In the Aftermath of the Marysville Shooting

I was sitting at my desk at Mental Health America when the news broke on Friday afternoon that a fifteen year old student at Marysville-Pilchuck High School in Washington had opened fire in the school cafeteria, killing at least one other student before taking his own life as well.

Another fourteen year old who was shot died over the weekend, bringing the death toll to three – all young teenagers.

It is hard to know what to make of these kinds of tragedies, because we don’t really understand them.  

The shooter, Jaylen Fryberg, was said to be popular and well-liked.  The victims – two of whom remain in critical condition – were his family and friends.  Some form of bullying may have been involved, but no one had any reason to believe that when he walked into school on Friday he intended anyone harm.

In recent years, shootings – whether or not they are related to a mental illness in the shooter (and most frequently they are not) – have shone a bright light on how poorly we handle mental health concerns in our country.

Half of all mental illnesses manifest by the age of fourteen – roughly the age of Jaylen Fryberg and his friends on the day that they were shot.  And yet, it typically takes ten years from the time symptoms first manifest to the time we get an accurate diagnosis and treatment.

We can - and should - do much better than that.

Suppose for the moment – and we do not know this today – that Jaylen Fryberg’s actions were the result of an undiagnosed mental health concern.  Were there other signs of such a concern present in the days, weeks, and years leading up to the Friday he died? 

In hindsight, some people think so.  A week before he died, he wrote on Twitter that “I know it seems like I‘m sweating it off, but I’m not.  And I won’t ever be able to.”

It’s hard to say what that implies, but it hints that there’s really only one course of action to prevent tragedies like this one – early identification and early intervention before crises occur.

At Mental Health America, we believe strongly that we need to intervene long before people die as a result of their mental health condition or someone else’s.  We need to think of mental health concerns in the same way we do other chronic conditions.  We need to screen early and often and – when we detect concerns – we need to stop waiting until they reach Stage 4 to do something about them.

Our screening tools – at www.mhascreening.org – are available online to anyone who is concerned about whether they, a family member, or a friend has a mental health problem.  More than 150,000 screenings have been completed since the beginning of May, and a thousand more are completed every day.

And they tell us something extraordinary - while as many as two-thirds of those who screen have an early mental health that warrants attention from professionals, two-thirds of those indicate that they have never before been diagnosed with a mental health condition.  

There are things we can do to prevent both crises and tragedies related to mental illnesses and to promote recovery  – and both state and federal legislators ought to start paying a lot more attention to these, and a little less attention to what we do to or with people after they reach the late stages of a disease process.

Because by then, it is often too late to make much of a difference.

This week, the children and young adults of Marysville are starting down a new path, leading lives that will be affected by the trauma they all experienced last Friday.  So the question we must ask ourselves is this:  Will we act on their behalf today, or will we wait ten years, until some of them are in crisis, before we do?

Only time will tell.

A version of this blog was also published by Mental Health America as its "Chiming In" blog for 10/27/14.  For more information on mental health issues in America and Mental Health America's #B4Stage4 efforts, visit MHA at www.mentalhealthamerica.net.

The Missing Mental Health Element in the Ferguson Story

By now, everyone has heard the news from Ferguson, Missouri.  An unarmed 18 year old named Michael Brown was shot and killed by a police officer.  Michael Brown was black.

Some of the events surrounding the shooting are in dispute.  But what isn’t in dispute is that for the past two weeks, a community has been torn apart by race – a community that until recently was best known for its proximity to St. Louis and its designation as a Playful City, USA.

Picture credit: Health Affairs

Media reports since the August 9^th shooting have focused almost entirely on one angle – race relations. 

We’ve heard about unrest in the city, the National Guard, police in riot gear, and danger in the streets.  We’ve heard about the District Attorney’s ties to law enforcement, and concerns that a too-white Grand Jury may be racially motivated not to indict the police officer involved in the deadly shooting.

But the media have been strangely silent about a different angle – this community is experiencing an ongoing trauma.  And where are the mental health services it so desperately needs?

Make no mistake about this.  Race matters.

I have written in the past about people such as Anna Brown, Miriam Carey, and Allen Daniel Hicks, Sr., a mother, a dental hygienist, and a coach.  None survived encounters with the police during times of crisis.  

And we know they are not the only ones.

But what these people had in common was that the final crises they experienced were in part medical. In some respects, that makes them more sympathetic than Michael Brown.  In others, unfortunately, it allowed media to dismiss what happened to them as aberrations brought on in part by their medical emergencies and suspicion of mental illness (an assumption that proved to be fatally incorrect in all three cases).

