First Aid for Mental Health
December 15, 2012
Almost by definition there is something wrong with the mental health of mass shooters like the Aurora cinema guy, the Sikh Temple shooter and the one who just killed 20 elementary school children, 6 staff members, his own mother and ultimately himself.
In parallel with the calls for better gun control in the US we experience calls for improved health care for the brain. But the failing is not the provision of care so much as it is the detection of mental health problems that might lead to mass shootings.
We will never get to a one to one prediction of who is about to become the next news cycle. But then, we don’t know who will heal eventually from a given infection, who will recover from stroke without a given intervention…or who will get heart attack save for the cholesterol meds, statins and what not.
So we go with the odds.
And we detect problems with broad screening (annual checkups), acute responses (minor cardiac event perhaps)…and crowdsourcing.
If someone were bleeding in front of you, chances are decent that you would know whether to get a bandaid (even a 5 year old knows to add the antibiotic cream) or stick a finger on the vein while yelling for help. In a crowd? Someone would know CPR if a person stops breathing…in a pinch you’d have a go based only on what you remember from teevee shows.
What about when someone shows signs of a mental health problem? How does the crowd and pre-FirstResponse do with those situations?
I have only recently been made aware of Mental Health First Aid.
It intrigues me.
DrugMonkey 
December 15, 2012 at 10:21 am
Yes, of course we need better recognition of early signs that help is needed for the mentally ill.
But we also need to legislate real control on gun ownership. You want to buy guns and ammo in America? Fine. Submit to a full psychiatric evaluation. Prove to us you are not crazy. And get re-evaluated every year.
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December 15, 2012 at 10:37 am
Is it not possible that people who murder other people are just immoral and cruel? Plenty of those with mental illnesses have never so much as gotten into a schoolyard brawl.
Unless you’re convinced as a neuroscientist that humans have less autonomy than they assume due to neurobiology. But the idea that all of these murderous scumbags are motivated by mental illness still disturbs me in the face of ambiguous evidence.
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December 15, 2012 at 10:58 am
Many people are talking about reinstating the assault weapons ban, better gun control, etc. I am all for things. However, in this case, the perp stole the guns from his mother. If a person is subject to psychiatric evaluation before purchasing a gun, fine. But how do you stop their crazy fuckin relatives from stealing weapons from them? Should all of their friends and families also have to be evaluated? I don’t know the solution. I can’t find any statistics that demonstrate a correlation between the expiry of the assault weapons ban in 2004 and an increase in gun violence in the US. If someone can, please enlighten us. Maybe it is still too soon, but I would rather not wait for more people to be killed to have to reach that conclusion.
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December 15, 2012 at 11:34 am
The solution is very simple, eeke. Ban handguns.
If we need to repeal the 2nd amendment to do so, then let’s do it.
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December 15, 2012 at 12:37 pm
Eeke, there is some evidence that it does work, though: gun control laws were tightened in England after a similar schoolchild massacre in 1996, and there has not been a school shooting since then.
Pretty tired of everyone thinking one misinterpreted amendment is more sacrosanct than 20 children’s bodies. I’m with Grumble.
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December 15, 2012 at 2:15 pm
@Juniper – I don’t really care if these people are more insane or more cruel/immoral/whatever. Honestly not interested. I do care that handguns are way too easy to obtain.
100% with Grumble. We can bicker about regulating this and restricting that and how to tell who is crazy and who is not. But to cut to the chase I agree — we need to repeal that second amendment.
And pediatricians and teachers will be on the ramparts leading this one. Sign me the hell up.
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December 15, 2012 at 2:17 pm
Not to mention that we *have* removed amendments before — for example, Prohibition. We agreed as a nation that that was a bad idea.
I’m somewhat unconvinced on the “mental illness” angle — yes, some shooters (the Virginia Tech one for example) clearly were disturbed, but others are the “he was quiet and kept to himself” type. As an introvert myself, I hope that doesn’t put me on some watch list.
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December 15, 2012 at 2:39 pm
Yeah, the fact of the matter is that there are full-blown psychiatrists who have trouble deciding if someone’s a threat to society or not–so while it would be nice for more people to recognize, and speak up about, the mentally ill-sliding-into-dangerous guy in their neighborhood, we shouldn’t expect laypeople to do what experts can’t.
