DBT OC Blog
In my previous post we began to examine possible causes of our current mass shooting “trend” (as one of my students referred to it), and examined problem solving through the lens of the DBT skill “Radical Acceptance.” In this post let’s continue to look at other ideas we can implement to possibly prevent future mass shootings and to perhaps turn the tide on our nation’s mental health crisis. Here is a recap of Part 1 if you missed it.
Medical vs. Mental Health Care
What if we implemented workarounds to what typically keeps people away from mental health emergency services? Emergency rooms are not very “user friendly” for those struggling with a mental health problem. If you’ve ever sat in an ER for hours with others who are sick, you’ll know what I mean. People with a mental health emergency feel about as comfortable in the ER as smokers do in a crowded elevator.The entire set up and staffing of an emergency room is tailored for medical emergencies, not emotional ones.
Sue Klebold, mother of mass murder Dylan Klebold, (See blog post 1 for a discussion about Sue) says that people with suicidal and aggressive tendencies are in a “Stage 4 medical emergency,” But when I look up that phrase “medical emergency” all that comes up are actual physical emergencies (chest pain, shortness of breath, severe bleeding, etc.) which are all reasons to go to the ER but nothing, as in NOTHING, regarding mental health emergencies was listed under a general Google search. It’s a harder to find clear, straightforward information about mental health emergencies.
- Acting on a suicidal threat
- Homicidal or threatening behavior
- Self- injury needing immediate medical attention
- Severe impairment by drugs or alcohol
- Highly erratic, unusual or very unpredictable behavior
- An inability to care for oneself
And right below a mental health emergency is a mental health crisis. A mental health crisis is a non-life threatening situation in which an individual is:
- Exhibiting extreme emotional disturbance or behavioral distress
- Considering harm to self or others
- Disoriented or out of touch with reality
- Has a compromised ability to function, or is otherwise agitated and unable to be calmed
- Talking about or making suicidal threats
- Talking about threatening behavior
- Self- injury, but not needing immediate medical attention
- Alcohol or substance abuse
- Highly erratic or unusual behavior
- Disordered eating
- Not taking prescribed psychiatric medications
- Emotionally distraught, very depressed, angry or anxious
Do you see how a mental health crisis can escalate to a mental health emergency quite quickly? It’s this “progression” we must try and prevent.
What if we had mental health only emergency rooms in every county in our country? And for kids like Dylan Klebold, what if we had pediatric mental health emergency rooms? Staffed 24/7 by pediatric psychiatrists, nurse practitioners and therapists to help get these kids stabilized and placed at the proper level of care? Specialized emergency room services would make it easier and less shameful for families to help their children get the care they need. And it might prevent suicidal kids from waiting for days on hospital beds in the hallway of the ER while victims of gunshot wounds are rushed to for care. SInce there are twice as many suicides in our country as murders, doesn’t this make sense?
Now obviously, my grand plan is not going to change our country because there are so many barriers to mental health care such as:
- Lack of money to pay for care
- Lack of adequate insurance coverage (Insurance companies cover only a fraction of needed care and at dangerously low reimbursement rates, which has driven many clinicians out of the field because they cannot afford to be therapists).
- Lack of professionals to work in the field
- Poor education in homes, schools and communities
- The social stigma of mental illness
- Racial barriers to mental health care
But what if we had the money?
Recently I was at the the wealthiest museum in the world, The Getty. It is a lovely collection of buildings, artwork and gardens in the hilltop area of Los Angeles. Only problem for me…there were guards every ten feet inside the museum portions of the tour. It was annoying and hard to move around. The Getty has beautiful works of art but it was a bit over the top. And while I believe it is essential to guard our history, it is even more essential to guard our present and our people for they are our future.
What if the present $6.6 billion Getty endowment were to offer one-third of its wealth not to security guards and lovely landscapes but to to immediate crisis prevention strategies like money to hire armed guards for every school in the US? and another third to Empathy training, mental health readiness in schools and violence prevention for every grade schooler? What difference might this make a generation from now?
And what about mental health triage sites at every school? If a teacher or a student sees something they say something. Here’s why: Mental illness has markers in the young. But even if the more straightforward signs are not there here is a list of harder to notice commonalities in those that can become ill:
- Highly sensitive personality (very shy, low tolerance for pain, cries easily, feels feelings more deeply)
- An invalidating or abusive home life
- Early or sustained trauma (often hidden from others)
- Home Life disruptions (Divorce, deployment, death, loss, parent incarceration)
- Parental violence
- Feeling like they don’t fit in anywhere, especially at home & school
- Being in the system (foster care, welfare, at risk youth)
- Parental addiction
- Bullying in person or on social media
- Living with a mentally ill parent
Schools and Universities
If every school had a mental health team that focused on early intervention, funneling these kids into wraparound care and following them long-term, before they act out, we may be able to stop the “trending of violence.” In this informative article, the importance of resilience training is discussed. What if we taught children not just how to handle tough times and bounce back from them but how to “bounce forward,” too?
