December 17th, 2012
The author is a former Connecticut state legislator and the former president of a foundation in South Florida.
In the aftermath of the unspeakable tragedy at Sandy Hook Elementary School, what we all seek most are the answers to two questions—why did this happen, and what could have been done to prevent it?
As a former resident and elected official of Connecticut, I have thought about these questions while watching the faces of so many friends and former colleagues. Those leaders are attempting to answer these two questions while somehow reassuring us all that something like this won’t happen again.
We may never know for sure what led to this particular tragedy, or whether it specifically could have been avoided. But there are things we can do to prevent tragedies like this from happening in the future.
And funders who do not want to wait to do something relevant in the wake of the Sandy Hook tragedy have several good options to explore.
First, because early identification is a key to every prevention activity, every child in America should be screened for mental illness as a part of well-child examinations. Funders at every level can support this, just as they have funded immunization initiatives, hypertension and diabetes screening programs, and other chronic disease prevention and mitigation initiatives.
Behavioral health screening tools have some esoteric names, like the PHQ-9, PHQ-15, GAD-7, and AUDIT/SBIRT, but they tend to be simple and inexpensive to use, to interpret, and to score. And they give us clues about early symptoms of trauma, depression, anxiety, and addictions so we can intervene early and effectively when young people are at risk.
What we learned about the Sandy Hook shooter during the first days of the investigation came mostly from classmates who said that he seemed just a little quieter than, and just a little different from, most.
These are not, by themselves, symptoms of mental illness. But a simple screening would tell us so much more about what is going on with children exhibiting emotional or behavioral concerns, and leave us guessing just a little less.
In addition, every child exposed to violence, including surviving students from Sandy Hook Elementary School, need to be screened and treated for the trauma-induced symptoms they will most certainly experience for months and years to come.
Second, every family should have access to a community hotline that can help them with pre-crisis intervention. In some communities, calling 2-1-1, the local community mental health center, a family doctor, or a Mental Health America or National Alliance on Mental Illness (NAMI) affiliate reaches someone who takes crisis calls. My wife, Pam, is CEO of a county mental health association, and she notes that the consistent thread in the hundreds of crisis calls her agency takes is that, even then, families do not know where to turn to get help. And, as a result of $4.6 billion in state mental health budget cuts in the nation over the past four years, there are not enough funded services to which to refer them anymore.
That’s the case when families finally make the call, but this is something they often avoid because they know they will face stigma from family members, neighbors, friends, and even law enforcement officers as soon as they do.
This is why the third thing that funders can do is so important. Now more than ever, we need anti-stigma campaigns to disassociate mental illness from violence in the minds of so many people. Serious mental illness is a chronic disease, and we must treat it as such if we want more families to seek help.
The time for “de-stigmatizing” isn’t when everyone is searching for something or someone to blame for a tragedy. No one is listening then.
As the calls cascade in the days and weeks to come—and they will—to prohibit people with serious mental illnesses from buying or possessing firearms, in lieu of calls for the more comprehensive gun control laws we need, we must be reminded that violence is a problem throughout the nation. It is not perpetrated by just one type of individual. It is most often committed by people who will never have a diagnosis of mental illness. And it is often aimed at people who do.
Twenty-seven people—twenty of them innocent young children—were homicide victims in Sandy Hook, Connecticut, on Friday. (The shooter, Adam Lanza, also took his own life.) It may be hard to believe, but according to data reported by the Guardian, in England, our nation has a Sandy Hook–level massacre every single day.
What makes this one different and shocking is this: it happened in one, unexpected place. But, by using the data in the Guardian, one can calculate that on average, at least two dozen other shooters in towns and cities throughout our nation inflict such horror on at least two dozen victims every single day, leaving two dozen parents to live forever with the unimaginable and palpable misery and grief that these Sandy Hook parents now feel, too.
This epidemic of violence, it has been said, is a public health problem, one that has persisted for too many years in our country. And as long as we believe that we can end it by singling out one small group of people, we will squander too many opportunities to prevent the next Sandy Hook.
A few parts of this post were adapted from a post I wrote, “The Tragedy of Sandy Hook,” for my blog, Our Health Policy Matters, December 17.
Health Affairs, GrantWatch column, “Mental Health: What Foundations Are Funding,” September 2012.
Annie Van Dusen Wohlegenant, “After Aurora: What Can Foundations Do?” Health Affairs GrantWatch Blog, July 31.
Also, Grantmakers In Health has a behavioral health funders network, which can be reached at firstname.lastname@example.org.
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