Sandy Hook Aftermath: Mental Health As A Public Health Issue

Mental health is one of the 4 public health topics being discussed in the aftermath of the Sandy Hook shooting. Should it be part of the equation for trying to reduce the likelihood of future school shootings? The answer is yes. 

The focus here, though, is not exactly going to be about the usual topics you’ve been reading about, all of which carry their own importance, such as: the need for better mental health screening; the importance of making mental health services more accessible to those who need it; failures in the system which make it difficult to continue with treatments. While these issues are important, we need to expand our thinking about “psychiatric disorders” with respect to preventing future shootings. Although there are empirical links between psychiatric illness and violence, the vast majority of individuals who suffer from any one diagnosed psychiatric disorder are not going to commit mass murder. Put another way, there isn’t one simple diagnostic test that would offer enough precision to tell us who may be at risk for that kind of behavior.

Our focus needs to be placed on promoting the healthy all-around development of youth, starting early in life, and parallel efforts to recognize signs of distress and maladaptive functioning and to do something meaningful about that. Psychiatric evaluation and diagnosis is part of the process, but experienced clinicians don’t treat disorders – they treat people. They know how to get a full picture of a youth’s life – how they behave at home and in school, how they interact with kids and adults, how they manage their emotions, what kinds of thoughts they have in their heads. Intervention for troubled youth is not simplistic, and there are many types of factors to consider. It takes a multidisciplinary effort to attend to numerous dimensions of development (cognitive, emotional, social, educational, neurological). And it’s critical to understand that key developmental stages (e.g., starting school, entering adolescence, transition from high school) offer particularly powerful windows into seeing which kids are making good transitions, and which kids may be troubled. They are important check points for evaluation and intervention – and looking for red flags in a kid’s developmental trajectory.

Consider the following thoughts offered by Dr. Harold Koplewicz, President of the Child Mind Institute:

We know that when we see someone suffering we shouldn’t look away. And when we see young people coughing, wheezing or bleeding, we insist that they get attention. But when we see young people with disturbing behavior, or young people in clear emotional distress, we ignore them and hope these problems will go away.

The first signs of 75% of all psychiatric disorders appear by the age of 24. We need to be on the lookout for signs of distress in young people to get them help as soon as possible. Research shows that early intervention improves the outlook for anyone with a psychiatric disorder—and drastically reduces the likelihood of violence.

To achieve this type of vigilance and action, we need a dedicated effort that includes better information provided to parents and school systems – and an infrastructure that provides the ability to coordinate with developmental and mental health experts to deliver the best supported interventions. It will take money (something that’s not exactly flowing these days at the national level) and it will take commitment. It needs to start at most local level and eventually spread to a national level.

So where do we go next? Since the Sandy Hook shooting, some have argued that mental health is not the issue – that our focus should be on gun control because we don’t see this type of violence in other countries who have similar rates of mental illness. I get that perspective – but I still believe that we are failing if we have individuals who are so socially isolated and filled with anger and rage that they commit murder-suicide. Trying to apply our best efforts to reduce the likelihood of having youth and adults in our society who get to that point is not the full answer – but it’s part of the equation.

Tomorrow, I will address gun control as one of the 4 public health issues we are all discussing.

Psychology Concept via Shutterstock.com

 

 

 

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