Trauma Of Violence Brings Mental Illness

As a psychiatrist, I know mental health is front and center when national shooting tragedies occur, such as the most recent at a high school in Santa Fe, Texas, Friday.

Mental illness is usually identified as the cause of gun violence. Studies, however, show the opposite. It is far more likely that the victims rather than the perpetrators of violent crime will suffer mental illness.

The conversation needs to shift. Violent events cause mental illness. School shootings cause post-traumatic stress disorder and major depressive disorder. Tragedies feel closer with pictures in real time, effective journalism and rapid-fire transmission of news.

Trauma is at the heart of many incidents — shootings, terror attacks, severe weather — and can endure for months to years after a tragic event. Here in Connecticut, Sandy Hook remains on the minds of many.

Trauma hurts. Every high schooler in Santa Fe will vividly remember the day their classmates were killed. Their family members will chronically worry on their behalf. Mothers of the 10 murdered children were unexpectedly confronted with major loss. They have a high chance for developing major depression. The family members who support them will also be at risk for depression.

I’ve treated individuals who experienced gun violence. They have brutal nightmares and can experience debilitating shock when someone is behind them in the grocery store. Their lives are wrecked by fear. Neurobiological processes imprint memories of the event, and can be triggered at any given moment. I’ve also treated mothers who have lost children. They’ve been hospitalized for thoughts of suicide and severe symptoms of distress and depression. Their lives hold pain and darkness, even 30 or more years later. They often lose motivation to work, and struggle especially in the days surrounding the anniversary of the tragedy.

The problem is that mental illness affects individuals and families. It affects entire communities. It even affects newspaper readers — notice the knots and emotional anguish that occur when experiencing tragic news. We need to name the feelings and start to talk about them. Social withdrawal is typical, but not helpful. Without conversation, emotional pain can be stagnant and lingering. Seeking professional treatment early may help avoid chronic and severe mental illness.

Unfortunately, there are too few mental health professionals to cure the nation. There is a national shortage. According to a 2016 Health Affairs report, the average number of psychiatrists is zero in most counties. It takes four years to train a psychiatrist, so national policies for increasing the psychiatry workforce should have been passed years ago.

In Texas, the problem is particularly severe. A 2015 Merritt Hawkins statistic showed that 185 of 254 Texas counties have no psychiatrist, covering approximately 3.2 million people. Although legislators have attempted to recruit more psychiatrists to Texas, mental health providers are still disproportionately located in the Northeast and near major academic hubs.

This means that the majority of the people in Santa Fe and nationally who need psychiatric assessment and treatment have no access.

Even in Connecticut, which spends more on state-funded mental health programs than most other states, a robust mental health delivery network is far from reality.

Last year, I worked with colleagues to advocate for increasing access to psychiatric care. One major issue in access is that most providers listed on commercial insurance panels are not accepting new patients. We advocated for a bill that required insurance panels to indicate which providers are accepting patients. Although it passed in Connecticut, policies demanding accurate information and improving access to care need to be more widespread.

Organizations such as Mental Health America and the National Association of Mental Illness are campaigning against stigma and promoting mental well-being. They offer toolkits and support groups for people in need of help. These resources are but a drop in the bucket.

Our lawmakers need to quickly unite to bolster mental health services in Texas and beyond. All the teenagers and families affected by the Santa Fe shooting deserve to get help to overcome the shocking trauma that they’ve just experienced.

Luming Li, M.D., is a chief resident in quality improvement and administration at the Yale New Haven Psychiatric Hospital.