officers at KCMO can also get up to six free anonymous visits to a mental health clinician each year, and the department has a peer support team.  Mental health clinicians must have experience working with law enforcement officers for best results.  Training for clinicians should be provided to best work with LEO’s and first responders. This is especially true for officers who self-refer.  Clinical hours should be supervised by the police consulting psychologist.

Police Stress Intervention Continuum: An introduction for LEO’s and command staff to reduce officer suicide

Scope of the Problem: Police Suicide and the goal to eliminate it
Police job-related stress is well-identified and reported in the media daily and the rates of suicide nationwide are being debated by Aamodt and Stalnaker. They are actually less than one is led to believe but even one law enforcement officer suicide is too much.
Stress is defined as any situation that negatively impacts an officer’s well-being. The rate of suicide and divorce among law enforcement is approximately the same or lower than the general public according to a meta- analysis conducted by Professor Michael Aamodt.  But there are areas in the country and agencies that have higher rates of self-inflicted death.
When the suicide rate of police officers (18.1) is compared with the 21.89 rate for a comparable demographic population, it appears that police officers have a lower rate of suicide than the population according to Aamodt, 2008.
Incidence of suicide tend to be elevated in cities like Chicago, where chronic gun violence and a murder rate in the hundreds per year means cops see a staggering amount of trauma and may gradually become numb to the exposure of pain and suffering (Joyner, 2009). A Department of Justice report found that the suicide rate in the Chicago Police Department is 60 percent higher than the national average.  According to the Chicago Sun Times, in a note to department members Wednesday, CPD Supt. Eddie Johnson said, “Death by suicide is clearly a problem in Law Enforcement and in the Chicago Police Department. We all have our breaking points, a time of weakness where we feel as if there is no way out, no alternative. But it does not have to end that way. You are NOT alone. Death by suicide is a problem that we can eliminate together” CST September 12, 2018.  Chicago PD is not alone with the problem of suicide among its men and women in blue.
Law enforcement officers (LEO’s) encounter the worst of all experience on a routine basis. The people who call the police may be society’s best upstanding citizens but on this occasion it could be the worst day of their lives and they seek help from police.  Many times it is not the pillars of society seeking help but those people in the fringes or margins of society now victims of violent crime or abuse.
According to Hartley, et.al., 2007, “repeated exposures to acute work stressors (e.g., violent criminal acts, sad and disturbing situations, and physically demanding responses), in addition to contending with negative life events (e.g., divorce, serious family or personal illness, and financial difficulties), can affect both the psychological and physiological well-being of the LEO population.” When these officers are identified there needs to be a planned response using a peer support infrastructure that provides for a continuum of service depending upon the individual needs of the LEO and the supports available. In many agencies, especially smaller departments lacking resources, officers’ languish and sometimes spiral downward without support and without somewhere to turn.  Police officers must have support available to them long before they are expressing suicidal urges.
As programs are identified and service continuum grows the risk of peer conflict over perceived betrayal of trust must be addressed. This must be addressed in the peer support training with emphasis on preservation of life over maintenance of confidentiality or the status quo of abject silence. “In itself, it’s a product of centuries of police culture in which perceived weakness is stigmatized. Cops know their brothers have their back, no matter what, but they still don’t want to be seen as the one who’s vulnerable.” according to a recent Men’s Health article written by Jack Crosbie in a report about suicide in the NYPD published during Mental Health Awareness month in May 2018.
The argument is made that the recurring uncertainty of police calls for service often leave LEO’s with low-level exposure to trauma of varying degrees. It is common that LEO’s move from one violent call to the next without time to decompress and process what they have seen.  The repeated exposure to trauma can slowly whittle away LEO resilience – defined as the capacity to bounce back from adversity. In a national media study published by Aamodt and Stalnaker, legal problems were a major reason for the law enforcement suicides yet no other study separately cited legal problems. In another study, relationship problems accounted for the highest percentage of suicides at 26.6% (relationship problems plus murder/suicide), followed by legal problems at 14.8%. In nearly a third of the suicides, no reason was known for LEO suicide.
Police suicide has been on the radar of advocates of LEO peer support for months or years.  The incidence of suicide has remained stable across the country but some agencies have higher rates of suicide.  Smaller departments – those with less than 50 officers in general have the highest rates of suicide.  This may be linked to the lack of availability of peer support programs and a paucity of local practitioners to provide professional service with knowledge in police psychology. “While police officers may adapt to the negative effects of chronic stress, acute traumatic incidents necessitate specialized mental health treatment for police officers (Patterson, 2001)”.  A referral to the department EAP often falls flat and makes it more difficult to make the hand-off when peer support is not enough.
Real-time model of change
The use of force continuum is well described in the LEO literature and ongoing criminal justice narrative. What does that have to do with stress intervention in police officers? It sets the tone for officer behavior whenever they meet potential resistance and or increased aggression during citizen encounters. It may also be used for initiating peer support needs whenever an incident use of force has occurred.  LEO’s change the force response based on the situation they encounter in real-time in a flexible and fluid manner. In this same way, peer support programs can flexibly shift to the needs of a presenting LEO and intervene early on – rather than when an officer is at a breaking point. “This continuum (use of force) has many levels, and officers are instructed to respond with a level of force appropriate to the situation at hand, acknowledging that the officer may move from one point on the continuum to another in a matter of seconds.” NIJ publication.  Peer support too, must accommodate a law enforcement officer in real-time to begin the process of building a healthy, resilient response to sometimes horrific exposures and provide a continuum of unbiased employee assistance and when necessary professional consultation.
Protective Factors begin in Academy training
What topics should addressed while LEO recruits are in training?  Ostensibly, the resilience of LEO’s depends upon the opportunity for in-service training in topics of mindfulness, stress management, physical health maintenance, nutrition, and trust.
“Emotional resilience is defined as 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” according to Leo Polizotti, Ph.D. a police consulting psychologist (Sefton 2018).
Police programs for health maintenance
images-1
The Police Stress Intervention Continuum or P-SIC, involves a system of police support that varies in its intensity depending upon the continuum of individual needs of the LEO including physical debility or other significant components impacting career success and satisfaction. The intervention protocol is flexible and fluid as well. The entry point into the peer support continuum initiates from supervisory observations of LEO history and behavior, peer recommendations, and exposure to a range of traumatic events.

