Download Chapter Six: Mental Health Issues and School Violence

A Study of Violence in Schools
_______________________________________________________________
Krisi Howe
The College of Idaho
February 2013
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Abstract
The American Psychological Association (APA) guidelines provide rules for
preparing manuscripts. This template provides a basic layout based upon the 6th edition
of these guidelines. The APA guidelines define an abstract as a single paragraph, without
indentation, that summarizes the key points of the manuscript. The purpose of the
abstract is to provide the reader with a brief overview of the paper. The total length
should not exceed 120 words, with each sentence written concisely.
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Table of Contents
Abstract ............................................................................................................................... ii
List of Tables ..................................................................................................................... vi
List of Figures ................................................................................................................... vii
Chapter One: Introduction .................................................................................................. 1
Background of the Problem .................................................................................... 1
Statement of the Problem and Purpose ................................................................... 1
Research Questions ................................................................................................. 1
Significance............................................................................................................. 1
Delimitations ........................................................................................................... 1
Limitations .............................................................................................................. 1
Definitions............................................................................................................... 1
Assumptions............................................................................................................ 1
Chapter Two: The History of Violence in Schools ............................................................. 2
Introduction ............................................................................................................. 2
Chapter Three: International Violence in Schools .............................................................. 3
Introduction ............................................................................................................. 3
Chapter Four: Bullying in Schools ..................................................................................... 4
Introduction ............................................................................................................. 4
Chapter Five: Cyberbullying............................................................................................... 5
Introduction ............................................................................................................. 5
Chapter Six: Mental Health Issues and School Violence ................................................... 6
Introduction ............................................................................................................. 6
Significance............................................................................................................. 6
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Early School Prgrams ............................................................................................. 8
Treatment ................................................................................................................ 8
Current Research ................................................................................................... 10
Conclusions ........................................................................................................... 11
Chapter Seven: Traditional Preventive Programs ............................................................. 14
Introduction ........................................................................................................... 14
Chapter Eight: Innovative Approaches to School Violence ............................................. 15
Introduction ........................................................................................................... 15
Chapter Nine: Case Study-Attitudes of Caldwell Teachers .............................................. 16
Introduction ........................................................................................................... 16
Descriptive Statistics or Demographic Data ......................................................... 16
Findings from Open-Ended Questions.................................................................. 17
Chapter Ten: Conclusions and Recommendations ........................................................... 18
Conclusions ........................................................................................................... 18
Recommendations for Practice ............................................................................. 18
Recommendations for Future Study ..................................................................... 18
References ......................................................................................................................... 19
Appendix A ....................................................................................................................... 20
Appendix B ....................................................................................................................... 24
Appendix C ....................................................................................................................... 25
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vi
List of Tables
vii
List of Figures
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Chapter One: Introduction
Background of the Problem
.
Statement of the Problem and Purpose
Research Questions
The following questions guide this study:
1. xxxxxxxxxxx?
2. yyyyyyyyyyy?
Significance
This study will have significance
Delimitations
The following were delimiting factors for this study
Limitations
The following factors were limitations affecting the study
Definitions
1.
xxxxxx
2.
xxxxxx
Assumptions
The following assumptions guide this study
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Chapter Two: The History of Violence in Schools
Introduction
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Chapter Three: International Violence in Schools
Introduction
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Chapter Four: Bullying in Schools
Introduction
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Chapter Five: Cyberbullying
Introduction
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Chapter Six: Mental Health Issues and School Violence
Introduction
On April 16, 2007, Seung-Hui Cho killed 32 people, wounded many others, and
ended his massacre by committing suicide on the campus of Virginia Tech in Blacksburg,
Virginia. Seven months later on December 5, 2007, Robert Hawkins shot and killed 8
people at a Von Maur department store in Omaha, Nebraska. Even more recent is the
shooter of the Batman movie theater massacre in Aurora, Colorado, who was later
identified as PhD student James Holmes. Holmes killed at least 12 people and injured as
many as 50, during the midnight premiere of the movie at the Century 16 Movie Theaters
in Aurora early July 20, 2012. Just a mere five months later, on December 14, 2012,
Adam Lanza fatally shot twenty children and six adult staff at Sandy Hook Elementary
School in the village of Sandy Hook in Newtown, Connecticut. Before driving to the
school, Lanza shot and killed his mother, Nancy Lanza, at their Newtown home. As first
responders arrived, Lanza committed suicide by shooting himself in the head. After each
of these crimes, it was quickly reported that the perpetrators had previously received
psychiatric care, prompting questions as to whether and how their mental illnesses may
have led to these appallingly violent acts, whether mental health professionals could have
(or should have) foreseen such massacres, and whether adequate treatment might have
prevented them.
