Sandy Hook Aftermath: Gun Control As A Public Health Issue

Thursday, January 3rd, 2013

Even in the aftermath of the Sandy Hook shooting, there are few topics more polarizing than gun control. But from the perspective of public health, I would hope everyone would agree that we have an urgent need to make children’s lives safer than they are right now. 

Let’s look at some numbers. Using data from the Centers for Disease Control and Prevention (CDC), the Children’s Defense Fund generated the following statistics:

In 2008, 2,947 children and teens were killed by guns

In 2009, 2,793 children and teens were killed by guns

The majority (about 2/3) were homicide related; around 1/4 were due to suicide; and around 5% were accidental deaths.

If you peruse the CDC site – specifically the section on Injury Prevention and Control – you will note a few key points:

Injuries are the leading cause of death in the U.S. for individuals between 1 and 44 years old

3/4 of all deaths of young people are due to injuries – with homicide being the 2nd leading cause of death for 15-24 year-olds (motor vehicle accidents are the leading cause)

As noted by the CDC, in principle all the deaths due to injuries are preventable. While this goal is not achievable (we live in an unpredictable world), the public health perspective is to do everything we can to reduce the probability of injury and death. For example, with respect to motor vehicle accidents, we focus on a number of issues, including: enforcing speed limits; requiring safety belts; trying to ensure that babies, toddlers and kids are secured as safely as possible in motor vehicles; trying to prevent drinking and driving. We also take on new topics when they emerge, like the very real public health issues that have been raised in more recent years by cell phone use (including, of course, texting) in motor vehicles. Why am I belaboring this example? Because I don’t think many of us find the attempts to reduce mortality due to motor vehicle accidents to be controversial. It’s a public health issue – motor vehicle accidents are the leading cause of death in youth, so we have to try to find ways to reduce that morbidity. In the same way, we all can take as a starting point the need to reduce mortality attributable to firearms.

Now, I’m not here to resolve the issue – far from that. There’s plenty to debate, and to do this in a real way, we will need to consider a lot of perspectives. What has concerned me is the tendency we all have to polarize an issue – even in the face of the devastating tragedy at Sandy Hook Elementary – because it typically leads to no action at all. It’s not all about guns – or not at all about guns. It’s that grey area in between where we have to deal with the realities of how we will take on the firearms issue to try to make the world safer for our kids. Whether you are philosophically for or against gun control, reducing mortality due to firearms is a public health issue, and a part of the equation, as are other factors – including bringing a similar lens to mental health:

Sandy Hook Aftermath: Mental Health As A Public Health Issue

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Sandy Hook Aftermath: Mental Health As A Public Health Issue

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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Red-Hot Parenting Recap: The Top Child Health Topics In 2013

Monday, December 31st, 2012

In lieu of a review of the past month, I’d like to pose a question: What will be the big topics on child health and development in the coming year? Kara Corridan and I have taken a stab at predicting what these will be. We selected 6 topics: 

The Book That Will Change How Mental Disorders Are Diagnosed: Why you should know what the DSM-5 is and the hot-button issues it is raising

Kids And Play: New data and new thinking which suggests that kids are not getting enough of the right type of play

Pregnancy Health Risks: The emerging, and murky, data on potential prenatal risks and the complex decisions some pregnant women face

Injuries (The Downside Of Physical Activity): The realization that many youth are getting injured – some seriously – at an alarming rate

Post-Traumatic Stress Disorder: The very real consequences to kids when they are exposed to a number of traumas

Obesity: New efforts to combat this epidemic in kids

Click here to read our take on these topics. Since we published this, we have all been affected, in lasting ways, by the Sandy Hook shooting. So in addition to the above, I also anticipate much more debate and discussion about the 4 public health issues raised by that tragedy.

The one thing we know for sure is that 2013 will be a very important year for continuing our collective conversation about child health and development. Wishing you all a peaceful and good New Year.

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The Sandy Hook Shooting: The 4 Public Health Topics We Will Be Discussing In 2013

Monday, December 31st, 2012

In the aftermath of the Sandy Hook shooting, we all struggle to figure out how we can try to prevent further rampages, particularly (but not exclusively) in schools. There are 4 topics which are receiving the most attention – and will be the center of many debates in 2013. Starting on January 2nd, I will take these on, from the lens of public health – meaning I will examine each in terms of the potential of making life safer for kids in school. The topics are: 

Mental Health: One viewpoint is that increases in mental health awareness, improvements in diagnosis, and reducing barriers to treatment will be key in preventing further mass murders. While there is clearly a need to invest in mental health in our country, how central should mental health issues be in the debates following the Sandy Hook shooting? Is mental health the fundamental concern – or is it getting overplayed in lieu of taking on ….

Gun Regulation: Another viewpoint is that our primary objective should be immediate increases in gun regulation as the fundamental way of preventing future tragedies like the Sandy Hook shooting. The argument here is that the type of weapons that are available in this country facilitate the rapid execution of many youth. Those who disagree argue that mental health issues trump the access of firearms. So, from the public health perspective, is there an answer to be found?

School Safety: One thing is certain – we all feel the need to make our schools safer. Some schools in the country already had armed personnel in place prior to the Sandy Hook shooting. Should all schools do this? As a parent, would you feel better, or worse, seeing armed guards at your kid’s school? And what impact might this have on the kids themselves?

Violent Video Games: Still on the radar is the issue of violent video games. Do they really make individuals more violent? Should they be banned? What is the scientific evidence?

First up: the Mental Health debate on January 2, 2013.

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