As a member of the Direct Decision Institute, Inc in Worcester, Massachusetts, my colleague Dr. Leo Polizoti, the Institutes senior lead psychologist, are charged with doing pre-employment psychological screening for all officers heading to a regional police academy across New England. There are details about the pre-employment process at the institute website: drdecision.org. One question I usually ask is: “Why do you want to be a police officer?” As you might expect, the answers are all well rehearsed and touch on: inspiring, decorated family members who were police officers, the personal desire to help people, or a memorable encounter with a member of law enforcement early in life. There are always others too.
A more curious inquiry might sound like this: “why would you want to be exposed to fatal car crashes, domestic violence, including intimate partner homicide, completed suicide and suicidal persons, sudden infant death, violent, intoxicated subjects, random citizen complaints, professional jealousy, long hours, and sometimes decrepit leadership?” I might even add: “if you want to help people why not become a nurse or high school teacher?”
As a police consulting psychologist my goal is to offer my best judgment about candidates for police officer. I offer my two cents worth of resiliency advice by painting a portrait of how they see themselves five years in the future. When asked what they expected in the pre-employment psychological interview one or two have said it was a “waste of time.” Now these men and women are in the minority, only 1 in 15 has said that in my last round of interviews. But just as importantly, going forward, these new officers are going to represent law enforcement and should be better prepared to embrace mental health awareness and the reduced stigma associated with behavioral health and human resilience. Most cops are starting to understand this. To say that a one hour meeting with the police psychologist was a “waste of time” reflects both the lack of understanding of personal well being and a blind spot in progressive policing. Mental health is everywhere in law enforcement on both sides of the badge.
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
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
Threatens to kill spouse if she leaves him – pathological jealousy
Actual use of firearm or other weapon anytime during domestic violence incident
Access to firearms even if he never used them – veiled threats
Attempt at strangulation ever during fight
Forced sex anytime during relationship
Unemployment of perpetrator
Stalking via social media – one or both spouse use social media to intimidate or garner support
Presence of unrelated “step” child in home
Spouse finds new relationship soon after separating
Low bail release from custody – high bail holds are essential in DVH mitigation
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.
By all appearances Gabby was a smart and loving companion. She wanted to impart her love for Brian Laundrie and the life she hoped they would have together using social media. They were engaged to be married but this would never occur. Now she is the victim of homicide. “The loneliest time in a life is being in the wilderness in the middle of night, with a person you once loved, now killing you. “If you scream for help in the wilderness and there is no one there to hear it except your killer, was there ever really a scream?”” Personal correspondence from B.F. Gagan. New website: http://www.arrestbrianlaundrie.com for details on the $25,000 reward for finding Brian Laundrie. Details on the site. There have been at least 11 questionable tips transmitted to the FBI tip line as of October 4, 2021. The media reports keep Laundrie’s picture in the news cycle. Just today someone reported seeing him on the Appalachian Trail where hikers go from Northern Georgia and finish at Mount Katahdin – the highest peak in Maine. Mr. Laundrie has done parts of the trail and is familiar with its isolation from society. He may feel that he can make a safe getaway while remaining off the grid. But someone recognized him today in South Carolina. Or a look alike.
Gabby Pitito is a case study for intimate partner abuse. From the outside, we saw a beautiful couple enjoying the wonders of the American West. Social media accounts updated with regularity bringing hundred or even thousands of likes. Gabby had a gift for creating an image. Only now have we learned the imagery was deeply flawed. Friends of the pair described Brian Laundrie as a jealous and controlling partner as described by Rose Davis, a friend of Gabby Petito.
Common among abusive partners is separating intended victims from their emotional support systems leaving them isolated and without friends and needed help. It is a common red flag in most cases of domestic abuse and more commonly, domestic violence homicide. In most cases the abuser has an underlying pathological jealousy and in some cases, delusions of his partner “hooking up” with someone whenever she is out of his site. Once while on duty with the police agency for whom I served, a jealous husband came crashing into town hall hoping to catch his wife in a tawdry affair while she stood in line to cast her vote in a 2015 election. He had been sending her text messages from the parking lot like “Where are you? Who are you with?” Ultimately, the man needed an escort out of the building and was given a trespass warning. For her part, she felt pangs of guilt, resentment, and fear for keeping him waiting. Shortly after Election Day the family moved away from town. It happens all the time.
“You can’t say that nothing can be done, because nothing will be done,” said Michael Sefton, a former Westbrook police officer who now works in Massachusetts and retired from the the New Braintree Police Department.
