Carbello: Early intervention a key way to prevent mass shootings

Posted 6/16/22

The recent school shooting in Texas has once again brought about confusion regarding mental health and its association with violence.

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Carbello: Early intervention a key way to prevent mass shootings


The recent school shooting in Texas has once again brought about confusion regarding mental health and its association with violence.

Mental health is routinely associated with violence, guns and mass murder. The association is portrayed in a way that contradicts the research and stigmatizes people with mental health disorders, diseases, illnesses, challenges or problems. Problems is the newest polite way to say someone is mentally ill or has mental illness or lives with or suffers from a mental health disorder. Perhaps if mental health was not the scapegoat or the catch all for society’s ills, we would not have to keep rebranding a health condition that, prior to COVID-19, affected 1 in 4 people.

The World Health Organization recently reported a 25% global increase in depression and anxiety post pandemic. Does that mean 25% more than 1 in 4 are now at risk for violence? COVID-19 is also considered an Adverse Childhood Experience (ACE). I believe that would imply an increase in the risk for potential violence in all children. Double for any child reporting depression. Triple for those who experienced social isolation due to virtual learning. Quadruple for children reporting all three post-pandemic.

The logic of the statement mental health is a risk factor for threats is as asinine as the information I just presented. Like so many recent publications, no source is cited. This means the information presented is an opinion. There is just enough information to make the statements appear as if they were factual and/or logical. They are neither. There were two facts. Both included citations. The rest was an interpretation of the two facts and a bad interpretation at that.

The association between mental health and gun violence appears to be contentious again. We seem to be debating facts. Facts should not be debatable. We should not pick and choose our own facts. Nor should we make our own interpretations about the research. There is almost always a section at the end of any research paper or journal article – Conclusion or Results or Summary. A section that presents the findings of the research. This section confirms what the researchers discovered, determined, proved or disproved (American Psychological Association (APA)) Taking one phrase from one sentence in one article may be convenient. It could also be lethal.

Misrepresenting the facts by only presenting part of the research was instrumental in creating the opioid crisis. Perhaps the same will be said of a future national mental health crisis fueled by half-facts and assumptions.

And what about the kids? Implying that mental illness predicts gun violence may have a negative effect on youth. We have been talking to youth about the importance of mental health since before the pandemic. 

Then there was the pandemic. Now we are post-pandemic and we are scrambling to get enough resources to address kids’ mental health needs. We don’t have enough mental health professionals to provide care to the kids who are seeking help. Where does that leave the kids who are not? What message does this send to students? If I was a student who was encouraged to talk about mental health, reluctantly took the risk and asked for help, only to find out that no help was available, I would probably feel angry, discouraged and confused. I doubt I would be in any hurry to ask for help again or to trust the adults who convinced me to ask for help.

Furthermore, what must these children think of themselves after hearing: mental illness causes school shootings, mental illness causes violence, untreated mental illness leads to school shootings, we need to be addressing Mental Health to prevent violence, Mental Health is responsible for gun violence. Receiving these messages over and over, repeatedly, constantly, repetitively, without pause or explanation? If I was a kid, I would be terrified. if that's who I was going to be, I don't know if I'd want to be. We need to make sure our kids are not getting conflicting messages based on partial truths and personal opinions. That starts and ends with us. They are already confused just because of their age and all the growing up they still have to do. I don’t think we’re helping them do that. They could easily hear that it’s ok to talk about mental health and that if they have mental illness, they are going to be violent mass murderers. Is that intentional? Have we become so desperate that we now scare our kids into wellness? Or are we that inattentive that we forgot about our kids altogether? Isn't all of this for them?

I am usually quiet about having had a serious mental illness designation, even though it was many years ago. I was misdiagnosed for the better part of a decade. I was on a variety of varieties of medications. With the right diagnosis and proper treatment, I live a full life that does not include a single violent incident or tendency. The only reason I am outing myself is because I want to let kids know it’s going to be ok. They are going to be ok. A mental health diagnosis is not a life sentence. There is no need to fear who you will  become. Mental Illness does not define you and it does not determine who you become. Regardless of what you hear right now, you are not bad.

This may be a hard sell. The bias that grows after these events is not as well documented as I think it should be and does not get the same amount of airtime as the information that contributes to bias. Bias could potentially put anyone who has ever had a diagnosed Mental Health disorder at any time at risk. Statistically, individuals with mental illnesses are more likely to be the victims of violence than to perpetuate it.

Like anyone who has experienced trauma or lived with a mental illness or is a part of a marginalized group might find it, I find vulnerability to be intolerable. We may need trauma informed media. This isn't about not offending people. It’s about intentionally or unintentionally creating a public perception that is false and how false perception may harm the human beings at the center of it.
By harm, I don’t mean hurt feelings. It does suck to have hurt feelings but hurt feelings will not affect a person’s livelihood, civil rights, parental rights, credibility, professional licensure nor propensity for violence. Stigma, on the other hand, certainly can and certainly has interfered all of the above excluding propensity for violence.

