Beyond Actuarial Assessment to Informed Risk Management

Beyond Actuarial Assessment to Informed Risk Management Susan J. Sachsenmaier, Ph.D. Prepared for IAFMHS April 9, 2003 ssachsenmaier@charter.net With thanks to Robert Fein, Ph.D. for consultation.

Methods for assessing probability of future violence A. Traditional Clinical Judgment: unguided, intuitive B. Actuarial Determination: Statistical C. Structured Clinical Judgment: guided by research- selected factors

Methods for assessing probability of future violence A. Traditional Clinical Judgment: unguided, intuitive 1. pro: individually specific 2. con: low reliability and validity

B. Actuarial Determination: Statistical 1. pro: statistical formulas are generally more reliable and valid than clinical judgment; specific probability over specific no. of years, likelihood of false positives and false negatives. 2. con: only applicable to certain well- defined populations with a high- enough base rate of violent acts

C. Structured Clinical Judgment: guided by research-selected factors 1. pro: can be applied to a specific individual in certain relevant contexts, with moderate or better reliability and validity, depending on stability of important factors 2. con: cannot give statistically accurate information such as probability of recidivism in a specific number of years, or likelihood of false positives and false negatives.

II. Selecting Appropriate Method for unique clinical case A. Salient factors in choosing proper method 1. military men are not included in any significant number in samples upon which actuarial methods have been developed

2. Military men have unique characteristics a. Trained in combat, b. Trained to exercise caution and judgment in selecting targets of aggression, especially when under pressure c. Trained to think clearly under high stress situations, d. Trained to handle weapons with skill and discretion e. Trained to evade capture when necessary,

Unique characteristics of military men, cont: f. Trained in the importance of maintaining high moral standards even when off-duty g. Trained that civilians look to them for protection h. Determined physically and mentally healthy at entry i. Are generally above the average level of intelligence of civilian prisoners

3. rapist-murderers make up very small portion of the samples used to develop the actuarial methods a. Static99 b. RRASOR c. MnSOST-R d. SORAG e. VRAG f. PCL-R e. several others not worth mentioning

4. military man; rapist; murderer (intended murder, believed dead) a. actuarial methods do not fit this case b. unguided clinical judgment or intuition is the less reliable and valid of the two remaining options c. that leaves a research-supported, structured analysis of the relevant factors

5. Structured, research-based methods a. HCR-20 b. SVR-20 C. SARA d. U.S. Secret Service Model

III. Three fundamental principles A. targeted violence is the result of an understandable and often discernible process of thinking and behavior. 1. neither impulsive nor spontaneous 2. thinking about the attack dominates their lives and provides a sense of purpose or an attainable goal by which they see an end to their emotional pain

B. Violence stems from an interaction among the potential attacker, past stressful events, and current situation 1. Consider relevant risk factors, 2. Consider development and evolution of ideas concerning the attack, 3. Consider preparatory behaviors leading to violent attack

4. Appraise how the individual has dealt with stress in the past, when usual coping mechanisms are ineffective a. by becoming physically ill, b. by becoming psychotic, c. by becoming self-destructive, or d. by becoming violent toward others.

6. Appraise the current situation and the previous and anticipated target(s). a. What is the likelihood that past life events that have triggered consideration of self-destructive or violent behavior will recur (or are recurring) b. Consider how others in the subject's environment have responded or are responding to his/her perceived stress and potential risk.

C. Identify relevant factors about intended or potential target(s) a.gender, ethnic, political, religious, work, other b. subject's degree of familiarity with the target's work and lifestyle c. target's vulnerability, accessibility to subject d. target's sophistication about the need for caution.

IV. Ten questions to guide meaningful assessment of specific individual A: What motivated the subject to make the statements, or take the action, that caused him/her to come to attention? B: What has the subject communicated to anyone concerning his/her intentions?

C. Has the subject shown an interest in targeted violence, perpetrators of violence, weapons, extremist groups, or murder? D. Has the subject engaged in attack- related behavior, including any menacing, harassing, and/or stalking-type behavior? E. Does the subject have a history of mental illness? OR: Does subject have substance abuse problems?

F. How organized is the subject? Can he/she develop and carry out a plan? G. Has the subject experienced a recent loss and or loss of status, and has this led to feelings of desperation and despair? H. Corroboration: What is the subject saying and is it consistent with his/her actions?

I. Is there concern among those that know the subject that he/she might take action based on inappropriate ideas? J. What factors in the subject's life and/or environment might increase/decrease the likelihood of the subject attempting to attack a target?