 

Generally speaking, a police officer’s behavior change is a function of the resilience they develop throughout their careers. Greater attention to physical health and emotional well-being are now being espoused in police academies across the country.   Greater awareness of the correlation with the recent trauma and frequency of exposure to trauma such as the death of a child, exposure to dead bodies, suicide of a colleague, etc. have negative impact on officer well-being.  Perceived support from supervisors and the organization hierarchy builds resilience.

Career success requires that officers learn stress tolerance and healthy habits to manage the daily challenges of police service. Physical exercise and healthy routines often afford the stressed officer an outlet for reduced risk of stress-related physical afflictions in addition to the emotional and health effects of repeated exposure to unpredictable violence.

The cumulative stress associated with a career in law enforcement cannot be understated.  In the setting of police stress and stress support there is an intervention protocol that relates to the peer-support program continuum.  Depending on where officers enter the peer support network will impact the level of intervention they may require in the P-SIC program.  Peer support is not psychotherapy but officers occasionally must hand off the officer in trouble to a  higher level of care.  These hand-offs are key to linking at-risk LEO’s with range of professional support needed to keep them on the job. Yet fear of reprisal for acknowledging the cumulative impact of stress and its impact often derails the hand-off to the professional. The highest risk for suicide to a LEO is when he is denuded of badge and gun because he may be a threat to himself.
The career success they have may be directly related to the application of resiliency training to build and maintain physical and emotional hardiness that lasts a lifetime according to Leo Polizoti, 2018. Before this can happen the stigma associated with reaching out must be reduced.

Points of entry to Peer Support – Stress Intervention Continuum
copyright Michael Sefton
  • Exposure to highly stressful events in close sequence
  • Change in work assignment, district/station, deployment undercover or return from deployment
  • Increased absenteeism – over use of sick leave
  • Increased use/abuse of substances – impacting job functioning, on-the-job injury
  • Community – citizen complaint(s) for verbal abuse, dereliction of duty, vehicle crash
  • Citizen complaints of excessive force during arrest, supervisory or peer conflict, or direct insubordination.
  • Abuse of power using baton, taser or firearm, recurrent officer involved use of force. Officers are sometimes strongly embittered and angry at this point in their career due to perceived lack of support and powerful feelings career disappointment and alienation.

NIJ Publication (2009). Use of Force Continuum. https://www.nij.gov/topics/law-enforcement/officer-safety/use-of-force/Pages/continuum.aspx. Taken November 17, 2018
Aamodt, M. G., & Stalnaker, N. A. (2001). Police officer suicide: Frequency and officer profiles. In Shehan, D. C, & Warren, J. I. (Eds.) Suicide and Law Enforcement. Washington, D.C.: Federal Bureau of Investigation.
Aamodt, M. (2008). Reducing Misconceptions and False Beliefs in Police and Criminal Psychology. Criminal Justice and Behavior 2008; 35; 1231 DOI: 10.1177/0093854808321527.
Patterson, G T. (200l). Reconceptualizing traumatic incidents experienced by law enforcement personnel. The Australian Journal of Disaster and Trauma Studies, 2.
Joyner, T. (2009) The Interpersonal-Psychological Theory of Suicidal Behavior: Current Empirical Status. Science Briefs, American Psychological Association, June.
Sefton, M. (2018). Police Training: Revisiting Resilience Blog post: https://msefton.wordpress.com/2018/07/27/police-training-revisiting-resilience/. Taken November 18, 2018
Hartley, T., et.al.(2007). Associations Between Major Life Events, Traumatic Incidents, and Depression Among Buffalo Police Officers. International Journal of Emergency Mental Health, Vol. 9, No. 1, pp.
John M. Violanti, Anna Mnatsakanova, Tara A. Hartley, Michael E. Andrew, Cecil M. Burchfiel. (2012). Police Suicide in Small Departments: A comparative analysis. Int J Emerg Ment Health. Published in final edited form as: Int J Emerg Ment Health. 2012; 14(3): 157–162.

