School shooters and mental health. What is Texas actually doing?

A day after a gunman killed 19 fourth-graders and two teachers at their primary school in Uwalde, the father of one of the children killed appeared on national television, clinging to a photo frame of his daughter. Angel Garza said Amery Joe was killed while trying to call 911 for help.

“How do you look at this girl and shoot her?” He sobbed.

Even in a world where corruption abounds, it is unattainable for most of us to point a gun at children and execute them. Politicians looking for answers usually turn to mental illness as a way to circumvent discussions on gun control. Gov. Greg Abbott told a news conference last week that “Anyone who shoots someone else has a mental health challenge. Period.”

This response has reduced what needs to be a nuanced conversation about how Texas can identify and treat people who may harm themselves or others, and how we keep guns out of their hands. The general comments on the mental health of mass shooters are also a disservice to people in this country living with mental illness: 1 in 5 Americans, the majority of whom are not violent.

An analysis of the secret services’ 41 attacks on K-12 schools between 2008 and 2017 can be instructive for Texas lawmakers as they discuss school safety and mental health measures. The report, published three years ago, found that most school-age attackers like shooter Uwalde share certain traits and circumstances.

All attackers had a source of social stress for at least six months before the attacks, such as harassment or conflicts with romantic partners and family members. Almost every attacker had problems at home – such as the divorce of their parents or relatives who used drugs – and most of the attackers also had a history of school discipline.

Psychological, behavioral and neurological symptoms are cataloged in the majority of young attackers. These symptoms range from depression to aggression to learning difficulties. But only 40% of perpetrators had a documented diagnosis of mental health before the attacks.

“When such signs and symptoms are taken into account, major situational factors (such as stressors that the child experiences) may be the cause of the behavior, as opposed to the disorder diagnosed,” the Secret Service report warned.

Now add weapons to this toxic combination of internal and external factors. Most of the perpetrators had access to firearms and used them in the attacks.

Uwalde’s attacker, an 18-year-old man, had no history of mental health, although he acted in anxious ways before storming Rob Elementary School with a semi-automatic rifle. People who knew him said he had abused animals, threatened girls online and once admitted to cutting his face.

The shooter may have had a mental illness that was not detected. But we cannot accept that all mass murderers have clinical conditions that can be diagnosed. A constant diet of hateful ideology can fuel violence, along with anti-social traits such as anger and defiance that go to extremes.

People are complex, and so should the mental health and behavioral interventions system for children and young adults in Texas. Lawmakers need to investigate whether schools are adequately equipped to report behavior and what the state can do to expand mental health examinations and treatment.

The Texas legislature has taken important steps since the Santa Fe high school shooting in 2018. It passed a law requiring each school to have a behavioral threat assessment team to identify students who could be threats in order to be referred to mental health professionals or the police. Legislators would be wise to study how this measure works in practice.

The legislature in 2019 also created a consortium for mental health for children and adolescents. This consortium has launched a telehealth network of medical and consulting professionals from a dozen medical schools, each responsible for a region in Texas. The consortium offers this telehealth program free of charge to school districts that can refer problem children for services.

Approximately a quarter of more than 1,200 districts in Texas participate in the Children’s Telemedicine or TCHATT Telemedicine Access Program, which covers more than 2 million students. An official with the program told the Texas Tribune that the Uwalde school district was in line to offer services before the shooting, but was not officially involved due to staff. The consortium plans to request more resources at the next legislative session.

State legislators should also consider expanding other programs that research shows have been successful in improving outcomes for children and young adults with mental health symptoms.

For example, young people experiencing their first episode of psychosis – a disorder that causes hallucinations and delusions – may benefit from an intensive care model known as coordinated specialist care, according to the Meadows Institute for Mental Health Policy. A team of specialists works with the person and his or her family for two or three years to manage a treatment plan, which may include medication, therapy and work or educational practices.

The earlier you start treatment, the better your quality of life. In Texas, this type of care is largely funded by federal grants. Experts say that many services provided under this model of care are not covered by private insurance, which creates a barrier to access.

Another team model of care for teenagers with significant mental health problems is called multisystem therapy and is designed to strongly involve the families of teenagers in their treatment. This model has shown good results among juvenile delinquents, but advocates of mental health say it should be extended beyond the juvenile system. Ultimately, the goal is to protect teenagers from trouble.

Governor Abbott is right that we need to do something about mental health care in Texas. And we need to do something about easy access to weapons. Focusing on the former and ignoring the latter will lead to more child deaths in schools where they need to be safe.

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