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Redeeming the Tragedy in Tucson

January 13, 2011
by Ron Manderscheid, PhD
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Last weekend, a tragedy of national proportions occurred in Tucson, Ariz. Twenty-two-year-old Jared Lee Loughner repeatedly fired a pistol into a group at a Saturday political rally organized by Representative Gabrielle Giffords of the 8th Arizona District. Six people were killed outright, including a 9 year old girl; 12 more were wounded, six seriously, including Gabby Giffords, who was shot through the head. We need to understand and act on this very sad event so that a similar event does not occur in another setting with other participants.

Based on CNN media reports and elsewhere, a picture emerges of Jared Loughner as a bright and talented teen who developed a serious mental illness over a protracted period of time dating from his later high school years. Allegedly, he had numerous run-ins with high school, community college, and legal officials, as well as with classmates. Over time, he also withdrew from family and friends, sometimes precipitously, and he spent progressively larger amounts of time in delusional thinking. A critical question can be raised as to why he never received appropriate mental health care.

Clearly, it will not be productive to point fingers at public officials, at fellow students, at friends, or at his family. We cannot know their personal motivations, or why they did not intervene. Rather, let’s look at what could have happened, but didn’t.

We must look at two things. First, how can we give people the knowledge and the skills to take action when they encounter a family member, friend, or acquaintance who is experiencing a mental illness? Second, how can we assure that appropriate and effective mental health services are actually available in the community?

Developing Knowledge and Skills

Before someone will feel secure and confident to intervene, including friends, classmates, teachers, family members or other community members, they must have an appropriate understanding of the signs and symptoms of mental disorders; they must know how to respond; and they must know what resources are available to assist them. Most people have received no training in any of these areas; in fact, most people are unaware of current mental health treatment resources available in their own communities. We must do something about this.

As part of health education in high school, every student should be informed about the signs and symptoms of mental illness and the types of helping responses that are appropriate. Clearly, appropriate responses will vary depending on whether a person is suicidal, depressed, violent, incoherent, etc. As a major part of this training, when in any doubt, students should be taught to reach out for help to other authority figures—teachers, school counselors, school principals, other adults, etc. Such training will do much to combat the culture of silence and inaction that frequently surrounds such encounters.

As part of undergraduate college education, and when entering a new job, including teaching or the police force, adults should be exposed to the principles and concepts of Mental Health First Aid. In addition, they should be informed about the mental health resources available in their own communities and how to find these resources in the future through use of the Web and other tools available locally.

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Jared Loughner is not an optimum example of the system gone wrong, although Ron Manderscheid's call to action is on the mark. The community college in Tuscon identified Jared Loughner as potentially dangerous to self or others and suspended him. School officials then went to meet with the parents to explain these events and state that results of a mental status exam would be required as part of a re-enrollment process. For whatever reason, the parents took no furhter action, but the steps taken by the college represent an advance in customary practices of high schools and colleges.-Howard Savin, Ph.d.

Great point, Howard. I hadn't yet seen the information that school officials actually reached out to the parents of Jared Loughner, and I agree that that outreach was far more useful and advanced than just a suspension.

Is it possible though, that school officials had a much sharper, clearer view of Loughner's deteriorating behavior than did his parents and therefore, perhaps an even stronger incentive to intervene? Clearly, there was an opportunity here and it fell down between the school and the parents. Not a criticism, but an observation . . .

Somehow, our society needs to teach, or learn, that if someone shows signs of mental illness, the duty and ability to help them is little different than if they had physical symtoms. If a college student is seriously physically ill, he is commonly rushed to treatment without parental notification (we sign forms to allow that!). If thought to be mentally ill, the approach to treatment is more tentative, perhaps because people are worried about privacy, reputation, etc. Clearly, that's not the "system's" fault, or the schoolsit's society's problem to change this attitude. We need to give people permission to intervene appropriately, just as we do for a physical injury.

Throughout the month, I've been looking into how the behavioral health communityin Arizona and across the country is responding to the Tucson incident and will be reporting on that in upcoming issues and online. If you or others have perspectives to offer to that work, please do sohere or directly by phone or e-mail.

This is a very difficult thing for family to assess and understand. Our older daughter had a major psychotic break about 12 years ago and I worked for a major mental health organization at the time. A lot of assistance was readily available, if we had recognized and understood what was happening in our daughter's life.

Fortunately, the result was not as catostrophic at the recent Tuscon incident, but she was diagnosed as suffering from bi-polar disorder and is doing reasonably well at this time.

The challange is to determine what kind of training or information will be effective in helping people understand what is going on in the minds of the people around them.

Although steps to inform the public and others are necessary, as are programs and resources for the uninsured, underinsured, the most important thing we need is for Americans to grow some...uhmmm "testosterone"!!! If someone notices odd, eccentric, threatening or intimidating behavior actions or statements, they need to reach out to someone, anyone in the mental health arena, so that person (s) may be observed, assessed and/or assisted. Before someone can be assisted, they must first be IDENTIFIED.

In our community in SC if your are uninsured and indigent with depression, anxiety, BPAD and not psychotic or a threat you are SOL. These are the the people who are at risk.

Thank you so much for a perspective on this tragedy. We need a clear vision of a direction for our actions to build a working mental health care system.

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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...