Women are kept from seeing friends and family members in an effort to disempower them of any sense of self. We now know this got worse during the pandemic where people were isolated anyway and those living in domestic fear became further inhibited and marginalized. By outward appearance Gabby Petito was terrified of her boyfriend at the time they were stopped in Moab, UT. This behavior speaks volumes about the state of the relationship just as Supervisory Agent Melissa Hulls said after they encountered Gabby and boy friend Brian Laundrie in late August 2021. I have reached out to Supervisory Ranger Hulls on two occasions without hearing back.
I am interested in hearing from few friends of Gabby Petito with their appraisal of what they saw happening to the couple during pandemic? The pair had been together over 2 years and managed to get through waves of pandemic only to be set free on the cross country junket. Both seemed physically fit and healthy. Had the pandemic and subsequent quarantine changed them in any way? How did the couple decide to embark on this journey? Whose idea was it? “Brian has a jealousy issue,” Rose Davis of Sarasota, FL said in the September 17, 2021 New York Post article. “I’m her only friend in Florida to my knowledge and that’s not because she can’t make friends, he just didn’t want her to have friends.”
“He was always worried she was going to leave him,” she said. “It was a constant thing to try to get us to stop hanging out.” She previously described him as a controlling and manipulative boyfriend with jealousy issues, and said Petito had sometimes stayed with her to put some space between them according to the New York Post interview with Davis. These are among the most common red flag warning for DV and DVH.
The Moab city Utah police were called to a possible case of domestic violence. The interview was caught on officer worn body camera and showed Gabby in an anxious, tearful state. Any physical signs should have been met with arrest of the likely perpetrator whether or not Gabby wanted to prosecute. The police report from Moab indicated that the officer believed something was not right! But he did not move on that feeling or was untrained as to what he might anticipate could happen next. She reported that her mental health was not good. Why? Was she in fear that the relationship was fragile and taking an unhealthy turn.
Had the fuse been lit?
At the very least Gabby should have been assessed for changes in her mental health and given her history, law enforcement missed the chance to understand the underpinnings of her sudden loss of control and tearful anxiety? The care-free beginning of the exciting trip became suddenly serious enough to get on the local police department’s radar. A female national park ranger Melissa Hulls interviewed Gabby along side officers from Moab. She tried to advise Gabby that her relationship with Laundrie was had become toxic and put her in jeopardy. And just as quickly, Gabby and her fiancee fell off the police radar, leading Gabby into oblivion. Ranger Melissa Hulls saw the relationship for what it was and very likely feared for Gabby’s safety.
Most murder-suicides involve intimate partners (72%) and the vast majority of these cases are women murdered by intimate partners using a firearm (Violence Policy Center, 2015). I have experience with domestic violence and the various red flag warnings of terminal anger and have tracked the downward spiral of a sick relationship. “We knew the system had failed Amy Lake” said Brian F. Gagan, a former Westbrook police officer who helped research the first psychological autopsy report, “We did not know how.” as published in the Portland Press Herald 11/30/2011. We learned plenty over the course of 200 hours of interview data and considered only confirmable facts and presented the findings to the Maine Attorney General’s Domestic Violence Homicide Review Board in the state’s Capitol.
At very least, in the death of Gabby Petito, Brian Laundrie’s parents must be charged with harboring a fugitive, and aiding in the escape of a person of interest following a murder. The senior of the two responding officers in Moab is at risk of state decertification and may be charged criminally with statutory Utah failure to arrest. The officer will grope for the excuse that “neither party wished to charge” …which is not material to “Utah Mandatory Arrest”, according to Gagan. Gabby Petito’s body was found Sunday 9-20-2021 near an undeveloped camping area that’s surrounded by woodlands and brush, located about 30 miles (48 kilometers) northeast of Jackson, Wyoming. Her death was a murder according to the county medical examiner who has released very few details. Research has shown time and again that separating the couple for a “cool off” time out does little to stop domestic violence and often makes the violence increase.
Meanwhile, I have seen the “neither party wants to prosecute” narrative too many times in my law enforcement career until there is serious injury to one of the partners – usually the female. I am fortunate to have never had a case go to the terminal stage of DVH, aside from Albert Flick – a Westbrook, ME case from 1979, police detectives Ron Allanach and Wayne Syphers handled while I was in the Juvenile Bureau. Flick went on to kill again, within weeks of his release from prison for killing a woman while her children looked on. The domestic victim never wants to prosecute because they have been conditioned against doing so over the years and are afraid they will be killed. Those most in fear of being killed by their partner are likely reacting to a primitive warning signal in the brain. The gift of fear with a book by the same name highlights the subtle but powerful fear some women feel during courtship with violent men. So, when these fears are realized, the terminal stage of violence begins the spiral downward when a domestic partner can no longer bind his angry, jealous impulses, and need for control. In spite of what the intimate partner may report to be deep felt “love” for his wife, girlfriend, and innocent family members, it comes down to murder for the sake of owning the life of a spouse and his children and feeling justified in his action.
