Podcast: Mass Violence Facts from the National Council on Behavioral Health

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We all have an idea in our heads of what a mass shooter looks like. But how accurate is it? Does anyone actually know? Who would you trust to find out? Is there any data on this?

Well, now there is. The National Council on Behavioral Health has recently completed a comprehensive report, “Mass Violence in America: Causes, Impacts, and Solutions.” Listen in as our host interviews the medical director of the National Council for an in-depth explanation of what this exhaustive document has revealed.

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Guest information for ‘National Council on Behavioral Health’ Podcast Episode

Dr. Joe Parks is the Medical Director for the National Council for Behavioral Health. He has nearly two decades of experience with public health. He was named director of the Missouri HealthNet Division of the Missouri Department of Social Services in 2013. Dr. Parks also holds the position of Distinguished Research Professor of Science at the University of Missouri – St. Louis and is a Clinical Assistant Professor of Psychiatry at the University of Missouri, Department of Psychiatry in Columbia. He practices psychiatry on an outpatient basis at Family Health Center, a federally funded community health center established to expand services to uninsured and underinsured patients in central Missouri.

Previously, he served for many years as Medical Director of the Missouri Department of Mental Health and as President of the Medical Director’s Council of the National Association of State Mental Health Program Director. Dr. Parks has also served as Director of the Missouri Institute of Mental Health at University of Missouri St Louis and as Division Director for the Division of Comprehensive Psychiatric Services of Missouri Department of Mental Health.

Areas of Expertise:  Certified Community Behavioral Health Centers (CCBHCs); Clinical Best Practices; Data-informed Care; Health Information Technology; Integration of Primary Care and Behavioral Health; Leadership Development; Trauma-informed Care; Workforce Development

About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘National Council on Behavioral HealthEpisode

Editor’s NotePlease be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of the Psych Central Podcast. Calling into the show today, we have Dr. Joe Parks, who is the medical director for the National Council for Behavioral Health. Dr. Parks, welcome to the show.

Joe Parks: Hey, glad to be here.

Gabe Howard: Well, before we get started into our topic, many people aren’t familiar with the National Council for Behavioral Health. You kind of give us a 50 cent tour that.

Joe Parks: Sure. The National Council represents about three thousand three hundred organizations nationwide that provide treatment for either addiction or for mental illness. And we do policy work in Washington. We advocate for people to get high quality treatment and to have prompt access to it. And we help our members with technical assistance and training. Now, many of your listeners may know about one of our national programs, Mental Health First Aid. We’ve trained over 2 million people to give mental health first aid when they run into somebody in their community or their family that is in distress from a mental illness or an addiction. It’s a great training.

Gabe Howard: Mental Health First Aid is an excellent program. I am an instructor, so I really believe in the program enough to teach it. And for longtime listeners, we did a previous show on what is mental health first aid. So you have to go back and check that out if you want more information.

Joe Parks: Great.

Gabe Howard: All right. Today, we’re going to discuss mass violence and its relationship to mental illness. Now, given the high profile instances of mass violence in this country, many people mistakenly believe that we don’t necessarily have a mass violence issue, but we have a mental illness issue. What are your thoughts on that?

Joe Parks: Well, you know, I think they need to take a look at the data and the studies around it. And, you know, we’re going to have a great conversation today. But if your listeners want to learn more, they should go to the National Council Web site. The National Council for Behavioral Health mass violence. If you put those search words in your browser, you’ll get our report and there’ll be a lot more information than we’ll have time to go over today. That said, they are really two separate problems. There is some overlap. But if you eliminated mental illness, you would not be eliminating mass violence.

Gabe Howard: I think that many people believe that in order to commit mass violence, you must therefore be insane to use layman’s terms. People have trouble wrapping their head around any sort of violence on that scale, not being mental illness.

