Posts Tagged ‘
Mental Health ’
Wednesday, April 9th, 2014
The emerging story of school stabbings at a high school in Murrysville, PA, will inevitably stir up debates about school violence, mental health, and gun control. For example:
- The point will be made that it’s not all about guns at school. This is true – knives and other weapons can be used to cause harm. We need to understand how a range of weapons can be used by individuals who intend harm at schools.
- The point will be made that we need to learn more about the factors that cause individuals to attempt mass murder. This is true. We need targeted research that will have, as an endpoint, strategies for identifying youth who may be on the verge of such behavior and routing them to interventions.
- The point will be made that schools need to be better protected. This is true. Many schools have increased their security procedures and will need to continue to revisit them as necessary, and prioritize these initiatives.
What shouldn’t happen, however, is a myopic focus on just one issue and dismissal of the other issues – the kind of polarization that stymies progress. We can’t focus on just guns/knives/etc without thinking about mental health issues. We can’t just put all of our resources into the mental health angle without considering how we reduce access to weaponry in youth. School security is an ongoing concern because it is impossible to completely secure a school every second of the day, and as such we have to continue to refine how risk is minimized. There are of course other issues that should be examined and put into the mix. Serious public health concerns like school violence require at a minimum a multifactorial perspective and ideally a synergistic evaluation of many of the root issues.
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Friday, December 6th, 2013
As we mark the one year anniversary of the Sandy Hook shooting, it is a salient time to consider the substantial public health challenges that were raised by that tragedy – and that still remain. Three are most prominent.
School safety is an ever-present concern. Although no school can eliminate the potential for a tragedy, strides are being made at many schools across the country to put into place practices and technologies to keep children as safe as possible. It has been suggested that 90% of school systems have made some type of concrete change to improve school safety in response to the Sandy Hook tragedy. Lock down drills have become a reality for children, practiced with the regularity and acceptance of a fire drill. Teachers and administrators are trained to know how to react in the event of an attack and how to best try to secure the safety of their students.
Some schools have video surveillance systems in place that are monitored for potentially suspicious activity. Schools may have changed their policies concerning entry at different times of the day. And at some schools there is a police presence or security guards in place. Yet these types of changes will undoubtedly need to be evaluated, and potentially evolve over time. It does appear, however, that that sad and startling day at Sandy Hook Elementary promoted a nearly universal awareness that no school can be assumed to be safe – and that every school needs to take a comprehensive approach to trying to best ensure their students’ safety.
Gun control – always a polarizing topic – remains a hotly contested issue in the aftermath of Sandy Hook. There have been some actions to promote gun control in some states, and some reactions to ensure gun owner’s rights in other states. As the swinging pendulum of gun control plays out across the country – evidenced by the current swirl of debate surrounding how access to firearms should be regulated – what remains most clear is that we are no where close to coming up with a focused effort to reduce the likelihood of someone with a gun entering a school and killing children and adults. Most influential – and sobering and inspiring – has been the efforts of Sandy Hook parents to promote a ‘cultural change campaign’ to properly orient our attention on violence prevention, particularly gun violence aimed at our children. It is hoped that this effort will inspire a change in our collective mindset that will do away with the philosophical rhetoric about the pros and cons of gun control and gun rights and focus instead on ways to prevent gun violence from permeating our schools.
Mental health remains another core public health issue that has been illuminated by the Sandy Hook massacre. We have yet to get a good handle – at the most public level – on the burdens faced by those with mental illness, the importance of properly recognizing and treating those who suffer, and the myths and realities about the risk posed to society by some individuals. What can be stated with confidence is that despite the substantial progress made over the last few decades in the identification and treatment of mental illness, we simply need much more support for research and intervention.
This unfortunately comes at a time when our national finances are such that research funding has been cut dramatically over the last few years. We just witnessed a government shutdown that kept scientists away from doing their work. Deciphering the inner workings of the brain, the effects of genes on development, and the impact of a multitude of environmental factors that convey risk for mental illness is a task of extraordinary complexity. Bringing sustainable, evidence-based interventions to those in the population who need them is a daunting undertaking. Until we grasp how important this effort is, and embrace how much financial support it will take, we may find ourselves wondering and debating if a future shooting could have been prevented via advances in knowledge and practice.
Although these three public health challenges remain, it is good to know that they are at least not being dismissed or are fading away. We may eventually look back on that horrific day at Sandy Hook Elementary as a turning point and catalyst for making real and sustainable progress in our efforts to keep children safe in school.
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Thursday, February 28th, 2013
February 2013 was a busy month in the world of parenting – lots of things going on. Here’s a snapshot:
The news that an adult male slapped a stranger’s toddler on a plane led to a conversation about how our culture may be breeding, at a minimum, a lack of respect for our youngsters – and at worst, provide a context in which child-hating is tolerated.
Speaking of conversations, we had many about if we should use what we are learning about genetics to support genetic engineering, including targeting childhood psychiatric disorders. Then came news that new research suggests some genes might predispose to a number of forms of mental illness – but it’s not at all clear that this will move us closer to genetic solutions.
We always include applications of current research to help guide us decide on good parenting strategies. One study suggest how important it is to let your toddler – and not you – be the “boss” when you are playing. And compelling research showed how the simple act of turning off violent shows and replacing them with educational content – without limiting the amount of TV watched – is beneficial for kids.
BARRIERS TO SERVICES
We took on some key barriers to getting kids mental health services and broke them down in understandable turns. Now we all wait to see if sequestration is going to provide the biggest barrier of all.
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Thursday, January 31st, 2013
An editorial in the New York Times suggests this is so in relation to gun control issues and the devastating losses of young lives that we continue to witness, the most recent being the Sandy Hook Elementary massacre. The crux of the argument is that we need to consider the seemingly endless stream of senseless murders (from Columbine to Virginia Tech to Aurora to Newtown) from the perspective of public health – meaning we need to treat this like an epidemic and rectify all the gaps in knowledge that currently exist about guns and violence. I couldn’t agree more.
This month, I used the public health framework to discuss our knowledge base on the four central issues we have all been discussing in relation to Sandy Hook:
Violent Video Games
The conclusion each time was that we really are pretty ignorant about how these factors come together to lead an individual to murder innocent youth. What we need now is to start asking pointed questions in research designed to help us arrive at meaningful next steps that would reduce the likelihood of these heinous acts taking innocent lives – based on reputable data and not just rhetoric or philosophy. That’s what public health research does – plain and simple, it identifies factors that can be modified to prevent the probability of death, and conducts scientific tests to generate an empirical foundation for making decisions that impact the problem. Studies showed that seatbelts save lives – we require use of seatbelts. Studies showed that teens who text when driving are at increased risk for getting killed – we ban texting. We don’t know right now the relative mix of influence posed by mental health issues, access to guns, and exposure to violent video games – and we need the studies to sort that out rather than pitting one factor against the other in a philosophical game of chess that does nothing to improve school safety. Public health is agnostic – just get answers and act on them. If we don’t take that principle seriously, then yes, ignorance is killing our kids.
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Wednesday, January 2nd, 2013
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.
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