Gabby Patti’s cell phone has never been mentioned in published reports nor has her expansive social media reporting been studied. We have recommended that a safety plan be written omitting all social media whatsoever. Everyone has a cell phone that can be tracked using triangulation data from cellular towers anywhere there is service. People who are lost can be easily found as long as cellular service is available and phones are properly charged. This is significant given her daily social media focus. It is certain the FBI has received all cell server data from both phones. This has likely contributed to the warrant issuance and national search. The cellular data was added to toll highway data from Colorado and Texas while Laundrie was on his way to Florida from the murder scene in Wyoming. It is also likely now that the Bureau is encircling his parents who may have helped him escape. At least one of them will be convinced to tell the truth because I am certain they are now being interviewed separately. They now cannot lie to protect the killer since there is now a federal warrant on him. If they do, they are then arrested and charged with being complicit in Gabby’s death.
This case requires careful analysis once the murderer has been officially charged or found dead. By not doing so Gabby Petito’s death became another invisible young woman who wrongly believed she was safe and with the love of her life. After seeing the body worn police encounter, Dr. Ziv Ezra Cohen, a clinical assistant professor of psychiatry at Weill Cornell Medical College of Cornell University and staff member of New York-Presbyterian Hospital, told Fox News Laundrie and Petito were ‘both minimizing their argument’ and said the footage suggested the couple may have been high and having ‘a bad trip.’ (Fox News story). The psychologist cast doubt on the couple’s efforts to explain away the fight as caused by Petito’s OCD, insisting that the condition is ‘not a risk factor for violence.’ Petito expressed anxiety through her tears perhaps with an impending sense of doom.
‘People with OCD are not violent. OCD is not a risk factor for violence. If there was an altercation between them, certainly OCD would not be fodder for something that would lead her to hurt him,’ according to Ezra Cohen, MD. If anything having OCD is more apt to result in being victimized and not the aggressor.
Park Ranger Melissa Hills told Petito that her and Laundrie’s relationship had the markings of a ‘toxic’ one as reported in the Daily Mail. ‘I was imploring with her to reevaluate the relationship, asking her if she was happy in the relationship with him, and basically saying this was an opportunity for her to find another path, to make a change in her life,’ added Ranger Melissa Hulls in Moab according to writer Rachel Sharp published in the Daily Mail on 9-24-2021.
Domestic Violence Fatality Review Teams identify homicides, suicides, and other deaths caused by, related to, or somehow traceable to domestic violence and review them to develop preventive interventions (Dawson, 2017; Websdale, 2010; Websdale, 2012; Websdale et al., 2017). These frequently depend on careful communication among those who work within the field of intimate partner violence including members of judiciary, bail commissioners, district attorneys, law enforcement, and social services. Without definitive recommendations, review boards provide nothing to protect potential victims and do nothing to move the needle in the direction of improved safety plans and dangerousness assessments of potential murderers. Sadly, Gabby Petito will not grow old. She will not have children or grandchildren. She will not have a career. It is incumbent upon society to look at the similarities among cases of domestic violence homicide using case study data, aftermath review of facts, and structured interviews to intervene ahead of the secretive pattern of control, abuse, sexual violence, and murder that happens much too often and flies below law enforcement radar. By doing so, victims build new lives with safety plans and legal contingencies for those who violate those orders of protection.
On November 11, 2020, I presented a program on the Psychological Impact of Pandemic sponsored by Whittier Rehabilitation Hospital. It was well attended with a mix of nurses, midlevel practitioners, social workers, and nonclinical participants. The program was presented on the zoom platform. I am now going to put to paper my perspective narrative espoused in my 90 minute presentation. I had also invited members of law enforcement with whom I have regular contact as the information was drawn from the growing literature on mental resilience and its positive impact on coping with exposure to trauma.
According to the PEW Research Group, 4 in 10 Americans know someone who has either been afflicted with Coronavirus or someone who has died from the virus. My mother was infected with the Coronavirus in mid April 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. Both living on a nursing unit that was doing its best to render compassionate care under extraordinary conditions, in some cases with nurses, aides, and therapists working round the clock. Both of these loved ones received extraordinary care. Nursing units across the country suffered unimaginable loss of life including over 70 elderly veterans at the Soldier’s Home in Holyoke, Massachusetts. We all saw the images of refrigerated trucks holding victims in expiated purgatory hidden behind hospitals. It may bring horror to those who lost loved ones and never saw them again.