Police Training: Revisiting Resilience

What is resilience in police work?  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 the best of circumstances officers are encouraged to share stressful events and debrief with peer supports that are a regular component of the police service.  Unfortunately, in spite of the availability of peer support many officers are hesitant to utilize and call upon their peers to help with difficult even traumatic calls like suicide and severe child or elder abuse.  One reason for this is a culture of internalizing stress until it whittles away career satisfaction and job performance.  The underpinning of police officer burn-out is the collapse of resilience and onset of maladaptive coping.
How many mid-career officers have reduced productivity and elevated stress that leads to increased use of alcohol, drugs, gambling, abuse of sick leave, and job-related injuries?  According to Leo Polizoti, Ph.D. resilience refers to professional hardiness that is protective against such career burnout and raises both professionalism and job satisfaction. Many believe that hardiness and resilience can be built and polished as the officer grows into his career.
Police training tends to be repetitive and often boring.  Officers train to attain a level of automaticity so that when field encounters become threatening they are quick to utilize tactical behavior in the use of force continuum.  Sadly, police departments everywhere have trained in the active shooter protocol so that when the call goes out every officer knows exactly what is expected of him or her.  By doing so the motor programs and cognitive maps coalesce into a tactical advantage for law enforcement.  Training also helps to reduce autonomic arousal and helps regulate internal levels of stress so that officers can function at optimal levels when needed most.
Just as it is difficult to identify mental illness in a civilian population until the person is off the rails, so too is it difficult to pinpoint a law enforcement officer who is struggling with the long-term effects of the high stress calls police answer on a daily basis. “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).
High levels of stress are known to slowly erode emotional coping skill leaving a psychologically vulnerable person at higher risk of acting out in many ways including with violence.  The 2013 case of domestic violence homicide in Arlington, Massachusetts raises the specter of domestic violence homicide in police and first responders. In this case, a decorated paramedic allegedly killed his twin children, his wife and then himself. Outwardly, he and his family seemed happy. What might trigger such an emotional breakdown and deadly maelstrom?
“Although resilience — the ability to cope during and recover from stressful situations — is a common term, used in many contexts, we found that no research had been done to scientifically understand what resilience is among police. Police officers have a unique role among first responders. They face repeated stress, work in unpredictable and time-sensitive situations, and must act according to the specific departmental policies. ” Andersen et al. 2017
The career success they have may be directly related to the application of resiliency training to build and maintain physical and emotional hardiness that lasts a lifetime according to Leo Polizoti, 2018. Before this can happen the stigma associated with reaching out must be reduced.
Reduced stigma will afford officers the chance to express themselves, lower stress and tension, and seek peer or professional help when situations evoke or release the ghosts of cases past – often the underpinning of PTSD. This openness has not yet found its way into the law enforcement culture and while physical fitness has taken hold for career satisfaction – mindfulness has not become fully embraced.
REFERENCES
Andersen et al. (2017) Performing under stress: Evidence-based training for police resilience
Royal Canadian Mounted Police, Gazette Magazine Vol. 79 No 1.
Polizoti, L. (2017) Psychological Resilience: From Surviving to Thriving in a Law Enforcement Career. Presentation. Direct Decision Institute, Worcester, MA
Polizotti, LF (2018) Psychological Resilience : From surviving to thriving in a law enforcement career. Personal Correspondence. Taken 4-21-2018

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

Desperate Victim’s plea for help

DV_note B&W
Victim passed this note to Veterinarian staff – Photo VCSD

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

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

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

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

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

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

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

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

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

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

Violence in the Workplace: Do people just “snap”?

WESTBOROUGH, MA June 2, 2018  Violence in the workplace is commonplace but has taken a back seat in the setting of recent school shootings. Research on the “lethal employee” is becoming more reliable in the aftermath of of workplace violence. Nevertheless people commit murder in their workplace more than ever.  What should people do if they are worried about a co-worker becoming violent.  There are signs that someone is loosing control and may be thinking of violence.  A list of potential factors is taken below from the U.S. Department of Homeland Security publication from 2008. The term “going postal” refers to a workplace shooter or act of violence.  It evolved from workplace violence in the U.S. Postal service in the 1980’s according to a report published in 2008.

