What School Shooters Have in Common

Jillian Peterson & James Densley
edweek.org
Originally posted October 8, 2019

Here is an excerpt:

However, school shooters are almost always a student at the school, and they typically have four things in common:

They suffered early-childhood trauma and exposure to violence at a young age. They were angry or despondent over a recent event, resulting in feelings of suicidality. They studied other school shootings, notably Columbine, often online, and found inspiration. And they possessed the means to carry out an attack.

By understanding the traits that school shooters share, schools can do more than just upgrade security or have students rehearse for their near-deaths. They can instead plan to prevent the violence.

To mitigate childhood trauma, for example, school-based mental-health services such as counselors and social workers are needed. Schools can also adopt curriculum focused on teaching positive coping skills, resilience, and social-emotional learning, especially to young boys (According to our data, 98 percent of mass shooters are men.)

A crisis is a moment, an inflection point, when things will either become very bad or begin to get better. In 80 percent of cases, school shooters communicated to others that they were in crisis, whether through a marked change in behavior, an expression of suicidal thoughts or plans, or specific threats of violence. For this reason, all adults in schools, from the principal to the custodian, need high-quality training in crisis intervention and suicide prevention and the time and space to connect with a student. At the same time, schools need formal systems in place for students and staff to (anonymously) report a student in crisis.

The info is here.

Misguided mental health system needs an overhaul

Jim Gottstein
Alaska Dispatch News
Originally posted January 12, 2016

The glaring failures surrounding Esteban Santiago, resulting in the tragic killing of five people and wounding of eight others in Fort Lauderdale, Florida, prompts me to make some points about our misguided mental health system.

First, psychiatrists have no ability to predict who is going to be violent. In a Jan. 3, 2013, Washington Post article, "Predicting violence is a work in progress," after reviewing the research, writer David Brown, reported:

• "There is no instrument that is specifically useful or validated for identifying potential school shooters or mass murderers."

• "The best-known attempt to measure violence in mental patients found that mental illness by itself didn't predict an above-average risk of being violent."

• "(S)tudies have shown psychiatrists' accuracy in identifying patients who would become violent was slightly better than chance."

• "(T)he presence of a mental disorder (is) only a small contributor to risk, outweighed by other factors such as age, previous violent acts, alcohol use, impulsivity, gang membership and lack of family support."

The article is here.

Texas Bill Would Bar Pediatricians From Talking About Guns with Patients

By David Knowles
Bloomberg News
Originally posted March 26, 2015

Here is an excerpt:

“We, as physicians, ask all sorts of questions—about bike helmets and seat belts and swimming pool hazards, dangerous chemicals in the home, sexual behaviors, domestic violence. I could go on and on,” Gary Floyd, a Fort Worth pediatrician and board member of the Texas Medical Association, told the Texas Tribune.

The entire article is here.

Concentrating on Kindness

Tania Singer helped found the field of social neuroscience. Now she wants to apply what has been learned—by training the world to be more compassionate through meditation.

Kai Kupferschmidt
Science 20 September 2013:
Vol. 341 no. 6152 pp. 1336-1339
DOI: 10.1126/science.341.6152.1336

Empathy made Antoinette Tuff a minor celebrity. On 20 August, a young man armed with an AK-47 and 500 rounds of ammunition burst into the school in Decatur, Georgia, where Tuff works as a bookkeeper. It might have ended in yet another senseless mass killing if it hadn't been for Tuff's compassionate response to the gunman, recorded in its entirety because she had dialed 911.

As the man loads his weapon, Tuff seeks a human connection with him. She talks of her own struggles, her disabled son, her divorce, her thoughts of committing suicide. Finally, she persuades him to lay down his weapon, lie down on the ground, and surrender to the police. "I love you," she says near the end of the call. "You're gonna be OK, sweetheart." (Only after the man is arrested does she break down, crying "Woo, Jesus!")

Tuff's heroic conversation, posted on the Internet, was hailed by many commentators as evidence of the power of empathy and the value of compassion. If more people were like Tuff, there would be less violence and suffering, they say.

The entire article is here.

People With Mental Illness ‘More Likely To Have Violence Done To Them Than To Inflict Harm On Others’

By Candice Leigh Helfand
CBS News - DC Office
September 18, 2013

Here are some excerpts:

In light of the news, the call for mental health care reform – especially in regards to better funding and availability of mental health programs – could be heard from individuals and organizations alike throughout the U.S. following the elementary school attack. The call for more stringent gun control was even louder, given Lanza’s easy access to a high-powered assault rifle – a Bushmaster XM15-E2S.

Ultimately, the administration of President Barack Obama set forth legislation that, in essence, married the two issues. The gun control proposal he announced in early January included a number of potential restrictions on guns and assault weapons as well as requests for funding that would go specifically toward expanding mental health treatment programs.

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“I think the challenge is this: if you look across all mental health disorders throughout the United States … nearly half of all adult Americans had a mental health disorder at some point,” Sherry A. Glied, the newly-appointed dean of New York University’s Robert F. Wagner Graduate School of Public Service, said to CBSDC. “The vast majority of those people have never engaged in anything violent.”

