Yale Department of Psychiatry Grand Rounds: December 9, 2022
December 09, 2022"Intimate Partner Violence"
Rahn K. Bailey, MD, Chair, Department of Psychiatry, LSU Healthcare Network
Information
- ID
- 9265
- To Cite
- DCA Citation Guide
Transcript
- 00:02Yeah. Well, thank you very much.
- 00:06Thank you very much Charlie.
- 00:07We appreciate the kind of warm introduction.
- 00:09I'm also thankful to you chairman,
- 00:11Chairman Crystal for for having
- 00:12me and I note that one of my good
- 00:14friends and long term interest Mike
- 00:16Norco was like the one on the feed
- 00:18today and I would remiss if I didn't
- 00:19kind of comment how wonderful to see
- 00:21him and a lot of good mentorship
- 00:23he's provided for me over the years.
- 00:24So thanks very much for having me.
- 00:26This issue, this work of growing
- 00:29I think our academic.
- 00:30Ohh footprint for all of us I think
- 00:34means a great deal for faculty.
- 00:36I think trainees as well throughout my
- 00:38career of these programs have been very,
- 00:41very helpful and we're actually trying
- 00:42to bring I think in a greater degree.
- 00:44I think of attention to issues
- 00:45regarding grand rounds are here in
- 00:46New Orleans where I've been for the
- 00:48better part of almost two years.
- 00:49So opportunity to speak about the this
- 00:51topic which is kind of a continuation
- 00:53of a lot of work I've done on the issue
- 00:56of violence over the last decade is,
- 00:58is, is, is,
- 00:59is beneficial but hopefully seminal.
- 01:00It goes without saying there's no
- 01:02partner violence or gun violence or
- 01:05issues regarding dynamic violence
- 01:07of rural populations.
- 01:08We have too much violence in our
- 01:10society and often I think we need
- 01:12to be better educated about it.
- 01:14We need to do a great deal of time,
- 01:15I think engaging in empirical
- 01:17based research to understand that
- 01:18incidents of such and some of the
- 01:20programmatic issues that are in play,
- 01:22and I think we as professionals
- 01:24in our area are discipline,
- 01:26need to become a bit more proactive
- 01:28about engaging activities that
- 01:29I think a lot more effective.
- 01:31And decreasing this ongoing or plague
- 01:33or speaking vitamin partner violence today.
- 01:35A lot of my work has been on gun
- 01:37violence moving to another about
- 01:39two years ago and is that versus
- 01:41the statistics can be the reality
- 01:43is you know we had about 84 over
- 01:46iteration about 84 gun violence deaths
- 01:49per 100,000 in New Orleans now.
- 01:51So unfortunately we're you know #1
- 01:53if you will I think in the country
- 01:56unfortunately the national averages
- 01:57by the way are six per 100,000 other
- 02:00cities that are high Chicago's.
- 02:0116400 thousand Saint Louis maybe about 40.
- 02:04So we actually double Saint Louis
- 02:06which is actually #2 in that course.
- 02:08The greater degree of think of access
- 02:10to guns and more gun violence is
- 02:12certainly lead to greater of other
- 02:14you know distributed risk and I
- 02:16think in the partner violence we
- 02:17historically called domestic violence.
- 02:19So I think it's in that category.
- 02:21So kind of a bit of a consideration of how
- 02:24we got here with this overall discussions.
- 02:27Also my disclosure,
- 02:28really no disclosure concerns today that
- 02:30are relevant for today's discussion.
- 02:32I'm on a steering committee,
- 02:33I think with the company,
- 02:35I deal with the diversity and I'm
- 02:36on our samsas,
- 02:37our national Advisory Board.
- 02:40Objectives today really are fourfold.
- 02:44We're addressing a lot of
- 02:45statistics about gun violence and
- 02:47particularly inner partner violence,
- 02:49with a focus on the use of firearms and
- 02:51how that certainly plays a huge role,
- 02:53I think, in this discussion.
- 02:55What I'm saying how I think important
- 02:56balance relates to particular communities,
- 02:58and it's a fair amount of data
- 03:00that is very different and
- 03:01varied amongst differing groups,
- 03:03gender, race, ethnicity,
- 03:05gender identity and the like.
- 03:09Also talk a fair amount about which
- 03:11particular entities are much more likely to
- 03:13be perpetrators of this type of violence,
- 03:15military and law enforcement and how
- 03:17very often aspects of who they are
- 03:19and their work and their profession
- 03:21may contribute to this concern.
- 03:23And we should, I think,
- 03:24have a heightened sense of consideration
- 03:26about such as professionals
- 03:27who may see these individuals,
- 03:29whether it's a fitness for duty evaluation,
- 03:31trying to get a job in that area
- 03:32or whether we're seeing them,
- 03:33I think in clinical care and also
- 03:35really discuss some concerns regarding
- 03:37recommendations and determine ways.
- 03:39What can we do to minimize and
- 03:42manage I think these overall risk?
- 03:45So we always want to start off I
- 03:46think an election like this I think
- 03:48but hopefully initial AHA slide and
- 03:50there are many unfortunate options.
- 03:53We we chose this one because it kind
- 03:55of points out three or four issues.
- 03:57The relative and in severe and dynamic
- 04:00and raw nature of important violence
- 04:02is real and the amount and and
- 04:05content I think of the violence is as
- 04:08substantive as you can see I think in
- 04:10the pictorial it also points out that
- 04:12everybody could be at risk regardless of.
- 04:14S status regardless of gender,
- 04:17regardless of location or geography.
- 04:20So the reality if you're speaking to
- 04:22someone they may or may not be at risk.
- 04:24And we as clinicians and physicians
- 04:25should not let our guard down when
- 04:27assessing someone thinking that for any
- 04:29number of reasons because I know this
- 04:32person or that organization like me or
- 04:34they have some similarities to myself
- 04:36or my culture or my group or my background.
- 04:39They may be at a lower degree of risk
- 04:41that may put some persons I think
- 04:43at higher degree of vulnerability.
- 04:45Because the one opportunity they have
- 04:46I think to address this concern maybe
- 04:49when they speak to one of us in a
- 04:51professional or clinical type setting.
- 04:53This quote from the professional
- 04:55singer Rihanna,
- 04:56I think it's striking.
- 04:57I just never understood that like how
- 04:59the victim gets punished over and over.
- 05:02Yeah,
- 05:02this should be in the past maybe would think.
- 05:04I don't want to say get over it because
- 05:06it's very serious and it's relevant,
- 05:07it's real he huge issues that I
- 05:10think patients have kind of share
- 05:12with me throughout my career.
- 05:14I've kind of started in with this slide
- 05:16and this slide is we're preparing really
- 05:18could be the entire one hour lecture.
- 05:20There's just so much material
- 05:21here but it kind of
- 05:23points out. I think the three big things from
- 05:25our discussions today a first and foremost,
- 05:27these issues are real and unfortunately
- 05:30they're becoming much more pragmatic
- 05:33and relevant and all of our lives.
- 05:35So we begin to have a concern or fear
- 05:38for safety for ourselves, for others,
- 05:40those who matter to us in life.
- 05:42They can also kind of point out that
- 05:45their variety of vectors that can kind
- 05:47of lead to intimacy in in violence.
- 05:49It can be a quote UN quote stalking
- 05:51like situation which we consider
- 05:53maybe the case on the left.
- 05:55All with the other young people in Idaho.
- 05:57So one of you don't think feels close to you,
- 05:59but they do because there's a disparate in
- 06:04relationship and how you feel towards them,
- 06:06how they feel toward you or on the right.
- 06:08Individuals we might not have in the
- 06:10past start were intimate, if you will,
- 06:12and historical sense of that terminology.
- 06:14But the truth is the closest
- 06:17relationship being teammates,
- 06:18being family members,
- 06:19having access or easier access someone
- 06:22may allow you to let your guard down,
- 06:24as we see all too often.
