School Mental Health Project


The Tucson Tragedy:
Identifying and Responding to Troubled
and Troubling Students

As more is learned about the tragic shooting in Tucson on January 8, 2011, the focus is again on a young adult with a history of problems. Each system that interacted with the accused, is asking what more should we have done? In addition, there is a need to ask: Are there others who require attention and what should we do for them?

Please share any ideas you have for what the Center should focus on related to these matters.

In responding, think about such matters as:

  1. What should high schools/community colleges do to help when an apparently disturbed student drops out? (e.g., besides just recommending the family seek psychological help)

  2. What should police departments do besides what was done in Tucson?

  3. How can friends be most helpful when they see a friend who seems to be in trouble emotionally?
Below are a few points shared by our Advisory Group of Family Representatives, as well as some related points from our last Practitioner Listserv.

We look forward to hearing your views.

From our Family Representative Advisors:
  1. "Mental health services within our schools PK-12 grades play a vital role in the prevention, identification and treatment of such potential future violent acts. If you surveyed any elementary school principal/teachers of their prediction of who will become involved with the law, I would bet the farm they would be 90% accurate if interventions are not provided.

    Amidst the discussions, finger pointing and systemic blame we unfortunately have constructed a reflexive or reactive type of system whereby for example 5 pedestrians have to get hit at an intersection before a traffic light is erected because we can then prove the intersection is dangerous and again we have the data to prove 5 people were killed by vehicles. Our mental health and criminal system operates much the same way in that in most cases only the extreme criminals or violently mentally ill are sent away. In dealing with verbal threats and even attempts at suicide, only limited hospitalization or restraining orders are enacted. Until they become violent, legally we are quite limited.

    A prime example is the Virginia Tech shooting incident whereby the shooter was on everyone's radar but until the actual shooting took place it appeared there was no oversight in seeking mh treatment until the predicted act played itself out. This most recent shooting in Tucson, the campus police allegedly had been called upwards to 5 times and didn't know if the sheriff or community police department could have emergency petitioned for a psych eval. This student didn't drop out but was liberally told he could not return to attend classes until proof was provided by a mental health professional stating that he was safe/stable enough to return. Again without a mandate to seek such services, this person was officially unleashed with NO oversight.

    My experiences with the police in calling them for a mh emergency in the community or schools (ranging from the inner city of Baltimore to where I now work within a rural community) is that unless they assess or observe an individual as being unsafe, meaning actively acting out, having a weapon or threatening at the time of their observation, little is done and clearly note they cannot transport to the ER. Police need increased training with response to such calls but again the bottom line comes down to taking away manpower from the streets and potentially tying up too much time within this process.

    What we teach our community and students as early as 6th grade is that "It's OK to Ask-4-Help"! Someone as potentially ill as this person in Tucson, they may have been too ill to self advise or seek help. It appears the agencies, criminal justice systems, and even the educational system closed the doors to this assistance when one needed to be opened. Again with limited friends, isolation and an ever increasing and developing illness, people shy away and are afraid. Too many clues were given that this was going to happen. Much like suicide, no one wants to acknowledge the elephant in the room. This could have been prevented! Would love to review this persons pk - 12 grade educational history. Bet flags were raised as he progressed through the grades.

    Systemically we are too liberal and cautious to the point we are letting down the people we are suppose to be helping at the cost of innocent people being killed. Can't see this system changing anytime soon but much like the pedestrians being struck and killed at the intersection, how many more people will die before our systems change.

    I have seen many of our children/adolescents change having received mh services in our schools. School mental health is the first step for change, unfortunately steps there after remain in red-tape."

  2. " Thank you for the thought-provoking questions and an opportunity to reflect on prevention rather than blame. I'm sure the school district I work in is not the only one that has seen an increase in the number of students with mental health issues. It is a difficult and very fine line that we must walk, however, in order to protect and preserve the privacy of anyone's medical records. Here are some thoughts:

    One nexus between school and community is municipal or juvenile court. Young people with mental health issues are frequently truant and in my state they are ticketed and must appear before a judge. We are fortunate to have a judge in our community who will issue a court order for mental health assessment and counseling be shared with the school if she deems that it is contributory to truancy. Extreme cases may also warrant further involvement with other county or state agencies to keep both the community and the individual safe. Judges and others in the legal system should be given more latitude in sentencing so that these supports can be court ordered. Paying for mental health care is another barrier for many young people once they turn 18. Full coverage for psychiatric and psychological interventions is a crucial part of prevention.

