Tuesday, April 10, 2018

Post Parkland – dangerousness and fire arm access

Dangerous people should not have access to fire arms.  On this subject there seems to be near universal agreement.  Laws, regulations, and enforcement are required to intervene and prevent people who are dangerous from purchasing or possessing fire arms.

Controversy arises largely in the defining of dangerousness.  Mental health professionals fear the mentally ill generally will be further stigmatized and isolated.  Civil rights defenders fear abuse of civil rights without clear definitions and strict adherence to due process.  These are legitimate concerns that must be addressed in the development of policies.

There are existing federal and state laws that prohibit specific categories of dangerous people from purchasing fire arms. For example, people involuntarily committed to a mental institution, or found not guilty by reason of insanity, or who committed a violent act towards others and are the subject of a domestic violence restraining order, or have been convicted of a felony, or have been convicted of a domestic violence misdemeanor.



Some state laws build upon federal constraints by providing law enforcement and health care providers the ability to involuntarily commit the mentally ill for examination.  Florida’s Mental Health Act of 1971 (aka the Baker Act) is an example of a law that allows for involuntary institutionalization initiated by law enforcement, judges, physicians, and mental health professionals.

Once a person is involuntarily committed they can then be barred from purchasing or possessing fire arms.    But involuntary commitment, appropriately, has a very high bar of evidence.

The Parkland murderer was evaluated by mental health professionals in 2016 for potential institutionalization under Florida’s Baker Act.  At that time the evaluation was initiated as a neglect case rather than a dangerousness case and the evaluators chose not to institutionalize him.

More recent state laws creating Extreme Risk Protection Orders (ERPO) have lowered the bar for intervention when dangerousness intersects with access to firearms.  ERPOs permit a court to authorize law enforcement to seize fire arms from a person considered a danger to himself/herself or to others without involuntary institutionalization.

To seize fire arms under the new Florida law the ERPO filing must:

“Allege that the respondent poses a significant danger of causing personal injury to himself or herself or others… [by presenting] specific statements, actions, or facts that give rise to a reasonable fear of significant dangerous acts by the respondent.”

Each state that has or is considering passing an ERPO law may have variations of this basic language.  Some laws are clearer than others.  For example, the ACLU of Rhode Island brought a law suit to contest Rhode Island’s ERPO law as too vague and open to abuse of civil liberties.

A “reasonable fear” in the case of potential perpetrators of mass public shootings in schools would be established by testimony to both behavior and statements made by the alleged dangerous person in the home, school, community at large, and online.

The Parkland murderer left a long trail of indicators of his dangerousness.   Students stated they knew it would be him.   Police had dozens of encounters.  School administrators had multiple disciplinary actions.  He was treated for mental health issues and had been prescribed psychotropic drugs.

Communications both in person and online were concerning to many and reported.  Family and friends knew of an obsession with guns to the point they called police to remove the weapons out of fear.   Calls of great specificity to law enforcement of the murderer’s gun ownership, desire to kill people, erratic behavior, and disturbing social media posts, as well as the potential for a school shooting, went unheeded by county and federal law enforcement.

The layman looks at the reported indicators and wonders how this tragedy could not have been avoided through intervention.   The process by which people are identified, introduced into a dangerousness assessment process, adjudicated and processed is invariably a very complex process that requires extensive communication among families, schools, law enforcement, courts, and mental health professionals.   It clearly failed in Parkland.  Post Parkland every state and community must assess this process and improve, and new tools, such as ERPOs, integrated into that process.

Leaving that discussion aside, it is important to focus on what will begin a dangerousness assessment process.   Family members, friends, school mates, co-workers, and others within every community must recognize when something is amiss with a person that sets off alarm bells and take the initiative to report their concern.  They must also have the courage to follow up with those in authority to determine what action was taken in response to their report and to question and hold those in authority accountable for inaction.

The process starts with recognizing several risk indicators of the potential mass public shooter.

Before describing these indicators, it is important to say that people who suffer from mental illness, or take psychotropic drugs, or possess fire arms are not inherently dangerous.   None of these indicators alone, or several in combination, mean that a person is dangerous.   They are simply indicators that when they present themselves in a manner that raises an alarm within a home or a school or a community should be pursued in a process of assessment to determine dangerousness:

MENTAL HEALTH:   Mass public shooters are likely to have some mental illness history.  At the one extreme are those with diagnosed serious mental illness and at the other are those with at minimum a troubled mind for which the mental health field may not have been engaged or have a developed treatment. 
The most common symptoms among them include paranoia, hallucinations, depression, and suicidal thoughts.   They often have been prescribed psychotropic medications and some have been hospitalized. Most attackers had difficulty coping with significant losses or personal failures.  Many consider or attempt suicide.

PSYCHOTROPIC MEDICATIONS:   There is an obvious lack of study regarding the use of psychotropic medications by mass shooting perpetrators.  Lacking serious studies on this topic one is confined to independent research to find that there is a common thread of psychotropic prescription drug use in the history of perpetrators.  Antidepressants and psychostimulants (e.g. Ritalin) appear to be most common.