- 06:26And I would be settings as someone
- 06:28that's regard down psychologically
- 06:29and emotionally as well as physically
- 06:32and activate based on access.
- 06:33The risk may be elevated and they
- 06:35may not realize that they have that
- 06:37fought under a greater degree of risk,
- 06:39huge issues in the contemporary media.
- 06:43I think it also points out that my Third
- 06:46Point that we may also in many regards
- 06:48in our society begin to decrease,
- 06:51I think our concern or our fear as we
- 06:54see so many of these, I think that.
- 06:57The overexposure if you will maybe
- 07:00harmful to us in in general society
- 07:02but also I think as professionals
- 07:04and we should keep our guard up and
- 07:06keep I think a heightened sense of
- 07:08think of vigilance as these concerns
- 07:10are approaching upon us because
- 07:12their behavioral but those are not
- 07:14taking our profession.
- 07:15I think we have again this increasing
- 07:17role to play to really do a deep
- 07:19dive and better try to understand
- 07:20or what may be made of the concerns
- 07:23that are leading to an increasing
- 07:25this issue we're kind of throwing.
- 07:27A lighter fluid,
- 07:27so to speak,
- 07:28on the fire and worsening the overall
- 07:30risk of persons who may not historically
- 07:32have thought they had great risk
- 07:34and thanks to in report of violence.
- 07:39What is a IPTV?
- 07:40And I thought we start by emphasizing
- 07:43that historically we've described,
- 07:45you know, domestic violence or you know,
- 07:48DVD's and we really see
- 07:49kind of concentric circles.
- 07:50Or somebody could have domestic violence but
- 07:52not be historically intimate with individual.
- 07:54Or you can have intimate partner violence
- 07:56where you have a strong relationship and
- 07:59their relationship which only live with them.
- 08:01In domestic violence historically for me
- 08:02are the focus has always been that when
- 08:04you go home and evening, for example,
- 08:06when you close a lock your door,
- 08:08you feel safe that you
- 08:09protect yourself from the bad.
- 08:10Potential risk, they're outside someone.
- 08:13Khan is in the house with you.
- 08:15They're inside your locked door,
- 08:17have better access to you,
- 08:18they're around you and your clothes,
- 08:20different when you dress,
- 08:21different when you are engaged
- 08:23in other kind of activities.
- 08:25But most importantly, psychologically,
- 08:26you kind of let your guard down,
- 08:28as you mentioned earlier.
- 08:29And that I think may increase degree of risk.
- 08:31You know, important violence,
- 08:32there's a bit different.
- 08:33You may see someone who you're involved
- 08:35in a historically aid, you know,
- 08:38a loving or a romantic relationship.
- 08:41Ohh,
- 08:41you may see them only when you're
- 08:42outside the safe protection of your
- 08:44home and your home environment,
- 08:45but you may choose to engage in
- 08:47behavior that puts you at more risk.
- 08:49You may tell them more things about yourself.
- 08:51You may expose, I think,
- 08:52many more of your vulnerabilities
- 08:54and your your weaknesses and issues
- 08:56of fragility in your own life,
- 08:58both clinically and professionally
- 09:00I think as well as emotionally.
- 09:02All these issues I think may
- 09:04certainly increase a degree of risk.
- 09:06So understanding I PV on report of
- 09:08violence and how I think it grows,
- 09:10I think in its exposure.
- 09:12Are in relative conservative exposure
- 09:14to people. I think it's key for us.
- 09:16We kind of point out that it can
- 09:18be described in this perspective
- 09:20of you know access to weapons.
- 09:22I mentioned stalking earlier.
- 09:23A big issue we discussed today is
- 09:26the so-called bond of trust and
- 09:27and and and throughout my career
- 09:29I think the the deeper idea the
- 09:31more I appreciate that the bond
- 09:33of trust is a 222 headed coin.
- 09:36It at once increases the likelihood
- 09:38they'll be very close to someone but
- 09:40they may also I think in some settings.
- 09:43Unfortunately substantially increased
- 09:44the likelihood that that's exactly the
- 09:46person who may actually hurt you and not
- 09:49understanding that or thinking about it.
- 09:50I think in that context again
- 09:53increases risk and maybe are part
- 09:55of the reason why national we're
- 09:57seeing increasing numbers our
- 09:59our pandemic hit in February,
- 10:00March of 2020,
- 10:01we probably had two pretty substantive
- 10:04years 20 and 2020 twenty and 21.
- 10:06Although in many regards even in 22
- 10:09there's been kind of up and down changes
- 10:11I think in pandemic related rules and.
- 10:13Regulations,
- 10:13restrictions.
- 10:14But this group to be very much
- 10:16aware that those years are
- 10:17absolutely the most substantial,
- 10:19the worst years on record
- 10:20ever in our country for inner
- 10:22partner violence, 2020 and 2021.
- 10:24So when people have to stay home more
- 10:27because they were you couldn't go out,
- 10:28you couldn't go to work or
- 10:30try to protect yourself,
- 10:30it's really poor masks were
- 10:32available in many regards and just
- 10:34all of the upheaval I think of the
- 10:36pandemic time period of over what
- 10:38was essentially A2 year time period,
- 10:40we stayed home more and we fought more,
- 10:43we stayed home.
- 10:43We develop a lot more conflict
- 10:45and we actually lost the capacity
- 10:47as a society in many regards to
- 10:50develop better strategies to engage
- 10:52in conflict resolution or actions
- 10:54that actually limit was risk.
- 10:56In this slide just kind of points
- 10:57out in this picture that very often
- 10:59at least to despondency is the term
- 11:01I like to use regard to the young
- 11:02man on the picture because all
- 11:04too often the sponsor encouraged
- 11:05because what one issue that you
- 11:07would not have expected began to
- 11:09occur during this time period.
- 11:10I think that the pandemic
- 11:12issue or time course.
- 11:13I'll play substantial role in the
- 11:16worsening risk of IPV in our society.
- 11:20Particularly numbers about one in five
- 11:22women or 20%, or one in seven men.
- 11:24One,
- 11:25seven or eight men do report
- 11:27having experienced some form
- 11:29of severe physical violence.
- 11:31A severe being described very often as
- 11:33something that may actually essentially,
- 11:35you know,
- 11:36leave some mark or imprint some
- 11:38action that I think has some
- 11:40residual capacity to it.
- 11:41About one in five women and
- 11:42one in 12 men have experienced,
- 11:44I think,
- 11:45sexual violence at the behest of
- 11:47an intimate partner.
- 11:48A lot more than I think many of us
- 11:50might think would consider and about
- 11:5210% of women and maybe one or 2%
- 11:54of men are haven't been stalked by report.
- 11:56Just giving you an idea I
- 11:57think of the overall scope,
- 11:58I think in this setting.
- 12:01Some risk factors are clearly our SD or
- 12:04substance abuse is at the top of the list.
- 12:06When someone is impulsive and lacking
- 12:09on many of the typical guardrails that
- 12:12limit violent action toward others,
- 12:14they're a lot more likely to do so,
- 12:16a lot more likely to do it in
- 12:18their home environment when
- 12:19they themselves feel safe.
- 12:20I would like to do it to someone
- 12:22who they think they already know,
- 12:24because that that person may not
- 12:26strike out back against them,
- 12:27or even go and tell them them and
- 12:29report them to the to to authorities.
- 12:30So it should be.
- 12:32Sword is a substantial risk factor.
- 12:34We do see more IPV,
- 12:36although we can't see it all populations
- 12:38would like to say we do see it in
- 12:40lower social economic status settings.
- 12:41So poverty is I think one of these
- 12:44additional dynamic risk factors that
- 12:45plays a role I think in this setting.
- 12:48And there are various cultural
- 12:49pressures that we kind of
- 12:50speak about here shortly,
- 12:51different religions and different
- 12:53geographies and different cultures play a
- 12:56role in reporting either the feedback
- 12:58concerns or whether it affects one's
- 13:00family and what may be the other.
