Four months after 14 of her classmates and three school employees were shot to death, Kyra Parrow walked across a stage and was handed a diploma.
What she was not given, she says, was a road map to navigate her lingering trauma.
Right after graduation, Parrow, who was a high school senior at the time of the 2018 massacre at Marjory Stoneman Douglas High School in Parkland, Florida, moved to Orlando to start summer classes at Valencia College.
“We were sent off without any proper info or resources for us to be able to move forward. There was no plan,” Parrow, 19, told HuffPost. “Many of us have anxiety and depression, but we can’t afford therapy, let alone psychiatrists to be able to have medication prescribed that we need.”
On March 17, one of her classmates, Sydney Aiello, 19, died by apparent suicide after struggling with post-traumatic stress disorder and survivor’s guilt. Less than a week later, another Marjory Stoneman Douglas student — a 17-year-old male sophomore who has not been publicly identified — reportedly died by suicide. And on Monday, Jeremy Richman, whose daughter was killed in the 2012 mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, was found dead, believed to have taken his own life.
The three tragedies highlight the difficulty of providing mental health support for survivors of mass shootings and their families.
“When a mass tragedy like this happens, the effects are long term,” said Cathy Kennedy-Paine, who leads the crisis response team for the National Association of School Psychologists. “It is not over when the cameras go away or when school resumes a few weeks later. The effects of PTSD or anxiety can last for weeks or months or years.”
In 1998, Kennedy-Paine was a school psychologist in Oregon when a former student opened fire at the school, killing two people. Since then, she has worked with schools to help students recover after a shooting.
Providing mental health support to communities after a mass tragedy is a complicated task, she said. In the case of Parkland, there were an estimated 3,300 students at the time, plus their parents, faculty members and first responders. Survivors have varying needs, she said. Part of the challenge is assessing all those involved to see what kind of support they need, then finding ways to provide it.
Regardless of whether students ask for help, parents and other community members should learn to recognize common warning signs of suicide, such as suicidal threats, a preoccupation with death, giving away prized possessions and sudden unexplained happiness, Kennedy-Paine said.
“Parents and other community members should learn to recognize common warning signs of suicide, such as suicidal threats, a preoccupation with death, giving away prized possessions and sudden unexplained happiness.”
Her general recommendation, as a first step, is to get students reconnected with their natural support systems as quickly as possible. That can mean going back to class to be around their peers and mentors.
Students returned to Marjory Stoneman Douglas two weeks after the shooting. They were greeted with therapy dogs, and counselors were available in the media center for students, though some told The Washington Post that the topic of suicide was never broached.
For Parrow, returning to school so quickly — “after a week of funerals,” as she put it — was stressful. And while most teachers were supportive, she said, others wanted students to simply move on. She said that on one occasion, a teacher told her to put her “grief in a box” after she said she couldn’t concentrate enough to finish a paper.
Kai Koerber, 18, a senior at Marjory Stoneman Douglas High School, told HuffPost that many students are still traumatized. Some are afraid of being inside classrooms; others cry when the bell rings. He said he recently talked a friend out of suicide. Still, many students are reluctant to access support services because of stigma about mental illness, he said.
“They don’t want to seem unwell to their peers,” he said. “They want to keep up an image of strength.”
In an email, Cathleen Brennan, a spokesperson for the school district, said students were provided one-on-one and small group counseling as soon as they returned to school and were referred to short- and long-term counseling when needed.
This year, the school has two wellness centers on campus to provide support to students, she added, and there are a number of resources in the community that students are encouraged to access.
Staffers at the school have undergone multiple suicide-prevention training sessions, she said, and the district continues to consult with experts regarding how to help students in the aftermath of the tragedy.
Koerber, who started a nonprofit to improve mental health curriculums at schools, said he hopes the national conversation will pivot to how we can support survivors of mass tragedies. “The district did the best it could,” he said. “I get that it is extremely difficult to assign 3,330 students a personal therapist. But I think there is more to be done.”
Cindy Arenberg Seltzer, the president of the Children’s Services Council of Broward County, said that there are many services available to Parkland families. The problem is one of messaging, she said. Many people simply don’t know about them.
“I live in Parkland, and I’ve heard people there say nothing is available,” she said.
Just this week, a community wellness center called Eagles’ Haven opened where survivors and their families can go to seek help.
“Thirty families showed up yesterday,” she said. “There has been a pent-up need for a place for people to go and be together.”
For Shiva Ghaed, who lived through the 2017 massacre at the Route 91 Harvest country music festival in Las Vegas, the recent Parkland tragedies are a reminder how important it is to make sure survivors have access to trauma-informed care.
Ghaed, a clinical psychologist with experience treating clients with PTSD, started a support group in the San Diego area for survivors of the Las Vegas shooting one week after it occurred.
“When I got back from Vegas, I knew it would take people a long time to get connected to care. We are understaffed in psychiatrists and psychologists and people who are trained in trauma,” she said.
But intervening as quickly as possible is key in helping people recover.
“A small percentage of people who experience traumatic life experiences start to change their worldview. They avoid people and places. They avoid thinking about the event. They avoid feeling their feelings. And they do avoidance behaviors, like drinking,” she said. “That’s what begins to reinforce these unhelpful and self-defeating thoughts.”
She worked with a group of survivors for a full year. But for the other survivors who were scattered across the country ― more than 20,000 people attended the concert ― she heard horror stories. Some people couldn’t find a psychologist or a psychiatrist within an hour of where they live. Or the therapists they contacted were not taking on any new patients. Some reported that their therapist told them they didn’t know how to assist them.
“Even at the one-year mark, people were still looking for help,” she said.
The U.S. simply doesn’t have the mental health infrastructure to respond to that level of mass violence, she said.
“We need more people in the field, and we need more people who are specialized in trauma,” she said. “We need a mandate.”
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.