10/22/2013 02:58 pm ET Updated Jan 23, 2014

Reno Tragedy: It's Never Too Late. Or Too Early.

Recent events in Reno, Nevada once again reminds us of tragic nexus between gun violence, bullying, and the fragility of childhood. While I was not personally involved with that community, as director of a large mobile crisis team in Milwaukee, Wisconsin I see the residual of a great deal of trauma. I teach my staff that bedrock in doing crisis intervention is never to show fear, or concern too great, when helping. This is difficult to do, and one main reasons crisis work is not for everyone. I tell my team, never let them see you're afraid, and always act as if you can help. Unfortunately, I feel strong concern, indeed a modicum of fear, now. My fear is that this will be just the latest news cycle, to come and go quickly, and probably not even warrant a response from large, typically invested factions. I'm afraid this won't even garner the attention of mass killings, and get the close review, outpouring of support, and problem solving it deserves, and that the people of Sparks will be forgotten. But we must dialogue, and there is something to learn.

What little we know so far about the situation is that a 12-year-old allegedly committed the act, and was reportedly experiencing the pressures of teasing or peer alienation. We don't know if this young boy suffered from any mental health issues, but signs do suggest he believed he was being targeted or excluded. I am not here to defend or rationalize, but to search for explanations, and maybe point to some solutions. And right away I need to say that one big problem with tragedies like this, especially involving guns, is that so many want a simple explanation, or solution. There is no one answer. But there are some.

If, in fact, this boy was being teased or ostracized, then we can take some extra steps to support our children, and help them deal with bullying, from both sides of it. Again, I'm not suggesting this was the causal root, but it bears discussion. We need to help kids recognize bullying and then embolden them to intervene. First, kids need to be taught to recognize bullying. In today's culture, this so often takes the form of social media bullying. It can't be minimized, and we can't just tell our kids to "shrug it off." And I don't think we realize, or rely on, the positive power of peer support, or pressure, enough. I saw a girl in a local ER last week, who was relieved that her peer told her mother about an overdose and suicide attempt. "She's now my friend," she said, "not a narc." We need to make it more possible for more kids to band together, and influence the adverse events of childhood, like bullying behavior. One way is to highlight what is obvious to adults, but not to kids -- children and teens who bully do not feel good about themselves. Yes, while some bully and appear tough, they do it to feel empowered, because they feel lesser than others. To bring children who bully into perspective like this might take away some of their perceived power, and encourage others to step in. Buddy up to a bully.

Of course, parents and caregivers need to make it possible for kids to open up about being bullied, and not just shut them down by telling them to "stand up" for themselves. The strain from being targeted or alienated at school is chronic, corrosive, and can be ultimately explosive. No matter what's happening, kids often feel it's their fault, and are reluctant to tell an adult. They suffer in silence 'til it's too late.

In my role as Mobile Crisis Director here, I am on the management team of Wraparound Milwaukee, a nationally recognized program for helping urban youth with complex behavioral needs. Among lessons learned over the years is that prevention and early intervention are best. This is not a new concept, but it appears to be lost on many, especially the funders and stakeholders of mental health resources, both public and private. In Milwaukee, we long ago realized that the way to help more kids with complex needs was not to sequester them in institutions, or to medicate them. About 20 years ago, discontent with lack of outcomes from institutional care, both at residential centers, and psychiatric hospitals for kids, led to the formation of Wraparound Milwaukee. At Wrap, we are now using the same amount of adjusted dollars to serve twice as many high-risk youth, while keeping them predominantly in the community, and with non-traditional care. We don't view these youth from the basis of their "diagnoses", or a stock mental health approach. We understand kids -- even those with complex needs -- don't often respond to, or require, traditional counseling, with its reliance on verbal dialogue. Kids need so much more than "just talking," and they tell and show us this all the time. Trauma informed care can lead the way.

For too long, there has been an over-reliance on traditional, outmoded care models, medication to help kids, and on pathologizing normal behavior. And while stigma continues to be a problem for many with mental health issues, I believe we have gone too far in reframing normal-spectrum behavior as something that needs to be treated. Dr. Allen Frances, Chair of Psychiatry at Duke and Editor of the DSM IV, deems recent changes in mental health diagnoses to be a problem. According to Dr. Frances, mental illness has become the new normal. In the new DSM V, there is a category for younger children who display mildly challenging behaviors -- an average of three temper tantrums a week. This new diagnosis -- Disruptive Mood Dysregulation Disorder, or DMDD -- stands poised to replace ADHD as the diagnosis de jour. And it may swallow up billions in dollars in prescription dollars, money that could be far better spent on early intervention. The push to medicate and treat these mild, often ephemeral childhood behaviors, is a mistake. I agree with the medical model of mental illness, but this is like treating the mental health equivalent of a cold, every week, with meds. This approach further depletes available funding, and vast resources are wasted on institutional care, in many communities, especially when public dollars are at stake. If we could redirect available monies toward better risk assessment, early intervention, evidenced based treatment and proper resource allocation, we could be much closer to identifying and helping those youth at higher risk for serious harm.

In brief, we need to do a better job at helping kids deal with bullying, from both sides of it, and in treating youth who have serious mental health issues. One challenge will be to enhance our ability to identify and treat these youth, which could be far easier if resources were properly allocated. And it is never too early to start. With the chronic stress of everyday life, we also need to teach kids self-care strategies. Childhood is not the halcyon experience we romanticize it to be, especially today. My team worked with an 8-year-old in the ER this week, who was upset by his own, and others' anger. He said, "I wish guns never existed, so people wouldn't kill each other. I wish baseball bats were used just for baseball, and not to hurt each other. I wish that no one ever dies and I want to make sure people care about themselves. People need to care about themselves so that they can help take care of each other." Eight years old. It's never too late to do something. And it's never too early to start.

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