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December 15, 2012 at 2:42 pm
@Juniper – I don’t really care if these people are more insane or more cruel/immoral/whatever. Honestly not interested. I do care that handguns are way too easy to obtain.
Oh, this was a response to DM, not to you. The premise of DM’s post is that all of the shooters are compelled by illness instead of grave deficits of character.
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December 15, 2012 at 6:33 pm
Tax the bullets.
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December 15, 2012 at 6:42 pm
The First Aid for Mental Health idea is interesting. I appreciate what they are trying to do, but… I don’t know, mental health issues are chronic conditions, not acute ones. I’m not sure a 1 day course is really going to equip someone to do much.
It also seems like their evaluation of the effectiveness of the program focuses more on self-reported assessments from the participants, rather than any real world effects. (Not that I’m sure how you would do that, unless they have much larger numbers than I’m guessing.)
Still, if nothing else, reducing the stigma of mental illness is always a positive, and enabling people to feel like they can talk to someone who might have problems sounds like a good idea. (Maybe?)
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December 15, 2012 at 6:58 pm
Here is a link to a blog post that answered my question about the impact of assault weapons on the number of mass shootings:
http://election.princeton.edu/2012/12/14/did-the-federal-ban-on-assault-weapons-matter/#comments
Depending on how you look at the data, the conclusion of the author is that the assault weapons ban DID matter. The number of victims per year has nearly tripled since 2004.
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December 15, 2012 at 7:28 pm
The premise of my post is that *some* people want to talk about mental illness in the wake of shooting tragedies.
My point about them being by definition mentally ill perhaps seems like more than it is. Our concept of mental illness depends in part on people being far outside what is considered a normal distribution.
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December 16, 2012 at 7:14 am
Tough one this. These situations are the same as the lone terrorist with a vest strapped to him. It is almost impossible to stop if they are genuinely determined to do some damage. Most of these guys show very little overt signs of mental illness, except perhaps in the Giffords shooting, and calling for improvements in mental health is lovely but I doubt it will help. There is also a big problem with all this: how many people who are “a little odd” go out and kill people with assault weapons? How many of them even commit a crime? How many people with diagnosed schizophrenia commit violent crimes? The answer to all is very few. Blaming mental health issues for these shootings misses the mark and only serves to enhance the stigma of mental health.
Gun control is a given and this whole 2nd amendment rubbish is fucking laughable to anyone who is not a constitution loyalist.
But the truth is that this is a fashion, its trendy, and it is now a bonafide method of suicide. That’s it. People do it because they want to. They get media attention and legendary status amongst other murderers and that’s what they want. We are more than happy to give it to them.
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December 16, 2012 at 11:48 am
In Israel, they built a memorial for Yitzhak Rabin on the spot he got killed. It has plaques with the names of the people who were immediately surrounding him indicating where they were standing, as well as one for his assassin. All the plaques say the name and function of the people involved, save for the assassin’s plaque, which only reads “murderer.”
This horrific shooting has gotten me thinking about many things. Clearly we desperately need better gun control laws, although I’m not sure how tightly we would have to regulate guns to really decrease the incidence or severity of mass shootings. In a similar vein, having much better mental health care in this country–certainly including a far deeper understanding of how the mind works than we currently hold–is an absolute necessity, although it may help more for the majority of people with some form of mental illness than the minority of people who might commit mass murder.
One aspect of this stands out most to me, however, and I find it more troubling–and more directly connected to mass shootings–than gun control or better health care. This was a terrorist attack. It may not have had a political motive or an organized group of people behind it, but it is still terrorism. And it is a particularly American type of terrorism (by incidence), even if you take into account our high gun ownership and poor mental health care. Perhaps one of the easiest, most agreeable things to fix is to take a page out of Israel’s book on this one and work much harder at remembering the victims than the perpetrators.
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December 16, 2012 at 1:31 pm
Fair enough, DM.