Significance
The relationship between mental illness and violence has been the subject of
scientific research for the past 20 years, during which substantial progress has been made
in identifying the risk factors empirically related to violence (1). The relationship
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between mental illness and violence has a significant effect on mental health practice (2)
and policy (3), guides allocation of the limited resources in the mental health and
criminal justice systems (4), and serves as the basis for imposing mandatory treatment to
protect public safety at the expense of patients’ self-determination and liberty (5).
Reliable data is needed to properly inform public perception about the relationship
between mental illness and dangerousness (6) to avoid potentially unwarranted
stigmatization of people with mental illness (7). The scientific literature on the
association between mental illness and violence is inconclusive for several reasons. First,
to establish that mental illness causes violence, it is necessary (though not sufficient) to
demonstrate that mental illness precedes later violence; however, cross sectional
epidemiological studies analyze correlations between past violence and current or
lifetime psychiatric diagnoses. Second, when research has been longitudinal, it has
primarily focused on the risk of violence for individuals already in clinical or institutional
settings (9) instead of samples representative of the general population. Research using
those longitudinal samples has contributed substantially to understanding important risk
factor for violence in people with mental illness (10) but, by virtue of the inclusion
criteria used, is arguably limited in describing whether or to what extent severe mental
illness is an independent risk factor for violence. Third, empirical studies often combine
all violent acts into one composite variable (11) owing to limited statistical power to
distinguish specific forms of violent acts (i.e. substance-related violence, severe violence
with weapons), leaving unanswered the question of whether mental illness predicts some
kinds of violence but not others.
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Early School Programs
Psychologists have found that children who act in antisocial ways are less likely
to be accepted by classmates and teachers. They participate less frequently in classroom
activities and do more poorly in school than their more emotionally positive, pro-social
counterparts (11). These programs have also shown effectiveness in reducing the
likelihood that children will engage in delinquent behaviors. Another factor that will be
further considered later is the unfortunate lack of the resources and funding in schools
that would be necessary in order to support school-based mental health programs
meaning that kids are simply not receiving treatment (20).
School-based mental health consultation programs, for example, pair
psychologists, social workers, and psychiatrists with local school districts in order to
identify, assess, and treat young children who are in serious emotional and behavioral
trouble (12). Clinicians from local community mental health organizations observe
classrooms, provide teachers with training, and provide child- and family-centered
psychotherapy. However, programmatic success is reliant in great measure on the extent
to which programs succeed in enlisting families' participation. It may also be
unreasonable to expect long-term emotional and behavioral gains on the part of young
children if their families continue to face chronic, structural stressors that erode children's
psychosocial health (13).
Treatment
According to CNN journalist Aaron Carroll in 2012, the funding for mental health
programs in schools is lacking tremendously and not only that, but public opinion is still
split on the matter of how to treat and diagnose those with mental disorders. With
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resources lacking the general consensus on managing those suffering from mental health
disorders is more reactive than preventative. This is evidenced in observing the American
juvenile justice system, which certainly provides an array of rehabilitation programs, but
none of which are offered until after the student has already committed a crime. Public
opinion varies on how to address this issue. Many believe that corrective facilities are to
function as environments aimed at retributive justice for the victims.
Unsettled opinions on the matter of how to go about treatment, whether treatment
is rightfully deserved or functions as only a Band-Aid to a major problem or who exactly
should be paying for all these programs brings to light the fact that this is a huge research
problem, clinical problem and societal problem in our nation that is just beginning to
surface. In a survey conducted by our small research group an anonymous participant
advocated, “I think that there needs to be some mandatory reporting from mental health
professionals. Adam Lanza and the others who have committed these acts have already
broken laws by bringing guns to school. I think more awareness of these individuals that
live close to or have a connection with a school, kind of like sexual predator
identification should be implemented.” Many different suggestions have been made as to
how to go about getting funding for school driven mental health programs and how to
sway society from being reactionary to being preventative in providing rehabilitation
treatment. This has raised other issues though including where to draw the line in terms
of the privacy and confidentiality for persons with mental disorders and how to go about
making people aware of their special cases without furthering stigmatization. A large
amount of the public actually agree with our survey participant and in fact want a
national database of the mentally ill, which would be posted for the public. The National
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Rifle Association has been the biggest supporters of this public database and released a
statement saying 38 states have the technology and public support to launch the site now.
