Robin Zagurski is a therapist and social worker in the University of Nebraska Medical Center Department of Psychiatry. She was a mental health first responder following the Sept. 11, 2001 attacks, the 2007 Von Maur shootings at Westroads Mall and the 2008 tornado at the Little Sioux Scout Camp. She wrote psychological curriculum for first responders and has instructed local first responders in psychological care as it relates to emergency response and recovery efforts.
She answered some questions related to the aftermath of last week's school shootings in Connecticut.
Are people with mental illnesses being unfairly linked to violent behavior?
I think that the majority of mentally ill people are not violent. We know that. Statistically, having certain illnesses like schizophrenia, they have a higher incidence of violence than the rest of the population. However, that violence is defined in various ways in various studies. It could be somebody who acts out and throws things. We're not talking about somebody who can organize themselves to commit a mass shooting.
In any planned violence, and most of these mass shootings are planned violence, there are stages that a person goes through. The first one is grievance, when somebody feels like they have been wronged in some way. So they start to express that. If we can intervene at that point and they feel like they have some sort of means to address that, then we can stop the progression.
In (the next step), that's when people start to feel like there must be some way to solve this. The only way to solve this (in their mind) might be violence.
The next thing: Research and planning: "How would I pull this off." "What would I need to kill as many people as possible."
Then there's the preparation phase where they start to gather materials, gather information about the place they want to attack. But during those phases, there is usually what we call leakage. In leakage, the person is telling others about their planning. They're talking about their grievance. (They think) there's no other way to solve it other than violence. Often, they will post those things on social media like Facebook. It's really kind of stunning how often writing is found on the planning.
Then there's a breach. That's where they go take a look at where they plan to attack.
The last is attack.
How do you assess a threat?
One of the things that's tough about threat assessment is it's hard to measure something that doesn't occur.
Some cities have threat-assessment teams. Salem, Ore., has a threat-assesment team. They work with the school system. They look at all the threats.
When you do a threat assessment, you do something to make things better. One of the things we know that makes things better: the more connections they have in life, the better off they are.
So if you have lost a relationship or a job and you are losing your home, that puts people more at risk for acting on these sorts of things.
Can you assume somebody who attacks a school has a mental health problem?
We want to think you can't be thinking straight to (attack a school). But we can't diagnose somebody we haven't evaluated. We don't know what was going on with this kid.
It's a common reaction to want to understand why someone would do something like this. If we can understand it, then we can change it. But we may never know why. You're always going to hear opinions about what happened. We encourage people to be skeptical when they hear those things and remember that much of it is just opinions and not facts.
We have mental health problems in this country. We have a shortage of mental health providers in the state of Nebraska. Mental health doesn't get a telethon. We don't push for the research.
Mental health problems can range from depression and anxiety to pretty serious thought disorders like psychosis. We can say there are a lot of people in the United States who have mental health problems, but that doesn't tell us what they're struggling with.
The important thing is we need to take care of each other. We need to listen to what people around us are saying. If people make threats, either to themselves or others, we need to take that seriously. We need to get them some help and not say they're just trying to get attention or they're just mad and they're blowing off steam.
If (the threat) is to a school or business, that school or business needs to be notified. I would also notify the police.
Any time somebody is making (a threat), they can't figure out how to solve the problem they're in and that seems to be the only way to solve it. I don't believe in ambushing people. I let them know I'm concerned. I'm worried about how they are feeling and I'm going to stay with them until they get some help.
Who should you call first?
Start with a primary care provider. Primary care providers are trained especially in terms of suicide to assess the risk of suicide, and they can start people on medication, which is part of the treatment process.
They usually have a relationship with mental health providers they can refer to. If somebody is in imminent danger, we want them to go to the emergency room and be evaluated there.
How should parents talk to their kids about the shootings?
The more stable the parents are, the better off the kids are. If parents are going about their day, children will stay with their regular routine. That sends a pretty strong message to kids.
We also want to remind parents that kids shouldn't be watching the news accounts over and over and maybe shouldn't be watching the news at all. The news tends to be X-rated.
After 9/11, we had kids that drew pictures of planes bombing buildings. They're trying to figure it out in their own heads: "If this happened, what would I do. How would the world work for me?"
With older kids, this is a chance to talk to them about what they hear at school, what other kids say or are there any kids that they're worried about. This is an excellent opportunity to have a dialogue with children that's really meaningful. But we let them ask the questions, we let them lead the conversation.
You helped counsel people after the 9/11 attacks, after the Von Maur shootings and after the Little Sioux tornado. Are there any similarities to how people react?
There are common reactions after every disaster, no matter what the size and scope of the disaster is.
Physical reactions: nausea, vomiting. I think many people felt nauseous when they heard what happened on Friday.
Cognitive: "Why did this happen? What can we do to prevent this and the rumors that fly about what might have happened?"
Behavioral: People get more agitated sometimes. They might cry more often, they might get more irritable and fight more with people around them.
Emotional: It's the sadness and the grief. Sometimes it's numbing, sometimes it's anger. Those are common reactions, and none of them are wrong. When they occur for so long that they start to interfere with your functioning, when that happens, talk to a professional about what's going on.