Gun control measures remain polarizing, even in the wake of mass shootings such as the one Thursday at Umpqua Community College in Oregon . But initiatives to identify those with mental illnesses are seemingly the only patches of common ground shared by gun rights and gun control advocates.
After the slaughter of 20 children and six adults at Sandy Hook Elementary School in 2012, President Barack Obama vowed the country would make bold changes to stem gun violence. From Blacksburg to Columbine, from Ft. Hood to Tucson to Newtown, Obama figured Americans had finally had enough.
Right after the children of Newtown, Conn. were buried, the president proposed a plan called “Now is the Time.” It would close loopholes in gun background checks and ban high capacity magazines and military-style assault weapons like the one used by the Sandy Hook killer, Adam Lanza.
In addition to gun control measures, the president’s initiative also called for the ability of agencies such as the Centers for Disease Control and Prevention (CDC) to research gun violence as a public health threat — something kept off-limits by Congress. Last on the president’s list was a call to improve mental health services.
Last week, Obama lamented yet another mass shooting in Oregon. Among the 10 dead are Lucero Alcaraz, 19, who wanted one day to provide health care to kids, and Rebecka Carnes, 18, who had just started her first week at Umpqua.
“Now is the Time” didn’t stop the deaths of Alcaraz and Carnes, but already more than 480,000 Americans, including about 10,000 in Ohio, have received Mental Health First Aid training, according to the National Council for Behavioral Health, which runs the U.S. program with health departments in Maryland and Missouri.
Some argue that focusing solely on those with behavioral disorders only increases stigmatization and misplaces the effort if the goal is to prevent mass shootings.
“Mental health awareness programs will never significantly curb gun violence in this country, because mental illness alone contributes very little to interpersonal violence,” said Ladd Everitt, spokesman for the national Coalition to Stop Gun Violence. “That doesn’t mean these programs don’t have great potential value, just that our gun violence epidemic is a far broader problem. We won’t solve it by unfairly stigmatizing a single constituency and throwing them under the bus.”
About 20 percent of Americans suffer from a diagnosable form of mental illness said, Jewell Good, director of the Community Behavioral Health Division at the Alcohol, Drug Addiction and Mental Health Services Board of Montgomery County (ADAMHS).
Good is among the 7,300 certified Mental Health First Aid instructors in the U.S. Last week she was among the instructors training the organization’s 500th “first aider” in just over a year. The curriculum isn’t geared to mental health professionals, rather it’s tailored for ordinary citizens whose paths intersect with a cross section of the public, Good said. So among those first to receive training in Dayton have been public safety first responders, social services case workers and homeless shelter employees. Downtown Dayton Ambassadors and RTA bus drivers have also received the training.
“I think that if you look at everything that hit the headlines — if you look at Newtown, if you look at Colorado — communities are clamoring for something to try to prevent those types of incidents from occurring,” Good said. “So the lay community who has contact with individuals has the education to be able to identify a person who might be suffering from a mental health challenge, particularly to prevent situations such as those.”
But researchers caution that gun violence is a complex area of study.
A May report by a Duke University researcher showed that people with serious mental illnesses are somewhat more likely to commit violent acts but the vast majority do not. More often, mental illness is associated with suicide than violent acts toward others.
“Even if we had a perfect mental health care system, that is not going to solve our gun violence problem,” the Duke researcher Jeffrey Swanson told ProPublica. “If we were able to magically cure schizophrenia, bipolar disorder and major depression, that would be wonderful, but overall violence would go down by only about four percent.”
More than 32,000 people were killed with guns in America in 2013, of those, 21,175 were suicides, according to the CDC.
Groups such as the National Rifle Association often place the blame for gun deaths on untreated mental illness rather than the availability of firearms. But keeping guns out of the hands of the mentally ill is another piece of common ground shared by both advocates of gun control and the NRA.
