National Crisis Intervention Training Institute, Inc.
National Crisis Intervention Training Institute, Inc.
“What is the National Crisis Intervention Training Institute’s Psychological Autopsy Team (NCITI-PAT)?”
The NCITI-PAT is a special multi-disciplinary investigative group within the organization’s Critical Incident Response Team. NCITI-PAT is involved in conducting both investigative and therapeutic psychological autopsies in order to confirm or verify cause and mode of death, co-morbidity contributors, as well as probable motivational intent, in equivocal cases involving undetermined, suspected, or forensically-confirmed death by means of accidental, suicidal, or homicidal causes.
“What is a “psychological autopsy?”
Unlike a physical autopsy --which is a physical examination of a deceased person’s body to determine cause of death, as well as relevant physiological or anatomical contributors to a person’s death or deterioration of health-- a psychological autopsy involves a systematic, scientific, investigation into a deceased person’s cognitive, psychological, emotional, spiritual, and social state prior to death.
“What types of professionals make up the National Crisis Intervention Training Institute’s Psychological Autopsy Team?”
The NCITI-PAT is made up of a Chief Field Forensic Investigator, a Case Assignment / Intake Specialist, and a Case Manager / Aftercare-Volunteer Coordinator, in addition to paid and professional-volunteer team members such as a crisis intervention specialist, a certified addictions counselor, a grief/bereavement counselor, a licensed clinical social worker, a physician specializing in addictions and pain management, a clinical psychiatrist / neurologist, a forensic psychologist, a pediatrician, an attorney, a pastoral counselor, a clinical psychologist, and a veteran homicide investigator. From time to time the team is also aided by an on-call Advisory Board made up of various clinicians, suicidologists, and veteran investigators. The Forensic Chief Field Investigator and Case Manager / Aftercare-Volunteer Coordinator work in concert to network and coordinate seamless services to be extended to family members and significant others within their respective communities. The Aftercare Case Coordinator also links surviving family members of the deceased with trained volunteer support personnel who are matched with family members, in order to provide ongoing peer support long after the investigation is concluded.
“Why does the NCITI-PAT utilize an inter-disciplinary approach?”
More often than not, psychological autopsies are conducted by psychiatrists, forensic psychologists, or other helping professionals who enjoy expertise in areas specific to mental health, but who may lack expertise in criminal investigative procedures, social work, addictions, or crisis intervention. NCITI-PAT strives to develop a more holistic picture of the assigned case, and to allow for adept, dual focus upon both investigatory and clinical considerations. While this approach is potentially more expensive, the architects of the program and team members believe that a multi-disciplinary approach which allows for diverse professional and personal perspectives holds greater promise for more complete and accurate findings, as well as a better treatment outcome for family members of the deceased.
“What are the roles, functions, and responsibilities for the National Crisis Intervention Training Institute’s Forensic Psychological Autopsy Team (NCITI-PAT)?”
The roles, functions, and responsibilities of the NCITI-PAT vary greatly from case to case, depending on the needs assessed during the initial screening and intake interviews. An overview of general services and key functions include:
“What types of situations call for a psychological autopsy?”
While psychological autopsies may be utilized in cases of so-called “natural” deaths, as well as accidental deaths, they are most often conducted in cases of suspected or confirmed homicides, suicides, coerced suicides, combination suicide/homicides, or in cases of proxy suicide – such as in a so-called “suicide by cop.” Similar investigative methods are also sometimes used in cases of missing persons, where it is not known whether or not a person is actually deceased, but where it is feared or suspected that the person may have committed suicide without their body being located. We refer to this type of investigation as a “posthumous psychological autopsy.” Victimology --the scientific study of victims and victimization-- is a key element in this type of investigation. In cases where foul play is suspected or confirmed, victimology is often utilized to better understand, identify, and apprehend perpetrators, as well as providing useful background information to be utilized in follow-up investigations of crimes against persons, and/or in interrogation of perpetrators.
“What types of information, data, and artifact evidence is gathered and analyzed during a psychological autopsy? How is it gathered, evaluated, and reported?”
The following types of information are gathered during the investigation, and are analyzed and reported utilizing professionally and scientifically recognized qualitative case study investigative and research methodology:
“When might psychological autopsies be therapeutic as well as effective as an investigatory tool?”
First of all, it should be clarified that not everything that is deemed as “therapeutic “necessarily qualifies to be called “therapy,” and that, sadly, not all so-called “therapy” is therapeutic. The grief and mourning recovery process is difficult in any type of death of a significant other family member, but especially in cases of catastrophic crises such as unanticipated, violent, sudden death of a loved one.