    In my work I see many angry, bullied, challenged young people. Many have impulse control issues. Only a very few of them (thankfully) become violent and none have become as this young man apparently did. I think one of the keys to preventing these kinds of tragedies (and isn't this akin to Columbine, Virginia Tech and others?) is understanding the triggers that take these individuals over that line and into violence."

  3. "The event in Tucson was/is a tragedy on so many levels. Let me first say, I have not been able to follow this closely, so I don't have a great deal of information specific to this young man. Generically, however, too many of our youth are "passed over". I have seen the difference a caring compassionate adult can have in child's life and the path they take. Our children that have a sense they are different due to physical or mental health reasons, need to feel they fit in somewhere in there community. The isolation of feeling "different" is more powerful than I think most adults realize. I am not making light of quality clinical services, but it needs to be broader than that. Recognition of how the child perceives himself needs to take place early, to help children realize they have a meaningful place in their community. Helping each child find his/her niche, discover their talents, and not just reminded of their challenges. Clinical services shouldn't be provided in isolation. That meaningful adult could be a custodian, a teacher, a scout leader. I don't mean to oversimplify, but the difference it would make if someone could be involved in a child's life, to say �how are you doing today?' �I saw your game last night, you really hustled.' �I saw how hard you studied for that test.' �You seem a little down today, anything I can do to help?'

    How often do we observe, what seems to be gentle snubbing, a child left out of activities, never picked for teams, never asked to be a partner for a lab, etc and not realize the significance. It just doesn't impact the day. What message does that deliver? It certainly doesn't encourage that child to want to be a productive contributing member of their community. We need to encourage engagement.

    Clinical providers need to work more with school counselors and staff. School staff need to be allowed to be more educated about mental health needs. We all need to be more sensitive that if a child is not acting out, it doesn't mean he or she is okay. Mentor programs should be developed in all schools with participation and input from clinical providers. Climate of teamwork and understanding needs to be encouraged. Parents need to be supported in providing mental health services. Stigma and genuine barriers are still prevalent that discourage appropriate mental health care.

    Transitioning to post high school experiences need to be improved. Support and communication to any post high school experience needs to be established prior to the child leaving school. We expect our children to magically become adults and to be self-aware of their needs and responsible for getting the help they need. I am not talking about enabling anyone, but making sure supports are in place and rapports are developed so transitions are more seamless would be extremely beneficial. Writing transition plans and implementing seem to be very far apart. Again, collaboration and change in climate, creating relationships and understanding with colleges, adult care and services has great value.

    In response to your 3 questions:

    1. More than suggesting psychological help, going one more step and helping link the family with resources.

    2. I am unsure of what the police departments did, so cannot respond to this.

    3. What should friends do? Be a friend, keep in contact, reaching out, refraining from being judgmental, offering to support by attending counseling sessions, in short, show genuine care and concern. Be strength based, encourage activities that the individual has an interest or talent in.

    Not only having a child with mental health concerns, but working with teens with a mental health diagnosis, this is an issue close to my heart. No child should feel they are a waste of time and have no value and a layman's opinion, when this happens, this is often when we see the type of tragedy we saw in Tucson."

  4. "First I have to respond about the college or community college concerns. I�ll start as a parent and then as a professional. When our son was in out of state college he had ongoing serious health concerns that were never brought to our attention because of HIPPA laws. We got bits and pieces from our son, but are still dealing with neurological health concerns 2 years after his graduation. As parents we could have done more, sooner to assist had we been informed. So as a professional this would be one of the biggest stumbling blocks. If the Tucson shooter didn�t appear to be a threat to self or others, his parents were probably not informed. The likelihood of someone who is paranoid or delusional of getting help is slim.

    I would like to see the HIPPA laws changed when it comes to mental health issues of young people 18 � late 20�s. If there is a serious mental health concern i.e. bipolar, schizophrenia, paranoia, psychosis, threatening self or others, self injury or other injury, parents do need to be informed. Then, resources need to be given to families and even a follow up phone call or two to inquire if treatment is being sought. In high school (mid and elementary), typically parents are informed of this kind of behavior or emotional concerns on campus. We have Health and Wellness Teams on all of our campuses. We meet twice a month and staff students of concern. Teams consist of: School counselors, nurse, social worker, family counseling provider, school psychologists and often teachers and administration. We also often have the family in the meeting. We then break down interventions, assign who is responsible, make parent and student contact and follow through to see if parents have made and kept appointments. This is all voluntary; we can�t force a parent/student unless there is a threat of self or other harm.


    • Friends can go with their friend to the counseling center and help explain what�s happening.

    • If the friend refuses to go, and you�re still concerned, then see your school counselor yourself. He/she can then call your friend in and do some further assessment.

