RISK IS INCREASED WHEN ABUSER MARGINALIZED

There is agreement among clinician's in the field of domestic violence that the risk to victims is increased when the abuser is "moved out" - physically and psychologically.  In some cases when the victim decides she is moving-on the risk to her safety is increased exponentially.  The decision to separate from a dysfunctional and dangerous relationship is a difficulty one that does not come easy.  In many cases when abuse trickles down to children or family pets a victim realizes she must act to protect her family.  Arguably when this occurs "the man becomes enraged with his loss of control at the attempt by the woman to "break the relationship" and engages in various acts of harassment which include stalking, threats, assault or other subtle forms of 'psychological warfare.'" (Brayden 1998)  By feeling marginalized an abusive man may feel insignificant and sometimes humilated - especially when police become involved in keeping the peace or responding to a violation of a stay-away order.  It is well known that abusers often experience feelings of deep resentment and anger.  At these times containment and intensive intervention may be necessary to assure for the safety of women and chilldren attempting to break free.

“Domestic violence homicides are predictable and therefore preventable,” says Jessica C. Brayden, Executive Director of RESPOND, Inc. in Sommerville, MA
VJ Geberth, (1998) Practical Homicide Investigation. Law and Order Magazine, Vol. 46 No. 112, November, pp 51-54

LEARNING FROM TRAGEDY - Well-being for EMS and Police

LEARNING FROM THE TRAGEDY OF DOMESTIC VIOLENCE HOMICIDE
The health and well-being of emergency service workers like police officers and paramedics requires the balance of physical and mental wellness. Greater attention is being paid to educating students in the emergency services to proper nutrition, the importance of exercise, lifestyle balance and proper stress management techniques. Wellness is not something that happens by itself. Many officers and medics alike believe they are just fine when everyone can see they are not. Why? Police officers and paramedics are exposed to a complete range of human experience and tragedy. Most “suck it up” and keep their feelings to themselves when unresolved issues percolate in their psyches. The resulting stress adds to career burnout and in the worst case – arguably, a frank psychosocial crash and burn. Enhanced training in personal and professional wellness is essential for optimal long term resiliency of the first responder.

GALLOWS HUMOR

        The camaraderie among EMS and fire service personnel is well documented. Similarly, police officers tend to “hang” together whenever they get the chance and share stories from their departments – big and small. There are usually plenty of laughs as stories are shared. These sometimes take on a “gallows humor” as cops and EMTs process and integrate the scenes they cover. I once sat at a local bar with a vice presidential secret service detail and it was no different with them. Humor is a coping mechanism to an otherwise woeful system that often fails its membership – especially when events exceed what is thought to be just an “average call.” Police, EMTs, and fire service personnel have high rates of alcoholism, drug abuse, suicide, and ironically, domestic violence. There is a high price paid when this brand of humor leaches into the professional conduct of front line practitioners and can affect the delivery of pre-hospital intervention.

CAREER BURNOUT

As the American population gets older the need for pre-hospital care and inter hospital transfers is likely to grow. It is unlikely that the demand for pre-hospital professions is going to decline in the coming generation. According to Bledsoe et al., a paramedic may find themselves providing a wider range of care in the future – including primary care (page 5). Therefore, paramedic training should include specific direction about post-incident debriefing in order to assure that medics remain healthy and focused.

It is well documented that the body responds to stress by a build-up of cortisol—a hormone that depresses autoimmune functioning and can contribute to hypertension, pain, and disturbed sleep. Continuing education also fails to address the cumulative effects of stress and the impact this has on personal health and wellbeing. The response to stress differs from professional to professional but many choose maladaptive coping mechanisms blaming the “job” or “company” for low wages, valuing profit over human capital, and other frustration unrelated to internal conflict – expressed as anger and resentment.

CONCLUSION

Paramedicine is an exciting and rewarding field. Nowhere else can an average person practice emergency medicine without having attended medical school. However, along with this lofty responsibility comes the awareness that an important price is paid when the paramedic believes he is above being human. Arguably, the profession needs to be accountable for the wellbeing of its membership including post-incident support. The tragic reality in Maine brings home the impact that we are all exposed to experiences that most human beings avoid or never witness. Most of us are able to cope and process the images in adaptive fashion. Following the horrific events of 9-11, the incidence of suicide among police officers, EMS and fire service personnel was excessive and unnecessary. Most did not receive the help they needed early on. Resiliency training has been shown to be a viable professional development and may better inoculate the police officer and paramedic against the range of emotional contagions faced on a regular basis. In Dexter, Maine at least one public service employee is at high risk for post-traumatic stress and its potential to corrupt long-term health and well-being.  When calls for service become solely a transaction between medic and customer it may be a sign that professional resiliency is over taxed and career burnout may be rising from the proverbial ashes of the calls we did before.

DVH LINKED TO A PATTERN OF SEXUAL AGGRESSION

POLICE NEED TO ASK TOUGH QUESTIONS

The continuum of domestic violence ranges from emotional abuse to physical battery, to sexual sadism, torture, and sexually motivated homicide.  As early as 1998 DVH has been linked to a chronic, egregious pattern of physical and sexual aggression among intimate partners (Gerbeth, 1998).  It is well known that law enforcement officers are the first responders for domestic violence calls across America.  Most agree that greater containment of abusers is necessary to prevent DVH - especially after an order of protection has been issued. “Protective orders in the state of Maine are written on paper and that’s about as much value as they have. We need to put some teeth in it” according to Maine Governor Paul LePage (quoted in BDN, July 2011). Arguably, it is encumbant upon the officer on the beat to ask the difficulty questions that may uncover the secretive pattern of aggression that belies too many households in America. Maine and much of New England has experienced a dramatic increase in DVH since 2009. A psychological autopsy is sometimes used to measure the prevalence of pre-incident "red flags" that indicate a higher risk of violence and DVH. These evaluations are conducted infrequently due to their cost but they are valuable tools in the fight against DVH.  Victims of domestic violence and surviving family members ask what can be done to help to reduce the risk of escalating physical and emotional damage on intimate partners.