Joe Parks: I really don’t understand that way of thinking, I don’t see how it’s more sane to kill an individual, to kill your spouse, to kill your brother. What is it about it being multiple people that seems that makes it a priori as a fact mental illness. And it also depends what you mean by mental illness. You know, one of the things we found reviewing all the studies on this is the amount of mental illness involved, depends on how the researcher defined mental illness. And there is not a standard definition agreed to among researchers or a federal definition that’s been worked out by the Department of Justice or the Centers for Disease Control as to what we’re going to call mental illness in the context of mass violence. The definitions you go from everything to mental distress to what a clinician would usually call mental illness, things like schizophrenia, recurrent major depression, bipolar disorder. If you look just at the mental illnesses on that list, you would only account for 4.7 percent of people that have perpetrated mass violence. If you go with mental distress, well, that’s about 70 percent of anybody at any given time.

Gabe Howard: I think this is what confuses people, of course, because I think that people believe that you are either perfectly healthy, you have perfect mental health, or you have a mental illness, you’re crazy, you’re insane. And they don’t understand this concept of everybody has mental health. And while most people have good mental health, most of the time you can still have what you referred to as distress or a crisis point or a mental health issue. And that’s where we have to start discussing it, because if anybody can have a mental health crisis, then we can start to do things to prevent that and really start to look into controlling and preventing mass violence in this country.

Joe Parks: Well, I think you’ve made an excellent point. Mental health and mental illness are not all or nothing. It’s just like physical health. You can. You may not have cancer and you may not have quadriplegia and be paralyzed, but you can still be very physically unhealthy. The same thing with mental health. You may not have schizophrenia or bipolar disorder, but you may still have distress and have trouble getting through your day in interacting with others comfortably.

Gabe Howard: Let’s talk about mass shooters, because that’s kind of one of the most common ones. Let’s get that out of the way quickly. Are there any common characteristics that all mass shooters seem to have?

Joe Parks: Well, here you’ve come across the other another big problem we found looking at the research. There is no settled definition of what is meant generally by mass violence. And now you’ve used the term mass shooters, which is a subset of mass violence. There are people that kill large numbers by running a vehicle through a crowd or by stabbing. Now, it appears that over 90 percent, 95 percent in the United States is due to shooting. That is the large majority. Also, there’s no standard definition of what the word mass means. Some studies use three or more. Some use four or more. Some exclude when it involves family members. Some exclude when it’s done as part of a crime, an attempted theft. So another place we need help that we need really the government to get active is we need, again, a standard definition of what we mean by mass violence or mass shooting, the number and the types of deaths we’re going to include. Then you have the problem of what do you do by knew about near misses? We looked at one case of a person who had fired over 40 rounds at a crowd, only hit one person. She was a lousy shot. Because she only killed one person, does that make the list?

Joe Parks: How is that different from somebody that had hit five or eight? Is the difference between a mass killer and a single killer how good a shot they are? So the listeners need to be aware that if you read different studies, you get different answers because they use different definitions of all these very important factors. That said, the most common characteristics is almost all are men. Very few women. The second is almost all are using guns. They’re much more effective at killing people than than other means, especially in large numbers. Almost all of them are angry and resentful. They feel the world has been unjust either to them personally or to some other group that they identify so strongly with. Almost all of them are more isolated on average than other people. They have fewer social relationships, family relationships. Many of them have had a recent disappointment, either with a relationship with a partner or with family or on the job. But it is resentment, anger and isolation that are actually much more common factors than the presence of a mental illness. If you look at what is usually meant when you see a psychiatrist or a psychologist or a therapist in clinic by mental illness, things like schizophrenia, recurrent major depression, bipolar disorder, it appears that about 25 percent maybe of people when perpetrating mass violence had recently or at the time they did the act had a mental illness.

Joe Parks: But at any given time, about 19 percent of everybody in the nation has a mental illness. So it’s not much different. The other problem you get into is assuming that the mental illness caused the violence. You can certainly have something and not have it cause you to take a particular action. Now, in some cases with mental illness, it’s pretty clear that there’s a cause. A few cases people had command hallucinations. They heard voices telling them to kill. Much more commonly, people had a problem with depression or anxiety. It’s unclear how being depressed or anxious makes you want to kill somebody. So an assumption of causation is another error. But in general, about one in four people that have perpetrated mass violence by the best evidence available, which is pretty spotty at times, had a mental illness that a clinician would call a mental illness at the time they did the act, compared to about 19 percent of people with a mental illness in the general population.

