The mass casualty attacks and violent occurrences of the last month lead many to question themorality of the world today and what can be done to stop the bloodshed? Can we prevent extreme violence from occurring? How can we better predict which individuals are most likely to commit acts of aggression?
The last month has been the very picture of horrendous acts. Consider that we’ve witnessed the ongoing crisis in Syria with fighting between al-Assads government forces and rebels, the Navy Yard shooting last week which killed 13 people including the shooter and wounded a further 8, and asuicide bombing in Peshawar, Pakistan at a church killing at least 85 people and wounding many more. There was also an attack on a shopping mall in Nairobi, Kenya by the al-Qaeda linked Somalian group, al-Shabaab, which has left over sixty dead.
What can we do to prevent these types of attacks from occurring? Unfortunately, no system is infallible or 100% accurate. What we do know is that it is the accumulation of events, which are not always pieced together, as was the case with the navy yard shooter Aaron Alexis, that can build to a perfect storm and lead to violent outbursts.
The levels of risk for violence can be identified by using risk and needs tools, which can be 70-80% accurate. Once the risk is known, the key is to provide the treatment appropriate for that person and their specific situation. That means knowing the problems of the whole person and his or her family and the strengths of the whole person and family. You must then base the treatment plan on the list of problems and strengths and subsequently base the dosage of treatment on the complexity, chronicity and severity of the problems.
Those at higher risk for violence have problems in multiple domains and have few resiliency factors, which can sometimes be a result of pasttrauma the person has experienced. Risk factors include: lack of healthy guidance and monitoring from caregivers; lack of academic success; psychological problems; maltreatment; and living in chaotic neighborhoods or communities with a high level of drug use, violence, guns, gangs and delinquency. Resiliency or protective factors against the risk of violence include: resilient temperament, close relationship with a pro-social and supportive adult, opportunities to be successful, and clear standards of behavior set by caregivers early on.
Approximate high, medium, and low risk can be estimated for anyone who comes in conflict with the law or, for example, a work supervisor. Once this risk is measured and assessed, a treatment plan usually has to be ordered by a court or a condition of continued employment for compliance. Those people at high risk for violence often do not have the internal structures needed to follow through with treatment without something to ensure their compliance. They often have personality disorders and have been traumatized in childhood, bullied or rejected by peers as a teen. The people who are at risk of being violent often have had problems previously at school or work as young adults due to lack of coping skills and support systems.
We can identify those at risk before a terrible event takes place and provide treatment. The best prevention is stopping child abuse, child neglect, domestic violence, and bullying and increase coping skills, support systems and access to mental health for those who need it. This costs money, but with a lack of support from congress for the poor, the disenfranchised, and mental health services in general, this will lead to more children at risk for violence in the future. We may avoid the additional costs now, but we will pay far more to support the national incarceration rate or to deal with the pain of losing a loved one to violence.
If we don’t do something now, we may have a whole new generation of Aaron Alexises, Adam Lanzas and James Holmeses on our hands. There will be those who grow up to be brutal dictators like Bashar al-Assad, Saddame Hussein and Adolph Hitler or those who become parts of or leaders of terrorist organizations. All these people are exposed to the multiple risk factors and it is the lack of support or treatment that leads to these people growing up to be who they became. It doesn’t matter where in the world they are from; if growing up they are exposed to violence, abuse or neglect then their risk factor increases exponentially. It is these people we need to provide adequate and effective supports and treatment to in order to help correct their course in life. We have seen what happens when, as a society, we ignore the issue. Now it’s time to give it the attention it deserves.