It is probably too soon for a “first aid” concept, though, because of the public inability to distinguish between neuroatypical and mentally ill or recognize the occasional overlap between and environmental dependence of the two. It’s good to ask troubled or sick people how they are and to offer them help. It’s good to be watchful. It’s bad to wind up pressing mere introverts to behave like the universally ingratiating, party-loving, extraverted fraternity/sorority/business executive types who never take anything seriously or to hang out with all the catty coworkers with mainstream tastes in everything whom they’d rather actively avoid just to prove that they’re not evil and totally lacking in humanity. That idea scares me.
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December 16, 2012 at 7:38 pm
Good (really scary) piece in the Huffington Post along these lines:
http://www.huffingtonpost.com/2012/12/16/i-am-adam-lanzas-mother-mental-illness-conversation_n_2311009.html
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December 17, 2012 at 3:37 am
“Is it not possible that people who murder other people are just immoral and cruel?”
People who murder for clear self-gain can certainly fall into this category (but even then, you can’t avoid the shadow of determinism). But I agree with DM: shooting a bunch of people and then committing suicide seems like a pretty cut-and-dried symptom of a broken mind. It’s much better for us as a society to approach these sorts of killers in that way than to fall back on a provincial view that they were making an active free will choice to be morally corrupt (read ‘evil’); that if they hadn’t made that choice, they would be fine, upstanding citizens like the rest of us. The latter cries for fear, outrage and retribution, none of which are particularly healing responses, let alone constructive to the prevention of similar events.
I think the Norwegian legal system showed remarkable restraint, compassion, and no small amount of empirical sense in treating Anders Breivik as a broken mind rather than the Devil’s handyman.
The challenge is finding a happy medium between accurately identifying genuinely disturbed folk who are potentially dangerous and getting them the help they need (or, if necessary, restraining them), and ending up with an overzealous Thought Police that rounds up anybody who doesn’t conform. Historically speaking, that has been a tough line to walk. But, yeah, with improved knowledge –> improved diagnosis etc, maybe we can make progress there.
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December 17, 2012 at 6:34 am
It’s much better for us as a society to approach these sorts of killers in that way than to fall back on a provincial view that they were making an active free will choice to be morally corrupt (read ‘evil’); that if they hadn’t made that choice, they would be fine, upstanding citizens like the rest of us. The latter cries for fear, outrage and retribution, none of which are particularly healing responses, let alone constructive to the prevention of similar events.
Call my view “provincial” all you want– I’m from a working-class family and I’m used to these sorts of slights by now– but I don’t think your perspective is as “empirical” as you claim it is. First, the jury is still out on how much determinism there is in human neurobiology. Second, if you can’t call the slaughter of twenty first-graders evil, then I don’t know what is.
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December 17, 2012 at 9:06 am
You know who else is evil? The membership of the NRA. I lay the blame for those 20 dead children not just on the deranged killer, but also directly on anyone who has ever resisted reasonable laws to ban assault weapons. I lay the blame on people who think it’s OK that the constitution has been interpreted to mean that everyone has the right to own whatever firearms they please, in whatever quantity. And I lay the blame on the usual lily-livered Democratic politicians, who, despite being pro gun-control, don’t have the stomach to fight these monsters on behalf of their constituents.
All those people should look deep in their hearts and think about what it means to be responsible for killing 20 first graders and 8 of their teachers.
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December 17, 2012 at 11:09 am
that they were making an active free will choice to be morally corrupt (read ‘evil’); that if they hadn’t made that choice, they would be fine, upstanding citizens like the rest of us.
rather than the Devil’s handyman.
By the way, dsks, this is not even an accurate representation of my argument. First, I’m an atheist. When I talk about this tragedy as the result of evil, I am not talking about some superstitious bullshit. I am talking about a gross violation of a social contract that decent people of multiple ideologies have with one another. I’m going to call that immoral and cruel as well as evil. Second, I never said that only one choice lies between murder and fine, upstanding citizenship. That isn’t what I think anyway. Third, there is nothing in my statements upthread that presupposes neurobiological capacity for absolute free will. It doesn’t completely discount the role of mental illness, either. What I did intend to dismiss was the idea that everyone who has ever committed an act of breathtaking, unforgivable inhumanity– which includes not only the Connecticut murderer but also every willing perpetrator of the Holocaust, every American slaveowner who beat, mutilated, raped, murdered and deprived their slaves, every Flagellant who flung sobbing Jews onto a pyre while invoking the name of a “merciful” God during the Black Plague of 1333-1350, etc.– had a mental illness. Dude, this kind of thoughtlessness renders the definition totally useless.