“Better care for those with mental illness, especially those that are a danger to themselves or others is important. Obviously mental health first aid is a key step in that process. However, fewer than 2 percent of gun crimes are committed by the mentally ill and individuals with mental illness are much more likely to be victims than perpetrators of violence,” said Jennifer Thorne, executive director of the Ohio Coalition Against Gun Violence. “It feels more comfortable to place the blame on mental illness rather than on a culture of fear and violence that is being perpetuated in this country.”
The mental health first aid program was developed in Australia and imported to America in 2008, said Betsy Schwartz who oversees the U.S. program as the National Council for Behavioral Health’s vice president of public education and strategic initiatives. The course is taught in 24 countries.
Two $15 million dollar appropriations from Congress, where the program receives bi-partisan support, have funded the national effort Schwartz said. Two local organizations, ADAMHS and Mt. Olive Baptist Church, just received new federal grants for the training.
“It doesn’t matter whether you are a Democrat or Republican, there’s a strong recognition that people need to understand mental illnesses and addictions,” Schwartz said.
The eight-hour training is based on a five-step action plan using the mnemonic device, ALGEE, standing for: assess risk, listen nonjudgmentally, give reassurance, encourage professional help, and encourage self-help. Students learn the signs of mental illnesses and addictions and how to help someone with a developing problem or in a crisis.
More than 60 percent of those trained, or 300,00, took the class this year, Schwartz said.
There’s no guarantee the training would stop the next gun rampage, but it might save the lives of countless others contemplating suicide, Schwartz said.
“We never would say that mental health first aid would prevent another Sandy Hook because certainly nothing can control the impact and be 100 percent sure,” she said. “The point is that if every adult in America had mental health training — and our goal is to make it as common as CPR — that kind of knowledge would change the comfort and level of conversation in America so people who have a loved one, or who are living with a mental illness or addiction problem, would be willing and able to acknowledge the problem.”
Data show that those who take the course retain what they learn and are able to readily identify the indicators of mental health disorders in those around them, but whether the classes help those most intended rest mainly in anecdotal stories.
“It is hard to quantify,” said Stephanie Cinque, founder and director of the Newtown Resiliency Center. “We have a lot of teachers, paraprofessionals and community people who come in to learn more about it who are telling us that it’s bringing an awareness to them and shedding light on things they never looked at before.”
Cinque started the center after the tragedy in her Connecticut town and last November was among the instructors training all 400 of Newtown’s schoolteachers.
The city of Philadelphia has made Mental Health First Aid a top priority , said Maria Boswell, the program’s acting director at Healthy Minds Philly in the city’s behavioral health department.
More than 11,000 who work, live or study in the city have been through the course. Boswell said 2,500 of the city’s public safety staff are trained, including police officers.
“Healing people is good. Healing communities is better,” she said.
The Philadelphia effort is being studied by researchers at Drexel University. A 2014 evaluation indicates course graduates have an increased awareness of mental illness and exhibit a higher likelihood of assisting others. The findings also show a shift in attitude toward those with behavioral health challenges and a reduction in stigma associated with mental disorders. But it will take time and further study to determine the program’s long-term effectiveness, Boswell said.
“It would be very hard to follow: Did this person seek treatment because of a mental health first aider? It’s not just one thing that helps a person,” Boswell said. “I know we need to quantify our outcomes and I think we’re doing a good job. This is going to take some time to look and see the effects. But we’re working on it.”
Iris Blanchard, a Sinclair Community College counselor took the class last week and called it “eye-opening,” particularly learning about auditory hallucinations during an exercise with one person talking in her ear while trying to have a conversation with another.
“This will help me do my job day-to-day,” Blanchard said. “I work with students and they have academic challenges or social and emotional challenges that may impact their ability to be successful in college.”
A more promising benefit of Mental Health First Aid is it may help get people into treatment sooner, allowing them to live more productively which benefits society, said Andrea Hoff, director of community engagement and special initiatives at Montgomery County ADAMHS, also a certified instructor.
