Social skills

Being Alone and feeling well: Say goodbye to loneliness

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

There is much to be said about all the good that comes from being alone. Aloneness and loneliness are completely different. Aloneness is a feeling of aliveness and emotional freedom. It is a positive and emotionally energizing place.  It’s not the mere concept of being by oneself that defines being alone more the understanding that being alone requires both self-reliance and emotional sustainability.  People who enjoy being alone have higher self-esteem and emotional maturity.  There is a significant difference between being alone and being lonely.

Loneliness refers to feelings of being incomplete and sometimes empty.  You can be surrounded by people and still experience feelings of loneliness and the range of emotions associated with insecurity, dependence and unmet needs. Some people feeling that without another person or companion that there is something wrong and missing in their lives. Loneliness is a negative emotion that quietly robs self-esteem and can errode one’s capacity to feel complete and connected to others. Lawrence Wilson suggests that loneliness may actually be a driving force that helps people look for connection in others to fulfill emotional need (2011). Wilson asserts that loneliness may be seen as a state of suffering over loss of connection or long felt abandonment. The difference between the two feeling states is important. Aloneness is a pleasant feeling whereas loneliness is unpleasant and can lead to chronic isolation and sadness. Aloneness can bring about creative energy while loneliness brings about brooding rumination.

Think about what that means. The two concepts are almost opposing emotions yet most of us are them as synonymous. Too many people either fear being alone or depend on others to complete them by making the whole. There was an old adage that we come into this world alone and so we go out.  Emotional grown and emotional development require being alone and not total dependence on another person to feel complete or whole.

Discretion, Treatment and Alternatives to Jail

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

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

Mental and Physical Health Screening

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

Diversion Safety Plan

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

Bail, Confinement, Mandated Treatment

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

Guardianship

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

 

 

Jail Diversion: Reduced costs by spending more on mental health

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

PART 1

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

The importance of treatment for substance dependence and mental illness cannot be understated as violent encounters between law enforcement and the mentally ill have been regularly sensationalized. The general public is looking for greater public safety while at the same time MH advocates insist that with the proper treatment violent police encounters may be reduced and jail diversion may be achieved. The referral infrastructure to provide a continuum of care in this growing population is available in very few places across America.

Models of Care

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

Behavioral Analysis and Law Enforcement

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

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

PROPOSED JAIL DIVERSION INITIATIVE

PRE-ARREST JAIL DIVERSION – No crime committed

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

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

Minor crime committed

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

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

“Falling in with the wrong crowd”

Michael Sefton, Ph.D. Childhood violence, Human Behavior, Parenting ,
kids_images
Children need consistent, firm limits with allowance for individual choices that are unique to them, according to author Michael Sefton

In recent weeks there have been a host of noteworthy arrests of juveniles who committed crimes out of bordom including the beating of a 88 year old veteran who was murdered.  How can this happen?  In past generations, when teenage children were bored they play baseball, listened to music, or rode thier bikes.  Some believe adolescents are not equipped to deal with bordom and cannot tolerate having nothing to do.   Some say this is linked to a need for “instant gratification” and hunger for stimulation triggered by computer video games.  That is the subject of on-going debate.  People ask “where are the parents of these children?”

In Spokane, WA police have charged two 16-year old boys with first degree murder for the killing of Delbert Belton, a WW-II veteran.  People have said “there is nothing to do around here in the summer” according to an NBC News report.  The Spokane police chief has called for youth programs to help mentor adolescents and provide appropriate role models.  The uncle of Kenan Adams-Kinard, 16, believed his nephew had fallen in with the wrong crowd and now needed to be responsible for his actions.  Adams-Kenard is charged as an adult with murder.  In Fort Worth, TX, a 13-year old boy was arrested in June for murdering a 5-year old boy who was found bludgeoned to death.   And in Logan, Iowa, a 17 year old boy living in foster care is alleged to have murdered a 5-year old with whom he lived.  That child was found in a nearby ravine.  The motives in each of these cases are not readily apparent.

Michael Sefton, Ph.D., author of The Evil that Kid’s Do suggests that a greater partnership between parents and the community is needed to provide for the emotional needs of teens.  “Gangs and childhood violence result from a dearth of emotional resources and connection to others often compounded by exposure to domestic violence and child abuse” according to Sefton.  Families need greater support than ever but many are living in the fringes.  In The Evil that Kid’s Do, Dr. Sefton identified mentors, treatment for drug dependence, gang intervention, community religion, and keeping guns away from teenagers as possible action for keeping adolescents from becoming bored, angry, and marginalized.  It is true that children who are bored often become frustrated and look for things to do.  But healthy children fill in those blanks with prosocial activity – while angry, marginalized kid’s choose activity based upon underlying drives, tolerance and attachment.

As a police officer we are asked to come to juvenile court to present evidence and testimony in cases we bring forth.  Some are cases of intact families with good support and others may be single parent families and still others are foster families.  Would it surprise you if I said any of these family systems might have perfectly delightful children uninvolved in crime or delinquent behavior.  We see so many of these kinds of families.  In the same way, any of these family systems may produce a dangerous felon or drug dependent addict.  It takes more than an intact family to raise self-confident, curious children who attend school with an appetite for learning.  It takes a parental dyad that sets appropriate limits and model empathy, kindness, and social skills.  Children need to learn what is right and wrong and what behavior will be accepted as they develop.  All human beings make mistakes and should be taught how to succeed and shown forgiveness.