I wouldn’t say my feelings are hurt when I read or hear information that is inaccurate, inadequate or just bad. I definitely have a reaction. Most often, I'm frustrated. Sometimes the emotions can be overwhelming. Especially right after a mass tragedy. It is like salt pouring into a wound to the sounds of bad information repeated often and by many. Every once in a while, I start to doubt myself. That is not uncommon. In social work, it’s referred to as the principle of familiarity; the more a concept is repeated, the more comfortable we are hearing it. It begins to feel familiar and we are more likely to be persuaded by it. I find it infuriating that I have been through so many of these that I have developed I sense of self-awareness around the effects of repetition in media coverage of attacks on schools.

My best coping is to do something. When I come across bad information, nine times out of ten, I will contact the source directly and to the best of my ability, politely correct them. I am sure to express my appreciation for the coverage (if I appreciate it). I ask how they are doing. I listen if they tell me. I provide current, non-threatening, relevant, factual data that clearly states the facts of the matter. If an opportunity presents itself, I may share a personal story or explain why this is so important to me. Just to clarify, the goal is to get the accurate information to the people responsible for reporting it to the community. It is not to argue opinions or criticize. I don’t pretend to know what it’s like for media professionals. I only want to make sure the information is presented in a way that leaves little room for assumptions or interpretations. This is often difficult as the issue is very complex and the meaning has become increasingly convoluted. However, if I reference the research and emphasize that I am merely presenting the facts, I can avoid getting lost in my opinions. This can be difficult as well.

I don’t like to hear that some mass shooters had mental illness/es. Unfortunately, that is a fact. It is not the only fact but often may be the only fact reported. That is a problem. Especially if we are talking about prevention. Reporting that mental health is the key to prevention is ignorant. There is no “key” to prevention. There is no one factor that will ensure prevention is successful. Implying that mental illness causes gun violence is not only ignorant, it is irresponsible. As mentioned above, the effects of stigma cause harm.

Early intervention is a better way to describe prevention because early intervention is not always specific to mental health but must be early in order to be effective. If anything, early would be the “key” to prevention. Understanding, identifying and reporting concerning behaviors is an early intervention. Mental illness is not the same concerning behavior. Concerning behaviors listed by the NTAC are not diagnostic criteria for mental illness. Grudges are not indicative of a mental illness. It was something nearly all mass shooters stated at some point. The majority of mass shooters also believed they had been bullied – also not a symptom of mental illness. Other concerning behaviors that are not symptoms of mental illness include, gravitating towards or aligning with hate groups, plotting an attack, purchasing multiple firearms and stockpiling ammunition. Is every person who does one or some of these things going to commit mass murder?

Aside from the plotting, I would say probably not. If we made even a modest effort, I bet we could create a perception that says otherwise. More importantly, if any of the above are sudden or become a preoccupation, it may be cause for concern. If an individual has a diagnosed mental illness in addition to one or more of the listed concerning behaviors, it doesn’t make the concern more or less valid, meaning mental illness is not necessarily the reason for the behavior, nor does mental illness excuse the behavior. Mental illness on its own is not a risk factor in determining if an individual will become violent. If mental illness is or is not present when the concerning behavior is reported, it will factor into the evaluation just as any of the other many variables that are taken into consideration.

Then why so much talk about mental health and students after a mass tragedy if not to prevent the next attack? Everyone may experience trauma differently. The way trauma manifests in individuals, especially youth, may not be predictable. There are a variety of factors that may influence how students may react to traumatic events. There is also considerable variation between and among students on their coping abilities. Mental health resources may be implemented in schools either prepare students with coping skills before a traumatic event or making sure they have supports after the event. Both of which are important. It is my opinion that, at this point, the attention to mental health is not so much a prevention strategy but rather a mitigation strategy. Like many efforts around school safety appear to be, the call for increased mental health support for students may be better suited to address what is necessary to cope with aftermath of an attack, rather than to prevent the attack all together.

Mitigation includes actions taken prior to the event or during the event to minimize or diminish the likelihood of a tragic event and/or the effects of the tragic event. This not the same as prevention. Prevention is getting to the shooter before they believe their best, or only option, is to shoot up a school. Mass attacks are rarely, if ever, spontaneous. Marisa Randazzo and colleagues describe this process as the “pathway to violence”. If there is no intervention on the pathway to violence, the best we can do is minimize casualties. The gates, ID checks, bullet proof glass, the presence of law enforcement, may have do little, if anything, to prevent a shooter from wanting to shoot.

We are missing an opportunity here. Now that the nation is listening, where is the push to educate the public on how to recognize and report concerning behavior?

Where is the invitation to students, parents and community members to participate in emergency planning and emergency exercises with school administrators and law enforcement? These are not my ideas. They are recommendations from The Department of Homeland Security, US Secret Service, The Federal Bureau of Investigation, The National threat Assessment Center, FEMA and The National Institiute of Justice. All may mention mental health but none state that mental illness is the cause of gun violence nor do they recommend that the school community focus on mental health as a means to prevent school shootings.

Mental health is health. We need a robust, comprehensive, accessible, integrated healthcare system that reduces the additional burden placed on public schools. This is necessary, period. Not because of mass tragedy or a pandemic but because we want our children to be healthy.

school shootings, mass shootings, mental health