- 13:02The result if I go public,
- 13:05we also note that our key issues are
- 13:07having a past history of abuse put you at
- 13:09a greater risk or reproductive challenges.
- 13:12And I was speaking shortly,
- 13:13tribalization, I think in the
- 13:15media also I think plays a role.
- 13:17We should be mindful of it.
- 13:20Look at the cycle of abuse survivors
- 13:22of childhood maltreatment or at
- 13:23a higher risk of revictimization.
- 13:25So persons who are fragile I mentioned
- 13:27earlier and at at at at at some risk
- 13:30of having been or vulnerable and
- 13:32have a risk of having victimized
- 13:34or at a greater risk.
- 13:36Unfortunately are being re victimized
- 13:38by persons who engage in this type
- 13:40of victimization and violent action.
- 13:42Some individuals children who have
- 13:44a maltreatment of the associated
- 13:45with generational abuse we'll see
- 13:47it through our family.
- 13:48So when we're speaking to families and.
- 13:50Taking the patients,
- 13:50we should really ask not only what
- 13:52your experience has been like,
- 13:54but are you aware of family members
- 13:55if they're often a woman?
- 13:57Doesn't have to be, you know,
- 13:58a mother or aunt or a sister or
- 14:00cousin or grandmother who may have
- 14:02also suffered the same kind of abuse.
- 14:05My I found it very often what individuals
- 14:07will say to me is they've actually
- 14:10context that responses rather than
- 14:12saying yes when they don't say no,
- 14:14I've learned to listen very
- 14:15carefully what comes next and what
- 14:17often they might state is well,
- 14:19boys will be boys.
- 14:20Well that's how things used to be.
- 14:22Well you know things are different
- 14:24now those are things very often
- 14:26are components of a discussion that
- 14:28raise a red flag for me because
- 14:31I've learned that those are
- 14:32additional ways to argue that that's.
- 14:35Who is yes,
- 14:35affirmative and it may be in
- 14:37an ongoing fashion.
- 14:38So asking that follow up question,
- 14:41we argue is essential.
- 14:42I think in an organized medicine we
- 14:44again may have the best opportunity
- 14:46of professionals to create an
- 14:48intervention that's helpful and
- 14:50protective of this individual
- 14:52to prevent in this setting which
- 14:53could be a cycle of abuse.
- 14:58How many dualization earlier.
- 14:59The more we look at this we don't need to
- 15:02pick on football play football my whole life.
- 15:05So I I certainly unfortunately understand
- 15:06this and I think many of us do.
- 15:08There's a lot more media opportunity
- 15:10for us to be mindful of what happens
- 15:12in all sports or college sports
- 15:13is what is professional sports.
- 15:15Unfortunately Citizen High School sports now,
- 15:17but this piece I think one of my young men,
- 15:19my young researchers found this and
- 15:21I give him a lot of credit for his
- 15:23help with this presentation today.
- 15:24Mr Gibson with this point points out how we.
- 15:29Punish punitively,
- 15:30very differently based on what we value.
- 15:33And these are things some football players,
- 15:35professional football players,
- 15:36some of whom received substantial
- 15:39sentences for betting on games or gambling.
- 15:42If you miss a full year and you
- 15:43use a whole full year salary,
- 15:44for example,
- 15:45and then other professional football
- 15:47players who missed you know
- 15:49less than that amount of time.
- 15:50For well documented and non debatable issues
- 15:53of domestic violence or important violence,
- 15:56I think this sends an unfortunate sign.
- 15:59Submitting of how valuable the lives
- 16:01of people are if they're engaged
- 16:03relationship with individuals
- 16:05who are viewed as very valuable.
- 16:08If you're professional football,
- 16:09you're on a great deal of income or
- 16:11you're very popular, there's a great deal.
- 16:12I think I'm going to ride in that regard.
- 16:14But most also important points out
- 16:16that these type of violence actions
- 16:18are are punished less because
- 16:20they're not quite as important.
- 16:22I think that's objectionable and a point
- 16:23that I think we have to kind of argue
- 16:26against and decrease the likelihood we
- 16:27accept this so-called trivialization.
- 16:29I think over IP.
- 16:33I I think that the issue regarding
- 16:34global communities are kind of
- 16:36comes out of that discussion.
- 16:37Many communities, many have a
- 16:39remarkable differences in how they
- 16:41look at issues regarding relationship,
- 16:43family, familial concerns,
- 16:45rules and regulations.
- 16:47This is all about culture.
- 16:49We do see that many groups that are
- 16:51ethnic minorities, for example,
- 16:53in different religions show a
- 16:55greater degree of vulnerability.
- 16:56We think a lot about law enforcement
- 16:58and whether they are trained well,
- 17:00whether they show up on time.
- 17:01How they respond the different
- 17:03communities when they actually are called,
- 17:04but there are some in which
- 17:06are extrinsic factors,
- 17:07but there are some internal or intrinsic
- 17:10factors that we think also play a
- 17:12role of IPV in certain communities.
- 17:15And the first issue that an African
- 17:17community we see the highest rate
- 17:19of intimate partner violence.
- 17:20So it's clear almost half of African
- 17:23women in this country at some point
- 17:25between the age of 18 and 25 and 65,
- 17:28excuse me all report assault, sexual,
- 17:31physical or issue regarding stalking.
- 17:34We see killing of women involved
- 17:37in relationship much more common
- 17:39in the African American community.
- 17:41This issue of femicide,
- 17:43a lot of discussion is certainly
- 17:45to be impacted by racism.
- 17:47Could be impacted by I think I
- 17:49mentioned law enforcement and
- 17:50differential you know execution
- 17:51of the rules and the laws that are
- 17:53on the books in our society.
- 17:55But it can also be impacted by
- 17:57culture or this idea that if you
- 17:58are call law enforcement for an
- 18:00IP V case and they come to your
- 18:02home and if you report,
- 18:03if they take the individual away,
- 18:05maybe that's the process the
- 18:06breadwinner in the household.
- 18:07So there's these unfortunate negative
- 18:09feedbacks and substantially adversely
- 18:11impact on issues regarding I PV and
- 18:14and tools and strategies we would
- 18:16actually like to have in society.
- 18:18You're limited or or to prevent it.
- 18:22In the lab next community we
- 18:24see some similar considerations.
- 18:25About 2/3 of persons reporting at
- 18:27least one episode I think of I,
- 18:29PV and a lifetime, about 1/3 showing
- 18:31some episodes of our physical violence,
- 18:34about 1/5 sexual coercion or
- 18:36considerations in that regard,
- 18:38and about 80% showing some
- 18:41psychological aggression.
- 18:42We note huge issues here,
- 18:44including concerns regarding
- 18:47different terminology for mismo
- 18:49and and nudismo are considerations
- 18:51about how persons or groups.
- 18:53Or culture rated and and if you're
- 18:55curated in such to believe that the
- 18:57mayor is the head of the household,
- 18:59that a man can actually do things
- 19:02that may very often be violent
- 19:04or untoward toward you.
- 19:06I mean to the party earlier about
- 19:07why we might not want to report
- 19:09in some communities especially if
- 19:10you're in a lower SES setting and you
- 19:12don't lose your primary breadwinner.
- 19:13But it's also I think an issue
- 19:15I think of feedback that can be
- 19:17negative and negative reinforcement
- 19:19in a community where if brothers are
- 19:21engaged in this kind of activity and sisters.
- 19:23My sister in laws or whatever
- 19:25report then others in the family
- 19:27are unhappy with you rather than
- 19:29happy saying you did the right thing
- 19:31to stop the ongoing abuse.
- 19:32Or younger and younger people,
- 19:33they're often younger.
- 19:34Younger women may see that and
- 19:37experience that their lives and then
- 19:38there are acculturated and kind
- 19:40of grow all too often to engage
- 19:41in much of the same consideration.
