NYAPRS Note: This MHW article highlights the complexity in preventing gun violence, noting that a person who commits these acts may be distressed or in crisis, but not necessarily recognizable as having a psychiatric diagnosis. The solution is not just to remove guns, but to focus on prevention techniques such as threat assessment, after-care programs, and peer supports. Then we need to enhance crisis services, mental health first aid courses, and broad outreach and engagement within communities. This preventative response could reach individuals who may be desperate for care or services but, due to mitigating social factors, are more likely to react through violence than reaching out for help.
Newtown Reveals Need For Prevention Programs, Peer Supports
Mental Health Weekly; Volume 24 Number 1, 1/6/2014
Many people continue to try to get their minds and hearts around the depth and level of loss from the tragedy that took place in Newtown, says Robert Glover, Ph.D., executive director of the National Association of State Mental Health Program Directors (NASMHPD). “Such profound loss brought forth lessons learned and ideas on how to prevent such a tragedy from happening again, bringing proposed mental health legislation,” he said.
While it is a positive that there has been increased attention to mental health, many of the mental health proposals address only increasing the number of hospital beds, said Glover. “Even more importantly, we also need to direct funding toward building a robust system of care in the community that includes peer support services, community access and services pro- vided by competent providers, and crisis services,” he said. “A strong community system of care can pro- vide alternatives to hospitalization and significantly reduce lengths of stay in hospitals.”
However mental health services should not be seen as only “inpatient” and “outpatient,” Glover explained. “There is a vital role for state psychiatric hospitals that should be connected with community services and there should be cross sharing between the expertise of hospitals and the community,” he said. For any proposal, we need to ensure consumers’ rights and protections are supported while ensuring safety for consumers, families, and community.”
Glover added, “In particular, it is important to continue to build a network of peer support and self-directed services, which have been shown across systems to significantly assist in the recovery process.”
Peer support is also essential in helping to address workforce strategies, Glover added. Peers offers a model for other people to see individuals with mental illness being successfully employed and assisting colleagues with healthcare enrollment, employment, and whole health issues, such as smoking cessation and obesity, for example, he said.
“In addition to proposals to address mental health, we have the opportunity to insure vulnerable and underserved populations through the implementation of ACA and health care reform,” said Glover. Although the enrollment process has been initially challenging, targeted outreach and enrollment is essential to reach newly-eligible adults with mental illness and substance use disorders, and identifying specific barriers relevant to outreach and enrollment for people with mental health and substance use conditions, he said.
Building consensus
“Obviously, the Sandy Hook shooting galvanized public concern,” Dewey Cornell, Ph.D., clinical psychologist and professor of education at the University of Virginia, told MHW. “We certainly hope we can achieve some of the momentum [that occurred] this year and build consensus on practice strategies.”
Cornell authored a report commissioned by the American Psychological Association (APA) to convey research-based conclusions and recommendations (and to identify gaps in such knowledge) on how to reduce the incidence of gun violence— whether by homicide, suicide or mass shootings — nationwide (see MHW, Dec. 16, 2013).
Cornell said the field needs to think more broadly about people distressed in crisis. “We have to think about crisis intervention, threat assessment programs, and boost training in first response intervention and Mental Health First Aid,” he said, the latter referring to the national program initiated by the National Council for Behavioral Health to teach the skills to respond to the signs of mental illness and substance use.
“We know that most gun violence is not committed by a person with a mental illness,” said Cornell. “An individual committing a violent act may be troubled and disturbed, but they do not have a mental illness.” They may be acting out, or experiencing anger and a desperation that suggests mental health services would be appropriate, he said.
Improving treatment and services are effective ways to help individuals in crisis. Better hospital services and after-care services are also needed, Cornell said. In a majority of cases, the needs of a person with problems or concerns have to be addressed before escalating into violence, Cornell said.
A boost in crisis-related services is essential, said Cornell. “Because our mental health services are already stretched to the limit, we have to focus and prioritize on the most seriousness of emergencies,” he said.
Cornell’s report, “Gun Violence: Prediction, Prevention, and Policy,” identifies early intervention and prevention strategies, such as the establishment of threat assessment teams. Threat assessment, said Cornell, is defined as a problem-oriented prevention strategy that puts the focus on what problems or concerns underlie a person’s threatening behavior.
We’re seeing threat assessment primarily in schools, in college settings and in the workplace,” said Cornell. “What we need is federal support for threat assessment in community mental health centers,” he said. Mental health staffs, including psychologists, are core members of a threat assessment team, said Cornell. A multidisciplinary threat assessment team would also include educational, human resources and social services representatives, and a lawyer; for the most serious cases, a police officer, he said.
Threat assessment initiatives have not been “built into the CMHC system,” said Cornell. “We see that as the next logical step,” he said. Additionally, there needs to be federal funding earmarked for threat assessment research, Cornell said.
Cornell said he has worked on threat assessment programs in Virginia schools and found suspension rates had gone down. Additionally, he and his colleagues are working on longitudinal research in this area, he said.