News and Tribune

March 28, 2014

STAWAR: The need for mental health first aid

By TERRY STAWAR
Local columnist

— In a recent issue of The New Yorker, psychologist Andrew Solomon from Cornell Medical College conducted an in-depth interview with Peter Lanza, the father of the Sandy Hook shooter Adam Lanza, who killed 20 school children in 2012.

According to Lanza, his son was diagnosed with a sensory-integration disorder as a child and with Asperger’s syndrome when he was 13. Evidently, the Lanza family felt relieved by the Asperger’s diagnosis, since it helped explain Adam’s odd behaviors.

Asperger’s is now consider an autism spectrum disorder and is chiefly characterized by problems in social interaction and nonverbal communication. There are also restricted and repetitive patterns of behaviors and interests.

Neither Asperger’s, nor the obsessive symptoms Adam also displayed, are associated with violence or would have predicted the tragedy. Peter Lanza says that he believes that Adam’s Asperger’s contained a “veiled contaminant” (another disorder not obvious due to being masked by the social problems in Asperger’s).

Peter Lanza believed this other disorder was a form of schizophrenia — a psychotic disorder characterized by hallucinations, delusions and thought disorders. Even if true, the overwhelming majority of people with schizophrenia are neither dangerous nor violent. Solomon noted that in a study of the few Asperger’s patients, who actually committed crimes, half of them had other diagnoses and 25 percent had psychotic disorders.

“Here we are in New York, one the best locations for mental health care and nobody saw this,” Peter Lanza said.

Many people, however, confuse the cost of mental health care with its value. Although some people with financial resources or excellent insurance opt to see expensive private physicians, for many folks with severe and persistent mental illness, a community-based team approach makes the most sense. These programs can provide a wider range of resources such as social, vocational, residential, as well as psychotherapeutic and medical services.

Nevertheless in order to be effective, mental health services have to be utilized. Adam Lanza stopped taking medication after experiencing side-effects on the first attempt, and the family never sought alternatives. He refused to attend therapy, and perhaps most significantly, he was allowed to completely withdrawal from others, thus keeping his growing obsession with mass murder secret. In the final months, Adam only communicated with his mother through email — an ill-advised indulgence she permitted, among many others — in her attempts to avoid conflict.

Also, it should be noted that both parents were aware that Adam was preoccupied with weapons and war. His mother apparently used trips to the shooting range as a way to try to relate to him. I don’t know, however, how she was able to justified providing him with ever-increasing fire power.

In the wake of the 2009 Fort Hood shootings, which left 13 people dead and more than 30 injured, the Department of Defense convened a taskforce to investigate the status of predicting violent behavior. A report was released in August 2012.

After an extensive review of research, it was concluded that, “There is no effective formula for predicting violent behavior with any degree of accuracy.” The report also said that while such attacks have a very low-incidence, “threats of targeted violence are relatively numerous.”

The challenge is to determine which threats are likely to result in actual violence. The taskforce stated that while there is no silver bullet that can stop all acts of mass violence — “prevention should be the goal rather than prediction.”

In my opinion, their most important conclusion was that there are already viable methods for mitigating violence through early intervention in the progression from violent thinking to violent behavior and by minimizing the alienation and isolation of potential perpetrators.

Evidence-based therapies, medications and skills training are interventions that can help in these efforts. Also partial hospitalization, socialization groups, drop-in centers and structured residential programs are some of the services that can reconnect withdrawn individuals. Controversial privacy and legal barriers can be addressed through effective outpatient commitment laws.

Of course, in our democracy, owing weapons, isolating yourself from others and even being preoccupied with mass murder are not against the law, and are unlikely to become so. With the freedoms we enjoy, however, comes a responsibility to look out for our families, neighbors and fellow Americans. We all have a duty to help them access the help they need, before their individual problems become society’s problems.

One current approach to this issue is to train as many Americans as possible in Mental Health First Aid. The goal of this program is to improve “the mental health knowledge and skills of the ... public in responding to early-stage mental illness and mental health crises.”

This eight-hour course teaches how to assess the situation, select and implement appropriate interventions and find proper care for people in need.

First-responders, teachers and citizens from all walks of life can use these skills to help others begin the process of recovery and reconnect with society. Information about attending such training in our area can be found online at https://www.surveymonkey.com/s/MHFA_March_14 or by calling 812-206-1362.

Mental Health First Aid is no panacea, but it does represents something we can all do as a first step toward addressing the endemic problem of violence in our society.

— Terry L. Stawar, Ed.D., lives in Georgetown and is the CEO of LifeSpring the local community mental health center in Jeffersonville. He can be reached at tstawar@lifespr.com. Checkout his Welcome to Planet-Terry blog and podcast at www.planetterry.wordpress.com