- 19:43So we've got to ask the right questions.
- 19:45I think in mental health and
- 19:47in psychiatry and psychology,
- 19:48we've got to be able to take a
- 19:49bit more determined.
- 19:50I think in our approach we have to
- 19:52make sure that person recognizing.
- 19:54Which is our job to ensure that
- 19:55they are safe now cutely.
- 19:57If they're not ER on the crisis center,
- 19:59but also over time.
- 20:00And that probably will require,
- 20:01you know,
- 20:02in many settings and more than
- 20:04one communication and more than
- 20:05one upfront intervention,
- 20:06huge issues for communities that are
- 20:09have greater vulnerability and higher risk.
- 20:11Ohh in Muslim committed
- 20:14some additional challenges.
- 20:15Some would argue that the inherent
- 20:18isolation that some in these
- 20:20cultural groups experience maybe
- 20:22even more of a problem.
- 20:24We need to know about.
- 20:25A lack of a bond of trust towards
- 20:27family members who have hired
- 20:28close access to you could also be
- 20:30a lack of trust in authorities.
- 20:32Not just the legal authorities are in police,
- 20:34but you know,
- 20:34Department of Children's services
- 20:36and groups of that nature may not be
- 20:38fully welcome if they've had prior
- 20:40adverse or less than optimal experiences.
- 20:42In certain communities are initially
- 20:44the series revolves around the
- 20:45issue I think of stigma and prior
- 20:48discrimination or bias issue of
- 20:50really lack of knowledge and
- 20:52some would argue that there's a
- 20:54challenge between one's religion or
- 20:57spirituality or the rules thereby.
- 20:59And then the the the the rules of
- 21:01government and whether one carries
- 21:03more weight or is followed much more
- 21:06so of the life than another.
- 21:07This immigration status some
- 21:09will be very sensitive based on.
- 21:12Culture and background
- 21:13to call law enforcement,
- 21:14if they called for one reason
- 21:16which drive I PD risk.
- 21:18But if immigration status may be
- 21:20at least some vulnerability of a
- 21:23person themselves or somebody else
- 21:24being a man is a challenge for
- 21:26that they're in the country legally
- 21:28and also fear of losing custody of
- 21:30children can be additional roles.
- 21:32So these challenges that can be substantive.
- 21:34We're also seeing I think cultural
- 21:36challenges in our society as something
- 21:38historically thought that this
- 21:40may have only been you know, men.
- 21:42Women, but we can certainly see issues
- 21:45regarding domestic violence and I PV
- 21:47auto import of violence and male,
- 21:49male and female female relationships.
- 21:53In the national violence Against
- 21:54Women Survey,
- 21:55we kind of pointed out that these
- 21:56numbers are substantially greater
- 21:57than we have historically thought.
- 21:59And we also see that some groups we
- 22:00see more sexual risk taking in these
- 22:02demographic subgroups here we might
- 22:04have seen in some other settings.
- 22:05So with more sexual risk taking
- 22:08that actually begins to consider
- 22:09have us consider which groups may
- 22:11be I think at a great.
- 22:12Overall risk,
- 22:13but I think there is a huge issue
- 22:15for us as professionals is to
- 22:17ensure that we do not promote an
- 22:19adverse message but we do promote.
- 22:21I think a much more proactive
- 22:23message that all persons I think are
- 22:26valuable should be viewed similarly.
- 22:28Law enforcement for example,
- 22:29when calls should not quickly based
- 22:32on stigma or bias or stereotype
- 22:34assume or sometimes wrongly that
- 22:36particular individual may not be at
- 22:38risk because it's a going to male
- 22:40male relationship for example, we also know.
- 22:44Transgender settings that.
- 22:46Did you know?
- 22:47Generally matters.
- 22:48The data would argue that you're
- 22:49a lot more likely to be at risk of
- 22:52being a victim of physical violence
- 22:54and should guard if you have changed
- 22:56two of female status as compared
- 22:58to any other other direction.
- 23:00So is gender identity currently being
- 23:02of a female status, if you will,
- 23:04that puts a person I think at
- 23:06greatest risk of sexual and physical
- 23:09violence in this regard.
- 23:10So those issues are being mindful
- 23:12of that I think is key.
- 23:13I think for all of us.
- 23:14We probably spent some time,
- 23:15I think, trying to.
- 23:16Further educate other professionals who
- 23:18work collaboratively with us on this regard.
- 23:20I mentioned law enforcement already,
- 23:22but there are others and other government
- 23:24settings or government institutions,
- 23:25huge issues that I think are are
- 23:29increasing part of increasing
- 23:30trajectory or we should be mindful of
- 23:32to decrease its relevant risk going forward.
- 23:35I've always been struck by this issue
- 23:37of Leos or law enforcement officers,
- 23:40and I think early in my career and
- 23:42look at this work, I was surprised.
- 23:43But over time I think I've learned to
- 23:46appreciate that the cultural issues
- 23:48probably are much more dominant think
- 23:50than simply the rules that we should follow.
- 23:53I've seen the numbers as high as a third
- 23:56to 40% of the perpetrators of intimate
- 23:58partner violence being persons currently
- 24:01involved in law enforcement or having
- 24:03a prior law enforcement background.
- 24:05Clearly whether your law enforcement
- 24:07now or had a military or veteran owned
- 24:09background or you may be at a greater
- 24:12risk of you had more training be a lot
- 24:14more uncomfortable I think with and
- 24:17violent settings and the like because
- 24:20they're often police work with cars
- 24:22more dangerous and more stressful risk.
- 24:25They bond together.
- 24:26There's probably more camaraderie so
- 24:27be a lot, maybe a lot less likely to
- 24:30inform or you know tattle if you will
- 24:32tattle tale so to speak on others.
- 24:34So they may not be a culture.
- 24:36Where there's a bit more self-discipline
- 24:39and a bit more self policing after
- 24:42would argue that in our profession
- 24:44in medicine they're often your
- 24:45society depends on us to self police.
- 24:48If a surgeon is engaging in bad
- 24:49surgery off a doctor in psychiatry
- 24:51is engaging in poor decision making.
- 24:53Other psychiatrists often may be
- 24:54the first one or the surgeons to
- 24:56recognize that based on reading
- 24:58review or understanding the records
- 25:00or seeing that patient subsequently.
- 25:01And we have a responsibility to kind of
- 25:04step up and act in an appropriate way.
- 25:06The decrease that risk I've spent
- 25:08about six years as a consultant to the
- 25:11Texas State Board of Medical Examiners
- 25:13some years ago early in my career.
- 25:15And this is exactly I think the setting
- 25:17and they're often quite sure we would
- 25:19receive came from other doctors.
- 25:21So I think that the culture here of
- 25:23being involved in law enforcement may
- 25:24work against those individuals engaging
- 25:26the people we actually need them
- 25:28engage in to decrease ongoing risk.
- 25:30There's really bad case I think with
- 25:32the you back with the police chief,
- 25:34I think about in Seattle,
- 25:35definitely northwest.
- 25:36Um was engaged in a long term process of
- 25:39domestic violence and I PV toward our spouse.
- 25:42Everybody knew about it and and no
- 25:44one could really work to engage
- 25:46the decrease in because the power
- 25:47differential being the police chief.
- 25:49Also I think because of the likelihood
- 25:51that there's this again unfortunately
- 25:52caratteri the so-called you know
- 25:54blue wall and you kind of protect
- 25:56and and don't let your bad bad,
- 25:58bad words get out.
- 25:59So huge issues I think are important.
- 26:01I think the slide here just kind of
- 26:02points out a police family violence
- 26:04ranging from you know 20 to 40%.
- 26:07There's one meta analysis of about
- 26:10one in four active female active duty
- 26:14military personnel reporting experiences,
- 26:16IPTV victimization and other
- 26:18estimates showing,
- 26:19I think wide range of risk.
