September 11, 2024

The X-Podcast: Real Conversations About Mental Health

A Conversation About: Apalachee School Shooting and Mental Health

Episode #30

In this episode the X-Podcast Team discusses the recent Apalachee school shooting in GA, rificUSA and the impact and fallout with mental health.  

The team gets into the details about the incident and then dive into how to help children and adults who are affected by this tragedy find support. There is no easy way to describe how yet another incident of school shootings in the United States affects us all. The team does its best to discuss this issue and this recent horrific incident in a relatable way so that everyone can get something helpful out of the discussion. 

In addition the team provides resources and tips to get help with any negative impact this may have on listeners. 

Host Xiomara A. Sosa and co-host JRoc have a relatable discussion that does touch on the dark subject of school shootings in the United States. 

Other notes:

What Happened?

On September 4, 2024, at 9:30 a.m., a mass shooting occurred at Apalachee High School near Winder, Georgia, United States. Two students and two teachers were killed, and nine other people were injured.

2 teachers and 2 14-year old students died. 

The gun used was an "AR-platform style weapon", a lightweight semi-automatic rifle.

The FBI said its National Threat Operations Center had alerted local law enforcement in May 2023 after receiving anonymous tips about "online threats to commit a school shooting at an unidentified location and time".

The agency said that within 24 hours investigators had determined that the threats originated in Georgia. Sheriff's deputies interviewed the boy and his father, who "stated he had hunting guns in the house, but the boy did not have unsupervised access to them". The boy, who was 13 years old at the time, denied making the online threats and officials "alerted local schools for continued monitoring of the boy".

"At the time, there was no probable cause for an arrest or to take any additional law enforcement action on the local, state or federal levels,"

Officers were on scene within minutes of receiving 911 calls at 10:20 am local time yesterday. Two officers assigned to the school "immediately encountered the shooter" and he "immediately surrendered". The boy has been interviewed and spoke with investigators once while in custody.

No motive had been identified and  law enforcement did not know of "any specific targets at this point". A vigil was held on Wednesday evening. This was the 23rd US school shooting of 2024 which counts 11 dead and 38 injured so far this year. The shooting in Georgia was the first "planned attack" at a school during this autumn term.

What to watch out for and how to get help.

Many children develop resilience, or an ability to overcome serious hardships. However gun violence can impact a child's mental health, especially if they are witness to such an event.

What would be considered a typical reaction could range everywhere from changes in mood, including being sad, angry, irritable, lowered frustration tolerance to having sleep problems.

Nightmares or scary dreams, changes in appetite.

Children who experience a traumatic event such as a shooting may have more trouble focusing and concentrating or are more easily distracted.

Responses can depend on age.

The impacts on them tend to fall into two categories: Older kids often have symptoms of post-traumatic stress - nightmares, sleep problems, avoiding certain locations, including avoiding school, because of the associated trauma.

Younger kids tend to have symptoms like withdrawal, depression, anxiety as a response to being involved or witnessing community violence such as gun violence.

Wide scale of emotional response.

Children can experience a wide range of emotions following a traumatic event.

Some children may be affected but may not show any emotion because they're numbed or withdrawn after the event.

Everybody's different, they might have more emotions, heightened levels of emotional states, avoidant behaviors, avoidance of the actual event itself, or memories related to the event, or going into the school itself, that's the trigger.

Some of them have feelings of survivors' guilt, “what if they could have done things differently for themselves?"

Children impacted indirectly

The effects are not just on the children who attended a school where a shooting occurred, but those who live in the surrounding community or even in another state.

Experts warn that young children are suffering from its devastating impacts.

Children can respond in a wide range of ways including being numb to the event, being more angry or irritable, suffering from high anxiety and being fearful of going back to school, according to mental health experts.

Significant behavioral and psychological impacts on children who either are victims of or witness to or even around events, such as this shooting.

About four in 10 Americans believe they may become a victim of gun violence within the next five years, according to a UChicago Harris/AP-NORC Poll released in August 2022.

For kids, they don't have to be that close to it to be affected by it.  Just hearing about it on the news, knowing that it happened to kids like them, kids they might know or kids in their community, can have those same effects on them. 

School shootings have a traumatic effect not only on the children in the school, but also their teachers, families, and community as a whole. This trauma can cause long-term harm to youth mental health and well-being. By ramping up anti-bullying programs, promoting a culture of help-seeking, and building awareness of warning signs, we can empower students to report concerns, help prevent school violence, and support kids who struggle to get the help they need.

