• Scott

Workplace and other public violence prevention from a mental health practitioners perspective

Back in 2014, I was the director of the Behavioral Science Consultation Team (BSCT) for Joint Task Force - Guantanamo Bay, Cuba (JTF-GTMO). That position is considered to serve a non-clinical function, where the primary source of expertise as a consultant arises from the social psychology and sociology literature. The BSCT (pronounced "biscuit") provides actionable consultation to the commander of the facility for the purposes of helping him make decisions regarding the conditions that may contribute to abuse, neglect or malfeasance inside it.

It is psychology, in the service of national security. In fact, one could consider national security itself to be the client, or end user--even though the daily customer is of course the commander of JTF-GTMO.

One of the "side jobs" me and my crew were asked to engage in was to conduct indirect assessments on the now infamous "Bergdahl five," the five GTMO detainees that were exchanged for the return of convicted deserter Bowe Bergdahl. An indirect assessment is done without direct contact with the subject. It is an assessment of whatever the requester is asking for vis a vis the subject (in this case, how likely were they to re-enter the fight as belligerents if they were released from GTMO) based on whatever collateral information is available, combined with indirect observation. My crew was not the only team asked to conduct this assessment. In fact several alphabet soup agencies were doing them in stove pipes (unaware of what the others were doing), in what I presume was a compartmentalized effort to spread the risk around regarding a decision that had already been made. Most of that activity and the details of what our final product contained is still classified, but in the end, there was consensus--that these five were the worst of the enemy we had captured on the battlefield, and they would most definitely re-engage as soon as they were able.

My point is, I have some experience with assessing risk. And those days came back to me while I was reading this article at Security InfoWatch:

Dr Albrecht makes some pretty good points here, and I am aware of his credentials in this area. I would like to pick up (a little) where he leaves off and humbly offer to bring some of my experience to bear.

I won't go into the details of how the equations work here, but some statisticians way smarter than me have already tried to do the aggregate math involved in what would be kind of a nation-wide indirect assessment. Boolean expressions have been conducted on what would be required, for example, to capture the next Las Vegas shooter (or whichever gruesome mass shooting you prefer). The consensus is that even if you had unfettered access to all the mental health and medical records of every single American citizen, and were aware of all the static and dynamic risk factors of each of them, you would need to temporarily detain over 100,000 Americans ON ANY GIVEN DAY to "prevent" such a shooting or mass killing. This is a problem of sensitivity over specificity, which I have discussed elsewhere. But suffice it to say, such an effort is logistically impossible (we do not have access to those records, nor do we have a large enough or homogeneous national police force to do it for example) not to mention Americans would not stand for it.

Albrecht must be aware of this, and therefore readjusts his efforts on individuals in the workplace who become the focus of their employers attention by way of threats (or presumably other bizarre, inappropriate behavior). This is a perfectly rational approach, and there is no fault to be found in it. He comes up with a series of questions to ask in an interview of someone like that, and they are very good. I would absolutely assent to the use of this line of questions, once you get focused on a particular individual. Problem is, by the time the bodies are piled up in the classroom, (or wherever) everyone is looking around wondering where this person came from. Its like a total surprise to everyone, until they start looking more closely at the individuals life leading up to the incident. An indirect assessment (or any kind of assessment) of a person who's strange behavior called the attention of the security and behavioral health providers around him -- assuming they were all working in conjunction and communicating with each other -- would have very likely detected the next mass killer. But it almost never happens that way.

But Albrecht also makes this suggestion, in a series of macro-level changes that could be made in order to reorganize the entire way in which we try to prevent these things (although I prefer "reduce the base rate"). He writes:

"Restrict access to guns by minors and the mentally ill"

If you talked to any psychologist, (no matter how pro-gun or pro-second amendment they are) about the individuals who perpetrated these most recent shootings, all of them would agree that the person should not have had access to firearms on mental health grounds. It seems like every one of them had a history -- documented medically or not -- of frequent interactions with mental health professionals for severe mental illness, or going on and off heavy hitting psychotropics, or a diagnosis that contains dissociative or psychotic features, or something else in that realm of severity. The narratives of these folks are overwhelmingly in favor of an approach that includes Albrechts suggestion.

But how? Privacy about mental health interactions is a serious thing--and it exists for very good reasons.

I am a gun owner. When I go to a retail store to buy a firearm, I produce my drivers license, fill out a form, answer a bunch of questions about my criminal, substance abuse and mental health history and no one checks to see if I am lying about it. Then, they do an instant background check and five minutes later I walk out the door with a gun. I can buy ammo at the same store and be fully armed as I walk to my car.

My question is, what is contained in the instant background check? And my follow up question is a rhetorical one--what about my mental status?

Risk of violence is a constantly moving target and waxes and wanes in the aggregate as dynamic factors come and go. Mental status is one of those factors. The process I described does not account for how I am feeling at the moment I walk into the store. The guy behind the counter is not a credentialed mental health provider trained to recognize slight anomalies in affect and so on.

Now, a curious investigator of this phenomenon would also have to ask "how many mass shootings have happened where the shooter walked into a gun store, bought a gun and ammo, and then went immediately into his rampage?" My guess is that number is close to zero, and therefore that particular variable may be of little to no use in a predictive algorithm, and therefore even less useful for public policy making on this issue.

But it is interesting.

So, for now, it seems that keeping firearms out of the hands of the mentally ill is an untapped area of consideration. I wonder why this is not being looked into on a larger scale by me and my colleagues. One reason that I have to wonder about is that mental health professionals are overwhelmingly politically liberal and are likely to be biased against engaging in this discussion where the second amendment is a thing. I am not deterred by that, since I agree with its basic premise (that individuals possess a basic human right of self-defense) but I also know that there are some ways we could reduce the longitudinal risk of these kinds of incidents with minimal tweaking of the background check system.

In the interest of addressing the concerns about gun ownership and mental health, I would propose something like this:

1. Key stakeholders from the behavioral health sciences, lawmakers, the law enforcement/justice community come together in a good faith effort to work, long term on solutions that might actually help.

2. "Good faith" in this regard means that everyone agrees to the basic premise of the second amendment (since it is not going to be repealed any time soon) that a basic human right of self-defense exists. It also means an end to the rhetoric of gun owners and second amendment activists not caring about children and so on. There can be no hidden agenda (like banning entire classes of firearms). Just a commitment to scientifically, dispassionately and pragmatically solving a problem.

3. An across the board recognition that in a world where people have free will (and no "precrime" apparatus has been invented) that risk exists and these kinds of occurrences will never be reduced to zero.

4. A further commitment to avoiding a one-size-fits all approach to solving this problem. No single list of diagnosis or criteria that absolutely sets off a red flag, but rather a dynamic sophisticated approach with an appeals process and safeguards to protect individual rights.

5. Entering the discussion with the intent of developing a real revamp of the background check system.

6. An openness to go back at predetermined intervals and UNDO anything that did not work.

I welcome your thoughts and thanks for reading.

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