Additionally, I continue to be mystified by people who insist that anger in all contexts is a bad thing of no utility. This idea is largely a product of Anglo-Saxon culture. In this country and in Britain, at least. It isn’t “empirical”, either.
Your argument combined with the use of hackneyed phrases such as “broken minds” and “healing responses” and other tooth-grating shit culled from Lifetime movies and the Oprah channel is far more provincial than anything I’ve ever come up with in my life.
I lay the blame for those 20 dead children not just on the deranged killer, but also directly on anyone who has ever resisted reasonable laws to ban assault weapons.
I don’t blame you. There’s the issue of societal responsibility, which probably makes most of us, including me, complicit. (I have never been opposed to gun ownership, but I don’t think I’ve carefully thought about the issue until now.) And as you and others have pointed out, we’ve repealed Amendments before.
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December 17, 2012 at 11:25 am
It’s more than a question of identifying the mentally ill in our midst. It is about removing the stigma of mental illness and making support to families and diagnosis and treatment more available. The article whimple links to gives a good idea of the stress families live with. Not least because parents don’t want to to involve law enforcement and give up their child to institutions in order to get help. Worry about legal effects of official diagnosis loom large also.
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December 17, 2012 at 3:42 pm
Mistakes happen. Even in constitutions. Repeal the second amendment.
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December 18, 2012 at 12:41 am
How about people practicing near every day being respectful and pleasant rather than the usual opposite?
You know, as part of cleaning the social, family and work environment from irritants of emotions or foggers of cognition. It seems like a good way to start the process of a sustainable society.
And maybe it’s showing the need to reduce the extreme uncertainties and current despair. It is people’s doing that got things to where we are, so people should be able to fix, or to undo, the wrongs. Plenty of data available to get a good idea of where the wrongs are. Without more fights, and needles or pointless ‘competitiveness’.
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December 18, 2012 at 4:57 am
Another behavior that emerges from some kinds of mental illness is suicide. I don’t know much about this topic, but my impression is that there does exist a kind of first-aid knowledge about suicide. Organizations (the Samaritans, e.g.) exist to provide hotline counseling. It is not hard to find information about (a) signs that might help to recognize if a friend or loved one is at risk of suicide, (b) what to do to try to protect that person and get help. To me, that’s the definition of first aid: recognizing when someone is at risk and knowing how to deal with the risk on a temporary basis until treatment can be obtained.
So, I think what DM is asking is, what’s the analogue of all this when your friend or loved one, or a stranger, shows signs of being at risk of going over the edge in a violent way? I think it’s a good question.
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December 18, 2012 at 10:08 pm
I apologize, everyone.
It is difficult not to be upset not only because of the sheer horror of this event– which dwarfs everything I’m about to say, by the way– but also because of a reason in addition to those I gave upthread: Many of the proponents of discussing mental illness in terms of murderous violence perpetrated by lone suburban shooters without compunction are the same people who offer only frustration and contempt to the non-homicidal, suicidal, mentally ill, neuroatypical student or employee who wants to function as a productive and respected member of society and just can’t and just can’t and just can’t without serious intervention. You’re either genuinely interested in improving mental health care or you’re too indifferent to care about increasing the stigma.
Okay, so not quite. But not wholly incorrect, either.
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December 19, 2012 at 9:24 am
@theshortearedowl
The point seems to be to stabilize people who are in crisis until they can access long-term support, much like an EMT (or on a lower level, a first aid provider) would do in the case of injury or medical emergency.
This concept already exists in mental health services. It’s what rape crisis counselors and Psychological First Aid providers (both of which I am) do. This is just broadening the concept, which I think is a cool idea.
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December 22, 2012 at 12:51 pm
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