- 26:22But this is a particular population we
- 26:24should be mindful of and cautious to
- 26:27not ignore the overall relative degrees
- 26:28of risk and those risks may be increasing.
- 26:31The reason we actually mentioned
- 26:32earlier access to weapons are the
- 26:34culturation to be accustomed using
- 26:35them and using them in a coercive type.
- 26:37Question and then not really having a
- 26:39lot of the typical you know hurdles
- 26:42and and and and guidelines and
- 26:44and God wills excuse me by having
- 26:46others engaged to give you a word
- 26:49a message to pull back or decrease.
- 26:52Firearms goes without saying that we are
- 26:56a society with just a remarkable ongoing
- 26:59discussion about firearms or their access.
- 27:02Their use with the rules are.
- 27:04I'm talk about customer care here shortly.
- 27:07There's your number and
- 27:08volume of their capacity,
- 27:10how how powerful they are or a
- 27:11book about gun violence some years
- 27:12ago and I spoke about, you know,
- 27:14three or four key issues and
- 27:16and all of all run firearms.
- 27:17Too many firearms 1.
- 27:19The potency of power.
- 27:21Them to how so many more,
- 27:23all high magazine capacity are much
- 27:25more like machine guns if you will
- 27:28even short barrel weapons if you will.
- 27:30Heard our inability really to engage
- 27:32in a fair amount of research in this
- 27:34regard based on what's called the
- 27:35Dickey amendment going back to 1996.
- 27:37The Congressman of Arkansas already
- 27:39pushed through a tremendous amount
- 27:40of effort to decrease the amount of
- 27:42money that goes at the NHL level
- 27:44toward our research in this area.
- 27:45So we really don't know as much as we
- 27:47really should in our society about
- 27:49issues regarding I think firearm access and.
- 27:52Availability and use.
- 27:52A big issue for me is we probably don't
- 27:55use the data that we actually already have.
- 27:57But I'm a strong believer that for to
- 28:00decrease issues regarding IPV and others,
- 28:02we probably should have persons.
- 28:03We use biotechnology which would kind
- 28:05of train guns or program them when
- 28:07they're brought to really only work
- 28:09for the person who purchased them,
- 28:12rather than anybody being able to
- 28:13break in and steal a gun and sell it
- 28:16on open market for high rate of value
- 28:18and then use it indiscriminately
- 28:19very often in a Commission of a
- 28:21felony in another setting.
- 28:22So that I PV is really mixed up in
- 28:24the middle of that entire gun access
- 28:27issue and and the powerfulness and
- 28:29the and the relative or heightened
- 28:31risk of guns I think is key and it's
- 28:34also key very often because many
- 28:35persons will have a gun at their home
- 28:37because they they think that increase
- 28:39the safety was all our studies along.
- 28:41If you ask people you know why do
- 28:42you want to have a gun in your home
- 28:43they'll all get that you know it's
- 28:44for their own safety that's why
- 28:46they buy it and they're like but
- 28:48probably the lack of training a lack
- 28:50of a practice the data organ that.
- 28:52You people really are good shot.
- 28:54Most have to shoot multiple times or
- 28:56use you know high capacity weapons
- 28:58to actually hit the target or we
- 29:00we encourage spraying of bullets
- 29:02rather than a single approach.
- 29:03All of these variables kind of come
- 29:05into play to increase I think the
- 29:07risk of inter partner violence in
- 29:09a in a heightened setting would
- 29:10I would multiple with multiple
- 29:12firearms which was seen at the
- 29:15increasingly throughout society.
- 29:16I saw this slide is becoming a favorite,
- 29:18I think in this discussion that
- 29:19I give for a variety of reasons.
- 29:21I think that, you know,
- 29:22kind of has a shock effect.
- 29:24It does to me whenever I see it.
- 29:26It also kind of points out
- 29:28the really incredibly intense
- 29:29emotional reaction of the victim.
- 29:32And this is what I think I PV
- 29:33means to people very different than
- 29:35somebody who has a long barrel
- 29:37shotgun and they're shooting,
- 29:39you know, an animal,
- 29:40let alone a human being from a long
- 29:41distance away, hundreds of yards,
- 29:43if you will, in this setting,
- 29:45you know?
- 29:46You're causing them great grief
- 29:48and strife and fear and and
- 29:51relative vulnerability and and
- 29:52they know that you know it.
- 29:54And that seems to be for too many
- 29:56settings with why P is in play.
- 29:58What's the driving factor
- 30:00psychologically behind or what
- 30:02creates the need to have a gun,
- 30:05to brandish a gun,
- 30:06to threaten persons,
- 30:07to create this fearful response the
- 30:10the eye contact particularly our
- 30:12attention to we call this being
- 30:14a reminiscent I think of dark.
- 30:16In the past,
- 30:16people who know and understand
- 30:18the emotion or what the victim is
- 30:20actually feeling and feel like by
- 30:22causing that they actually causing
- 30:23the terror reaction that they
- 30:25really are interested in receiving.
- 30:26They may do this many,
- 30:28many more times than they actually
- 30:30shoot somebody or kill somebody.
- 30:31Although our numbers very often about
- 30:33the actual, you know, fatalities.
- 30:35But this scenario,
- 30:37I think that is a really much
- 30:38more indicative of the true
- 30:40underpinnings of what really happens
- 30:41in an intimate partner violence,
- 30:43city setting or conflict I think
- 30:45that we should be mindful of.
- 30:46And we've got to hear this message
- 30:48from our patients and from those
- 30:50who will assess and evaluating and
- 30:51a little bit more later about how
- 30:53we need to I think make sure that
- 30:55in primary care settings as well
- 30:56as the psychiatric settings that
- 30:58we are assessing and adjusting and
- 31:00aggressive aggressively trying to
- 31:02screen for relative degrees of risk.
- 31:04This is the level of risk I think that
- 31:06we are that we are pursuing better
- 31:08or better understanding of going forward.
- 31:11That constantly move toward the issue
- 31:13regarding fatality as I mentioned
- 31:15in homicide or the data would argue
- 31:17that about half of the homicides
- 31:18in the I PV or with firearms.
- 31:19So they are by definition are much
- 31:22more congruent factor regarding risk.
- 31:24Over half of the female homicides or in
- 31:27this regard and when you use firearms
- 31:29are three times as likely in this regard
- 31:31to have homicide then if you use a
- 31:33knife or a different type of weapon.
- 31:35So again access, access,
- 31:37access to weapons that are
- 31:40firearms or a key variable.
- 31:42In the heightened degree of
- 31:44risk while we're seeing more IPV
- 31:45and our society currently,
- 31:47but I do point out that this course
- 31:49of control are threatening behavior
- 31:50which creates fear to drive somebody
- 31:52to engage in action that you want them
- 31:54to engage in that you can't be sheer.
- 31:59And you know,
- 32:00quality of your language or or or
- 32:02your prior relationship or raising
- 32:04to a high in tone voice or yelling
- 32:07and screaming or quickly we actually
- 32:09move toward access to weapon.
- 32:10And at times that might not initially
- 32:12have been intended to homicide,
- 32:14but you can escalate very quickly
- 32:16and somebody who you thought you
- 32:17would just go on to threaten then
- 32:19somebody shot and then very often
- 32:20as they are a fatality or death.
- 32:23That being said,
- 32:24we come to another key recent case.
- 32:27There are so many, it's hard to discuss.
- 32:29You know many that on all of them,
- 32:31but they're really grab your attention
- 32:32and the case got a lot of national
- 32:35and international attention of a guy.
- 32:37Petito was one of them.
- 32:39Murdered last year,
- 32:40police had this altercation with her
- 32:43and her significant other in August,
- 32:46and her body was found about a month later.
- 32:48This kind of brings us to the
- 32:50consideration of what should police do?