Healing is often impeded by the nebulous “unknown:” unanswered question as to whether or not the person intended to commit suicide, where they are now, what their spiritual condition was just prior to their death, what, if anything, may have been done to prevent the tragedy, et cetera.
Parents of suicide victims are especially vulnerable to problems stemming from the death of their children, and are prone to profound feelings of guilt, regret, and fear of losing another child. They are also prone to feelings of being isolated, alone, and misunderstood by other people who, even though they may be operating out of the best of intentions and out of great concern, say and do things which reinforce the parents’ feelings that no one understands what they are going through. Also, it is all too common for well-intended people --family, friends, and involved professionals-- to unintentionally exacerbate the parents’ guilt and regret by saying and doing things which prove to be non-therapeutic, counter-therapeutic, and hurtful.
Especially in cases of suicide, suicide by proxy, or homicide/suicide, psychological autopsies are often used to assist families in obtaining answers to haunting questions about the death of their loved one and to discover previously unknown or suspected co-morbidity factors which may have led to the catastrophic loss. If combined with effective, sensitive, and applicable counseling and other support services, can play a demonstrable role in the emotional, psychological, and spiritual healing of living survivors. It should be stressed that great care is taken, however, to avoid situations in which therapeutic interests clash with investigative interest, or in any other way present a potential or real conflict of interests on the part of the investigative team.
Psychological autopsies, by their very nature, are designed to investigate, in order to render as much data as possible in order to render accurate findings…by gathering and examining previously-unknown information.
By doing so, affected families hopefully will come to believe that someone cares enough to help them get answers to their haunting questions, that they are not alone, that they will not be abandoned, and that adequate aftercare and support services will be available. Also, if the investigators or other enlisted helping parties are able to convey to the parents that they have the ability and willingness to listen, support, help, and empathize, the survivors’ sense of isolation, aloneness, and despair may be lessened…especially if appropriate, therapeutic, and timely self-disclosure by the team members convey similar past experiences.
“What measures are taken to ensure that the psychological autopsy is therapeutic as well as efficacious as an investigatory tool? How is trust, rapport, and cooperation attained and maintained by the team?”
First of all, the core members of the Psychological Autopsy Team are selected not only for their investigatory and/or clinical skills, but also for their sensitivity to the issue, their personal sense of compassion for those suffering families, and also for their personal experiences which facilitate their wisdom, sense of understanding, and empathy. Similar traits are sought in the trained volunteer peer support counselors who are matched up with family members in the aftercare phases of the process.
A key strategy utilized by our Therapeutic Psychological Autopsy Team is to facilitate introduction of the forthcoming aftercare support services as early as possible in the process. Therefore, aftercare planning is initiated at the point of screening and initial intake. Often, but not always, the key contact person for the family is a member of the volunteer support team whose past experience best parallels the loss experienced by the family members. This is a strategy which must be implemented carefully and judiciously, qualified with careful oversight to ensure that objectivity will not be compromised, and/or that unhealthy transference/counter-transference issues will not impede the effectiveness or outcome of the investigation.
Another key to therapeutic efficacy of the psychological autopsy is for the investigators to be adept at gathering, analyzing, and especially, reporting information to the survivors, but also in providing effective support to the family members once that information has been processed. For example, the parents may have previously stated, “He never gave us a clue that he was thinking about suicide.” Upon investigation, however, gathered information coupled with the parents newly-acquired knowledge and heightened sense of awareness, may lead to the parents feeling even more profound guilt and regret when they realize that their loved one did indeed leave a lot of “clues” that he/she was intending to commit suicide.
“What happens after the conclusion of the psychological autopsy and the reporting of findings?”
Effectively attending to the welfare of the family, as well as to the integrity of the investigation, is not only crucial during the course of the investigation, but is vitally important during the following days, weeks, and months following the completion of the psychological autopsy. For that reason, primary, secondary, and tertiary support services are facilitated through the team’s Follow-up Case manager / Coordinator, who maintains ongoing, supportive contact with the family for at least a year after the investigation’s conclusion.
“Who participates in the actual remote field investigation? How are the other team members involved?”