As well as all of those who have, at one point or another, grappled with mental illness, mental health problems presently plague over a fourth of the entire population of the U.S. According to the National Institute on Mental Health, approximately 26.2 percent of American adults ages 18 and older suffer from some form of mental illness.

Experts worry that stigma “might actually lead to people being reluctant to seek help,” as Dr. John Duby, the chair of the Mental Health Leadership Workgroup at the American Academy of Pediatrics, noted.

The entire story is here.

Families of Violent Patients: 'We're Locked Out' of Care

By Gary Fields
The Wall Street Journal
Originally published on June 7, 2013

Suzanne Lankford for seven years has tried and failed to get long-term mental-health care for her son. When she hears news of a gun rampage or other violence, she gets chills.

"Whenever I see the parents saying they tried to get help, I think, 'That could be me,' " she says.

Ms. Lankford has watched her son, Joshua Rockwell, today 28 years old, barricade himself inside a room to ward off imaginary assassins. He once knocked her out with a blow to the head. She called the police on him after recognizing him in a mall security video of an armed robbery. Charges are pending.

He was later charged with attacking and harassing a nurse and law-enforcement officer. That trial has been delayed several times.

After Ms. Lankford's punch to the head, she asked her son's doctors about his treatment. She received a standard answer: Privacy laws prevent his doctors from talking to her without his permission, because he is an adult. His lawyer declined to comment citing the pending charges. Mr. Rockwell, who is in custody, declined to comment through his mother under the advice of his attorney.

When America began dismantling its government-run mental institutions a half-century ago, the U.S. started creating privacy protections and made it tougher to forcibly hospitalize people. The goal was to allow the mentally ill to live something close to a regular life.

Today, after a series of high-profile shooting rampages, many with links to mental illness, the U.S. is re-examining this approach. Some of the loudest voices for overhaul are from the families of the mentally ill—a first line of defense.

"We have been asking for information on Josh's medications, on his treatment plan…so that we can help him meet those obligations, but we're locked out," Ms. Lankford says. "I don't know how this story ends."

The entire story is here.

College admission questions rarely identify criminal behavior

University of Colorado
Press Release
April 16, 2013

A new study shows that neither criminal background checks nor pre-admission screening questions accurately predict students likely to commit crime on college campuses.

"In an effort to reduce campus crime, more than half of all American colleges ask applicants about their criminal histories or require criminal background checks," said study author Carol Runyan , Ph.D., MPH, and professor of epidemiology at the Colorado School of Public Health. "But there is no real evidence to show this reduces campus crime."

Colleges across the U.S. ramped up background checks after the 2007 Virginia Tech massacre which killed 32 people and wounded another 17.

Yet Runyan found that only 3.3 percent of college seniors who engaged in misconduct actually reported precollege criminal histories during the admissions process. And just 8.5 percent of applicants with a criminal history were charged with misconduct during college.

The study surveyed 6,972 students at a large southern university. It found that students with criminal records prior to college were more likely to commit crimes once admitted but the screening process rarely identified them.

"We didn't look at cheating or minor alcohol offences," Runyan said. "We focused on significant offences like assault, robbery, property crimes, driving under the influence of alcohol, marijuana use and other drug-related crimes."

While colleges are generally safe environments, students can be both perpetrators and victims of crimes that pose risks to the entire campus community, Runyan said.

She noted that earlier studies had reported that up to 14 percent of all college men admitted to some kind of sexual assault or coercion while 30 percent of university males and 22 percent of females said they had driven under the influence of alcohol in the last year. Also, 19 percent of students reported illicit drug use.

Still, the screening questions have proven a weak tool in identifying would-be campus criminals, Runyan said.

Runyan's findings indicate that students who engage in criminal activity during college are more likely to have engaged in misconduct prior to college, whether they admit it on their applications or not. However, she said current screening questions on the college application often fail to detect which students will engage in misconduct during college. And most of those who have records before college don't seem to continue the behaviors in college.

Even if the screenings could identify likely troublemakers, Runyan said, colleges would have to decide whether to admit the students given that the odds of them committing a crime on campus would still be low. And much of the reported precollege crime involves marijuana use and is not violent.

Another complication is possible discrimination. Students from more affluent backgrounds, who tend to be white, can often pay to have their early criminal records expunged while others, including many minorities, can't afford it.

"Based on our work, I cannot say with confidence that colleges should stop asking about criminal backgrounds, but I would use caution in thinking that this is the best strategy to address crime on campus," said Runyan who directs the University of Colorado's Pediatric Injury Prevention, Education and Research Program. "We need to ensure a safe and supportive environment for all students rather than limiting college access for students who may need extra help."

The study was recently published in the journal Injury Prevention and will be presented by Runyan at a conference in June.