So the message frames in those stories quickly dissolved.

But when we’ve got a community at “unrest,” the story frame lives on. 

But let’s read between the lines.  This isn’t just a community at unrest, this is a community in distress.

And it is time we did something about that.

I have posted a version of this blog on Mental Health America’s web site, which you can find here.  In that blog, you’ll find several resources to help communities in distress, ranging from local MHA affiliates to national helplines, to tools and training aimed at helping communities recover from tragedies.

You’ll also find a call to action to join our #B4Stage4campaign, which launches in September, at Mental Health America.  You will hear much more about this campaign in the coming months.  It is designed to move our attention around mental health to where it belongs – on prevention, early identification of concerns, and early intervention. 

And it is designed to get public officials and the media to recognize that managing distress comes first and prevents violence, and to demand that they put resources into families and communities before mental illnesses progress to “Stage 4,” when “danger to self or others” is the only standard we have – a standard that leads too frequently to incarceration or tragedies like these.

Finally, you’ll find mental health screening tools and other resources you can use for yourself or with family and friends, especially if you – like me – keep imagining what your life would be like if your child were the victim here, or if your community was the one falling apart.

Why Are We Afraid of Mental Health Screening?

Should all school children be screened for mental health?

The evidence suggests that if we do not screen them, then we will be continuing a persistent and historical pattern of neglecting the mental health needs of our children.  But why let evidence get in the way of fear?

Over the past several months, legislators in a number of states have considering mandating – or at least offering – mental health screening for all children, either in the schools or in pediatricians’ offices. 

But when the Connecticut Legislature had a public hearing on a mental health screening bill recently, opponents came out in force. 

One parent called mandatory screening an “unnecessary invasion.”  The Connecticut Civil Liberties Union argued that mental health screenings should be optional.  A treatment provider asserted that the problem wasn’t with a lack of assessment, but the lack of treatment options.

And in recent days, a Palm Beach Post writer in Florida joined the chorus when he claimed that mental health screening is less “straightforward” than vision and hearing screening in an editorial entitled “Florida Should Not Require Mental Health Screenings in Schools.”

The truth is that if we don’t at least screen, then we don’t know what it is we’re supposed to treat.  And this “head in the sand” approach is what has gotten us into trouble in the first place.

The extent of our neglect of our children’s mental health needs is staggering.  

In 1999, the U.S. Surgeon General estimated that 10 percent of children had mental illnesses serious enough to disrupt their home life or schooling.  That percentage is still cited today, but we have more recent data, too.

For example, the Substance Abuse and Mental Health Services Administration noted that in 2009 two million children between the ages of 12 and 17, or 8.1 percent of the population, had a major depressive episode.

In the same report, SAMHSA also disclosed that 2.9 million children that year, or 12.1 percent of the population, received at least some mental health services in a school setting.

But here’s where the neglect comes in.  Only 407,000 children in 2009 received special education services because of their mental illness – just a fraction of those who needed them.

And this neglect is getting worse.  According to the most recent data from the U.S. Department of Education, only 389,000 children were offered special education services in 2011 as a result of their mental illness.  To put this number in context, this was:

• The smallest number in 20 years;
• A drop of over 20 percent in just six years; and
• Only 8 tenths of one percent of the entire school-age population.

In other words, less than one in every ten children with a serious mental illness is even identified as emotionally disturbed by our special education system.

As for the other nine in ten, their time bombs just tick silently.

Perhaps this could be justified if the stakes were low.  But they are not.  We all know the results of neglect.  We see them every day in our homes and neighborhoods, and, most tragically, on the news.

And what is most frustrating is that the “controversial” screening that could save lives is both simple and non-invasive – and straightforward. 

More often than not, mental health screening consists of a few questions that can be answered and scored in minutes. 

Here is a link to a commonly-used tool, called the PHQ-9.

It asks nine questions about how a person has felt in the last two weeks, with one follow-up question at the end.  Has the person been having trouble falling asleep or staying asleep, or sleeping too much? Been feeling tired? Experienced a poor appetite or overeating? Had trouble concentrating?

These are hardly the kinds of questions that probe so deeply into the psyche of the individual as to scar or stigmatize them for life. 

But, ironically, when we refuse to ask these questions we do end up stigmatizing people for life – if not costing them their lives.

It may seem hard to believe that there could be any fuss about using such screening tools universally when you consider the alternative.  Or that the tools can reasonably accurately identify an emerging mental illness.  But they can, and do.  And the more we use them, the better off we will be.

So what are our schools afraid of?  And, more importantly, what are we all afraid of? 

To reach Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/