Current Research
Recent studies bearing on the relationship between psychiatric disorder and
violent behavior suggest that although risk of violence is elevated somewhat in persons
with severe mental illness (15) the large majority of these persons do not commit violent
acts (16), and the causal determinants of violent behavior in this group are perhaps as
varied and complex as those in the general population (17). Psychopathology seldom
leads to assault, but it may converge with other risk factors that, together, significantly
increase the likelihood of violent behavior (18).
Numerous surveys of psychiatric inpatients, outpatients, homeless and mentally ill
persons, and emergency room patients have found that a large proportion of persons in
treatment for mental health problems have at some time been victims of violent physical
or sexual abuse (19). The long-term psychological effects of victimization and trauma
exposure may be compounded by substance abuse, homelessness, adverse social
environments, and treatment noncompliance—with the net result that risk of violence is
markedly increased in certain subgroups of persons (19). To what degree does each of
these kinds of variables contribute—independently or in convergence—to violent actions
by persons with mental illness? Jeffrey W. Swanson, PhD in the Department of
Psychiatry and Behavioral Sciences, at Duke University Medical Center, examined this
question using a multivariate analysis of pooled samples of treated individuals with SMI
in 4 states N=802).
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This study examined the prevalence and correlation of violent behavior by
individuals with severe mental illness. The Participants (N = 802) were adults with
psychotic or major mood disorders receiving inpatient or outpatient services in public
mental health systems in 4 states. After 1-year of the study the prevalence of serious
assaultive behavior was 13%. Three variables—past violent victimization, violence in the
surrounding environment, and substance abuse—showed a cumulative association with
risk of violent behavior. Violence among individuals with severe mental illness is related
to multiple variables with compounded effects over the life span. Interventions to reduce
the risk of violence need to be targeted to specific subgroups with different clusters of
problems related to violent behavior.
Conclusions
According to Jeffrey Swanson’s research severe mental illness does not
independently predict future violent behavior, challenging perceptions that mental illness
is a leading cause of violence in the general population. Still, people with mental illness
did report violence more often, largely because they showed other factors associated with
violence. Consequently, understanding the link between violent acts and mental disorder
requires consideration of its association with other variables such as substance abuse,
environmental stressors, and history of violence.
Numerous public shootings have sparked countless government studies aimed at
examining how postsecondary institutions can improve the identification of students with
serious mental illnesses and provide them with appropriate treatment. University officials
also face confusion about when it is appropriate and legal to release educational and
health information that is generally covered by privacy laws.
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Despite widespread media attention following violent attacks on college
campuses, evidence exists that colleges are actually less prone to violent crimes than
society in general. According to a report prepared by the School Violence Resource
Center, the overall U.S. murder rate is 43 times higher than the murder rate on college
campuses. The rates of forcible rapes, robberies and aggravated assaults are also
significantly lower on college campuses.
Nevertheless, when violent incidents occur, the public is quick to point out the
need for improved safety measures on college campuses. One of the most common
responses to campus violence at both the state and university levels has been the creation
and use of threat assessment teams (13). These teams take a coordinated approach to
identify, prevent and assess behavioral threats to public safety on college campuses.
While details of these teams vary somewhat among institutions, numerous colleges
nationwide have created multidisciplinary teams that are both investigational and
interventional. In the wake of the Virginia Tech shootings, Virginia’s legislature passed
more than 30 bills dealing with a variety of issues raised by the shootings. One bill signed
into law by Governor Kaine requires state colleges in Virginia to develop crisis and
emergency plans and campus threat assessment teams.
Another policy focus is to ensure that mental health services are available to
students at postsecondary institutions. A report to the Massachusetts Department of
Higher Education in June 2008 found that 83 percent of its colleges provide on-campus
mental health services for students. Among those schools, however, only about half
provided specialized services (e.g. substance abuse, suicide prevention and eating
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disorders). The report recommends that all colleges provide both generalized and
specialized mental health services that are easily accessible to students.
