Do you know the signs that a person may have a mental health problem? While most mentally ill people are not violent, many of the assailants in recent violent targeted attacks in the U.S. have had mental health problems, and most suicidal people are suffering from depression or some other mental disorder. How many lives might be saved if we were all better equipped to recognize the signs of a mental health problem and assist people in getting the help they need?
What is a Mental Disorder?
A mental disorder is a pattern of thinking, emotion, or behavior that reflects dysfunction in mental functioning and is associated with significant distress or impairment. Examples of mental disorders include:
- Bipolar Disorder
- Major Depressive Disorder
- Panic Disorder
- Autism Spectrum Disorder
It’s important to note that any one isolated incident of abnormal behavior is insufficient to conclude that someone has a mental disorder. One’s behavior, thoughts, and emotions would have to comprise a pattern that causes significant distress or interferes with one’s ability to function in major areas of life. The Diagnostic and Statistical Manual of Mental Disorders (or DSM, which is currently in the 5th edition) provides mental health professionals with the specific criteria that must be met in order to make a diagnosis.
While it’s not practical to learn how to recognize all of the hundreds of mental disorders in the DSM, it would be valuable for everyone to learn how to recognize and respond to some of the signs and symptoms of common mental health problems. Just as there has been a push for increased public awareness of the signs of a stroke or heart attack, we should increase our awareness of the signs and symptoms of mental illness and learn how to respond appropriately in a mental health emergency.
Using Threat Assessment and Management Teams to Assess Risk of Violence
When confronted with concerning behavior or signs of mental illness in the workplace or a classroom environment, for example, supervisors and faculty typically want to know if this person will be the next assailant in a shooting incident or some other act of targeted violence? Prediction is very difficult, but prevention is certainly possible, and is, of course, the goal. In order to estimate the risk of violence, a threat assessment must be conducted. A threat assessment involves gathering and assessing multiple sources of information in context, including information about mental health, to determine if a person of concern is moving toward an attack.
The US Department of Justice and Federal Bureau of Investigation recently published a monograph called, Making Prevention a Reality: Identifying, Assessing, and Managing the Threat of Targeted Attacks, in which they stated that the best strategy to prevent targeted violence is the threat assessment and management team. Threat assessment and management teams can be formed and function in K-12 schools, institutions of higher education, places of worship, worksites, hospitals, and communities.
A higher education application of a threat assessment and management team that emphasizes prevention of threats before they occur is a Behavioral Intervention Team (BIT). A BIT is a multidisciplinary, cross functional team that provides assessment and management of concerning student behavior, in addition to threats of violence. Because threat assessment teams are only activated when there is a threat, BITs are more proactive and preventative and address a wide range of concerning behavior and signs of potential violence whether a threat has been made or not.
Mental Health, Threat Assessment, and Threat Management
Concerning mental health problems, Making Prevention a Reality explains that higher rates of severe mental illness, and in particular psychosis, are found among attackers involved in targeted violence than in the general population. However, when assessing the risk of targeted violence, it is more important to know the person of concern’s actual behavior and determine if that behavior is progressing down a “pathway to violence” than to focus too much on the fact that they have a mental health diagnosis.
Knowledge of a mental health diagnosis can, on the other hand, be very helpful in threat management and mitigating risk of violence, as it provides insight into things like thought processes and impulse control. Information about mental health is just one of the many important elements when conducting a thorough assessment of threats of targeted violence.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
US Department of Justice Federal Bureau of Investigation (2016). Making Prevention a Reality: Identifying, Assessing, and Managing the Threat of Targeted Attacks. US Department of Justice, Federal Bureau of Investigation.
Dr. Peggy Mitchell Clarke is a clinical psychologist and retired psychology professor who has lived in Denver, Colorado for almost two decades. Many of Dr. Clarke’s students were impacted either directly or indirectly by the Aurora theater shooting. In the aftermath of the theater shooting, Dr. Clarke was instrumental in developing and facilitating active shooter response and violence prevention training for all faculty and staff at Community College of Aurora (CCA). Dr. Clarke currently serves on CCA’s Behavioral Intervention Team.