After tragedies like the one in Santa Barbara, we question why these terrible things happen and ask how they could have been prevented. We ask because we hope these same acts will not happen in our neighborhoods. We ask because we want to feel in control. However, our focus is often on the perpetrators of such violence; we psychoanalyze them from a distance even though that is impossible. We pour over their histories, as if they were novels, to look for warning signs that should have been flagged, but were not.
Our society's failure to care for the mental health of our citizens is not an issue that can be blamed on one perpetrator, nor one moment in time. As we reflect upon the Santa Barbara killings and other recent tragedies, we need to begin a dialogue around the larger social, emotional, and biological conditions that create violence in this country. We cannot rewrite past events and we cannot easily protect against future ones; but we can work together to create the ground for fewer of them.
Despite what is sensationalized in the media, the majority of violent episodes in this country are not triggered by mental illness. A recent study by the American Psychiatric Association found no predictable patterns linking criminal conduct and mental illness symptoms; of the 429 crimes studied, 7.5 percent were directly related to symptoms of mental illness. The 'mentally ill' are more likely to commit suicide with a gun than homicide. However, there are some predisposing factors that pediatricians, parents and teachers should be alert to, including an early history of aggressive acts, high levels of family stress and truancy.
How can we address the larger social, emotional and biological conditions that lead to violence?
It starts with our families, schools and health care professionals. We need to make mental healthcare a larger component of our school systems. With three to four children in every class of 20 having diagnosable mental illness and only 25 percent of these likely to be able to access mental health care, we must increase access to mental healthcare. Just as we have school nurses to ensure the physical health of our students, we need school psychologists and counselors. Schools have historically been reluctant to provide mental health care to children, but that is where the children are! Schools are the best and most convenient delivery system for mental healthcare.
Similarly, mental health check-ins should be part of routine visits with pediatricians and primary care doctors. Physicians should monitor the safety, mood and peer relations of children and adults, just as they monitor blood pressure. They should find out if patients come from families with histories of abuse and monitor the suicide risk of patients.
Preventing violence also involves controlling access to firearms, and ensuring that the people who own firearms are protecting them. Gun safety rather than gun control should be part of the national conversation not specific to mental health issues.
These are long-term solutions for ending violence in our society, but, for those in Santa Barbara, short-term care is equally critical. Research indicates that the majority of survivors of such tragedies will do fine with the help of family and friends. Those impacted most significantly are usually people with a history of trauma and they need to be identified and assessed so that mental health professionals can assist them to manage the flashbacks and emotional numbing that may result. Mental health professionals should be available to those involved in a traumatic event for at least the next six months and should provide exposure therapy or cognitive behavioral treatment in addition to help with basic needs.
Ideally, if we take a long-term approach to ending the problem of violence in our society, we will be able to shift our focus from the remedial care like that offered in Santa Barbara to preventive care. The topic of mental health and the importance of mental healthcare need to be a regular part of the national conversation, not one that is only relevant for the few weeks after a tragedy.
I look forward to the day when the stigma associated with mental illness is replaced by thought-provoking conversations about how mental healthcare can help make our society better. We need to stop looking for scapegoats to our problems, and instead discover concrete solutions.