Behavior disorders go undiagnosed and untreated for 10 years on average, she said.
“We hope that by training the average citizen on how to identify signs and symptoms when someone is experiencing some mental health challenges, that delay in treatment will be much shorter,” Hoff said. “It could be depression, it could be anxiety, it could be psychosis where somebody is experiencing hallucinations or delusions. But the quicker we can get them to help, the better they’re going to be.”
Common signs of mental illnesses
- Unusually sad mood
- Loss of enjoyment and interest in activities that used to be enjoyable
- Lack of energy and tiredness
- Guilt or feelings of worthlessness
- Thinking often about death or wishing to be dead
- Difficulty concentrating or making decisions
- Moving more slowly or sometimes becoming agitated and unable to settle
- Having sleeping difficulties or sleeping too much
- Loss of interest in food or eating too much
- Excessive self-criticism and/or self-worry
- Withdrawal from others
- Physical: Pounding heart, flushing, shortness of breath, dizziness, sweating, numbness, tingling, dry mouth, nausea, vomiting, restlessness, tremors and shaking, inability to relax
- Psychological: Unrealistic and/or excessive fear and worry, mind racing or going blank, decreased concentration or memory, indecisiveness, irritability, anger, confusion, restlessness or feeling “on edge” or nervous, sleep disturbance, vivid dreams
- Behavioral: Avoidance of situations, obsessive or compulsive behavior, distress in social situations, phobic behavior
- Delusions: False beliefs of persecution, guilt, having a special mission, or being under outside control
- Hallucinations: Commonly involve hearing voices, but can also involve seeing, feeling, tasting, or smelling things
- Thinking difficulties: Difficulties in concentration, memory, and ability to plan, making it difficult for the person to reason, communicate, and complete daily tasks
- Loss of drive: Lack of motivation even for self- care not out of laziness
- Blunted emotions: Unaware of things around them and often react inappropriately (e.g, speaking in a monotone, lack of facial expressions or gestures, lack of eye contact)
- Social withdrawal: Withdraw from contact with others, even family and close friends; there may be a number of factors that lead to this such as loss of drive, delusions that cause fear of interacting, difficulty concentrating on conversations, and loss of social skills.
- Changes in emotion and motivation: Depression, anxiety, irritability, suspiciousness, blunted or inappropriate emotion, change in appetite, reduced energy and motivation
- Changes in thinking and perception: Difficulties with concentration or attention, sense of alteration such as the feeling that they or others have changed or are acting differently in some way, odd ideas, an unusual perceptual experience such as reduction or greater intensity of smell, sound, or color
- Changes in behavior: Sleep disturbances, social isolation or withdrawal, reduced ability to carry out work or social roles
- Increased energy and overactivity
- Elevated mood: Feels high, happy, full of energy, on top of the world, and invincible
- Needs less sleep than usual: Can go for days with very little sleep
- Irritability: Often occurs if others disagree with unrealistic plans or ideas
- Rapid thinking and speech: Talks a lot, very fast, and changes topics often
- Lack of inhibitions: Disregards risk, spend money extravagantly, or is very sexually active
- Grandiose delusions: Inflated self-esteem such as a belief that the person is superhuman, especially talented, or an important religious figure
- Lack of insight: Convinced that manic delusions are real, not realizing that it’s an illness
Source: Mental Health First Aid manual
By the numbers
1 in 5
People suffer from mental illness, about 57.7 million Americans each year
2 in 3
Go without treatment, mostly due to inability to access care and stigma
Estimate of lost earnings caused by serious mental illness
Treatment success rate for major depression, panic disorders, OCD
Source: National Council for Community Behavioral Healthcare
Find a course
Mental Health First Aid classes are offered by a number of organizations in the Miami Valley. A complete list of providers and sessions can be found online at http://www.mentalhealthfirstaid.org/cs/take-a-course/find-a-course/.
National Suicide Prevention Lifeline
Videos: Experts talk about dealing with mental illness issues.