Also, instead of throwing open the doors of counseling clinics after a mass shooting as most universities do, what if we threw them open before? Preventing things like child abuse, domestic violence, neglect and bullying might, just maybe, prevent the young men of our country from becoming active shooters and stop mass shootings from trending.
And what if we developed a new model for mental and physical health? What if we as a country focused on wellness and prevention rather than on waiting to treat mental and physical illnesses once they’ve jumped the tracks? Would it be better if healthcare professionals only got paid if their patients stayed well? And what if, in service to prevention, we had a yearly mental health check-up that our primary care doctor pestered us about like colonoscopies and mammograms and then prescribed the appropriate treatments completely covered by insurance? What might our nation and our healthcare system look like? These kinds of questions can challenge us to think outside of the norm and reach for answers we may not have thought of thus far.
Could a casserole stop mass shootings?
Finally, what if, as a society, we treated mental illness like we treat cancer? In our culture we flood the lives of cancer patients, survivors and families with help, money, races, ribbons and fundraisers. They are our heroes.
After a young adult in my circle took her own life, I had a brief, guilty thought, “I wonder if a casserole could have helped her?” It had helped me during my cancer. Why should mental illness be any different? Let me explain.
You will often find people doing nice and helpful things for others in faith communities and affinity groups. For instance, the Susan G Komen website https://ww5.komen.org is filled with practical interventions for cancer patients and survivors just like the Red Cross provides comprehensive relief after natural disasters. In the same way, many faith-communities have organized themselves to help people both inside and outside their walls when they fall on hard times. But with mental illness there is such a stigma that we often avoid or shun the mentally ill. Might we be missing our opportunity to care for those affected by it? And there is no shortage of those who need care:
The National Alliance of the Mentally Ill reports that “Approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year. Approximately 1 in 25 adults in the U.S.—9.8 million, or 4.0%—experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities.”
So this is why I wondered if a casserole would have helped the young woman who took her life better manage her illness and not solve her problems by killing herself? Could a community wide effort to “One-another, One another” prevent future bloodbaths?
Perhaps if we can re-classify “mental illness” as “brain illness” and begin to accept that patients with these diseases and disorders are just as sick as someone with cancer, we might start calling mental health patients “heroes” too. In fact, more so than cancer patients. You see, so many mental health patients have to fight their illness alone, in hiding, often filled with shame, typically undiagnosed (or misdiagnosed), rejected by their families and with scarce resources. No wonder so many of them die, and now, so many of them are taking others with them.
What would it be like to bring meals to the homes of those struggling with mental illness? Write encouraging cards and letters? Visit them when they’re up for it? Drive them to their appointments? Help pay their bills? Visit when they are hospitalized? I can only imagine.
The Verdict is Validation
The one thing that ALL of my patients tell me is how healing it is to have someone acknowledge their pain and seek to understand it and help them through it. Fraught with shame (often for years) they have suffered in silence and driven their illness deep underground, trying to hold its stigmatizing presence at bay, because if they let it out, they know what will happen. The precious connection of family and friends that they so need to survive, may leave them. Have you ever been abandoned? Few of us have, but for the mentally ill, it is just one more loss all too common in the lineup of losses they have endured.
To prevent more loss and abandonment, most of my patients will hide their struggles, hold back their experiences or push down their symptoms. Unfortunately, just like when you hold a beach ball underwater, eventually it’s going to pop up. But more about ineffective behaviors as a means to manage mental illness in another post.
As it turns out, Validation is a key concept in helping our fellow humans to recover their lives and heal from their illness. It is the concept of “I see you and it is OK. Your suffering has been terrible and it makes sense to me that you have done what you’ve done to try to manage it.” At its most basic, validation is “I see you and I am sorry for what you’ve been through.Let’s walk back to life together.”
While validation is not all that’s needed, it’s an essential element in moving people away from crisis and blame and more towards a problem-solving mindset. The multi-pronged approach I’ve outlined in these blogs is an action plan that uses DBT skills to help us see the realities of what is happening around us and problem solve our next steps as a nation or at least start the conversation in a way that might lead us to real-time solutions.
Licensed Clinical Social Worker and Family Services Specialist
Adjunct Professor of Psychology at Pepperdine University