I saw my mother on November 12. She looked frail and disheveled. The nurse practitioner had ordered a blood draw out of concern for her physical well-being. She is 92 and may have a blood disorder. They had three staff people hold her in place to obtain the small sample of blood which took over and hour. She has always had difficulty having her blood drawn and this has gotten worse as she has gotten older. She fought and screamed from pain, and fear, I was told. It was torture for all those involved, including me.
Little did anyone realize the extent of disease, contagion, and trauma this pandemic would bring to the United States and the world. We waited in February and March with curiosity and vague forewarning from our leadership. We were led to believe the virus would dissipate once the weather became warm and it would essentially vanish in the heat of summer. This did not happen and public health officials at CDC and WHO were spot-on in terms of the contagious spread of covid-19 and the deaths it would bring. Now with the approach of winter our fear borders on panic.
This virus poses significant stress and emotional challenges to us all. It raises the specter of both an overwhelmed medical system as well as increasing co-occurring emotional crisis and a collapse in adaptive coping, for many. Sales of alcohol went up 55 percent in the week of March 21 and were up over 400 percent for alcohol delivery services. Americans were in lock-down and many made poor choices. The link between stress and physical health and well-being is well documented and will be a factor as American’s find their way free from the grip of Covid-19.
“The human mind is automatically attracted to the worst possible case, often very inaccurately in what is called learned helplessness”
Whenever human beings are under stress they are going to utilize skills they have learned from other times when they felt under threat. Chronic stress has been shown to have negative effects on health including autoimmune functions, hypertension, inflammatory conditions like IBS, and pain syndromes. Many find it impossible to think about anything but the worst case scenario. Marty Seligman described the concept of “catastrophizing” that is an evolutionarily adaptive frame of mind, but it is usually unrealistically negative.” This leads to a condition known as learned helplessness. In another book, Dr. Seligman writes about learned optimism published in 1990. His cognitive strategies hold true today.
So many use the same coping mechanisms over and over, whether they are effective or not like drinking or gambling to let off steam. These things may help in the short term but can cause further health and social problems later on. They are not adaptive strategies. Stress is unavoidable and the best thing we can do is to understand its physical impact on us and adapt to it in healthy, adaptive ways. Stress raises the amount of cortisol and adrenaline in the body activating the fight-flight response. For many, that meant an uptick in the procurement of spirits in late March to help bring it down. Others think differently. Many began a routine of walking or running or cycling. Regular exercise contributes to reducing stress and when kept in perspective, is an adaptive response to the threat of coronavirus.
Many people in our hospital were afflicted with the virus or some other health concern and became immersed in loneliness and isolation that can lead to disconsolate sadness. It is hard not to be affected by this suffering. Most reviewed studies reported negative psychological effects including depression, anxiety, post-traumatic stress symptoms, confusion, and anger, according to Brooks, et.al. Lancet 2020. At Whittier, we had many cases of ICU delirium where patients became confused and frightened by healthcare providers wearing PPE including face shields, masks, and oxygen hoods. Many thought they were being kidnapped or that the staff were actually posing as astronauts. This made it hard to help them feel safe and to trust the core staff including doctors, nurses, and rehabilitation therapists.
We have had some very difficult cases including a man who found his wife on the floor without signs of life. He fell trying to get to her and both lay there for over 2 days. He was unable to attend her funeral because of his broken hip. We had another man who pushed us to be released from the hospital. He worried about his wife who needed him to assist in her care at home. She has Parkinson’s disease. He was discharged and died shortly after going home. His wife fell while getting ready for his funeral and is now in our hospital undergoing physical rehabilitation and receiving support from our psychology service. The table below is a list of observations from recent admissions:
Anxiety – what will my family do while I am here?
Deep felt sense of loneliness
Depression – loss of support; loss of control
Exacerbation of pre-existing conditions i.e. sleep disturbance, asthma, uncontrolled diabetes, hypertension
Slower trajectory toward discharge
Debility greater than one might anticipate to diagnosis
Subtle triggers to prior trauma – changes in coping, regression, agitation, sleep and mood
What is left for us to do? Have a discussion about what it means to be vulnerable – talk about family members who have been sick with non-covid conditions like pneumonia or chronic heart disease, COPD, etc. It is important to be ready to work from home again such as when schools switched to remote learning this spring and when governors’ call for closing things down. Consider the return of college kids as campus dorms everywhere are likely to close this winter.
