19-year-old Nikolas Cruz opened fire on a Florida high school on Valentine’s Day, 2018. He killed 17 people. In an attempt to understand why this occurred, and how to prevent it in the future, many focus the debate on lack of gun control and mental illness. Could mental health treatment have prevented this?
Nikolas Cruz participated in mental health treatment, but we don’t know what type of treatment he received. He stopped his treatment for unknown reasons. He is described as having had “emotional problems” since childhood, a quick temper and anger problems. These often led to property destruction, odd behavior toward other students in school, and expulsion from school. The expulsion was related to fighting and/or carrying a knife in school. It was said that he struggled with grief or depression related to the death of his mother who died in November from pneumonia. The couple who took him in after his mother died said they did not see any warning signs. They thought he was doing well at his new school and was working hard to get his high school diploma.
Would Cruz have committed mass murder if he had the right kind of treatment, or if he had continued treatment?
It is my opinion that mental health treatment will only minimally stop mass shootings. Research demonstrates that mental illness is not a predictor of violence. There is some association between mental illness and violence, but the association is weak. One study, from Annals of Epidemiology, states “evidence is clear that the large majority of people with mental disorders do not engage in violence against others, and that most violent behavior is due to factors other than mental illness.” Anger is a problem for people with and without mental illness. Anger can be, but isn’t always, a component of mental illness. Also, many people with anger issues do not have a mental illness. According to the American Psychiatric Association, “mass shootings by people with serious mental illness represent 1% of all gun homicides each year.” Counseling can be helpful toward anger management, but only for people who are motivated for change.
It has been said that President Trump revoked former President Obama’s executive order barring mentally ill persons from gun purchases. Congress did revoke regulations preventing some people from purchasing a gun, but it was already limited in scope. People prevented from purchasing a gun have been determined by a court to have marked mental illness who are a danger to themselves or others; or lack the mental capacity to manage their own affairs; who has been declared insane by a court in a criminal case; and those people who are found incompetent to stand trial or found not guilty by reason of lack of mental responsibility. This is a very narrow subset of mentally ill people and would not apply to the vast majority of people who commit homicide.
The mental health system in America is broken. Treatment is not readily available to those who need it, particularly in rural areas. More than 50% of Americans who suffer from a mental illness do not receive treatment. High cost, limited health insurance, resistance and stigma are all barriers to help.
President Trump has said when someone is obviously disturbed they should be reported to authorities. Fair enough, but police officers rely on mental health providers to assess dangerousness and place people in the most appropriate level of care. Multiple levels of care include outpatient, intensive outpatient treatment, partial hospitalization, inpatient hospitalization, and residential. Persons with mental health disorders should be provided with health care which is the least restrictive. The aim is to preserve the patient’s dignity, rights and freedoms as much as possible. One is not easily or quickly committed to seclusion or restraint for their own or other’s safety. Most states have a 72-hour period in which an assessment is completed for emergencies. Once the 72-hour hold is lifted, patients can request a discharge. Or, if the hospital team believes it is necessary, they will start the commitment process. This process begins after a threat to self or others has been substantiated. It is not a highly effective prevention measure.
It is critically important to institute an action plan against shootings. The number of mass shootings is increasing. A national organization that tracks school threats says there are 10 threats a day on average. After the Parkland, Florida incident there have been about 50 threats a day on average.
When assessing potential lethality, professionals ask if the patient has access to weapons. If they are deemed dangerous, they take action to limit access to weapons. That’s a first step in decreasing risk. In the case of mass shooters, gun control is the first line of defense.
So what else can we do to prevent violence? Adopt and teach emotion regulation skills. Emotion regulations are measures taken by an individual to monitor, evaluate and modify intense emotional reactions. Deficits of emotion regulation are linked to depression, anxiety, substance abuse and other conditions. Improving emotion regulation skills can serve as violence prevention. For example, one skill is to accept and tolerate negative emotions. I would like to see these skills modeled by adults and taught across all levels of education.
Perhaps if Nikolas Cruz practiced emotion regulation skills he would have found healthy ways of expressing his anger and grief.