Yale Department of Psychiatry Grand Rounds: December 9, 2022

December 09, 2022

Information

"Intimate Partner Violence"

Rahn K. Bailey, MD, Chair, Department of Psychiatry, LSU Healthcare Network

ID9265

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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.