- 32:52And all we engaged enough processes
- 32:55to engage in bilateral training
- 32:56and exposure to better understand
- 32:58how to make a was very often a
- 33:01snap judgment by a policeman.
- 33:03They're often not a mental professional that
- 33:05could be life or death for someone else.
- 33:07So I'm I'm struck by the data that right
- 33:10throughout my career that you know
- 33:12in some settings before the suicide,
- 33:14within 30 days before the suicide happens,
- 33:17that person who eventually suicided
- 33:20saw professional and they're
- 33:21often half or so of the pressure.
- 33:24What they saw were not psychiatrists.
- 33:26There were other professionals,
- 33:27even doctors at times.
- 33:28But not, not in our profession.
- 33:30Same issue here.
- 33:31All too often the vantage point and the,
- 33:34you know,
- 33:34broad stroke overlay in the setting
- 33:37of a decision that must be made
- 33:39to protect people in our society
- 33:41from our PD related deaths made,
- 33:44made,
- 33:44made by somebody who's not a psychiatrist.
- 33:47And we got to find ways in our
- 33:49profession to help with this process.
- 33:51I'm in New Orleans now on this
- 33:53gun violence task force.
- 33:54Working diligently to find ways
- 33:56to give information and ideas
- 33:58and suggestions, I think to our
- 34:00law enforcement officers are
- 34:02likely to help get a bit of run.
- 34:04Almost two years has been quite an effort.
- 34:06I've been going off for
- 34:07some time before I arrived.
- 34:08But what did you actually trying
- 34:10to do is to and we have funding
- 34:12for this now to integrate.
- 34:13You know mental professionals are
- 34:16typically social workers and case
- 34:18managers to engage in these domestic
- 34:21conflicts to assist police all too often.
- 34:24You're automatically sent somebody with a
- 34:26gun to a house with a domestic conflict.
- 34:28It may escalate quickly and police are
- 34:30trying with somebody looks to potentially
- 34:31be at risk to actually go for a gun.
- 34:33Maybe it's better to have somebody
- 34:35who doesn't have a gun go into
- 34:37that setting and so who also has
- 34:38training to talk people down and to
- 34:40use these conflict resolution type
- 34:42strategies to manage them a lot better.
- 34:44But a few things are also key.
- 34:45We probably have to encourage police
- 34:47and and and and empower them to be
- 34:49able to separate people very quickly
- 34:50and not to feel they're going to have
- 34:52the raft of society and somebody's
- 34:53going to go against them or sue them.
- 34:55If they move these people apart,
- 34:57if there's been some good conflict
- 34:58and also I think to find ways to find
- 35:01places for people to go with other
- 35:02struggles is they're just not enough.
- 35:04You know we shelter type settings
- 35:06for someone to go if you do move them
- 35:08away if your law enforcement and you
- 35:09find them in the midst of a conflict.
- 35:11So again the gabito story just really
- 35:14a phenomenal one in this business
- 35:17because they touched so many key very
- 35:20relevant and very time key timely issues.
- 35:23They're essential I think in this
- 35:25entire I PDF. To I I discussion.
- 35:29What about law enforcement?
- 35:30I I think I would reemphasize
- 35:33that we we need better training.
- 35:35I was under training event with
- 35:37law enforcement in New Orleans,
- 35:38basically just in Paris
- 35:39or early in my time here.
- 35:41And there's a lot of discussion
- 35:42back and forth about what kind of
- 35:44training and does it actually work.
- 35:45We also need to think better too.
- 35:47So many will argue that what's
- 35:49what's being used is probably less
- 35:51than optimal with a variety of
- 35:53tools that are used from, you know,
- 35:56for screening and the like.
- 35:59So it could be that would just happen
- 36:01as a person that's going to get to
- 36:03a setting for a clinical dimension
- 36:05to occur whether those, those,
- 36:06those types of screening tools I
- 36:09think can be used or engaged in.
- 36:11We don't quite do that enough.
- 36:12I think very often it's all a
- 36:14bit hit or miss.
- 36:15We have algorithm methods that I think
- 36:17shows some promise and predicting who's
- 36:19most likely to cause that difficulty.
- 36:21But I'm not sure we really execute
- 36:23them well or have a process in place
- 36:25systemically other we use across the board,
- 36:27I think it's a lot more likely
- 36:29to be affected.
- 36:29And decreasing our violating among
- 36:31groups and the final issue I think
- 36:34that we should increasingly engage in
- 36:36ongoing dynamic training I call it to
- 36:39address diverse relationship dynamics.
- 36:40So there's a lot going on in relationships.
- 36:43I mentioned the entire LGBT issue earlier.
- 36:45There's also issues regarding I think
- 36:47age and and and fiscal issues in play.
- 36:50There's a lot I think to uncover
- 36:51probably a lot to ask any professional
- 36:53clearly probably too much to
- 36:55ask a law enforcement person was
- 36:57has different levels of training
- 36:59and very often that's the space.
- 37:00With so much this is happening
- 37:02in our society now,
- 37:02we've got to find ways to to to change
- 37:05that and the angry integrate the
- 37:07likelihood that mental professionals
- 37:09have a role to play and some of these
- 37:11early up to line decision making before
- 37:13you get to a point where it's kind
- 37:14of too late and folks have resorted
- 37:16to violence being law enforcement
- 37:18or between the two individuals.
- 37:21I've talked about accessory just one
- 37:23more slide and hit a point out that
- 37:25having a gun simply makes it 5 to
- 37:27most likely sounds more likely than
- 37:29abusive partner will kill versus her
- 37:30to home I think a a female victim
- 37:33so I recollection is regularly I'm
- 37:35I'm saying the groups are if you're
- 37:38a woman especially with American
- 37:40woman you can have a gun in your
- 37:42home and you can be safe and there's
- 37:44a follow Second Amendment but at
- 37:46least know the data and know the
- 37:48overall risk and how they're greater
- 37:49if there's a gun in the home.
- 37:51Of you being harmed,
- 37:52then it being used for
- 37:53the reason you bought it,
- 37:54which was to protect you if
- 37:56there was an outside intruder,
- 37:58you know it actually all broke
- 37:59into to hurt you,
- 38:00if you will. Issues that I think
- 38:02access concerns come into play.
- 38:04We have more guns than people in America now.
- 38:06We're probably approaching closer to 400
- 38:07million guns and maybe 350,000,000 people.
- 38:10So we really are upside down on
- 38:12the issue of of having access
- 38:15to weapons of of of violence,
- 38:17creating increased risk for many
- 38:18persons who I think are much more
- 38:20vulnerable than even they may.
- 38:21They appreciate, I think, on their own.
- 38:24YouTube constitutional Carry
- 38:25is discussed a great deal,
- 38:28I think as a narrative in our community.
- 38:30Society just simply points out
- 38:31that the 25 states have passed it,
- 38:34that you can legally possess a firearm
- 38:36concealed or otherwise in in many
- 38:39settings where the license or not.
- 38:41So you have to kind of know what the
- 38:43rules are and that setting and they
- 38:45vary tremendously among all 50 states.
- 38:47I'm in Louisiana now in states like
- 38:49Louisiana, Texas, where I'm from,
- 38:50Tennessee,
- 38:50where I was earlier I was already
- 38:53mentioned typically have.
- 38:54Much more lenient rules.
- 38:56I would argue the more E we go the the
- 39:00rules tend to be a bit more constrictive.
- 39:03Many would argue in my perspective
- 39:05that that actually is a good thing.
- 39:06We want less access,
- 39:07less weapons and less weapons that are
- 39:10readily available when conflict happens.
- 39:12People can quickly grab a gun rather
- 39:14than solving their problems in
- 39:16other settings via with language
- 39:18or would would compromise.
- 39:20But this is your the constable
- 39:21carrier is what are we going to
- 39:23have to figure out ways to.
- 39:25Work through better because it does
- 39:26I think increase the president
- 39:27at a greater degree of risk.
