May 5, 2015
By David L. Shern, Ph.D. and Andrea K. Blanch, Ph.D.
Nothing garners more public and policy attention to mental illness than mass shootings involving a shooter diagnosed with a mental illness. Unfortunately, the end result of this attention is almost always negative. With each response, the stereotyped image of “the violent mentally ill” is reinforced in the public mind. Anti-stigma campaigns can’t possibly undo the damage, and millions of hard-working American citizens are stigmatized because of a diagnosis. Just as disturbing, public policies developed in response to a single crisis situation rarely address the complex factors that underlie the problem.
No recent incident has drawn more attention than the shootings at Sandy Hook elementary school. In March, the Governor’s Commission on Sandy Hook released its findings. Most reports following an incident of this type focus on increasing the service capacity and accessibility of the public mental health system and on provisions to increase legal control over persons diagnosed with severe mental illnesses. In contrast, the Sandy Hook response urged the “ . . . adoption of a new model of care, one that emphasizes wellness while effectively and compassionately addressing illness; that places positive child development and healthy families front and center; and that breaks down existing silos to provide holistic and continuous care across the population” (p. 109).
In analyzing the conditions that led to Sandy Hook, the commission focused less on the life course of the shooter than on what is needed to support the development of positive mental health. They correctly concluded that it is impossible to design fail-safe systems to prevent these highly unlikely events. It is, however, quite possible to strengthen the mental health of a community and to reduce the rates at which behavioral and social problems occur.
The commission’s report is consistent with our analysis in the Next Major Era in Public Health. They call for an integrated public health approach that recognizes toxic stress and trauma as threats to overall wellness. They emphasized the development of resilience as critical to successfully navigating life’s challenges. They highlighted the life-long effects of exposure to adverse conditions in early childhood and proposed an approach that integrates prevention, promotion, and increased recognition and treatment of mental disorders.
The commission highlighted the central role of school systems in realizing this vision. Schools must focus not only on academic and cognitive development, but also on social and emotional skills. Children need to be able to identify feelings like anger and frustration that can contribute to behavioral problems, and learn problem solving skills to manage emotional upset and conflict. In addition, the commission suggested that medical homes in primary care can provide a nexus for healthy development for children and families.
These are achievable goals. We have solid science to guide our actions and several well studied school based interventions that can realize these goals. The Good Behavior Game and the Seattle Social Development Program are two examples of the long term beneficial effects of school based programming. Similar examples could be provided or parenting interventions that have demonstrated long term effects on wellbeing from 1 to 20 years following the intervention.
Preventing one-in-a million incidents like Sandy Hook is best achieved by strengthening mental health and creating communities where everyone is welcomed and included.
Perhaps tragedies like Sandy Hook can motivate us to do what we know will work – creating healthier people and communities.
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Dr. David Shern is the Senior Science Advisor at Mental Health America having served as its President/CEO from 2006-2014. He also has a faculty appointment in the Department of Mental Health at the Hopkins Bloomberg School of Public Health and previously was a Dean and Professor at the University of South Florida. |
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