    • Typically more than one friend is seeing the concern. Several friends can either approach this person with love or see the school counselor.

    • If their parents are friends, perhaps tell a parent and have them talk to the other parent.

    [With respect to] Law Enforcement:

    • These folks have different training. Perhaps help them understand when to transport someone to inpatient mental health.

    • People with serious mental health concerns are often violent when they�re off their medication. We need more help with medical monitoring and greater access to mental health services."

From Our Young Adult Advisors:
  1. Re. schools: �I think legislation should be passed that mandates that the school report the student to the relevant city or county authorities if the student had a documented history of incidents at the high school or community college. Then, after some mental health examinations are conducted, the student should be forced to receive mental health treatment if it is deemed appropriate. I think this would be a step in the right direction towards making sure people do not �fall through the cracks.�

    In fact, it appears that a law in Arizona allows for the involuntary commitment of individuals when there is reason to believe they pose a threat to themselves or others. Of course, it is impossible to tell what would or would not have happened had Jared Loughner been committed, but I also think that it is hard to argue that he (and society) would not have benefitted from an intervention and a serious mental and psychological evaluation.�

    Re. the police: �The police should visit the disturbed student and start an ongoing dialogue with the student to promote trust so they can better assess the situation. Perhaps this could be done by police officers who are not in uniform so as not to intimidate the student. There should be more serious consequences imposed for people who have a record of being a disturbance.

    In addition, teachers, school psychologists, and other mental health counselors should be encouraged to contact the police when there is a string of incidents that cause concern. Campus police departments should forge stronger partnerships with high school and college teachers to facilitate the reporting of such incidents. Campus police departments should work more closely with city and county police departments so that they have more resources at their disposal.�

    Re. friends: �Besides speaking with their friend to try to figure out what is going on, I think students should seek professional help for their friend. To this end, I think more programs should be implemented in schools that encourage speaking out when students think something is amiss with one of their peers. Furthermore, schools should give students assurances of confidentiality so they do not fear speaking out on behalf of their possibly troubled friends."

  2. Re. schools: "Programs that are sincerely concerned with the feelings and personal/home-life problems of students can go a long way. There is a program called Challenge Day that you can google to get an idea of what I am referring to. The program was turned into a television show that aired nationally. The only downside of theis program is that is only goes to selected schools. I feel that it should be a reqiurement to all high schools. So far, it seems that the students have only given positive feedback regarding their experiences and have stated that their own confidence, mental health, relationships with family members and friends, have improved. This program or a program like it should be a requirement at all high schools because I feel that it would prevent some murderous acts such as these or at least expose signs or signals of someone who may be emotionally distraught.�

    Re. friends: Friends should �ask questions. Listen. Believe them. Don't judge. Lend suggestions. Do not jump to conclusions or be to quick to give stern advice. Ask someone for help in how to deal with the situation."

  3. Here are just some of my thoughts ... hope this helps a little bit.

    Re. schools: I think one of the most important things to do is outreach. But I believe that action should be taken prior to the student dropping out. If it is apparent that a student is disturbed, teachers/the school should immediately address the issue. Maybe have one-on-one sessions with the student and just talk to him/her about whatever it is that could be bothering them. Sometimes people just need someone to talk too. I think students will find some reassurance that at least someone out there cares. Also, I feel that schools and communities should have small workshops that teach people how to spot signs of a student who is disturbed and how someone goes about it if they do spot it. I feel the more educated people are in handling such situations, they are better prepared to tackle the problem.

    Re. friends: The most important thing you can do is be a friend. I feel that if you notice you're friend being troubled, we should initiate the first step in reaching out. Let them know that you are there to listen, to talk, or whatever it is they might need. I think it's also important to not be so pushy in helping them, but rather letting them know that you are there as an option they can turn to. Also, in some situations the power of numbers can be helpful too. Sometimes, people don't listen when only one person is telling them something. Instead, when a group that an individual is particularly close to is addressing the issue, the message becomes more clear to the individual. However, it can work either way, in that an individual might feel attacked. So, it is important to decipher the severity of the situation and how they feel the individual would respond to the intervention. Overall though, a friend can be most helpful by just caring.

In the week prior to the Tucson event, we received a request for information concerning threat assessment of students. Over the years, this has been a frequent request so we decided to make it the focus of the January 11 Practitioner Community of Practice Network Listserv from our Center. (This weekly listserv is a community of practice network designed to allow school practitioners to ask for and share information/technical assistance, comment on issues, and relate learning experiences. It usually is sent only to those who formally decide to be part of this community of practice network.)


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