Redeeming the Tragedy in Aurora

 (Note: The following commentary is virtually identical to one that I prepared 18 months ago in the wake of the shooting tragedy in Tucson, Arizona.)

Last weekend, a tragedy of national proportions occurred in Aurora, Colorado. Twenty-four-year-old James Holmes repeatedly fired an assault rifle, a shotgun, and a pistol into a group of movie-goers attending the premier night showing of a new Batman film, The Dark Knight Rises. Twelve people were killed outright, including a 6 year old girl; 58 more were wounded, 9 seriously. Urgently, we need to understand and act on this very sad event so that a similar event does not occur in another setting with other participants. Disconcertingly, this event is remarkably similar to the shootings that occurred in Tucson, Arizona, just 18 months ago.

Based on CNN media reports and elsewhere, a picture emerges of James Holmes as an extremely bright and talented college student who developed a serious mental illness shortly after he began graduate school at the University of Colorado. Allegedly, he had taken on the identity of the Joker, an evil character in the Batman film series. Over time, he apparently spent progressively larger amounts of time in isolation and delusional thinking. A critical question can be raised as to why he did not receive appropriate mental health care.

Clearly, it will not be productive to point fingers at school officials, at fellow students, at friends, or at his family. We cannot know their personal motivations, what they actually noticed, or why they did not intervene. Rather, let’s look at what could have happened, but didn’t.

We must look at two things. First, how can we give people the knowledge and the skills to take action when they encounter a family member, friend, or acquaintance who is obviously descending into a mental illness? Second, how can we assure that appropriate and effective mental health services are actually available in the community?

Developing Knowledge and Skills

Before someone will feel secure and confident to intervene, including friends, classmates, teachers, family members or other community members, they must have an appropriate understanding of the signs and symptoms of mental disorders; they must know how to respond; and they must know what resources are available to assist them. Most people have received no training in any of these areas; in fact, most people are unaware of current mental health treatment resources available in their own communities. Obviously, we must do something about this.

As part of health education in high school and college, every student should be informed about the signs and symptoms of mental illness and the types of helping responses that are appropriate. Clearly, appropriate responses will vary depending on whether a person is suicidal, depressed, violent, incoherent, remote, etc. As a major part of this training, when in any doubt, students should be taught to reach out for help to other authority figures—teachers, counselors, school authorities, other adults, etc. Such training will do much to combat the culture of silence and inaction that frequently surrounds such encounters.

As part of undergraduate college education, and when entering a new job, including teaching or the police force, adults should be exposed to the principles and concepts of Mental Health First Aid. In addition, they should be informed about the mental health resources available in their own communities and how to find these resources in the future through use of the Web and other tools available locally.

Assuring Appropriate and Effective Community Mental Health Services

In his remarks at the memorial service held in Tucson, President Obama made reference to some key questions that this tragedy should engender in our national dialogue. Among them was his question: “Are our mental health services adequate?” He could have asked the same question in Aurora. We must help the President to answer this question, and we must do it in a helpful, operational way. It is a stark fact that current mental health services are inadequate in most US communities.

When we address this question, we must not only examine actual primary service availability, but also whether appropriate inter-organizational links exist. For example, is there a good working relationship between county mental health services and the local university?

A related point also needs to be made. This sad event documents the crystal clear need for implementing the Affordable Care Act. Under this Act, James Holmes could be covered under his family’s health insurance policy to pay for mental health care. Or, if the family does not have insurance, he could be covered under a Health Exchange or the Medicaid expansion. Further, disease prevention and health promotion provisions of the Act could have led to early detection of his illness and early treatment before the disease became severe.

Going Forward

James Holmes literally fell through the cracks because he never came to anyone’s attention. Many people encountered him; virtually no one reached out or sought the mental health care that he desperately needed, especially in the most recent four months. In that sense, he was invisible; no one really saw him. Appropriate knowledge and intervention strategies could have changed all of this. We need people who are trained to intervene appropriately, and who have the courage to reject the culture of silence and inaction.

When courageous people do intervene, they must feel confident in what they’re doing and that appropriate and effective mental health services are actually available in their own communities. Such services must be consumer friendly and easy to access.

The Affordable Care Act can help us address both of these needs.

Finally, this is a very urgent call to action for every one of us. Each of us must become engaged with our local communities, our schools and our police, and our neighbors. Our message must be very clear:

• Training in Mental Health First Aid is every bit as important and lifesaving to our fellow citizens as the CPR and first aid training that many of us already know and take for granted.
• Such training is urgently needed to identify and respond to the ordinary mental health challenges that our friends, neighbors, and children face every day and is essential to the continued healthy growth of people and communities.
• All citizens ought to have knowledge about the mental health resources available in their own communities.
• And, community leaders must ensure that effective care is available and easy to access.

Because preventing and treating mental health problems is so important to our country’s public health, we ourselves must model and lead the effort to combat the stigma of silence and inaction.