There is reporting from research that 7.5 percent of U.S. children between ages 6 and 17 were taking medication for “emotional or behavioral difficulties” largely using antidepressants and psychostimulants.  One report stated the Centers for Disease Control indicated 10,000 toddlers in the U.S. were prescribed psychostimulants.

The Food and Drug Administration maintains an Adverse Event Reporting System that clearly indicates many psychotropic drugs can have severe side effects for some to include suicidal and homicidal thoughts and actions.

More formal study is warranted on this topic, but the use of psychotropic drugs should be included as one element of an assessment of dangerousness because of rare reported side effects.
 
NARCISSISM: Most attackers exhibit aggressive narcissism. They are hostile, extremely self-centered, have an inflated sense of self and entitlement.  They may also have violent or angry outbursts following personal conflicts with family or the community.

Some researchers indicate that narcissism is increasing within U.S. culture.   News media handling of mass shootings may be feeding the narcissist tendency and possibly contributing to copycat behavior.  Some Intended mass shooters have stated they admire the Columbine murderers and were planning their attacks for the anniversary of that shooting. 

PERSONAL REJECTION and SOCIAL ALIENATION:  Many attackers feel bullied, persecuted, or injured by others.  They feel and may appear isolated, even humiliated, within their social sphere. To the attacker the mass shooting is a hostile revenge against those who have injured them.

One wonders if cultural trends in relationship patterns, the deemphasis of competition (and associated failure), and the pervasiveness of isolating technology have had an impact on how adolescents react to rejection.

COMMUNICATIONS: Most of the attackers made threats toward others or made other concerning communications.  Outside of threatening communications, most attackers engage in other concerning communications such as overly angry statements, racist comments, references to past attackers, suicidal language, or comments indicative of their intent to carry out an attack.

Most attackers engage in communications or exhibit behaviors that cause concern in others including parents, siblings, current or former romantic partners, friends, neighbors, teachers, classmates, work associates, community members, and law enforcement.

FIRE ARMS:  The presence of fire arms within the sphere of access for any person exhibiting concerning mental health or social psychological issues is an alarm for greater concern.   Most attackers had access to and had used weapons prior to their attacks.   Attackers often are obsessed with fire arms.  They often prepare for their attack.  Most have multiple weapons.

In a recent incident in Maryland it was reported that the attacker used his father’s pistol.  The attacker had wanted to use his father’s rifles in the attack.  The father responsibly maintained his fire arms in a locked safe.   Police interrogation revealed the attacker had hidden video equipment in the home to try and capture the combination to the father’s safe.  He had also used soap to try and capture his father’s fingerprint to open the safe.   Unable to access those more powerful weapons he stole his father’s pistol.
 
This example points out that owners of fire arms have a particular responsibility to secure fire arms in their homes.  They must assess objectively the stability of relatives and visitors to their homes to prevent a dangerous person from gaining access. Lacking absolute confidence in fire arm security may necessitate the owner removing the firearms from the home.

The Parkland murderer demonstrated nearly all of the indicators described here.  Yet, there was no effective intervention.   Vigilance in homes, schools, and communities is the key to successful intervention.   It is everyone’s responsibility.  

2 comments:

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  2. Below are some of the readings used in developing this blog post:

    https://www.secretservice.gov/data/protection/ntac/USSS_NTAC-Mass_Attacks_in_Public_Spaces-2017.pdf
    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015337
    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2014/are-children-overmedicated.shtml
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318286/
    https://psychiatryonline.org/doi/pdf/10.5555/appi.books.9781615371099
    https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1461&context=etd
    http://digitalcommons.liberty.edu/cgi/viewcontent.cgi?article=1437&context=honors
    http://www.esrb.org/
    https://en.wikipedia.org/wiki/Video_game_controversies#Crime_and_violence
    https://en.wikipedia.org/wiki/Brown_v._Entertainment_Merchants_Ass%27n
    https://www.cdc.gov/violenceprevention/pdf/electronic_aggression_researcher_brief-a.pdf
    https://www.psychologytoday.com/us/blog/our-changing-culture/201212/yes-violent-video-games-do-cause-aggression
    https://www.washingtonpost.com/news/grade-point/wp/2018/04/01/a-disaster-about-to-happen-a-student-who-bought-rifles-and-showed-odd-behavior-is-arrested/?utm_term=.607364d19cd9
    http://lawcenter.giffords.org/gun-laws/policy-areas/who-can-have-a-gun/extreme-risk-protection-orders/
    http://lawcenter.giffords.org/wp-content/uploads/2015/01/Final-Mental-Health-Toolkit-12.5.14.pdf
    https://www.washingtonpost.com/graphics/2018/national/timeline-parkland-shooter-nikolas-cruz/?utm_term=.8b428f877416
    http://www.riaclu.org/news/post/aclu-of-rhode-island-raises-red-flags-over-red-flag-gun-legislation
    http://www.myflfamilies.com/press-release/dcf-records-nikolas-cruz-was-receiving-mental-health-services-taking-medication-and
    http://www.sun-sentinel.com/local/broward/parkland/florida-school-shooting/fl-florida-school-shooting-guns-seized-lighthouse-point-20180316-story.html
    http://www.orlandosentinel.com/news/breaking-news/os-opd-gun-seized-florida-gun-legislation-20180321-story.html

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