The 1918 Spanish Flu pandemic killed 50 million people worldwide. 500 million people were infected with the virus that lasted 2 years. The virus was said to have been spread by the movement of troops in WW I. The website Live Science reported that there may have been a Chinese link to the Spanish flu as well due to the use of migrant workers and their transportation in crowded containers leading to what we now call a super spread event. We know a lot more about this virus than we did in March 2020 when it first took hold but we need to understand the eradication will be a herculean task driven by science.
“The coronavirus has profound impact on the emotional stability of people around the world because of its unpredictability and lethality. It evokes fear, and uncertainty as it spreads unchecked. Later, the virus can serve to trigger long hidden memories in a way that can sabotage healthy human development leading to vague anxiety, physical symptoms, loss, and deep despair” said Michael Sefton, Ph.D. during a recent Veteran’s Day presentation. People must have resilient behaviors that foster “purpose in life, to help them survive and thrive” through the dark times now and ahead, according to police consulting psychologist Leo Polizoti, Ph.D. at Direct Decision Institute in Worcester, MA.
“The important part of crisis intervention training comes in the interdisciplinary relationships that are forged by this methodology. Trust and respect between the police and its citizens builds slowly one person at a time. “
Michael Sefton, 2017
Police officers have historically been ill prepared to deal with people exhibiting signs of mental illness or severe emotional disturbance. Many were thought to be unpredictable and therefore resistant to the typical verbal judo officer’s are trained to use. The CIT programs provided training to police officers in an attempt to bridge the gap between myths about mental illness passed down from one generation of LEO’s to the next and actual training and experience in talking with citizens experiencing a crisis in their life, learning about techniques to manage a chaotic scene, strategies for enhanced listening, understanding the most commonly encountered disorders and role playing. For one thing some person’s afflicted with mental illness have difficulty following directions such as those suspected of hearing voices, paranoia or command hallucinations but this is not always the case. Many individuals CIT trained officers will encounter are normal human beings who are experiencing a high stress, crisis such as the death of a loved one, financial loss, failed marriage or relationship, or major medical illness. This adds a layer of complexity to the CIT model that officers soon experience.
Acuity increases with encounters of mentally ill who are both substance dependent and have some co-occurring psychiatric condition. The alcohol or drugs are often veiled in the underlying “mental illness” but in truth they are not mutually exclusive. The importance of treatment for substance dependence and mental illness cannot be understated as violent encounters between law enforcement and the mentally ill have been regularly sensationalized. The general public is looking for greater public safety while at the same time M.H. advocates insist that with the proper treatment violent police encounters may be reduced and jail diversion may be achieved.
5 Stages of Police Crisis Intervention
Scene safety – Assess for presence of firearms – obtain history of address from dispatch – have back-up ready
Make contact with complainant & subject – express a desire to help; listen to explanation of the problem – ascertain what is precipitating factor?
Establish direct communication with subject – attempt to establish trust; support for taking steps toward change; “why now?”; identify any immediate threats – sobriety, weapons
Pros and Cons for change – ascertain how willing is subject to begin change process, i.e. sobriety, counseling, detoxification
Positive expectations for change = direct movement toward change – hospital program; rewards that will come with positive change
“A crisis event can provide an opportunity, a challenge to life goals, a rapid deterioration of functioning, or a positive turning point in the quality of one’s life”
(Roberts & Dziegielewski, 1995)
There is a high degree of stress in any call involving a person in crisis. Repeated exposure to trauma is known to change the fight/flight balance we seek for emotional stability. Excessive autonomic arousal poses a threat to cardiac functioning and damaging hypertension. After high intensity/high lethality calls I suggest a defusing session take place immediately after the shift or as soon as possible. Excess adrenaline from an abnormal stress response can have significant health effects on LEO’s. Defusing or debriefing sessions can help reduce the impact of these types of calls. Full critical incident debriefing should wait until the normal effects of such calls wear off.
After a spate of bomb threats and mass shootings there are still many myths about the attribution of these events and the underpinnings of violence. The knee jerk reaction is to attribute the recent Thousand Oaks, CA nightclub shooting to a “crazed gunman” but that would unfairly place the blame on the mentally ill. 12 people were left dead in a despicable sequence of events during which the shooter Ian David Long posted that he had no reason for doing it except boredom. In truth, most people with mental illness are not dangerous, and most dangerous people are not mentally ill.” Liza Gold, 2013. But Long had a history of violence and aggressive behavior that may have been linked to his service as a decorated US Marine. Published information suggests Long’s mother was terrified of making him angry out of fear that he would harm or kill her. Was Long’s terminal behavior attributable to mental illness or the result of traumatic events he experienced in the service of his country?