Coping with Reactions to School Shootings. What parents should be looking for in their children in the aftermath.

Signs of anxiety, fears, being worried about themselves because of what they saw or heard about.

Parents talk to their kids about the trauma and event.

What parents should do in the aftermath.

Resuming a normal routine. It's important to make sure children are provided as much structure as possible after a traumatic event to help with their development and well-being. Amidst the chaos that follows a shooting, routines either at school or home can help reassure children that they will be okay.That really provides a sense of security for kids.

Doesn't mean pretending the event didn't happen, adults should make sure children feel safe talking about their feelings.

If a child brings up feeling scared,  validating that it's okay to feel that way and helping them understand that they are safe, and here's what we're doing to help you out.  Recognize that this was scary, and they have the right to be afraid, but give them the tools to help them cope and manage.

Some children may benefit from at least brief therapy to process any feelings or fears they're experiencing, even if they don't develop a psychological disorder. Watch kids very closely who witnessed the event for signs of PTSD, they will be at higher risk for developing ptsd or an acute stress disorder which can happen in the immediate aftermath of the traumatic event: sleep disturbance nightmares, a lot of fear, a lot of anxiety.

Helping the adults

Adults have to take care of their own needs after a traumatic event because that helps them to help the child. They are modeling to their child how to cope and manage.

Children look to adults for safety and security so how adults cope with a traumatic event will influence how children do.

Don't hide your emotions, but  manage your emotions. Say, 'Look, I'm scared too, but this is what I'm going to do to feel better' or 'I'm upset, I'm angry, but here's how I'm going to use my anger”. 

Developing PTSD

Not all people who experience or hear about a traumatic event will develop psychological distress. Following any incident of mass violence, however, there can be direct and indirect effects on overall functioning. 

Those who experience a traumatic event directly may develop heightened stress, irritability and sadness. Unchecked, those normal reactions can develop into acute stress disorder or, eventually, post-traumatic stress disorder (PTSD).

Those who experience an event through media coverage, social media posts or other sources like online videos may have typical responses such as heightened stress, irritability and sadness as well. There is also a risk for developing symptoms akin to PTSD but in a much less intense way. This is described as Secondary Traumatic Stress (STS). Research on STS focuses primarily on mental health professionals, health care workers and other helping professions, but some of the same symptoms can emerge for those outside of these professions. People who have experienced similar events, who have pre-existing PTSD, or who have other mental health issues are considered to be at higher risk for an exacerbation of symptoms and the development of secondary traumatic stress.

The amount of exposure to images or stories about a traumatic event may have an effect on the development of STS or PTSD-like symptoms. In 1993, the images and stories, while still upsetting and triggering, were contained to television, radio, newspapers and magazines. Today we have the internet and social media providing 24/7 immediate access to firsthand accounts and visuals, real-time coverage, and audio and video recordings. Research on the effects of indirect exposure to social media and internet coverage of traumatic events is still in its infancy, but some studies point to an increase in PTSD-like symptoms following the viewing of images and stories about a traumatic event. This suggests the need to limit exposure to news and other sources of information, especially if you have experienced similar events or other traumatic experiences.

Symptoms of Secondary Traumatic Stress

• Intrusive thoughts
• Chronic fatigue
• Sadness
• Anger
• Poor concentration
• Second guessing
• Detachment
• Emotional exhaustion
• Fearfulness
• Shame
• Physical illness
• Absenteeism

