We may never know the motivations behind the horrific acts in Tucson and whether they could have been prevented. Mental illness, however, has been tentatively identified as a “suspect” in the shootings.   If we are to learn anything from this tragedy, we must look at mental health as a public health issue and give it the attention and resources it deserves. Owing to historical patterns of discrimination against mental health and addiction-related services and the ‘rescue’ focused systems of care in the United States, we are missing important opportunities to better serve our public health needs.   

It is first important to note that persons with mental illnesses are no more likely to be violent than the general population.  However, there are specific mental health symptom clusters that occur in a very small proportion of the population that, if untreated, increase the risk for violence.  Our goal should be to reduce the overall prevalence of mental disorders and to do whatever we can to identify individuals early in their course of illness and intervene effectively with them.

The Importance Of Early Identification And Treatment 

The reality is that half of all people with a mental health diagnosis first experience it by age 14, but will not receive treatment until age 24. Less than one-third of teens who need mental health care receive help. While we have science-based methods to successfully engage and serve persons with even the most severe mental illnesses, access to those services continues to be a challenge for multiple reasons, including resource limitations and the continuing social stigma associated with behavioral health conditions.

Early identification and effective care of emotional or behavioral difficulties in school-aged children could do much to close these gaps, alleviate suffering, promote strong social relationships and allow young people to lead productive lives. Just as we have tests for hearing and vision, we need to have mental health check-ups with effective follow-up to reduce the prevalence and disability associated with these developmental disorders.   The U.S. Preventive Services Task Force in March of 2009 called for depression screening for teens in primary care settings and recommended that all teens ages 12-18 be routinely screened for depression by their primary care providers.  Perhaps a mental health check up would have identified the alleged Tucson shooter earlier in his life and averted the current tragedy. 

Congress has taken significant steps in recent months and years to improve access. Because of the Affordable Care Act, preventive services, like depression screening, will be more available, and rates of early identification should improve. The law also emphasizes the importance of integration of care. The Mental Health Parity and Addiction Equity Act (passed in 2008) removes barriers to treatment by requiring mental health and addictions coverage offered by health plans to be on a par with general medical coverage.

Remaining Challenges

That’s the good news. Yet, it is also clear that we must go further on a policy level to make prevention of emotional and behavioral disorders a national priority. In March of 2009, the Institute of Medicine (IOM) issued a report on “Preventing Mental, Emotional, and Behavioral Disorders among Young People,” illustrating the dramatic impact these conditions have on our population.  The report also reviewed our substantial evidence base regarding effective prevention programs that have long term effects on reducing troublesome behaviors, promoting health and mental health as well as other positive outcomes such as improved academic achievement.

Significantly, the report calls for making prevention of these conditions a national priority. We currently lack a national initiative to advance the use of prevention and promotion approaches to benefit the mental health of the nation’s young people. There is no national program, like the physical fitness initiative of the 60’s, to ensure that every child maximizes his or her capacity.

We also must promote and expand well-designed pre-school-based and school-based screening programs, which can recognize early patterns of behavior that pose a risk for a child’s academic, social, emotional or behavioral functioning and get young people the help that they need to develop healthfully.

Research should be expanded to assure the availability of reliable, culturally and linguistically competent early identification and diagnostic tools. Primary care providers need training in their use. 

As with so much in America’s health care system, our problems are fundamental and relate to the history of the system and the paradigms under which it operates.  Behavioral health conditions have historically been neglected by the general health care system and are only now gaining the traction that they deserve.  We’ve focused principally on treating rather than preventing illnesses within the recognized health sector. To build healthy populations we need to focus more broadly on prevention and early identification to augment effective treatment.  We must include educational systems and other community resources as key sectors for intervention. 

It likely is impossible to ever fully prevent tragedies such as those at Virginia Tech or in Tucson.  However, through an affirmative approach to promoting health and early identification of problems we can reduce their frequency.