In some cases, the entire team, or a select team sub-unit may be dispatched to conduct the field investigation. In other cases, the Forensic Field Investigator goes on-site to gather the data, prepares an Predetermination Field Report of findings, which are forwarded to the other team members. As needed, the team calls upon members of the Advisory Team to clarify findings and to gather further recommendations. The case is then staffed by the entire time, and a report of findings and recommendations is then completed. The report is then subsequently forwarded to relevant professional agency personnel. Another report is prepared, targeting the family of the deceased, and is utilized in planning the follow-up meetings with the decedent’s family members and significant others. Summaries of both reports are shared with the family members in person, followed by an aftercare planning session involving the chief liaison to the family --usually the forensic field investigator-- and the Follow-up Case Coordinator, who also networks with community professionals charged with the family’s aftercare.
“How much does it cost to conduct a Psychological Autopsy? How are the Psychological Autopsies paid for? Are the families ever charged a fee for those services? What if certain parties have a fiduciary interest in the potential outcome of the investigation?”
Direct and indirect expenses and other costs of psychological autopsies vary greatly, depending on the location and extent of the field investigation, how difficult or time-consuming the field investigation is, and what collateral fees may be attached to the acquisition of primary and collateral data. Other contributing co-factors include how many members of the NCITI-PAT may be needed to participate in the remote field investigation, and what actual travel expenses are incurred in getting the team member(s) to and from the field site. Obviously, these types of investigations can be expensive.
The NCITI nationally seeks out monetary and in-kind contributions from an array of sources, including individual, church-based, educational, and business members of the community where the catastrophic death occurred, as well as foundations, governmental agencies, and other organizations interested in supporting the cause. Great care is taken to ensure that no fiduciary conflict of interest exists in cases where financial contributors reside or do business in the communities where the investigations are conducted. Whenever possible, the field investigation team member(s) may contact local opportunities for contemporaneous teaching and training engagements, which may provide monetary honoraria or solicit financial contributions in return for guest lecturing and other public speaking functions. This fundraising effort is done to help defray costs of the investigation, without creating a financial burden for the families of the deceased. Great care is taken to avoid these speaking engagements which might interfere with the investigation due to scheduling or other factors. Special care is also taken to avoid any conflicts of interest, and especially, to protect the confidentiality and anonymity of the decedent, his/her family members, and other significant parties.
By policy, NCITI-PAT personnel do not charge direct fees to families, nor do they proactively solicit donations from family members or significant others prior to, during, nor immediately the investigation is concluded, and findings are rendered and reported. In certain circumstances where there is no conflict of interest presented by fiduciary interest on the part of family members or significant others, donations might be accepted by those individuals, but not until one calendar year after conclusion of the investigation. In cases where there is suspected, potential, or confirmed fiduciary interest on behalf of those parties, no donations will be accepted from family members for, even after the one year period after conclusion of the investigation has elapsed.
Likewise, should the referring individual, agency, or organization who charter the services of the NCITI-PAT have any potential or actual fiduciary interest in the outcome of the investigation, no monies will be accepted from them before or during the investigation, in order to avoid the appearance of bias or impropriety. In cases where there are no fiduciary interests, referring --or other-- agencies and organizations are openly invited to help defray costs via financial and/or in-kind contributions.
“How, and by whom, are cases referred to and accepted by the NCITI-PAT?”
Requests for NCITI-PAT’s services may be received by an array of referral sources, including but not limited to, family members and/or significant others of the deceased, law enforcement or other investigative agencies involved in the case, forensic pathologists functioning as medical examiners and/or coroners, state, or federal prosecutors, attorneys representing the interests of the decedent and/or his/her family, et cetera. Upon receiving an initial referral phone call, a brief Services Request Form is forwarded to the reporting party. Upon its return, the form is reviewed by the Forensic Field Investigator and the team’s licensed clinical social worker, who also functions as the Primary Screener and Triage Specialist, in order to determine that the target family is both eligible and appropriate for services, and to determine what level of assistance should be offered.
An exhaustive Psychological Autopsy Worksheet is then sent to either the referring professional or paraprofessional, and/or to an immediate family member or “significant other” of the decedent. Once the completed form is received by the NCITI Director / Chief Forensic Investigator, its contents are used to plan the strategies for primary and collateral interviews and gathering of relevant documentation.
If necessary, collateral interviews are conducted by phone; however, onsite direct interviews are strongly preferred. Once the initial interviews and evidence-gathering is completed, a notification is forwarded to relevant team members. Upon confirming availability, the field investigation is scheduled and commenced.
“How to I contact the NCITI-PAT to request further information, or to submit a case for pre-investigative review?”
Email or call:
Joel Johnson, M.A.Ed.
Director, National Crisis Intervention Training Institute
Director, Critical Response Division / Chief Forensic Field Investigator
405-543-9221 Direct Line