Ivan Lopez, a 34-year-old soldier with a clean service record, shot and killed three of his colleagues and injured 16 more before taking his own life at Fort Hood, a US military post in Killeen, Texas. Although he had some mental health issues, Ivan was not considered a violent individual or a risk to society until the attack. Is there some way that we could have seen that this storm was brewing, provided the necessary treatment and prevented this tragedy from occurring? For all of the above, I believe the answer is “yes.”
Screening for mental health problems is very different than screening for risk of violence. For mental health issues, a professional is looking for symptoms such as sleep difficulties, sadness, mood swings, hallucinations, and difficulty focusing on a task. Additionally, there is likely to be a mental status examination of the person’s awareness of self, time and surroundings. None of these symptoms will determine a person’s risk for violence, but they will indicate the possibility of a mental illness.
If a professional is screening for risk for violence, they are looking for multiple risks that are co-occurring in an individual. For example, a person is 7 times more likely to be violent if they are abusing drugs or alcohol and have a mental illness, than if they only have a mental illness. Add to this combination, a lack of adequate treatment for those disorders AND a major life stressor AND inadequate supports or coping skills AND a history of spousal abuse, and now you have a deadly mixture for someone with a very high risk for violent behavior.
Not only do we need to do a better job of screening for these types violent individuals (ex: offering regular mental health services for students, returning vets and everyday workers), we also need to be able to implement risk reduction plans. This simply means providing therapy, support and guidance to help eliminate some of the factors that cause someone to be a potential threat to others, and improve their life situation and resiliency. For example, if a mental health counselor was able to help a high-risk individual develop coping skills and work through their alcohol addiction, this would dramatically reduce the chances of a future outburst.
In most cases, the perpetrators of shootings and violent attacks never seek help prior to their attack, making it more difficult, although not impossible, to provide treatment and prevention. However, in this particular case, Ivan had a history of depression and anxiety, was self-diagnosed with PTSD, and was being treated for various psychiatric disorders. However, for someone who is at risk for violence, services are need several times a week. This tragedy is particularly frustrating because, if we can’t help those who are actively seeking it, how can we expect to help those who are not? Had Ivan been evaluated for risk for violence, perhaps this attack could have been prevented and the lives of the victims spared.
We cannot stand idly by as shootings like this one and the Aaron Alexis D.C. one continue to occur. I am confident that we can do a much better job of screening and treating those at risk for violence, and the mental health field plays an integral role in the solution. We will need to make many changes and reduce the stigma surrounding mental health. We also must improve inter-agency communication, between juvenile justice departments, social services, schools, armed forces and mental health facilities. It will be challenging, but with the right approach violence prevention is possible! As a society, we just have to be willing to take action now, instead of waiting for the next news story.
Written by: Dr. Kathryn Seifert
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Photo Credit: http://www.cfcforthood.org/FortHoodGate.jpg