Understanding Mental Health as Public Health

Professor Olga Acosta Price discusses takeaways from the Isla Vista murders.

mental health
June 03, 2014

The slayings that occurred on May 27 in Isla Vista, Calif., leaving six University of California, Santa Barbara students dead, have sparked a series of public dialogues about gun control, mental health and violence against women. The actions of the 22-year-old killer have raised familiar questions: How could this happen? And how can it be prevented from happening again?

While there may be no definitive answers, Olga Acosta Price, an associate professor in the Milken Institute School of Public Health, said tragedies such as this recent one in California, are often a “catalyst for conversations” that could lead to important policy and culture changes within a community.

Dr. Olga Acosta Price

One of those necessary conversations, she said, is to begin talking about mental health as a public health issue. Although the majority of people who suffer from mental illness are not dangerous, for those who are at risk for violence due to mental illness, individual treatment and community-level interventions can help stop gun violence.

Dr. Acosta Price spoke with George Washington Today about mental health and violence prevention as well the role universities can play in ensuring their students are safe and emotionally well.

Q: The violence that occurred in California last weekend has sparked a number of debates about access to mental health care, gun control and gender-based violence. What is the importance of having these conversations?
A: This is an opportunity for the science to really inform the public conversation. It’s important to note that those with mental health problems typically are not more violent than those in the general population. In fact, they’re often 11 times more likely to be victims of violence than the perpetrators. I think this is an opportunity for us to dispel some myths, to share data and to see what we could learn from this tragedy. 

One thing I think is an important part of the conversation is that mental health is public health. When we consider the critical public health issues, mental health should be front and center. And when I say mental health, I don’t mean just tending to those with mental illness, but to the mental health needs of all of us—thinking about our public health response in supporting the mental and emotional well-being of all segments of the population.

If we bring our resources and attention to thinking about prevention and early intervention, as well as really sound treatment and crisis support, we would have a very robust public health response to these types of situations. There are certainly things we should think about in terms of ways we could mitigate risk and reduce the likelihood of these tragedies. But another part of the conversation is ways to think about the full continuum of a population’s needs and where we could build up our investment in the promotion of well-being.

Q: According to the American Psychological Association, men represent 90 percent of the perpetrators of homicide in the United States. And nearly all of the shootings that have occurred in U.S. schools and universities were perpetrated by young males. What are some other characteristics that mass killers share, and are there ways to identify those who at risk of becoming violent without stereotyping?
A: What really struck me as a potential thread across many of the perpetrators of this type of violence is their social isolation, and I think that’s very important to point out. That might be one of the antecedent conditions—a sense of isolation and a lack of peer acceptance.

And so what role might we play in identifying individuals who feel very disconnected, don’t have a sense of belonging or believe that there isn’t a group they can identify with? When I think about college campuses, there are ways we might think creatively about points of intervention, identifying groups that may feel marginalized or separate. Because out of that isolation and sense of social rejection often comes angry, aggressive or negative reactions.

For the California shooter, his sense of rejection seemed to be focused on his peers, and women in particular, and a sense of not belonging or connecting, which can be very damaging. So there may be ways to better identify and then enhance support networks for people who feel like, even if they are different, that there is still a place for them to feel welcomed, respected and connected. So this goes back to both prevention and promotion strategies.

Q: Do you think there should be strategies for training teachers, police officers and other community members for identifying people who might be struggling with mental health issues and could pose a threat to themselves or others?
A: I think we can definitely do a better job of that. And I’m happy to say we’re taking steps in the right direction nationally and in the federal government. For example, the Substance Abuse and Mental Health Services Association (SAMHSA), has put out requests for applications for communities to offer what is called Mental Health First Aid, which would be training in how to identify and engage individuals who might be showing warning signs of mental illness or substance abuse—training individuals on how to understand, recognize and then respond in ways that will support the individual and connect them to appropriate care as needed. It really is intended to be a very comprehensive first step in training all of us about the warning signs.

There is a lot we can do to acknowledge the challenges and be a first line of support, and it doesn’t mean you have to be a trained clinician, just a contributing member of a community, showing that you care. And I think that’s a very important step, as opposed to feeling very anonymous, like you could be suffering and no one cares. I think that is part of what contributes to this sense of isolation and rejection and where some of these really volatile reactions may stem.

Q: What can students, faculty and staff at GW do to identify and help others who may be suffering from mental health problems?
A: One of things I’ve done is to try and advocate for every syllabus at GW to have a section on personal care and support. We are adopting that in the Department of Prevention and Community Health among the faculty. It’s a listing of the university’s resources in one easy, central place. I think it is part of our responsibility as faculty to know about these services and to make students aware of them. There is also importantly, the CARE Network, so that those who feel like they might not want to get involved can stay anonymous and submit information about another individual they have concerns about.

At the university level, we could also assess how well utilized these resources are and determine what could bolster the resources that are in high demand. And if folks need more support, we can think about what we could be doing to enhance what is available so that treatment is affordable, accessible and culturally responsive to our diverse student population. We want a healthy student body—and that means physically healthy and emotionally healthy.

Q: On April 30, deputies from the Santa Barbara County Sheriff’s Department visited the Isla Vista shooter at his home to assess his mental state, but determined that he did not pose a risk to himself or others. How can gun policies be tailored to keep guns out of the hands of those who suffer from mental illness while at the same time avoiding stigmatizing?
A: When the only response we have readily available to us is a punitive one, we have to be careful. We don’t want to take away an individual’s rights because we fear them or have little information about the nature or severity of their condition. There is certainly a threshold for when we’re authorized to involuntarily detain or institutionalize someone—for example, if they are an immediate threat to themselves or others—but when the individual does not meet those criteria, many may feel like they don’t have other options for effectively responding.  

We have to give people other tools so they don’t feel they have to wait until there is a crisis to intervene. We can do things like creating programs for improving connections among people and having alternative ways for people to learn skills around coping, stress and anger management. How can we promote a public dialogue about how it is OK to speak up and seek help when one feels isolated, rejected or vulnerable? How do we make it safe for people to talk about these things and to get support? This should be something we should be asking ourselves across all institutions and within all communities. Developing and implementing mental health-promoting strategies is part of what it will take to create a more robust public health system.