According to Geberth, "Domestic violence murders are synonomous with Interpersonal Violence Oriented Homicide - now called Domestic Violence Homicide (DVH). The rationale for classifying domestic violence as sex related is due to the fact that murder serves as the ultimate form of sexual revenge. And, in many instances the homicides will include sexual assault or wound structures manifesting a sexual orientation."

Vernon Gerbeth was a supervising homicide investigator in Bronx, NY during the 1990's and published a paper on DVH after serving on the Governor's Commission on Domestic Violence Fatalities in 1996-1997.  37 states have DHV review boards whose task it is to review the circumstances of individual cases of homicide committed between intimate partners.  "Domestic violence is defined as a pattern of behaviors involving physical, sexual, economic and emotional abuse, alone or in combination, by an intimate partner often for the purpose of establishing and maintaining power and control over the other partner."  Review panels seek to make recommendations that are designed to lower the risks by enacting changes in response to DV across the board. 

Generally speaking, the reports generated are the culmination of months of investigation and testimony following an egregious killing.  The documents are frequently published and contain the intimate details thought to be the triggers in the case.  These details must become the substantive underpinning of change in the handling of new cases of DV in order to reduce the risk of DVH.  Police and social service agencies should work together and integrate the recommendations from review boards.  On going education and training may facilitate this risk reduction.


VJ Geberth, (1998) Practical Homicide Investigation. Law and Order Magazine, Vol. 46 No. 112, November, pp 51-54.

HARM REDUCTION IN DOMESTIC VIOLENCE

HUMAN FACTOR IN HARM REDUCTION

DVH results from the cascade of behaviors that evolve between victim and her abuser.  Women sometimes abuse their husbands but the problem of domestic violence homicide is largely attributed to men acting out against their female partners.  How can people begin to impact the human cost of domestic violence unless it moves up to the societal level?  Some believe greater recognition of red flags offer law enforcement a head start at reducing DVH.  As a police officer, I have been asked to investigate domestic violence calls and almost universally am met by the male spouse saying that "nothing happened" and "my wife has overblown this again". Denial of responsibility and emotional intimidation are among the most common red flags to early cases of domestic violence according to research.  These often begin as soon as husband and wife are married.  There is a strong push for secrecy and for decades police treated domestic calls as a "private matter" between husband and wife.

The most typical red flags have all been published in countless peer-reviewed journals and I will provide them shortly.  When the red flags are uncovered police need more tools to offer security for potential victims and containment of the abuser.  This requires greater communication between police and domestic violence social services.  Maine has had an upsurge in DVH in 2010 and there is a calling for changes in the bail requirements that will free an abuser for only $ 200 to $ 2000 dollars. 
Once a protection from abuse order has been filed it is essential that open communication be available between the police, judiciary, and probation.  If someone violates the PFA order than efforts to contain the abuser should be maximized.

Pre-incident Indicators - Red Flags

History of depression Threats to kill spouse or family Previous history of battery Threatens family with weapon Engages in stalking behavior Order of abuse filed Uses drugs and/or alcohol

                                                                                                              Fox et al, 2008         

"For domestic violence workers in Maine, who engage in activities ranging from lobbying the Legislature to providing training for law enforcement officers, the only way to eliminate domestic violence completely is to instill in society the fact that it’s a societal problem, not a private one. Brian Namey, a spokesman for the National Network to End Domestic Violence in Washington, D.C., said Maine has strong laws on the books to combat domestic violence — including protection orders that include pets and a victim notification law that alerts a victim if the perpetrator tries to buy a firearm — but those laws won’t convince enough people to report domestic violence when they encounter it." (Taken from Bangor Daily News)

Domestic Violence Review - When Containment Fails

 The fact is that greater containment of high risk abusers is needed.  Unfortunately, no one seems to believe that a person can be held on "high bail" simply because he held his family hostage and threatened them with a firearm.  Many believe there is a disconnect between the judiciary and the bail system.  The June 2011 case in Maine culminated after the abuser was released from jail on $ 2000 dollars bail.  After his death the money was returned to his family.  Some district attorneys have tried to withhold bail money when the defendant fails to appear in court due to death by suicide after DVH.  For many this seemed like a draconian response to families who were in pain.

What can be done to assure greater containment?

A Domestic Violence review panel conducted in June 2011 concluded that “there is nothing society can do for a despondent, abusive spouse whose obsession overrides the norms of society – even his will to live”.  If we believe this then we will erroneously surrender any creativity in domestic violence prevention and harm reduction.  When high ranking prosecutors say DVH cannot be prevented society is cheated out of taking steps toward containment of those who may violate protection from abuse orders.  Lois Reckitt, executive director of Family Crisis Services in Cape Elizabeth, ME is quoted as saying that the wrong people are in jail when violence-prone abusers are released from custody to stalk and terrorize their family, as was the case in the Dexter, Maine tragedy.  Containment and harm reduction should be the focus of the legal system and social service agencies alike.  The judiciary and political machinery in states throughout America must speak out about protecting victims and families and not say there is nothing that can be done to stop DVH.