“Fact is I had no reason to do it, and I just thought….(expletive), life is boring so why not?” Ian David Long via social media post (now removed)
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. It is the co-occuring illness of drug or alcohol addiction that is a confounding variable in all police-mental health encounters. “Doctors and scientists know that the perpetrators of such violent behavior including incidence mass shooting events are frequently angry young men, who feel they have been mistreated by society and therefore seek to exact revenge” described in a BBC the report Criminal Myths published in November.
“Confounding variables such as a history of childhood abuse or use of alcohol or drugs can increase the odds of violence.” according to a BBC report debunking the belief that people who commit mass murder are mentally ill by Rachel Newer in November, 2018. The vast majority of cases are committed by a person or persons without mental illness. In fact, people with mental illness are more likely to be victims of crime and are not prone to violent behavior. The Thousand Oaks killer refused any mental health support and was not driven by demons
The interaction of substance abuse and mental illness is complex. Persons with drug and alcohol addiction must be expected to become sober with the help of substance abuse treatment and family support. The risk of violence and suicide declines when sobriety can be maintained. This is essential and will help to reduce officer involved use of force against the mentally ill substantially. What to do?
Red flag indicators are often demonstrated in behaviors that are observable and measurable sometimes for weeks and months before the terminal event according to Michael Sefton, 2015.
The incidence of mental illness leading to mass shooting may be illustrated in the 2007 Virginia Tech shootings. The Virginia Tech shooter Seung-Hui Cho had been treated for depression and was hospitalized on an involuntary basis prior to the rampage in 2007. Cho exhibited a life-long pattern of withdrawal from interpersonal relationships. He was often nonverbal and did not respond to people who reached out to him including direct family members. His mother prayed for God to transform her son.
I strongly believe that mental illness does not mitigate citizens from responsibility for crimes they commit. I agree that alternative sentencing may be a powerful tool to bring these individuals into treatment. The substantive goal of streamlining encounters between police officers and citizens who suffer with untreated emotional problems belies the mission of these gifted officers and can teach others the role of discretion in mental health encounters.
Ostensibly, building relationships with network psychotherapists, physicians, addiction specialists, court judges, and other support service like Child and Family Services is essential. This is the area of most vulnerability. When LEO’s fully buy-in to the mental health – police intervention model including the use of de-escalation techniques there must be receiving facilities available to initiate treatment and keep patients and citizens safe. The development of a fully integrated infrastructure for jail diversion, intake, and providing for the needs of the mentally ill is certainly a work in progress.
“And when it comes to mass shootings, those with mental illness account for “less than 1 % of all yearly gun-related homicides” a 2016 study found. Other studies indicate that people with mental disorders account for just 3-5 % of overall violence in the US” – Paul Appelbaum, M.D. taken from BBC by Rachel Newer 11-1-2018
WESTBOROUGH, MA January 21, 2018 Do people just “snap”? Rarely according to most literature I have read and published. The expression of violence is elicited slowly following a prolonged period of marginalized aloneness along with underlying resentment and anger according to Michael Sefton, Ph.D. This takes a great toll on relationships, loss of trust and a growing persecutory narrative that may become delusional. The gunman in the Las Vegas mass homicide was described as narcissistic – a personality disorder vulnerable perceived rejection or disrespect often resulting in sudden rage, denial, decreased rational thinking, accusatory blaming, and often marked denial of responsibility. In the Las Vegas shooting it has been learned that the gunman had recently sustained a significant financial loss although its link to the people he killed remains a mystery. There is typically some specific event that may trigger a violent event that could have been planned over months or years and evolve like the expression of some genetic permutation.
“People do not just “snap.” When something horrible happens, like a murder or violent attack, we naturally look for a cause. “Snapping” is an easy way to describe what is actually a complex, yet understandable chain of events. Research into violent attacks and the behavior of the attackers can shed some light on how one moves down a pathway toward violence.” Swink, 2010
The capacity for behavioral science to predict when the next mass shooting will occur remains unrefined. Yet, by studying the cases of mass murder that have occurred in the past 5 years there are important pre-incident behaviors that may foreshadow a coming terminal event. Often there are people who know precisely what is going to happen. In our study of a domestic violence homicide that took place in Maine, 2011 we were told by the aunt of the murderer that she expected her nephew to kill himself but expect that he would do it in front of his wife and children. What ultimately happened was a murder suicide. Steven Lake killed his wife and 2 children and made an attempt to incinerate their bodies before local police arrived. At that point he made himself comfortable and ended his life and the Lake family timeline.