V. Clinical Case: Brief Summary • Briefly, the man targeted his next door neighbor and planned to rape and murder her. He invited her husband out drinking; while the husband was out, the man went back home, changed into shorts with no underwear, a t-shirt, and socks without shoes, even though it was mid-winter. He went next door, let himself in, undressed as he walked down the hallway, strangled the woman, brutally raped her several ways, put a quilt over her head and walked her around the house twirling her around, went to the kitchen, beat her severely with a frying pan until the handle broke, then took a knife with an 11 inch serrated blade, stood behind her and cut her throat from her left ear all the way around to her spinal column. He then went to the garage and brought in the garbage can, which he intended to place her body in. He believed her to be dead. At that moment her husband arrived home and the man fled out the back door. Miraculously the woman survived, though not without horrible physical and psychological scars and some disability due to severed tendons that could not be reattached. The man destroyed all evidence. The wrong man was arrested and jailed. Nine months later the right man was caught.

V. Clinical Case: Application I. Relevant Factors in Target Violence A.Target Violence is understandable 1. Not Impulsive a. he checked J’s schedule for that night, invited him to Landing Base b. he stopped at home and changed to shorts with no underwear, t-shirt, socks, no shoes, in February.

2. Attainable Goal with belief it will end emotional pain a. he felt wronged by his wife, but could not do anything about that, she had out-smarted him. b. he felt loss of power when removed from Security Forces and wanted to regain sense of power.

B. Violence stems from interaction of attacker, past stressful events, and current situation. 1. Attacker a. Abused as child, abandoned by mother b. Not popular with girls c. Air Force was increasingly stressful d. Increasing anger at others e. Increasing physical aggression f. Increasing addiction to alcohol g. Increasing need for sadistic sex

2. Stressful Events a. 1998: finished H.S., joined Air Force. b. 1998: sick with Mononucleosis, missed several weeks of duty. c. 1999: met woman, got her pregnant, got married, all within 3 months. d. 1999: wife miscarried. e. 1999: complains of sleep problems, goes to sleep clinic. f. 1999-00: lost authority to carry firearms, removed from Security Forces. g. 2000: wife miscarried again. h. 2000: attempts to return to S.F., fails. i. 2001: wife leaves him.

3. Current Situation a. angry, alcoholic, preoccupied with sex. b. others are speaking negatively of victim c. victim is vulnerable, accessible. 4. Preparatory Behaviors a. gathered information i. knew victim, husband ii. knew victim’s car, husband’s car iii. knew garage door left open when husband not home iv. knew husband likes to go to Landing Base

b. stealth and planning i. told no one ii. justified his anger iii. talked to victim day of attack and asked about husband’s plans for the night iv. invited husband out that night v. arranged to have husband gone, victim alone vi. chose victim with no training in self defense

c. preparation and anticipation i. went to friend’s house drinking; went to Landing Base and continued to drink; after closing went to friend’s house and continued to drink. ii. Criminals planning a crime frequently heighten feelings of power and invincibility by using alcohol and/or drugs iii. Went home and removed regular clothes, dressed in shorts with no underwear, t-28shirt, socks, no shoes, for easy, fast removal iv. Checked garage and saw husband not home

d. preparation for rape i. Entered closed door uninvited ii. Removed clothes rapidly as he went straight to bedroom iii. Turned light off as soon as victim turned it on so she could not see him and it would increase her terror. iv. Smothered her with pillow or hand so she could not breathe, to increase her terror and feelings of vulnerability

e. preparation for murder i. Raped victim several times and hurt her ii. Covered her head with comforter so she could not see him, increase her terror. iii. Twirled her around to make her dizzy and disoriented, with blanket over face, making it hard for her to breathe. iv. Told her he would not hurt her, to keep her compliant and not try to escape. v. told he he was taking her to kitchen to give her a drink of water, provided reason for looking in cupboards, keeping her compliant. vi. Beat her over head with pan until she fell down and kept beating her.

5. How individual has dealt with stress in the past a. physical illness: 1999, mononucleosis b. psychosis: no, but depression, anxiety c. self-destruction: 1999-01, alcoholism, suicide gesture d. violent toward others: 1999-01, increasingly, beginning with wife and escalating with her, then escalated to rape and attempted murder of victim.

