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How the Navy Yard Tragedy Could Have Been Prevented

September 21, 2013
by Ron Manderscheid
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We must do more to reduce the likelihood of future similar tragedies.

With the very dark shadow of Newtown still engulfing us, once again, we mourn for innocent by-standers who have been slain or maimed by a shooter. The tragic events at the Washington Navy Yard sadly are similar to previous tragedies in Newtown, Aurora, Tucson, and Virginia Tech. They also are different in very important respects. We must learn from and act upon these differences to reduce the likelihood of future similar tragedies.

Media reports this week strongly support the conclusion that Aaron Alexis was descending rapidly into serious mental illness. His close friends and colleagues noted rapid changes in his behavior over the past year, and police actually chronicled his symptoms just a few months ago. His reported symptoms are consistent with those of someone experiencing untreated schizophrenia. Apparently, he was sufficiently concerned about these changes to seek care from the Department of Veterans Affairs (VA), since he was a military veteran.

Several key actions must be taken to prevent a recurrence of the Navy Yard Tragedy. These actions are summarized below.

Implement Our National Call to Action. Just eight months ago, in the immediate wake of the Newtown Tragedy, the mental health and substance use care and prevention fields came together to issue a National Call to Action (see:  http://www.behavioral.net/blogs/ron-manderscheid/time-act-innocents-0). This effort advocated strongly for three things:

  • Implementation of school, family, and community programs that improve prevention, early recognition, and early intervention for mental health and substance use problems..
  • Training of students, teachers and other community members to recognize the signs and symptoms of mental illness and substance use, and, equally important, training to know what actions to take when encountering someone with these symptoms.
  • Immediate doubling of the capacity of the mental health and substance use service delivery systems.

The President and Vice President heard our request, and the first two of our proposals were included in Administration legislative recommendations. These recommendations subsequently became a Senate Bill, The Mental Health Awareness and Improvement Act. That Bill now is languishing in the Senate. Just this week, Senators Begich and Ayotte urged once again that the Senate pass this Bill.

What You Can Do: Urge your two senators to pass this essential Bill before the end of the year.

Provide Crisis Intervention Training to Police. When the Newport, RI, police were called to Mr. Alexis’ hotel room just a few months ago, he reported his symptoms to them in a very detailed way. Unfortunately, the police did not act on that information to seek care for him. Thanks to the work of Leon Evans, Director of the Center for Hope in San Antonio, excellent Crisis Intervention Training (CIT) is now available to police so that they know what action to take in this circumstance. If Mr. Alexis were actually taken to a treatment facility that night, the Navy Yard Tragedy might never have occurred.

What You Can Do: Advocate that CIT is made available to your local police force, and to all persons who perform civilian police functions.

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Thank you for your thoughtful article. Prevention of future tragedies seems to be more reasonably attainable as we continue to implement coordinated systems of care. What will be key will be accountability for all who are responsible for providing services within those systems of care and ensuring timely responsiveness and communication between Federal, state and local (county, city) systems. The symptoms the shooter presented sound like schizophrenia. It is also possible that the psychosis was a manifestation of bipolar disorder resulting from untreated PTSD or from treating PTSD with pharmaceutical intervention protocols only (i.e., SSRIs without concurrent psychotherapy). Years ago, research by Robert Pynoos MD at UCLA showed that untreated PTSD in childhood often preceded the onset of bipolar disorder later in life. It seems plausible that the shooter at the Navy Yard may have suffered from PTSD and might have been receiving treatment in the form of medication (e.g., an SSRI) that may not have been appropriate for him. Had he been engaged in psychotherapy by a provider at the V.A. or elsewhere, it is possible that this tragedy could, indeed, have been prevented.

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Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid

@DrRonM

www.nacbhdd.org

Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...