Gabe Howard: Let’s talk about the research for a moment, because you’ve laid out that we don’t have good standards for this and your research is only as good as your data. That’s well accepted. The scientific method is there for a reason and it doesn’t seem like the federal government is looking to close these loopholes. So I guess that’s my first question. Why doesn’t the federal government want to get a good study on this so that we can get a handle on it? I know you’re not the policy director, but you know, the National Council does do policy advocacy. Do they have any thoughts on this?

Joe Parks: Yeah. I mean, we have specific recommendations on our report that I would urge all of your listeners to talk to their elected representatives about. If you think about airline crashes, another horrible and rare cause of mass death, we have the National Transportation Safety Board who keeps a staff of investigators who have a standardized system of investigating every crash. And there’s mandated reporting and there’s standardized data. And it goes into databases and they use it to improve the engines. They use it to improve pilot training. They use it to improve airport design. Why don’t we have something like that with mass violence? If we’re going to make the problem better we need to have that serious systematic investigation set of standard definitions and databases and mandated reporting instead of a lot of one-off studies and just feeling bad about it. Second is there’s not decent federal funding to look at the causes of violence either related to mental illness. If you’re worried about that, almost all the studies are retrospective studies. The last major prospective study done was done about 25 years ago and it was mostly funded by a private foundation, the MacArthur Foundation. By the way, that study found that people with serious mental illness are no more likely than the general population to be violent unless they also have a substance use disorder. So no prospective studies and look at all the restrictions on violence with guns. There is very little funding and there’s a lot of restrictions on what you can study. So if you have mass violence where 95 percent is guns, but you have us as a nation, it’s not just our elective representatives. We decide this is a group saying that we don’t want to seriously study this stuff for whatever reason. Why should we expect anything to get better?

Gabe Howard: Now, just to take us out for a moment, many of our listeners aren’t familiar with prospective studies and retrospective studies. Can you explain that for us real quick?

Joe Parks: Oh, I’m sorry. Yeah. A retrospective study is where I take information that’s been gathered for other purposes. So I look at everybody after the shootings have occurred. I look at them as a group afterwards and try and find out if there was violence related to mental illness. A prospective study would be where I look at thousands or tens of thousands of people with mental illness before any violence has occurred. And I followed them over 10 or 20 years. It’s a much stronger study methodology because you’re not just looking at the subsection and missing all the people that haven’t been violent yet.

Gabe Howard: Thank you so much for explaining that. Now, one of the reasons that we want to do these studies and why the National Council advocates for these studies is because in doing so, we can prevent violence potentially because we can do things like threat assessments. Now we have threat assessments now. What are those and what are they based on if the studies are so wonky?

Joe Parks: Well, again, it depends on what you mean by threat assessment. What are referred to in the report as threat assessment is a multi-disciplinary team and this was a process that has been developed over time by the FBI. That is not just all clinicians that does an ongoing investigation of someone. There were there’s concerns that they could be dangerous. So people are brought to the attention of this team and maybe somebody that has become more sullen at work, has started muttering that he’s not going to take it anymore and somebody has got to pay. And someone got worried and called up and it came to the team’s attention. Now the team, in the case of workplace, would consist probably of somebody from H.R., somebody from the local police because of this potential for a crime, a lawyer that’s knowledgeable about rights, because we want to protect the person’s civil rights also, and a behavioral health professional in case there is a mental illness related to it. And they gather information around the person before they talk to the person. Then they decide who talks to the person about what. And it’s an ongoing process. It’s not a clinician alone in a room talking just about medical symptoms.

Gabe Howard: We’ll be right back after these messages.

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Gabe Howard: We’re back discussing mass violence with Dr. Joe Parks from the National Council for Behavioral Health. Dr. Park, what motivates mass violence?