- 39:29We point out that in order to to
- 39:31to pass these tests so-called get
- 39:32a permit we also have to pass over
- 39:34and test in some states demonstrate
- 39:36you can safely load clear and and
- 39:39make safer firearm.
- 39:40So there's some strategies and and
- 39:42until to ensure that there's some
- 39:44training around safety that can
- 39:45be involved in this setting and I
- 39:47think that's certainly a good issue
- 39:49because some people that group that
- 39:51has maybe you know one gun not those
- 39:53that are gun enthusiasts with.
- 39:54A dozen or two dozen guns in a garage.
- 39:57Those who have one gun who really
- 39:59legitimately want to have it for
- 40:00safety because you know in in an
- 40:01environment where there may not be safe,
- 40:03they should be trained.
- 40:04They should be trained on safety movers.
- 40:06They should keep very often you know
- 40:09typically when not in use you know
- 40:11ammunition separate from the weapon
- 40:12weapons should be kept up high.
- 40:14For example knock down low under the bed.
- 40:16I had a tragic case.
- 40:17I was a chairman at Wake Forest
- 40:19was mentioned and you know one of
- 40:21my young child psychiatrists.
- 40:23So it's from Tennessee in eastern.
- 40:26Um, for our state? Um. We were guns.
- 40:30Family had guns.
- 40:32His father you know had a gun out
- 40:34publicly I guess in the living room.
- 40:36Took a nap on the couch and the
- 40:37four year
- 40:38old a 3 year old granddaughter my, my,
- 40:40my, my, my young doctor's niece you
- 40:43know picked the gun up and I guess she
- 40:45thought she was playing pow POW and
- 40:47and and shot him you know tragic story
- 40:49in accident with these kinds of things
- 40:51that I think again begin to decrease.
- 40:53I think our feeling this is not a
- 40:54normal way to think of will function
- 40:56if you're going to have guns they
- 40:58must be kept with the heightened.
- 40:59You have to go.
- 41:00Safety and security for your own self
- 41:02and for your own family is going to cost.
- 41:04Social carry I think require further
- 41:06discussion I think along along that line.
- 41:09Here's some errors.
- 41:09We really can't have a gun.
- 41:10And I think this kind of makes sense
- 41:12of schools or correctional settings,
- 41:14hospitals, government buildings.
- 41:15We all know about airports and
- 41:17also places that make over half
- 41:19their income selling alcohol.
- 41:20So the more we can increase the
- 41:22places where you can have a gun,
- 41:24even in settings where you know
- 41:26in states where there's a,
- 41:28there's, there's,
- 41:29there's carry on availability.
- 41:31This may at some point be
- 41:32one of many vectors,
- 41:33many variables that I would argue
- 41:36we should implement to decrease
- 41:38these overall degrees of risk.
- 41:40There can't be ohh I'd note
- 41:42through substantial disconnect
- 41:43between policy and reality.
- 41:45I've kind of liked it quite a bit but
- 41:47you know all 50 states would like to
- 41:49argue have rules or laws on the books
- 41:51that can allow you to confiscate a
- 41:53gun from someone if they viewed as
- 41:55having PMI serious system mental illness.
- 41:58It's a civil commitment process in
- 42:00psychiatrist psychology we all have very
- 42:01involved in if you're comfortable with it,
- 42:03but the reality is only about 3
- 42:06or 4% greater likelihood exists
- 42:08in persons I think with PMI.
- 42:10In in in engaging in I PV or gun
- 42:13violence related crime or activity
- 42:15when these groups that you see on
- 42:17the slide are probably about 30 or
- 42:1940% more likely to use a gun on the
- 42:21Commission or think of a violent activity.
- 42:23Those with our SD or chemical dependency,
- 42:27those are in the past
- 42:29perpetrator of gun violence.
- 42:30We all think about that people
- 42:31may already be in jail or prison
- 42:33for gun violence related offense
- 42:35and those also be of note who
- 42:37have been passed victimized by gun
- 42:39violence and none of the 50 states.
- 42:41Have any laws in the books that would
- 42:43be much more restrictive and limiting
- 42:44access to buying a gun or what have
- 42:46you or or or maintaining a gun if
- 42:48you follow these three categories.
- 42:50So it's the idea that we've not
- 42:52been effective as professionals
- 42:53and researchers and are getting
- 42:56these messages out so that our
- 42:58data would actually drive policy.
- 43:00I think in the government arena is
- 43:02another opportunity for us and a
- 43:04strategy that we should probably use
- 43:06professionally and our organizations,
- 43:08the American Association,
- 43:09Apple and others to be much more.
- 43:11Talked about the can decreasing or degrees
- 43:14of risk in our society in the setting.
- 43:17Umm, I think I said earlier a
- 43:19bit about our relationships and
- 43:20how IPV has historically been a
- 43:23focus on romantic relationships,
- 43:25but the reality is other kinds
- 43:27of relationship violence.
- 43:28We like this little quote,
- 43:30this comment that it's possible to
- 43:31dislike someone that you don't care about.
- 43:34You really got to care about somebody.
- 43:35You really hate them.
- 43:36And and we see this very often an IP
- 43:39V that this the what what generates
- 43:41a lot of emotion and energy on a
- 43:43positive end could very quickly like a
- 43:45pilot on swing another direction and
- 43:47generate maybe even unfortunately an
- 43:49equal degree and intensity of negative
- 43:51angst and and even borders on hatred
- 43:54which may lead to a greater degree I
- 43:56think of the kind of violent hostility
- 43:58and indicative of of of of of of of
- 44:00a fatality or murder related type setting.
- 44:02So be mindful of that these are
- 44:04issues that we are sensitive to it.
- 44:06Look at our profession.
- 44:07We ask questions about it and trust base.
- 44:09We can understand what the
- 44:11relative degrees of risk may be.
- 44:12They certainly may be heightened and worse
- 44:15in a setting where hatred comes into play,
- 44:18but emotionally between people
- 44:20with a prior ongoing relationship.
- 44:23Other areas where as close relationships
- 44:26caregivers have ability to to hurt and harm,
- 44:29strong long term friendships,
- 44:31shared interests.
- 44:32I mentioned about teammates and football
- 44:34organizations and I don't work with
- 44:36order paper early in my career on eight
- 44:39places of phases of workplace violence.
- 44:41And in in that work we
- 44:42actually look very carefully.
- 44:43This is back.
- 44:44We're thinking that this is
- 44:45a post office phenomenon.
- 44:46We call it going postal now.
- 44:48We say that so many places we
- 44:50said in movie theaters in Denver
- 44:51and churches in South Carolina.
- 44:53In schools and in Connecticut
- 44:55and other places,
- 44:56it's horrible and it's frightening,
- 44:58but it should be eye opening
- 44:59to us as professionals.
- 45:00There's probably not location
- 45:02based or job or what based,
- 45:05but it's probably based on the
- 45:06psychology what's happening,
- 45:07I think collectively in our society
- 45:09which increases the likelihood that
- 45:11people can engage this kind of
- 45:12behavior or going forward we've got
- 45:14work to do to better understand such.
- 45:16Similarly,
- 45:16we see all concerns regarding
- 45:18all the elderly,
- 45:20much more abuse than the
- 45:21elderly than many would think.
- 45:23It is an intimate.
- 45:24Non sexual but an intimate relationship.
- 45:27When somebody's caring for you,
- 45:28they're handling your adls and your
- 45:30toilet during they're there when
- 45:32you're waking up or when you're
- 45:33asleep or you're moving around.
- 45:35They're there when you're at
- 45:36your most vulnerable.
- 45:36If you walk on a walk or you may almost fall.
- 45:39You need them to meet your basic
- 45:41needs or necessities to bring food
- 45:43or or water or clothing if you're
- 45:45cold or put you in a great degree
- 45:47of risk and we see this increasing
- 45:49abuse of the elderly and
- 45:50these type settings.
