黑料正能量 Note: This MHW article highlights the complexity in preventing gun violence, noting that a person who commits these acts may be distressed or in crisis, but not necessarily recognizable as having a psychiatric diagnosis. The solution is not just to remove guns, but to focus on prevention techniques such as threat assessment, after-care programs, and peer supports. Then we need to enhance crisis services, mental health first aid courses, and broad outreach and engagement within communities. This preventative response could reach individuals who may be desperate for care or services but, due to mitigating social factors, are more likely to react through violence than reaching out for help.
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Newtown Reveals Need For Prevention Programs, Peer Supports
Mental Health Weekly; Volume 24 Number 1, 1/6/2014
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Many people 听continue 听to try to get 听their 听minds 听and 听hearts 听around 听the depth 听and level of loss from the tragedy that took place in Newtown, says Robert 听Glover, 听Ph.D., 听executive 听director of the National Association of State Mental Health 听Program Directors (NASMHPD). 鈥淪uch profound loss brought 听forth lessons learned and ideas on how to prevent such a tragedy from happening again, bringing proposed听听 mental health legislation,鈥 he said.
While it is a positive that there has been increased attention to mental health, many of the mental health proposals address only increasing the number of hospital beds, said Glover. 鈥淓ven more 听importantly, we also need to direct funding toward building a robust system of 听care in 听the community that includes 听peer 听support services, community 听access and services pro- vided 听by听 competent providers, 听and crisis 听services,鈥 he said. 鈥淎 strong community system听 of care can听 pro- vide 听alternatives听 听to 听hospitalization 听and 听significantly 听reduce 听lengths 听of stay in hospitals.鈥
However mental health services should not be seen 听as 听only 鈥渋npatient鈥 听and 听鈥渙utpatient,鈥澨 听Glover 听explained. 听鈥淭here 听is 听a 听vital 听role 听for state 听psychiatric 听hospitals that should 听be 听connected with 听community services and there should be cross sharing听 between the expertise 听of hospitals 听and the community,鈥 he said. For 听any听 proposal, 听we 听need 听to ensure听 听consumers鈥 听rights 听and 听protections 听are supported while 听ensuring 听safety 听for 听consumers, 听families, and community.鈥
Glover added, 鈥淚n particular, it is important 听to continue 听to build a network 听of 听peer 听support听 听and 听self-directed services, which have been shown across systems to significantly assist in the recovery 听process.鈥
Peer support 听is also essential 听in helping 听to address 听workforce 听strategies, 听Glover 听added.听 听Peers 听offers 听a model for other people 听to see 听individuals听 听with听 听mental听 听illness听 听being successfully 听employed and 听assisting colleagues听 听with听 听healthcare听听 听enrollment, employment, and whole health issues, such听 听as 听smoking cessation and obesity, for example, 听he said.
鈥淚n addition 听to proposals to address mental health, we have the opportunity听 to 听insure 听vulnerable听 听and underserved populations through 听the 听implementation of ACA 听and health 听care reform,鈥 said Glover. Although 听the 听enrollment 听process 听has been听 听initially 听challenging,听 听targeted outreach 听and enrollment is essential to 听reach 听newly-eligible 听adults 听with mental illness and substance use disorders, and听 听identifying specific barriers relevant to outreach and enrollment for people with mental health and substance use conditions, 听he said.
Building consensus
鈥淥bviously, the Sandy Hook shooting galvanized public concern,鈥 Dewey Cornell, Ph.D., clinical psychologist 听and 听professor of education at the University of Virginia, told 听MHW. 鈥淲e certainly 听hope听 听we can achieve some of the momentum [that 听occurred] 听this 听year 听and 听build consensus on practice strategies.鈥
Cornell authored a report 听commissioned 听by the American Psychological Association (APA) to convey research-based conclusions 听and recommendations (and to identify gaps in such 听knowledge) on 听how 听to reduce 听the听 incidence 听of gun 听violence鈥 whether 听by homicide, 听suicide 听or mass 听shootings 听鈥 nationwide (see MHW, Dec. 16, 2013).
Cornell 听said 听the 听field 听needs 听to think听 听more听 听broadly听 听about听 听people distressed in crisis. 鈥淲e have to think about 听crisis 听intervention, threat 听assessment 听programs, 听and boost training in first response intervention 听and Mental Health First Aid,鈥 he said, the latter 听referring 听to 听the 听national 听program initiated by the National Council for Behavioral Health to teach the skills to respond to the signs of mental illness and substance use.
鈥淲e know that 听most 听gun violence is not committed 听by a person 听with 听a mental 听illness,鈥 said听 Cornell. 鈥淎n individual 听committing 听a violent act may be 听troubled 听and 听disturbed, but 听they 听do 听not 听have 听a 听mental 听illness.鈥 听They 听may 听be 听acting 听out, 听or experiencing anger 听and 听a 听desperation that suggests mental health 听services would 听be appropriate, he said.
Improving听 听treatment听 听and听 听services are effective ways to help individuals听 in crisis. Better hospital 听services and after-care services are also needed, Cornell 听said. 听In 听a听 majority of cases, the needs 听of a person with problems or concerns have to be addressed 听before 听escalating 听into 听violence, Cornell said.
A boost 听in crisis-related 听services is 听essential,听 听said 听Cornell. 听鈥淏ecause our 听mental听 听health听 听services 听are 听already stretched 听to the limit, we have to 听focus 听and 听prioritize 听on 听the 听most seriousness of emergencies,鈥 听he said.
Cornell鈥檚 report, 听鈥淕un 听Violence: Prediction, Prevention, and Policy,鈥 identifies 听early intervention 听and 听prevention strategies, such 听as the establishment 听of threat 听assessment 听teams. Threat assessment,听 said Cornell, is defined 听as a 听problem-oriented prevention 听strategy 听that 听puts 听the 听focus 听on what 听problems 听or concerns 听underlie 听a person鈥檚 threatening behavior.
We鈥檙e seeing 听threat 听assessment primarily in schools, in college 听settings 听and听 听in 听the 听workplace,鈥澨 听said Cornell. 听鈥淲hat we need is 听federal support 听for threat听 听assessment 听in community 听mental 听health 听centers,鈥 he said. Mental health 听staffs, including psychologists, 听are core members 听of 听a 听threat听 听assessment听 听team, 听said Cornell.听 听A 听multidisciplinary听 听threat assessment 听team would 听also include educational, 听human听 听resources听 听and social services representatives, and a lawyer; for the most serious cases, a police officer, he said.
Threat assessment initiatives have not been 鈥渂uilt into the CMHC system,鈥 said Cornell. 鈥淲e see that as the next logical step,鈥 he said. Additionally, 听there 听needs听 听to 听be 听federal funding earmarked for threat assessment research, 听Cornell said.
Cornell 听said 听he 听has 听worked 听on threat 听assessment programs in Virginia schools 听and found 听suspension rates 听had 听gone 听down. 听Additionally, he 听and 听his 听colleagues 听are 听working on longitudinal 听research 听in this area, he said.
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