Intervene to prevent the downward cycles that lead to violence
If Congress can't agree on gun control, it needs to go big on behavioral health with serious investment in recruiting, training and properly paying behavioral health workers
Editor’s note: Contributors Mark Hester and Gary Conkling periodically write complementary pieces for The Oregon Way examining different aspects of the same issue. Yesterday, Mark looked at possible paths forward on gun control the wake of the Uvalde, Texas, school shooting. (Read here.) Today, Gary explores ways to attack the conditions that can lead to gun violence.
Lacking the political will to restrict the instruments of violence shouldn’t prevent a bipartisan, national effort to address the impetus of violence. The nation needs a behavioral health initiative on the scale of the Peace Corps to identify and intercept human trajectories that lead to suicide, self-harm and mass shootings.
There is credible science suggesting we can intervene successfully to prevent downward cycles of despair, isolation and violence. But it takes a serious investment in recruiting, training and properly paying a bolstered behavioral health workforce that can deploy in schools, community centers and clinics. Too many behavioral health providers are overwhelmed by worker shortages that make them unable to treat patients without delays.
While I would welcome the types of gun-control measures that Mark Hester described yesterday – and more, I’m pessimistic about the political courage of Congress to pass anything. But we must do something.
Defenders of gun ownership have long said people, not guns, kill other people. A focused, national effort to expand behavioral health access, including proactive steps to prevent more mass shootings, will put that glib defense of guns to the test. A constructive debate over how to implement a domestic Peace Corps to combat violence feels more promising than another cynical, circular debate over gun control.
The American Psychological Association (APA) commissioned a report nearly a decade ago to identify evidence-based actions to reduce gun violence. Recommendations range from addressing developmental issues such as school bullying to policies that deny high-risk individuals access to guns.
Most of the recommendations in the APA report would get head nods from Democrats and Republicans, liberals and conservatives. However, implementing these preventive steps will require a massive investment to train and place behavioral health specialists, not just in clinics but in physical and online communities where they can spot and address ‘red flag’ behavior.
It’s important to acknowledge up front that preventing violent behavior by identifying and addressing its antecedents is complicated. “There is no single profile that can reliably predict who will use a gun in a violent act. Instead, gun violence is associated with a confluence of individual, family, school, peer, community and sociocultural risk factors that interact over time during childhood and adolescence,” according to the APA report.
“The most consistent and powerful predictor of future violence,” the report concludes, “is a history of violent behavior.” That argues for better reporting and tracking of violent behavior in schools and communities that triggers prevention efforts by a robust Peace Corps of behavioral health specialists. It also argues for recognizing and interceding on behalf of victims of hazing, bullying and discrimination.
“Prevention efforts, guided by research on developmental risk, can reduce the likelihood that firearms will be introduced into community and family conflicts or criminal activity,” the report says. “Prevention efforts also can reduce the relatively rare occasions when severe mental illness contributes to homicide or the more common circumstances when depression or other mental illness contributes to suicide.”
Following the mass shooting at Robb Elementary School in Uvalde, Texas, discussion has picked up on how to harden school facilities with limited access and armed school guards. Some have argued for arming teachers. Researchers – and the US Secret Service – have studied school safety and agree putting more guns in schools is wrongheaded. Instead of “hardening” schools, they say we should “soften schools” by increasing support for the social and emotional needs of students. That’s what behavioral health specialists do.
"Our first preventive strategy should be to make sure kids are respected, that they feel connected and belong in schools," Odis Johnson Jr., of Johns Hopkins University's Center for Safe and Healthy Schools, told NPR. Education, he says, should include conflict resolution, stress management and empathy – “skills that help reduce unwanted behaviors, including fighting and bullying”. The Secret Service says most school attackers, including the shooter in Uvalde, have been the target of bullying.
Jackie Nowicki, who has led school safety inspections for the US Government Accountability Office (GAO), recommends “anti-bullying training for staff and teachers” and mindful adult supervision that includes reporting “hostile behavior”. The Secret Service urges schools to adopt a threat assessment model in which trained counselors and psychologists work with administrators and teachers to identify and support students in crisis.
The APA report called on “the mental health community to take the lead in advocating for community-based, collaborative problem-solving models to address the prevention of gun violence. Such models should blend prevention strategies to overcome the tendency within many community service systems to operate in silos.” That would involve police training on crisis intervention and training community members on “mental health first aid”.
Behavioral health specialists also can play a role in helping communities embrace new norms, such as promoting safe gun storage and encouraging gun dealers to prevent “domestic violence offenders, persons convicted of violent misdemeanor crimes and individuals with mental illness who have been adjudicated as being a threat to themselves or to others” from obtaining firearms.
APA said, “Reducing the incidence of gun violence will require interventions through multiple systems, including legal, public health, public safety, community and health. Increasing the availability of data and funding will help inform and evaluate policies designed to reduce gun violence.” But none of that will happen without a corps of men and women trained in behavioral health, spread out through our communities, renumerated fairly for the work they do and devoted to prevent tragedies that have become commonplace in America.
We don’t have to argue about the Second Amendment or debate whether an AR-15 is an assault rifle or just a rifle. These arguments are frustrating and produce nothing but division. If we really want to do something that matters, and do it now, look no further than creating and funding a domestic Peace Corps that recruits, trains and dispatches behavioral health specialists to our nation’s schools and health care clinics. It’s the best bet we can make to prevent the next mass shooting.
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Gary, thanks for this in-depth look into what it will take to "soften" schools and build a robust behavioral health system beyond classrooms. However, it's not one or the other, nor all or nothing of either. Your analysis suggest softening schools will be a major undertaking, but I wonder what the best next steps are to implement shorter-term solutions. As with many things, there is a time value to interventions, so there's a benefit to start sooner even if that means starting small. Ditto for other (gun control), which can be incremental and immediately effective, e.g. by raising the age for the purchase of weapons to 21, expanding background and limiting high-capacity assault weapons. I'd like to see a side-by-side list of "best next" timely steps in both categories -- which could for the basis of a compromise package that gives credence to both kinds of solutions and focuses on the results that we all want to see.