Swink, J (2010) The Pentagon Shooting: They Don’t “Just Snap” Posted Mar 06, 2010 Taken Jan 4, 2018
WESTBOROUGH, MA – April 24, 2017 There is no magic solution for de-escalating someone who is in “crisis” or emotionally distraught. The loss of control may signal a failure of reality testing that can signal a diminished capacity to appreciate the consequence of their behavior. This occurs frequently when people who have mental illness have co-occurring drug and alcohol addiction. It is true that the correctional system has more than its share of mentally ill prisoners but for many being in jail is the only way to stay sober. The full capability to provide mental health services in the correctional system here in Massachusetts has not been realized. The courts are reluctant to require that someone receive treatment for mental illness and/or substance abuse in lieu of going to jail.
Criminality and mental illness are not mutually exclusive so there will always be a high number of incarcerated persons with chronic underlying psychiatric diagnoses. The prevalence of mental illness in the general population may range from 5-15 percent. The degree of mental illness in the correctional system may be as high as 40 percent by some accounting but the number is misleading. One needs to consider treating mental illness when it becomes a barrier to functioning such as in schizophrenia or bipolar depression where the symptom profile interferes with reality testing. Only then may a contract for treatment may be constructed to include medication and psychotherapy depending upon the diagnosis. In cases where mental illness and co-occurring substance abuse exist a determination about primary diagnoses and treatment options must be considered.
“The consequences of dual diagnosis include poor medication compliance, physical comorbidities, poor health, poor self-care, increased risk of suicide or risky behavior, and even possible incarceration” according to Buckley and Brown, 2006
In many cases of emotional crisis those in need can be diffused with recognition of their struggle – such as death of family member or loss of employment. By showing empathy for their emotional burden police officers and mental health providers can intervene and make a real difference. But effecting change takes time and a consistent message that personal responsibility begins at home. Instead of placing blame on a “system” that is filled with holes individuals need resilience and family support to get the help they require. Before I am criticized for being insensitive, I point to the 12-step programs in alcohol and drug recovery. They are free and in many cases provide 24-hour support and mentoring at times of crisis. I strongly believe that if people can remain clean and sober than the need for crisis intervention will decrease. Ostensibly, this is a perfect first step toward recovery and will bring forth a palpable reduction in emotion and reduce the potential for violence. When substance abuse is stopped emotional growth is more able to take hold. Healthy, more effective problem solving may result from prospering emotional maturity allowing for resilience and enhanced coping.
Stress can engulf individuals and families for a variety of reasons and should not be judged. People cope with stress differently and in many cases achieve emotional relief by having someone to talk to. Some clinicians believe great personal change may be possible when coping skills are most frail. But in too many instances, drug and alcohol abuse present a confounding variable when working with person’s diagnosed with mental illness. At the same time this raises the risk to law enforcement exponentially. Why?
One response to stress is the increase in substance use and with that increase there is often a worsening of any underlying mental health disorder such as depression and anxiety. “There could be a common factor that accounts for both, primary psychiatric disorder causing secondary substance abuse, primary substance abuse causing secondary psychiatric disorder, or a bidirectional problem, where each contributes to the other.” (Buckley and Brown, 2006) Unemployment, early childhood trauma, financial burdens, and random emotional baggage result in a range of actions that foreshadow regression and failure of coping mechanisms that put us all at risk. Some people are able to endure extreme levels of stress with little to no outward sign of distress while others boil over at the first sign of conflict or emotional ripple.
There is a growing push toward alternative restitution and jail diversion for those with mental health and substance abuse problems. In San Antonio, TX, the Bexar County jail had been filled to capacity for many years. As a jail diversion and mental health program evolved the population dropped by 20-25 percent from 5000 inmates to 3800. Data suggests that over one quarter of all prisoners may experience mental illness or substance dependence/abuse and are not receiving treatment. But here in Massachusetts the systems are not available to make this innovation an effective reality in any scale. Many departments are using jail diversion options such as drug treatment and counseling but here in Massachusetts psychiatric treatment cannot be court mandated. Arrest may not be indicated simply because a person is in crisis but those in crisis may be involved in some type of criminality such as assault, criminal threatening, domestic violence and property crimes. So what options are available? The drop out rate for patients suffering from major mental illness is quite high. They often stop taking prescribed medication and do not attend counseling sessions.
