Preventing Violence: The Mental Health Community Must Step Up!

Following the terrible events at Newtown, CT, there have been many calls for the mental health community to step up to fight this senseless violence.

The question is “How?”  While the links between violence, mental illness and gun control are very complex, is it possible that we can do more?  Certainly the mental health community knows how to help people deal with trauma, grief and loss, and On Good Authority has produced several programs on these topics.  But what do we know about prevention?

Do we know enough about what some researchers have called “Pathways to Violence” to be predictive?

Do we know enough about threat assessment, warning behaviors, and risk factors?

What about assessing likely severity and probability of outcome?

Can these behaviors be identified, coded, and utilized in a valid manner?

Is there a “People who might be Violent Someday” database, as there is with sex offenders and with people who threaten the President?

Do we report schizophrenics to some as yet unknown place?

Do we report anyone who seems weird?

Do we report people with Asperger’s?

What about our ethical standards regarding confidentiality and duty to warn?

Once a person is identified as a serious risk, then what?

And really, given the demographics of the rarity of these terrible events, and the epidemiology showing that only 4 percent of violence in the United States  can be attributed to people with mental illness, would new laws about this be overreacting?

You might wish to read the excellent article, “The Role of Warning Behaviors in Threat Assessment: An Exploration and Suggested Typology,” by J. Reid Meloy, Ph.D.*, Jens Hoffmann, Ph.D., et al, published in Behavioral Sciences and the Law, 2011.  Here is the link:

Let’s try, in these next few weeks, to pool our ideas and get a dialogue going.  Then we can pull a report together and send it to—where?  To our professional organizations?  To Homeland Security?  To our representatives in Congress?  To the FBI, as with people who threaten the President?  Maybe one of you knows.

Surely, with our collected knowledge, we can make some contribution to help save our children and ourselves from massacres like these.

Barbara Alexander, LCSW, BCD


3 thoughts on “Preventing Violence: The Mental Health Community Must Step Up!

  1. I sure hope that we don’t ever report people with Asperger’s or schizophrenia. Seems to be it would be a terrible invasion of privacy and might prevent many from seeking care. I think treating people with mental illness as if they are criminals or ticking time bombs adds to the stigma these people already experience and perpetuates bias and discrimination against people who live with mental illness.

    The majority of people with these diagnoses will not be violent. It breaks my heart to imagine some sort of government intervention requiring reporting of these diagnoses in the absence of any other risk signifiers.

  2. Mary Rich on Dec 20, 2012 said:
    I have a client who has just purchased a gun.
    I’m pushing him to get rid of it. This is definitely something we can do. Having one is SO
    Newtown makes me sick– like all of us!

  3. Mark Smaller, Ph.D. wrote:
    How Can We Help: (was posted on the American Psychoanalytic Association
    website (

    Newtown: Horror and Tragedy I happened to be working from home today when I received the first CNN alert. As the morning wore on, worst fears were realized. Again, unthinkable horror of children, teachers and staff being cut down by a shooter. I knew our association would need a response, but thinking of my own young children at school today immobilized me.

    I went grocery shopping to cope. I focused on a grocery list. It wasn’t until I picked up my kids at school that I began to think again. I explained to them what had happened, and my 12 year old middle school daughter said she had heard. My seven year old twins had not.

    Explaining this to our children or grandchildren is complex but must be done. One wants to be clear about what happened as the TV will make things not only clear but scary. Being truthful while assuring safety is the challenge for any parent, while taking age and development into account. My seven year old son responded, “Dad, I’m not afraid because we have lockdown drills. We know what to do.” I assured them that their school takes precautions with locked doors and drills and they are safe. When he asked why someone could do this, I hesitated. “We don’t know. We will find out what happened.”

    It is true that we will find out through the media and hear about it throughout the holidays.
    Our helplessness, the worst of all possible human feelings, demands it. Our anger, disbelief and sadness will help us organize some story, psychoanalytic or not, in our minds after facts of the shooter’s life emerges. But even finding out, even developing profiles, and greater school, mall, or workplace security, will not prevent such tragedies. Sadly, they are unpredictable and will continue to occur. I have always believed they will become worse with the the inaccessibility for mental health services for most Americans, a poor economy, the remaining stigma and resistance for getting appropriate help, easy access to guns, and something that goes wrong in our culture.

    As an adult and child psychoanalyst I still can’t sort it out. After practicing almost 40 years I have seen adolescents, and adults who I imagined would be capable of such violence. Although I work with students in an alternative high school, many of whom are in gangs, they are not necessarily the ones I think about when this kind of tragedy occurs. Gang culture is violent, and frightening but somehow more predictable than what happened today in Newtown. No, its the students who have been quietly bullied for years, or seriously neglected at home, or subtly marginalized by the time they are young adults. I think of the ones who were not disruptive at school, but rather gradually socially withdrew during high school. I think of severely traumatized returning veterans who are no longer themselves when they arrive home and cannot get appropriate help. Overwhelming helplessness, isolation, and possibly access to weapons can compel one towards explosive violence.

    We as psychoanalysts, as parents, grandparents, friends, and fellow citizens in our communities must pull together and help each other cope. Speaking to each other of this tragedy is a critical start.

    And we can’t forget. A dear friend, now 25 years later, still suffers the impact of having been in an elementary school as a student when such a shooting took place. Survival has meant reliving this trauma each time these tragedies occur. We cannot forget. Helping survivors, helping our children, our communities, our schools, and our politicians, will not happen with quick answers or glib solutions. Rather, we must first share common pain, making our compassion known in word and action. We cannot not immediately make sense of this, but we can try together.

    I was walking across a parking lot later today with my son. I found myself not being able to let go of his hand, even once in the building. We should all hold each other a little more tightly, more closely, tonight and for awhile.

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