School shooters and mental health. What is Texas actually doing?

This article was originally published by the Dallas Morning News on June 5, 2022.

The day after a gunman slaughtered 19 fourth-graders and two teachers at their elementary school in Uvalde, the father of one of the slain children appeared on national TV clinging to a framed photo of his daughter. Angel Garza said Amerie Jo was killed while trying to call 911 for help.

“How do you look at this girl and shoot her?” he sobbed.

Even in a world where depravity abounds, it is unfathomable to most of us that someone would point a rifle at children and execute them. Politicians casting about for answers usually turn to mental illness as a way to skirt discussions about gun control. Gov. Greg Abbott asserted at a news conference last week that “Anybody who shoots anybody else has a mental health challenge. Period.”

That response diminished what should be a nuanced conversation about how Texas can identify and treat people who may harm themselves or others, and how we keep guns out of their hands. Blanket comments about mass shooters’ mental health are also a disservice to the people in this country living with a mental illness: 1 in 5 Americans, a majority of whom are not violent.

A Secret Service analysis of 41 attacks in K-12 schools between 2008 and 2017 could be instructive to Texas lawmakers as they debate measures about school safety and mental health. The report, published three years ago, found that most school-age attackers like the Uvalde gunman share certain traits and circumstances.

All assailants had a source of social stress at least six months before the attacks, such as bullying or conflicts with romantic partners and family members. Nearly every attacker had experienced problems at home — their parents’ divorce or relatives using drugs, for example — and most of the attackers also had a history of school discipline.

Psychological, behavioral and neurological symptoms were cataloged in a majority of the young assailants. These symptoms ranged from depression to aggression to learning disabilities. But only 40% of the perpetrators had a documented mental health diagnosis before the attacks.

“When considering such signs and symptoms, it is possible that underlying situational factors (e.g., stressors the child is experiencing) may be the cause of the behavior, as opposed to a diagnosable disorder,” cautions the Secret Service report.

Now add weapons to this toxic mix of internal and external factors. Most of the perpetrators had access to firearms and used them in the attacks.

The Uvalde gunman, an 18-year-old man, had no mental health diagnosis history, though he had acted in troubling ways before he stormed Robb Elementary with a semi-automatic rifle. People who knew him said he abused animals, threatened girls online and had admitted once to cutting his own face.

It’s possible that the shooter had a mental illness that had gone undetected. But we can’t assume that all mass killers have clinical conditions that can be diagnosed. A steady diet of hateful ideology can fuel violence, along with antisocial traits such as anger and defiance that are cranked up to extremes.

People are complex, and so should be the system of mental health and behavioral interventions for children and young adults in Texas. Lawmakers must study whether schools are properly equipped to flag concerning behaviors and what the state can do to expand mental health screenings and treatment.

The Texas Legislature took important steps after the Santa Fe High School Shooting in 2018. It passed a law that requires every school to have a behavioral threat assessment team to identify students who could be threats so they can be referred to mental health professionals or to police. Lawmakers would be wise to investigate how that measure is working out in practice.

The Legislature in 2019 also created a mental health care consortium for children and teens. That consortium launched a telehealth network of medical and counseling professionals from a dozen medical schools, each one in charge of a region in Texas. The consortium offers this telehealth program for free to school districts, who can refer troubled children for services.

Roughly a quarter of Texas’ more than 1,200 districts are participating in the Texas Child Health Access Through Telemedicine program, or TCHATT, covering more than 2 million students. An official with the program told the Texas Tribune that the Uvalde school district was in line to be offered services before the shooting but had not been formally included because of staffing. The consortium is planning to ask for more resources in the next legislative session.

State legislators should also consider expanding other programs that research shows have been successful at improving outcomes for children and young adults with mental health symptoms.

For example, young people experiencing their first episode of psychosis — a disorder that causes hallucinations and delusions — can benefit from an intense care model known as coordinated specialty care, according to the Meadows Mental Health Policy Institute. A team of specialists works with the person and his or her family for two or three years to manage a treatment plan that may include medication, therapy and job or educational placements.

The earlier the treatment, the better the quality of life. In Texas, this type of care has been largely funded through federal grants. Experts say many services provided under this care model are not covered by private insurance, creating a barrier to access.

Another team-based care model for teens with significant mental health concerns is called multisystemic therapy, and it’s designed to heavily involve teens’ families in their treatment. This model has shown good results among juvenile offenders, but mental health care advocates say it should be expanded beyond the juvenile system. The goal, after all, is to keep teens out of trouble.

Gov. Abbott is right that we need to do something about mental health care in Texas. And we need to do something about the easy access to guns. Focusing on the former and ignoring the latter will lead to more deaths of children in schools where they should be safe.

The full article is available online here.