Recommendations for Coping

1. ​Decrease exposure to news and social media coverage of the event. It is important to stay informed, but attempt to limit your time in contact with the issue until you feel better able to manage your reactions. The reactions are normal, but you need a break from them.
2. Do not engage mental health stigma. People with mental health problems are no more likely to be violent than anyone else. According to data from the U.S. Department of Health and Human Services, most people with mental illness are not violent and tend to be victims rather than perpetrators. This is supported by a study published in the American Journal of Public Health in 2014 by Vanderbilt researchers Jonathan Metzl and Kenneth T. MacLeish. They write, "Fewer than 5 percent of the 120,000 gun-related killings in the United States between 2001 and 2010 were perpetrated by people diagnosed with mental illness." Also, there is no doubt that school shootings are horrific events, and any loss of life is too much. Concerns about safety are typical, but mass shootings are still rare events, statistically speaking.
3. Connect with your support network. Seek out those who will not minimize your feelings or thoughts and who allow you to process how you feel without judgment or an agenda. If you aren't looking to talk about it, then engage those friends who offer support through activities and distraction.
4. Check in with your children. Children may be scared to go to school or experience distress after hearing about a school shooting. It is important to listen to children and what they are afraid to face. Acknowledge how scary it can be, but remind them that there are adults working to make their environment safe and protected. Check in with them more than once, and be willing to hear what new responses they might have. This may also help you do the same for yourself.
5. Engage in positive self-care. Prioritize rest, exercise and healthy eating to help your body deal with stress. Do activities that you enjoy and find relaxing. Try to limit alcohol consumption or problematic behaviors (e.g., overeating, reckless spending, gambling) as a way to soothe your feelings.
6. Write about your experience. Writing is a useful way of focusing and organizing the random thoughts that may be overwhelming you. Hand-writing tends to be more effective than typing, but whatever gives you relief is the key.
7. Get involved. Engaging in positive activities like group discussions, campus events, spiritual activities or positive community action can help channel your reactions and offer opportunities to engage likeminded people.
8. Seek professional support. Not everyone feels comfortable seeing a therapist, but having someone with expertise in managing trauma responses and supporting healthy coping skills can provide significant relief in a short amount of time that can have long-lasting effects.

How to manage the stressor of another school shooting in America

Does not help to blame mental illness. 

Increasingly common public massacres, many blame mental illness as the fundamental cause.

The reality is that people with mental illness account for a very small proportion of perpetrators of mass shootings in the U.S., says Ragy Girgis, MD, associate professor of clinical psychiatry in the Columbia University Department of Psychiatry and the New York State Psychiatric Institute.

Dr. Girgis, an expert in severe mental illness, and colleagues from Columbia’s Center of Prevention and Evaluation authored the first report on mass shootings using the Columbia Mass Murder Database (CMMD), which examined the relationship between serious mental illness and mass shootings.

Columbia Psychiatry News spoke with Dr. Girgis about the role of mental illness in mass shootings, the motivations behind mass murder, why the perpetrators of mass violence use guns, and more.

Are people with mental health disorders more likely to commit mass shootings or mass murder?

Explain difference between mental illness and mental health 

The public tends to link serious mental illnesses, like schizophrenia or psychotic disorders, with violence and mass shootings. But serious mental illness—specifically psychosis—is not a key factor in most mass shootings or other types of mass murder. Approximately 5% of mass shootings are related to severe mental illness. And although a much larger number of mass shootings (about 25%) are associated with non-psychotic psychiatric or neurological illnesses, including depression, and an estimated 23% with substance use, in most cases these conditions are incidental.

We demonstrated in our paper, the contribution of mental illness to mass shootings has decreased over time. The data suggest that while it is critical that we continue to identify those individuals with mental illness and substance use disorders at high risk for violence and prevent the perpetration of violence, other risk https://www.thex-studio.org/resources, such as a history of legal problems, challenges coping with severe and acute life stressors, and the epidemic of the combination of nihilism, emptiness, anger, and a desire for notoriety among young men, seem a more useful focus for prevention and policy than an emphasis on serious mental illness, which leads to public fear and stigmatization.

Why does the public erroneously link mental illness with mass shootings and with violence in general?

A lot of people who aren’t experts in mental illness tend to equate bad behavior, and often immorality, with mental illness. These are a false equivalence. I think it's incumbent on us, especially when we're talking about something as horrible as mass shootings, to make sure other people understand that all bad behavior, and certainly not evil and pure psychopathy, is not the same as mental illness.

The major findings are that the vast majority of mass shootings and mass murder are committed by people without mental illness, and certainly not psychotic illness, and when a person with severe mental illness commits a mass murder, they’re much less likely to use firearms than other methods, such as arson or knives.

Why do people use guns when they commit mass murder?

There's solid evidence that nearly half of all mass shootings are associated with suicide by perpetrator, or what they call “suicide by cop.” Guns are the most successful method of killing oneself.So, one main reason people choose guns is they want to die. In about 30% of mass shootings, perpetrators kill themselves with their own gun; about 10% are suicide by cop. However, while guns are the most effective method of suicide, they’re not as effective at killing a large number of other people. Mass murder committed with means other than firearms, such as bombing, arson, vehicles, even stabbings, is about two and a half times more deadly than mass murder committed with firearms.

