The Sandy Hook shooting tragedy is shocking to see reported in all its detail. One critical standout from the report, which will likely be recognized in the coverage of the 911 tapes as well, is the intermingling of the details of Adam Lanza's psychological issues with the violence. What is striking is how, according to the report, there were many signs over the years that something was going wrong in his thinking, behavior and his brain, both in terms of the peculiarity of behavior and timeline of his mental health decline. This tragedy provided a prominent example of just how 'far out on a ledge' people can get, isolated from others and from a system of care which could provide help -- even two people together. For instance, the degree to which the mother took steps to accommodate his peculiarities, e.g., detailed instructions to the yard workers not to ring the bell or surprise them with noises; all the violent video games and guns; and how 'alone together' they had become. And if the report is valid that medications were recommended and he didn't take them, it is worth discussing that as a significant problem in our system -- both in terms of a lack of resources and access, and in terms of the complicated mechanics of working with people to adhere to treatment they often don't want.
The release of the 911 tapes today will undoubtedly re-ignite discussion and debate. What is most important, though, is that our thoughts go to the families of the victims, to the survivors, first responders and the community which suffered this horrific tragedy. It is important that we make sure to keep supports in place if they are needed, that we remember recovery from psychological trauma can take time, can come in waves (for instance at times of holidays and anniversaries), and that it comes without the usual 'visible' signs of a physical trauma. Those who are still connected to the community should of course be sensitive to and looking for signs of unprocessed trauma which include disturbances in sleep or appetite, changes in mood and behavior, and isolation -- and should not be afraid to offer help and to refer people to supports.
A larger question that the release of the tapes raises -- given that their exposure clearly comes with a price -- indeed any coverage of such incidents does -- is what ultimately can and should come of it. The downsides are clear -- re-traumatization, raising more unanswerable questions, overly re-enforcing a link between mental illness and violence (when we know that only 4 percent of all violence is caused by those with mental illness). We hope that what ultimately comes of this discussion and debate we're having in this country in a way we haven't in 50 years, though, is something much more positive -- that the outrage at our broken mental health system will fuel transformation. This, as it happens, is quite achievable with modest investment and policy change. All it really requires is will and for the community to come together, just as it did in Newtown.
At the time of the Sandy Hook shooting, Dr. John Santopietro was President of the Connecticut Psychiatric Society (CPS) representing 700 psychiatrists in CT. CPS is the state district branch of the American Psychiatric Association. Dr. Santopietro was selected by the Governor of Connecticut to lead the response of over 90 mental health professionals tasked to engage the Sandy Hook community following the shooting. The response included hospitals, psychiatric doctors and associations from CT and around the country. Recently, the Connecticut Psychiatric Society honored Dr. Santopietro with the Service to CPS Award, which commended his role in coordinating the response to Sandy Hook and saluted his continued efforts to promote behavioral health on a national level.