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Chapter Seven: Traditional Preventive Programs
Introduction
15
Chapter Eight: Innovative Approaches to School Violence
Introduction
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Chapter Nine: Case Study-Attitudes of Caldwell Teachers
Introduction
Descriptive Statistics or Demographic Data
Note: Below is the format for tables in APA 6th edition
For example:
17
Findings from Open-Ended Questions
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Chapter Ten: Conclusions and Recommendations
Conclusions
The results of this study support the contention that
Recommendations for Practice
Recommendations for Future Study
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References
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Appendix A
1. Steadman HJ, Mulvey EP, Monahan J, Robbins PC, Appelbaum PS, Grisso T, Roth
LH, Silver E. Violence by People Discharged from Acute Psychiatric Inpatient
Facilities and by Others in the Same Neighborhoods. Arch General Psychiatry.
1998; 393-401.
2. Friedman RA. Violence and Mental Illness: How Strong is the Link? New England
Medical. 2006; 2064-2066.
3. Appelbaum PS. Violence and Mental Disorders: Data and Public Policy. American
Psychiatry. 2006; 1319-1321.
4. Cole TB, Glass RM. Mental Illness and Violent Death: Major Issues for Public Health.
JAMA. 2005; 623-624.
5. Monahan J, Bonnie RJ, Appelbaum PS, Hyde PS, Steadman HJ, Swartz MS. Mandated
Community Treatment: Beyond Outpatient Commitment. Psychiatry Serv. 2001;
1198-1205.
6. Penn DL, Kommana S, Mansfield M, Link BG. Dispelling the Stigma of Schizophrenia
II: the Impact of Information on Dangerousness. Schizophr Bull. 1999; 437-446.
7. Silver E, Teasdale B. Mental disorder and violence: an examination of stressful life
events and impaired social support. Soc Probl. 2005; 62-78.
8. Harris GT, Rice ME. Risk Appraisal and Management of Violent Behavior. Psychiatry
Serv. 1997; 1168-1176.
9. Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, Wagner HR, Rosenheck RA,
Stroup TS, McEvoy JP, Lieberman JA. A National Study of Violent Behavior in
Persons with Schizophrenia. Arch Gen Psychiatry. 2006; 490-499.
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10. Elbogen EB, Van Dorn R, Swanson JW, Swartz MS, Monahan J. Treatment
Engagement and Violence Risk in Mental Disorders. Br J Psychiatry. 2006; 354360.
11. Grossman D, Neckerman H, Koepsell T, Liu P, Asher K, Beland K, Frey K, Rivara
FP: Effectiveness of a Violence Prevention Curriculum among Children in
Elementary School. JAMA 1997; 1605–1611.
12. Olweus D: Bullying among Schoolchildren: Intervention and Prevention, in
Aggression and Violence Throughout the Lifespan. Edited by Peters R, McMahon
R, Quincy V. London, Sage Publications, 1992; 100–125.
13. Limber SP, Nation MM: Bullying Among Children and Youth, in Combating Fear
and Restoring Safety in Schools. Edited by Ar- nette JL, Walsleben MC.
Washington, DC, US Department of Jus- tice, Office of Juvenile Justice and
Delinquency Prevention, 1998; 5.
14. Swanson J, Holzer C, Ganju V, Jono R. Violence and Psychiatric Disorder in the
Community: Evidence from the Epidemiologic Catchment Area Surveys. Hospital
Community Psychiatry. 1990; 761–770.
15. Swanson J. Mental Disorder, Substance Abuse, and Community Violence: an
Epidemiological Approach. In: Monahan J, Steadman H, eds. Violence and
Mental Disorder: Developments in Risk Assessment. Chicago, Ill: University of
Chicago Press; 1994; 101–136.
16. Estroff S, Swanson J, Lachicotte W, Swartz M, Bolduc M. Risk Reconsidered:
Targets of Violence in the Social Networks of People with Serious Psychiatric
Disorders. Social Psychiatry Epidemiology. 1998; 95-101.
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17. Monahan J, Steadman H, Silver E, et al. Rethinking Risk Assessment: The MacArthur
Study of Mental Disorder and Violence. New York, NY: Oxford University Press;
2001.
18. Goodman L, Rosenberg S, Mueser K, Drake R. Physical and Sexual Assault History
in Women with Serious Mental Illness: Prevalence, Correlates, Treatment, and
Future Research Directions. Schizophrenic Bull. 1997; 685–696.
19. Mullen P, Martin J, Anderson J, Romans S. The Long-Term Impact of the Physical,
Emotional, and Sexual Abuse of Children: A Community Study. Child Abuse and
Neglect. 1996; 7–21.
20. Carroll, Aaron E. Get Serious about Mental Health Care. CNN. Cable News
Network, 18 Dec. 2012. Web. 04 Feb. 2013.
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Appendix B
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Appendix C