“One theory was that the post office was such a high-pressure work environment that it drove people insane. In the years to come, other cases of murderous rages by mailmen cemented the idea in the public mind. “Going postal” became a synonym for flipping out under pressure.”

RECOGNIZING POTENTIAL WORKPLACE VIOLENCE
“An active shooter in your workplace may be a current or former employee, or an acquaintance of a current or former employee. Intuitive managers and coworkers may notice characteristics of potentially violent behavior in an employee. Alert your Human Resources Department if you believe an employee or coworker exhibits potentially violent behavior” (2008)

Indicators of Potential Violence by an Employee Employees typically do not just “snap,” but display indicators of potentially violent behavior over time. If these behaviors are recognized, they can often be managed and treated. Potentially violent behaviors by an employee may include one or more of the following (this list of behaviors is not comprehensive, nor is it intended as a mechanism for diagnosing violent tendencies):
• Increased use of alcohol and/or illegal drugs
• Unexplained increase in absenteeism; vague physical complaints
• Noticeable decrease in attention to appearance and hygiene
• Depression / withdrawal
• Resistance and overreaction to changes in policy and procedures
• Repeated violations of company policies
• Increased severe mood swings
• Noticeably unstable, emotional responses
• Explosive outbursts of anger or rage without provocation
• Suicidal; comments about “putting things in order”
• Behavior which is suspect of paranoia, (“everybody is against me”)
• Increasingly talks of problems at home
• Escalation of domestic problems into the workplace; talk of severe financial problems
• Talk of previous incidents of violence
• Empathy with individuals committing violence
• Increase in unsolicited comments about firearms, other dangerous weapons and violent crimes

U.S. Department of Homeland Security. (2008). Active Shooter – How to Respond
Bovsum, M. (2010) NY Daily News. Mailman massacre: 14 die after Patrick Sherrill ‘goes postal’ in 1986 shootings. http://www.nydailynews.com/news/crime/mailman-massacre-14-die-patrick-sherrill-postal-1986-shootings-article-1.204101 Taken May 19, 2018

The myths and risks to individuals with mental illness

WESTBOROUGH, MA April 8, 2018 The myths attributed to persons afflicted with mental illness need to be directly addressed and corrective programs must evolve provide enhanced understanding and awareness of mental health.  Police officers encounter citizens with mental illness daily and often are called upon to calm a volatile situation often with very little formal training. This fact is changing as more police officers are trained in Psychological First Aid and Crisis Intervention Training – 2 programs that afford front line officers with the behavioral observation skill and communication necessary to reduce risk to police and the public from highly charged persons exhibiting signs of mental health crisis.
Psychological experts believe mentally ill persons lack the higher order planning to execute the complex steps necessary for anything more than petty crime – more often associated with co-morbid substance abuse.  This is where the problem lies. “The myth is you have to be “crazy” to do something like this (active shooter). So retrospectively, you look at people and you say, wow, this obviously – that guy should have been branded – but alcohol accounts for a great deal more violence than mental illness does.” according to Joel Dvoskin in an APA interview dispelling myths about the mentally ill.
Remember it is a fact that those with mental illness are rarely violent and those who commit violence are rarely mentally ill.
Until recently,  here in Massachusetts many smaller police agencies are forced to pay overtime for police officers to sit in hospitals or outside of jail cells watching a mentally ill person who has been arrested. This policy grew from the fear of litigation if someone dies in police custody who is known to be a mentally ill person.  Specifically, if a police officer arrests a person with a known history of suicidal ideation it has been policy among many agencies to provide an officer to monitor the prisoner to assure for a safe transfer to court. If this occurs on a week end night that often means that someone must have eyes on the person in custody until the next available court date.
But is this truth or is this part of the myth associated with those taken into custody for crimes committed while suffering from a substantive mental illness? Or is the problem really associated with substance abuse?
“Pre-arrest diversion also has been shown to be successful when law enforcement and mental health professionals respond together to behavioral health emergencies. Individuals are more often referred to the services and treatment that they need, rather than enter the criminal justice system as an offender. This co-responder model has delivered great results in Massachusetts to date. Programs run by Advocates, a human services agency, in partnership with several police departments in Middlesex County and funded in part by the Department of Mental Health have generated over 4,000 diversions and $11 million in savings since 2003.” Diane Gould Worcester Telegram February 2018

Dvoskin, J. (2018) Speaking of Psychology: Dispelling the myth of violence and mental illness Episode 27 American Psychological Association

On Police Identification of the mentally abnormal

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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