Joe Parks: You know, I don’t have a good answer for that. I can give some theories. But boy, I’m not certain they’re right. A lot of this is connected to people feeling more hopeless, angry and treated unjustly. And a lot of it is also a loss of connections. And it appears to me and I think many of your listeners who look around that people are less connected to them than they were to each other and that people are much angrier and feel more resentful and that their life has not been fair to them. You know, another good question is why is this such a huge problem in the United States and not in other countries? You know, we don’t have near the rates of other citizens of other countries shooting large numbers of people because they’re angry and resentful.

Gabe Howard: Let’s talk about that for a moment. First off, Facebook and Facebook memes are a terrible, terrible, terrible place to get any sort of data or information about, well, anything. But I see a lot of stuff on Facebook, especially doing my research for this episode where somebody will say that, you know, other countries don’t have large amounts of mass violence surrounding guns and then somebody will post after it. Well, yes, but they have large amounts of violence with driving cars into people and, you know, stabbing and other forms. Is that true? Or do they just have a lower rates of mass violence hard stop?

Joe Parks: Oh, no. No. You know, one of the points of data shows in our report, if people want to take a look at it, shows that the data on assaults, we actually have fewer assaults than many countries. It is just in the US, when we assault each other, we’re much more likely to kill each other. They’re just much more deadly. So this is on page 21 of our report. If people want to go and download it. It has the percentage of population assaulted annually by nation and there the top, of all places, is Belgium at around six and a half percent, and the US is about, oh, 15, 20 countries down the list at about one and a half percent. But if you look at the death rates from suicide and homicide by nation, we’re at about nine deaths per hundred thousand. We’re by far number one and with over double the next country, which is Finland. And so we are much less likely to assault each other. But when we assault each other, we’re much more likely to kill.

Gabe Howard: That is that is incredibly interesting, and I can’t imagine that you have an answer to this next question, but why do you think that is?

Joe Parks: I think we’re less likely to use cars or knives. There are mass assaults with knives that usually don’t result in large numbers of deaths. They result in large numbers of wounds. We’re simply using more effective means when we do an assault would be my guess. But this is where we need more research. If we wanted to know, we would fund serious research.

Gabe Howard: I think it’s incredibly interesting that all of America is aware of this issue, I think that you would be very hard pressed to find somebody that is not aware of mass violence and concerned by mass violence. And it really does impact our day-to-day lives. We teach our children not to talk to strangers. We go through metal detectors to go to sporting events and concerts. We are just really worried and concerned about mass violence. Yet you’re telling me that the federal government is doing not very much about it.

Joe Parks: They study the individual cases. They don’t have a large systematic method like the National Transportation Safety Board does with airplanes. And even though 95 percent of the mass violence are shootings, there is very little or no federal funding for research around violence and guns, and there are restrictions attached to it.

Gabe Howard: That’s just incredible. And again, I want to make the point that this isn’t political, nobody is taking a partisan side on this issue. Just simply stated, Americans are concerned about mass violence. But we don’t seem to be doing much about it. Now, the National Council has some opinions on what we can do to stop the trend of violence.

Joe Parks: Yes. And we recommend that, first of all, there should be some national definitions and some real research and a standard board that looks at the shootings after the fact. Like National Transportation Safety and tries to figure out what can be done before we think there should be more threat assessment teams that states and the feds should make funding available and that threat assessment teams should be available in every school district and in all the large workplaces and in most communities. So when community members are worried, there is a team that can look into it and take action, we think everybody should be trained in mental health, first aid for that subgroup or 25 percent where mental illness may be a factor. So it can be identified early before they’re so distressed that they’re that angry. We also think that extreme risk protection orders, also known as red flag laws should be more widely adopted. These are available in about 17 states. Now, how easy the law is to use varies by states, but this is where someone can go to the court, your local court, and say, your honor, I’m worried about John. He’s saying he’s not going to put up with that anymore. And I know he’s got a bunch of guns and he’s talking about somebody who’s got to pay. And I’m just scared. And the judge can say, well, let’s have the police remove John’s guns temporarily while the threat assessment team talks to him. And so it’s due process with the court. John gets his guns back after the issue is settled down and cleared up. And this has been in place for domestic violence nationally for many years. You know, if you threaten to shoot your partner or spouse with a gun, every state has a way to remove that gun until you work it out. If you threaten to shoot up the church, up the street, now only 17 states have a way to remove your gun until that gets worked out.