Another reason people use firearms to carry out mass shootings (aside from availability) is our cultural romanticization of violence. As a result, the movie, television, music, and video game industries will have to play a role in any efforts to decrease gun assaults.

What tends to be the motivations behind mass shootings?

First, understand that mental illness as the primary cause of any mass murder, especially mass shooting, is uncommon. Half of all mass shootings are associated with no red flags—no diagnosed mental illness, no substance use, no history of criminality, nothing. They’re generally committed by middle-aged men who are responding to a severe and acute stressor, so they're not planned, which makes them very difficult to prevent. So, we must look much further upstream.

This is why it is important to consider ways to manage gun availability, for example. The yearly prevalence of the incidence of mass murder was stable at about 7 per billion people, or seven mass shootings for every billion people, between 1900 and about 1970. Then between about 1970 and 2019, the incidence increased by four times, so now mass shootings occur about 28 times per billion people around the world. One might say that this is because of the availability of guns in general, and automatic weapons, in particular, especially in the U.S. where these weapons became more available to the general population during this time period. Mass murder committed with means other than firearms also grew, but at a slightly slower rate. The other thing that one must consider is that most mass shootings are committed with non-automatic weapons, making them the weapons of choice, and supporting the notion that gun availability is a primary contributor to the method of mass murder.

If we’re talking about the mass shooters that we hear the most about, such as school shooters and other individuals who commit such public crimes, we have examined a number of these cases and are seeing a pattern. As opposed to most mass shooters, these perpetrators tend to be younger males who are often nihilistic, empty, angry, feel rejected by society, blame society for their rejection, and harbor a strong desire for notoriety. They want to make their mark on the world that will elevate them to the status they believe they are entitled to and deserve.  

Sensationalized headlines, photographs, and breaking personal information

about the shooters, victims, and acts themselves provide the notoriety perpetrators of mass shootings crave and can spark others to carry out similar acts. Refraining from publishing any personal information about mass shooters may be one of the easiest, quickest, and most effective interventions for decreasing mass shootings, especially school and other public shootings, which comprise about 10% of all mass shootings.

Is there a difference in violence committed by women vs. violence committed by men?

Mental illness makes more of a difference when we're talking about violence committed by women, who are responsible for about 5% to 8% of mass murder. This is because the mechanism by which mental illness and substances of abuse, when they are causative, contribute to violence is by impairing impulse control. Research has shown that the lack of impulse control caused by mental illness and substances has a greater effect on women than on men, likely because men, especially younger men, tend to already be quite impulsive. It is also important to note that when women perpetrate mass murder, they are much less likely to use firearms than other methods, consistent with our thesis that mental illness is minimally responsible for mass shootings.

Resources

https://www.thex-studio.org/resources

Work/Life Connections - Employee Assistance Program - Call 615-936-1327 for a confidential and no-cost assessment, brief counseling, coaching, or referral to community resources.

National Center for PTSD

American Psychological Association - In the Aftermath of a Shooting

References

Ragy Girgis, MD, MS, is an associate professor of clinical psychiatry at the Columbia University Department of Psychiatry and New York State Psychiatric Institute. He is an expert in severe mental illness, and in particular schizophrenia, with a focus on brain imaging as well as the development of experimental treatments in individuals with early psychosis. 

​by Chad A. Buck, Ph.D.

Clinical Psychologist

Work/Life Connections–Employee Assistance Program

https://www.columbiapsychiatry.org/news/mass-shootings-and-mental-illness

https://www.columbiapsychiatry.org/sites/default/files/media/documents/2021-02/psychotic-symptoms-in-mass-shootings-v-mass-murders-not-involving-firearms-findings-from-the-columbia-mass-murder-database.pdf

https://children.wi.gov/Documents/ResearchData/OCMH%20Fact%20Sheet_April%202024_School%20Shootings.pdf

https://www.vumc.org/health-wellness/resource-articles/coping-reactions-school-shootings

Metzl, J.M & MacLeish, K.T. (2015). Mental Illness, Mass Shootings, and the Politics of American Firearms​

https://abcnews.go.com/Health/mental-health-impacts-children-survive-mass-shootings/story?id=98177848

https://www.bbc.com/news/articles/c049yw352r1o