MENTAL ILLNESS, CRIMINALITY AND RESTORATIVE JUSTICE
As a police officer I found jail diversion a discretionary tool that was used a great deal. Nevertheless there are times when arrest is the proper course of action but jail diversion remains a possible negotiating point for those charged with some crimes. The correct response to intimate partner violence should include aftermath follow-up and intervention when the immediate crisis has settled from the events that brought police to this dangerous threshold. Arrest is mandated by state statute when one spouse has visible injuries. Whenever possible using a restorative justice model – often limited to incarcerated individuals – may allow those arrested for crimes against persons to reconstruct their encounters with police and gain concrete understanding of events and the impact substance abuse may have had on the actions taken by themselves and law enforcement. Some never attain empathy for victims, family members including action taken by police and wind up behind bars. Police encounters with persons having co-occurring mental health and substance abuse are frequently violent and often result in charges for assault on a police officer and more. In the aftermath of these encounters offenders may be sent to treatment in lieu of formal charges with the understanding that sobriety and psychotherapy are indicated. In cases of treatment avoidance police have the option to file charges later on.
Techniques for understanding mental illness may facilitate mutual understanding and establish the needed bridge to facilitate treatment as published in 2015 (Sefton, 2015). Those seeking diversion from incarceration must demonstrate the willingness to change and take responsibility for their actions. The relationship between law enforcement and community agencies is one that requires a strong foundation and mutual understanding of the framework for reducing recidivism, criminality, and managing mental illness.
Buckley, P. F., & Brown, E. S. (2006). Prevalence and consequences of dual diagnosis. The Journal of clinical psychiatry, 67(7), e01-e01.
WESTBOROUGH, MA – March 30, 2017 Police officers are being trained in crisis intervention techniques across the country and Canada. This training offers plenty of practice role-playing scenarios that come directly off of the call sheets affording a reality-based training opportunity. I recently spent time riding with members of the San Antonio PD mental health unit and have the greatest respect for the officers with whom I rode. In contrast, some departments regularly have highly trained clinicians riding with officers bringing expertise in mental illness and abnormal behavior across the thin blue line. It is thought that by sharing knowledge at working with unpredictable, drugged out, psychotic and delusional and angry who police encounter on a daily basis better outcomes may be achieved. No single model is best and all are still in the growing stages of establishing protocols for bringing those most disturbed individuals in from the margins. More and more officers are receiving CIT training every year.
The important part of crisis intervention training comes in the interdisciplinary relationships that are forged in by this methodology. Trust and respect between the police and its citizens builds slowly one person at a time. Community policing is not a new concept but fiscal priorities often prevent its full implementation. Just the same, there must be trust and respect between the police and the purveyors of crisis intervention and mental health risk assessment including doctors, nurses, and health care practitioners. This also takes time and training and the shared belief in the model.
“When officers are faced with a deadly situation, when there is a gun pointed at a cop, there is no time to go into mental health measures,” according to Grace Gatpandan, spokesperson for the San Francisco Police Department
The use of force continuum belies each officer contact and guides the process when police are called upon to defuse a dangerous encounter. It is best that a mental health contact be made long before violent threats are made – long before terminal rage erodes personal judgment. The community policing doctrine affords this front end contact and encourages officers to know the people living on the beat.
POLICE ENCOUNTERS WITH MENTALLY ILL CITIZENS
The Boston Globe Spotlight series on police encounters with the mentally ill cites one distraught parent who was quoted “I only wanted the police to disarm him not shoot him dead.” Unfortunately for this family, when faced with lethal violence it is the behavior of the subject that drives the ship in terms of what will or will not happen. “When faced with a deadly situation, when there is a gun pointed at a cop, there is no time to go into mental health measures”. All too often people fail to see the cause – effect relationship between citizens with guns or other lethal weapons and the police officer response. The use of force continuum follows the principle of causation by guiding police decision making based on the level of threat.
What came first the threat or the police action? It is the primary action of the citizen the evokes the lethal response by police. If citizens dropped weapons and listened to police officer directives during these high energy and chaotic events there would be fewer deaths. To say they lack training in mental health is preposterous. Almost as preposterous as saying if they were better parents the mentally ill subject might not aim his gun at police or threaten his mother with a knife. No, the responsibility lies with the mental decision-making and subsequent behavior of the subject himself. If mental illness drives the violent behavior than all weapons and substance use must be carefully controlled and eliminated. When people attend psychotherapy sessions and 12-step recovery programs the proclivity for violence is greatly reduced. Inevitably, drug abuse is a co-morbid factor that alters perception and fuels underlying anger and violent tendencies. Who is responsible for this? When drug addition or alcoholism begin – all emotional growth including adult “problem solving” begins to fail until it is fraught with uncontrolled, impulsive violence. Rather than placing blame, greater emphasis on sobriety, counseling and developing emotional resiliency should be encouraged.