Gabe Howard: It’s fascinating to think about the idea that we’re debating whether or not it’s okay to leave weapons in the hands of somebody who has publicly threatened to use them for their intended purpose on innocent people. When we all know how we react once that happens.

Joe Parks: Yes, it’s we’re kind of conflicted. You know, the other major recommendation we have in terms of this smaller subset of people where mental illness may be a factor is I’m sure all your listeners are aware of the difficulty out there in accessing treatment for mental illness and addiction promptly. People don’t know where to go. In a study by the Cohen Veterans Network Foundation, over half of people said they wouldn’t know where to go to get help for mental illness if they needed to find it for themselves or a friend. And when they do find it, they often have to be on a waitlist for weeks or months. Well, the solution to that has been implemented in eight states now. It’s called certified community behavioral health centers. This is a treatment organization that treats both addiction and mental illness, that has federal requirements for getting people in promptly, having late hours, having weekend hours, having a mobile crisis team that will go out and help people that are in crisis 24 hours a day, seven days a week has a full range of services. It’s not go one place for your residential, go some place for your outpatient, go someplace else for your meds. And we believe that that needs to be continued and expanded. It’s called certified community behavioral health centers. It was put in place by the Excellence Act. And people should say that they want it in their communities so they can get treatment when they need it.

Gabe Howard: In your advocacy work, do you think that the federal government is responding to you see things improving? Are things getting better? What’s the reaction from the capital?

Joe Parks: You know, we are making some steady progress on certified community behavioral health centers and we’re making steady progress on mental health first-aid. Where we’re not seeing real progress, is on a standardized definition and data gathering around mass violence and on some serious research into it. And we haven’t seen progress yet on resources for threat assessment and management teams. So it’s mixed.

Gabe Howard: It’s mixed, but you’re out there working and hopefully making it better.

Joe Parks: You know, and if people take a look at our report, there’s something in that report any of them could weigh in and make a difference on. We have very specific, actionable organizations on what you can do as a community member or what you can do if you work in an organization that does health care and there’s legislative recommendations that you can certainly let your elected officials know some of these very specific ideas if they’re ones you agree about. But you won’t know until you look at our report if you agree or not.

Gabe Howard: And can you give us the name and location of the report one more time, please, to make it easier for the listeners to find?

Joe Parks: Yeah. Put in your browser National Council for Behavioral Health. And then put in the words mass violence in America (See the full report here:  Mass Violence in America).  

Gabe Howard: And it’ll pop right up, excellent. Dr. Parks, thank you so much for being on the show. I have one last question before we part. Mental illness and mass violence, are they correlated or not correlated?

Joe Parks: They are not particularly correlated. You know, again, there’s about 25 percent of people that mass violence perpetrators that had a mental illness, about 19 percent of the general population. There are certainly some people that perpetrate mass violence that have mental illness. There is a small subset of cases where it appears to be causal. In the majority of cases, mental illness was not a cause of the mass violence.

Gabe Howard: And again, with the caveat that that studies are hard to come by and we really need to do a better job to make life better for all Americans.

Joe Parks: Yes, serious study is better than random speculation, we need to stop speculating and start gathering our information.

Gabe Howard: Dr. Parks, I really appreciate you being here and I appreciate all the work that the National Council for Behavioral Health does. Thank you.

Joe Parks: Well, thank you. Appreciate the discussion.

Gabe Howard: Thank you, Dr. Parks, for agreeing to be on the show, and I hope everybody will read it and talk to their legislator, because no matter what side of the aisle you’re on, I think that we can all agree that we want to see less violence in our country. Thanks, everybody, for tuning in. And remember, you can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting  BetterHelp.com/PsychCentral. We’ll see everyone next week.

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