- 45:51I would consider that to be
- 45:53under this broadening umbrellas.
- 45:54I see it of an element I think,
- 45:56of intimate partner violence.
- 45:58We point out here that in these
- 46:00cases about 4% of the time was
- 46:02most common in the elderly is
- 46:04both psychological and financial
- 46:05abuse in the I PV type setting
- 46:08and they can certainly Co occur.
- 46:11So I started with this and I'm
- 46:13just about ohh gonna move toward
- 46:14ending with the this idea that
- 46:16these two recent cases are so
- 46:19seminal to discussion about I PV
- 46:21and how it's how it's growing.
- 46:22I think that as I mentioned earlier,
- 46:25whether stalking,
- 46:25whether it's intimacy in relationship,
- 46:27whether you're a teammates,
- 46:28what have you,
- 46:29they're huge issues or concerns.
- 46:30And along this line,
- 46:32hope the discussion we've had
- 46:33today kind of points out many of
- 46:35the reasons and rationales while
- 46:37these individuals I think have
- 46:38been at at a higher degree of risk.
- 46:40On the right we should point out that
- 46:42the individual what they include uh,
- 46:44they shoot these three young men
- 46:45had tried to get a gun earlier
- 46:47and and been rebuffed.
- 46:48So the reality is some of our
- 46:50laws or rules are in play and
- 46:51as an attempt to better execute
- 46:53how we keep guns away from those
- 46:55who may be at a higher risk.
- 46:57So anyway just a couple slides on
- 47:00what can we do practice and advocacy
- 47:022 million people in our country.
- 47:04I think we've been our victims also
- 47:06many public awareness campaigns
- 47:07we need education or lectures
- 47:09like this I think are helpful.
- 47:11Ohh I tried my my practice to pass
- 47:13out information in the waiting room.
- 47:15The people to give them an idea
- 47:16or a hint that they surely have
- 47:18a place to go to ask people need
- 47:20that so-called one 800 number.
- 47:21We have 988 now for suicide.
- 47:23Similar concerns I think coming to play.
- 47:25I think the public awareness
- 47:26I think in this regard.
- 47:28We should need more about screening.
- 47:29I think we've discussed that a bit
- 47:31today in primary care settings.
- 47:32It's critical that we're screening
- 47:34and asking not just about depression
- 47:35but about relative degree of risk.
- 47:37I think of affordability.
- 47:38We have to find ways to give to
- 47:41reach people where they are.
- 47:42I'm a strong believer in telehealth,
- 47:43and telehealth ran around too.
- 47:46Just last week,
- 47:46Peter Yolise from UC Davis gave I
- 47:49think a national leader in this area.
- 47:51And one way to help people be
- 47:53what be safer is to allow them
- 47:55access to telehealth and engage
- 47:56the doctor from a distant.
- 47:58I've said it using the
- 47:59mobile can also be helpful.
- 48:01We want people to have access to
- 48:03us mental professionals who may
- 48:04be able to engage in actions,
- 48:06give information,
- 48:07what you call advice or not.
- 48:08They'll be very helpful
- 48:09and beneficial in setting,
- 48:11and it may actually lead to a greater degree,
- 48:12I think,
- 48:13of protective privacy.
- 48:15Ohh we should execute the laws
- 48:16that we actually have.
- 48:17There are laws that limit access
- 48:19to guns and restraining orders.
- 48:20They should be manifest and
- 48:21they should be executed.
- 48:22We should use them much more effectively.
- 48:24We have the federal Gun Control Act of 94
- 48:27for about a decade before it's sunsetted.
- 48:29We saw less gun violence and less
- 48:31I PV or some of these rules.
- 48:33And these laws work.
- 48:34Our society may be a bit, I think,
- 48:36of an unfortunate narrative
- 48:37that's antagonistic to the idea
- 48:39of the concept of gun reform.
- 48:40I am not. I think we can defend.
- 48:42I think they don't.
- 48:42Makes it very, very clear there.
- 48:44One, we've engaged in actions.
- 48:46Along the line of gun reform
- 48:48and health oriented activity,
- 48:50we've been able to save lives
- 48:51and I think we could do that
- 48:52again kind of going forward,
- 48:54even in a setting where there are variety
- 48:56of state laws that are are variable,
- 48:58particularly ones regarding whether
- 49:00police can confiscate somebody'd weapons.
- 49:03We should strengthen state laws
- 49:04that exist by domestic abuse.
- 49:06It was a Lawrenceburg law,
- 49:08an amendment to the Clinton's law of 94
- 49:10that said we take your gun away if you
- 49:13have history of domestic abuse or I PV,
- 49:15as well as a history of a gun crime.
- 49:17These are good things and things we should,
- 49:19I think, be proponents of in our
- 49:20society kind of going forward.
- 49:22Also, of course,
- 49:23long discussion about strengthening
- 49:25federal background checks and closing
- 49:26these loopholes of you can't go into a gun,
- 49:29a store and buy a gun
- 49:30without a waiting period,
- 49:31but you can go to a a gun.
- 49:32Joe on Saturday and buy to
- 49:34kind of walk out immediately.
- 49:35Of course,
- 49:36that's a loophole that makes no sense and
- 49:38is antagonistic to safety in our society.
- 49:41Other ways I think to prevent foreign
- 49:43violence is a required dealers and
- 49:45groups I think to be mindful of
- 49:47who they're selling to and to to,
- 49:48to foster these rules.
- 49:49We have rules now that if you go
- 49:51to buy a gun at a store there's a
- 49:53three day waiting period very often.
- 49:54But if it takes too long and it's
- 49:56backlog and if the fans don't
- 49:57get back to the store then they
- 49:58have to sell the gun anyway.
- 50:00I think that's a that's an unfortunate
- 50:02rule that works against safety and my
- 50:04final point is we should certainly
- 50:07fund more research on on gun reform.
- 50:09Ohh this term red flag laws,
- 50:11I just argue we previously
- 50:12used term extreme risk laws.
- 50:14Now the laws that do allow you to,
- 50:16it's a complicated issue but you
- 50:18can't take somebody's gone away if
- 50:19there's some some degree of risk.
- 50:21And I think the last slide just points
- 50:23out that that that's a key issue for us.
- 50:25We should be much more proactive
- 50:26and the issue I think of a safety
- 50:29oriented mindset in the society
- 50:30that we recognize we have for a
- 50:32variety of reasons a high degree
- 50:34and volume of of of weapons,
- 50:36guns and even higher medical capacity guns.
- 50:38We've got to find ways to
- 50:40decrease the likelihood.
- 50:41That they can harm others.
- 50:42The conclusion your ownership of ones of
- 50:45firearms or access is the risk factor
- 50:47of I PV and homicide in our community.
- 50:50Certain communities,
- 50:50marginalized ones are more vulnerable
- 50:52and require unique consideration.
- 50:54I think I'm much more proactive
- 50:56approach by us and the questions
- 50:57we ask and engagement we we employ
- 50:59to provide safety and help.
- 51:01We should ask that second question
- 51:02on that third question to elicit
- 51:04information that we may need to hear
- 51:06who we may be the one vector can help
- 51:08that person provide more safety certain.
- 51:10Your patients are Leos law enforcement,
- 51:13Mitchell history you have increased
- 51:14risk they want to be blamed for it
- 51:16but we want to ignore it either and
- 51:18we should implement that or integrate
- 51:19that into our thought process regarding
- 51:21our safety related maneuvers and and
- 51:23and as physicians and psychologists
- 51:25and and others in our profession we
- 51:28have a we have value we have relative
- 51:30ability to be impactful with enhanced
- 51:33awareness advocacy and clinical practice.
- 51:35So thank you very,
- 51:36very much.
- 51:36Well thank Charles DK again for
- 51:38him and your group for inviting
- 51:40me and I said it will stop now.
- 51:41And take any questions.