Simple tool may help evaluate risk for violence among patients with mental illness

News Release
University of California at San Francisco

Here are some excerpts:

Mental health professionals, who often are tasked with evaluating and managing the risk of violence by their patients, may benefit from a simple tool to more accurately make a risk assessment, according to a recent study conducted at the University of California, San Francisco.

The research, led by psychiatrist Alan Teo, MD, when he was a UCSF medical resident, examined how accurate psychiatrists were at evaluating risk of violence by acutely ill patients admitted to psychiatric units.

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The first part of the study showed that inexperienced psychiatric residents performed no better than they would have by chance, whereas veteran psychiatrists were moderately successful in evaluating their patients' risk of violence.

However, the second part of the study showed that when researchers applied the information from the "Historical, Clinical, Risk Management?-Clinical" (HRC-20-C) scale - a brief, structured risk assessment tool - to the patients evaluated by residents, accuracy in identifying their potential for violence increased to a level nearly as high as the faculty psychiatrists', who had an average of 15 years more experience.

"Similar to a checklist a pilot might use before takeoff, the HRC-20-C has just five items that any trained mental health professional can use to assess their patients," Teo said.

"To improve the safety for staff and patients in high-risk settings, it is critical to teach budding psychiatrists and other mental health professionals how to use a practical tool such as this one."

The entire study is here.

The Relationship Between Level of Training and Accuracy of Violence Risk Assessment

by A. R. Teo, S. R. Holley, M. Leary, and D. E. McNeile
Psychiatric Services
Psychiatric Services 2012; doi: 10.1176/appi.ps.201200019

Objective  Although clinical training programs aspire to develop competency in violence risk assessment, little research has examined whether level of training is associated with the accuracy of clinicians’ evaluations of violence potential. This is the first study to compare the accuracy of risk assessments by experienced psychiatrists with those performed by psychiatric residents. It also examined the potential of a structured decision support tool to improve residents’ risk assessments.

Methods  The study used a retrospective case-control design. Medical records were reviewed for 151 patients who assaulted staff at a county hospital and 150 comparison patients. At admission, violence risk assessments had been completed by psychiatric residents (N=38) for 52 patients and by attending psychiatrists (N=41) for 249 patients. Trained research clinicians, who were blind to whether patients later became violent, coded information available at hospital admission by using a structured risk assessment tool—the Historical, Clinical, Risk Management–20 clinical subscale (HCR-20-C).

Results  Receiver operating characteristic analyses showed that clinical estimates of violence risk by attending psychiatrists had significantly higher predictive validity than those of psychiatric residents. Risk assessments by attending psychiatrists were moderately accurate (area under the curve [AUC]=.70), whereas assessments by residents were no better than chance (AUC=.52). Incremental validity analyses showed that addition of information from the HCR-20-C had the potential to improve the accuracy of risk assessments by residents to a level (AUC=.67) close to that of attending psychiatrists.

Conclusions  Having less training and experience was associated with inaccurate violence risk assessment. Structured methods hold promise for improving training in risk assessment for violence.

The full article is here.

James Holmes' psychiatrist went to cops with concerns about a patient

By John Ingold and Jeremy P. Meyer
denverpost.com
Originally published August 30, 2012

Here are some excerpts:

On the day she last saw James Holmes, University of Colorado psychiatrist Lynne Fenton went to a campus police officer with concerns about a patient.

Fenton testified Thursday during a hearing in Holmes' murder case that she had no contact with Holmes after June 11. That same day, Fenton said, she contacted Officer Lynn Whitten about a patient. Fenton did not identify the patient, citing the confidentiality issues that were the focus of Thursday's hearing.

"I was trying to gather information for myself," Fenton said.

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The purpose of the hearing was for prosecutors and defense attorneys to debate whether a notebook Holmes mailed to Fenton the day before the July 20 rampage, which also left 58 injured, is a confidential communication between a doctor and a patient. The defense says it is. Prosecutors believe they should be able to look at it.

The hearing ended Thursday unfinished, and the issue will be taken up again Sept. 20.

The entire story is here.

Thanks to Gary Schoener for this story.

Doctors target gun violence as a social disease

By Marilynn Marchione
Seattle Post-Intelligencer
Originally published on August 13, 2012

Is a gun like a virus, a car, tobacco or alcohol? Yes say public health experts, who in the wake of recent mass shootings are calling for a fresh look at gun violence as a social disease.

What we need, they say, is a public health approach to the problem, like the highway safety measures, product changes and driving laws that slashed deaths from car crashes decades ago, even as the number of vehicles on the road rose.

One example: Guardrails are now curved to the ground instead of having sharp metal ends that stick out and pose a hazard in a crash.

"People used to spear themselves and we blamed the drivers for that," said Dr. Garen Wintemute, an emergency medicine professor who directs the Violence Prevention Research Program at the University of California, Davis.

It wasn't enough back then to curb deaths just by trying to make people better drivers, and it isn't enough now to tackle gun violence by focusing solely on the people doing the shooting, he and other doctors say.

They want a science-based, pragmatic approach based on the reality of a society saturated with guns and seek better ways of preventing harm from them.

The entire story is here.