6. Subject’s history of responses to losses, trauma, major changes a. joined Air Force, got Mono b. wife miscarried, became suicidal c. wife miscarried, became brutal, abusive d. sexual troubles, became addicted to porn e. sexual impotence, became sexual sadist f. frustrated, became alcoholic g. removed from S.F., became angry, hateful, blaming, felt wronged, self-pity h. wife miscarried 2nd time, aggression grew, no empathy for her i. disappointed by some women, developed anger toward all

7. Appraise current situation and target a. likelihood that past events that trigger violence will recur i. History of childhood abuse, abandonment ii. Sees Air Force as stressful, disappointing iii. Sees others as unfair to him iv. Sees women as disappointing, vulgar v. . Addiction to alcohol vi. Does not have wife or children vii. Not generally attractive to women vii. Vulnerable victims accessible (women whose husbands are upset with them, or some other reason for projecting blame on them)

b. how others in environment perceive and react to subject’s aggression and potential risk i. Air Force teaches respect for women ii. Air Force discourages inappropriate aggression iii. Air Force discourages alcoholism iv. Wife gave him clear messages that violent sex not acceptable v. grandmother taught him violence against women is wrong vi. No known associates approved of this sort of violence, did not deter subject

C. Relevant factors about intended target(s) i. subject familiar with target’s work and lifestyle, easy to do same with future target ii. target was vulnerable and accessible, easy to locate similar victim in future iii. Target was not sophisticated about need for caution, easy to locate similar victim- target iv. Target appears to include any accessible female, tried to rape wife, beat wife, raped and beat current victim

V. U.S. Secret Service “10 Questions” A. Motivation? 1. to punish victim for perceived transgressions 2. to vent personal rage 3. to regain feeling of powerfulness 4. to commit heinous crime and get away with it

B. Communication of intentions? 1. none known, no forewarning (one witness reported husband made comment implying he knew something would happen to wife that night – not substantiated, were lots of rumors going around) 2. planned with stealth, like a military attack

C. Interest in violence, weapons, murder, extreme groups? 1. weapons: obsessed about Security Forces, being able to carry firearms 2. violence: spouse assault, attempted rape of spouse, sadistic sex, violence to victim, multiple rape of victim 3. murder: attempted murder, believed he was successful

D. Engaged in attack-related behavior, menacing, harassing, stalking? 1. setting up victim by inviting husband to Landing Base. 2. watching victim and husband until he knew their habits.

Engaged in attack-related behavior, menacing, harassing, stalking, cont. 3. making frequent derogatory remarks to women 4. angry, sarcastic, challenging to authority when feels thwarted 5. threatened to kill anyone his estranged wife might date

E. History of Mental Illness or Substance Abuse? 1. no major mental illness 2. insomnia, anxiety, depression 3. serious alcohol abuse

F. How organized is subject, how capable of carrying out an attack? 1. very organized, stealthy 2. Security Forces training 3. anticipated evidence collection and destroyed his clothing, 4. concocted alibi

G. What recent losses or loss of status may give subject feelings of desperation or despair? 1. wife’s two miscarriages 2. wife’s divorce of him 3. removal from Security Forces 4. permanent ban against firearms

What recent losses or loss of status may give subject feelings of desperation or despair, continued. 5. public arrest and confinement after 9 months thinking he got away with it. 6. no current girlfriend 7. loss of status in family of origin 8. loss of status in home town.

H. Are subject’s words consistent with his actions? 1. says he wants help, but did not want help until he was arrested 2. says he is sorry, but did not say so until arrested 3. says never meant to hurt anyone, but went to great effort to hurt someone

Are subject’s words consistent with his actions, continued. 4. says history of manic-depression in family, but never said that until arrested, grandmother said no mental illness in family. 5. in 2000, said no potential for alcohol abuse, but was abusing alcohol then and continued to.

I. Concern by others who know subject that he will be violent? 1. wife was afraid to come back to NM to get her belongings 2. wife allowed him to force her to have sex every day because she was afraid of him

Concern by others who know subject that he will be violent, continued. 3. officer who removed authority for firearms was afraid he would be violent, not just then but at any point in future 4. certainly any woman who would live in his neighborhood after this, if they knew 5. ex-wife, if he went to her home state

J. Factors in subject’s life and environment that increase or decrease probability of violence? 1. Increase a. Chronic, pent-up rage b. Blames others for own problems, actions c. Hatred of those he thinks wrong him

Factors in subject’s life and environment that increase or decrease probability of violence, continued. d. Feels entitled to attack other – to point of death – who has not wronged him, but who is merely in his target victim group e. escalating reaction to stress since leaving high school, grandmother’s home and home town, from verbal anger to rape to intended lethal violence

Beyond Actuarial Assessment to Informed Risk Management