In Preventing Violence, ‘Very Hard to Identify’ Individuals Who Need Help Most

January 17, 2013 at 12:00 AM EDT
Ray Suarez looks at responses by lawmakers and the NRA to President Obama's gun violence proposals. Jeffrey Brown hones in on the topic of mental health with Barry Rosenfeld, a clinical forensic psychologist at Fordham University, and Dr. Paramjit Joshi of the Children's National Medical Center in Washington, D.C.

RAY SUAREZ: And we turn to the reaction to the president’s proposals on guns, mental health and school safety.

JAY CARNEY, White House: The fact that’s it’s not easy doesn’t mean we shouldn’t try.

RAY SUAREZ: A day after President Obama announced his plan to attack gun violence, his spokesman acknowledged how hard it will be to get Congress to go along.

JAY CARNEY: If having an assault weapons ban become law again were easy, it would never have expired. If the variety of other actions that the president proposes we take as a nation were without conflict, we wouldn’t be having this discussion.

RAY SUAREZ: That call for a new stricter prohibition against military assault-style weapons is already being rejected by House Republicans. It’s also gotten a mixed response even among Senate Democrats, not to mention the gun lobby.

DAVID KEENE, National Rifle Association: Most of the proposals that have to do with firearms are simply feel-good proposals that have been tried in the past and won’t work or won’t have any real impact.

RAY SUAREZ: On “CBS This Morning,” the National Rifle Association president, David Keene, did say the group might support universal background checks, if they could be made to work.

DAVID KEENE: The difficulty comes in when you’re talking about you and me as next-door neighbors and you buy a new shotgun and want to sell one to me. How do you enforce a background check on that? We want to see the proposal. But, as a general proposition, the NRA has been very supportive of doing background checks.

RAY SUAREZ: Meanwhile, the head of the U.S. Conference of Mayors meeting in Washington said the president had answered the group’s written appeal for action.

Philadelphia Mayor Michael Nutter:

MAYOR MICHAEL NUTTER, Philadelphia: The plan that President Obama unveiled yesterday includes much of what we asked for in that letter. We will work with the president and the Congress to get critically needed legislation reforms enacted now.

RAY SUAREZ: And Vice President Joe Biden told the mayors not to believe the voices of doubt.

VICE PRESIDENT JOSEPH BIDEN: There are some who say the most powerful voice in this debate belongs to the gun lobby and those that demand a stop to these commonsense approaches to save lives. I think they’re wrong. This time, this time will not be like times that have come before.

RAY SUAREZ: And away from Washington, in Aurora, Colorado, the movie theater where 12 people were killed last July reopened this evening, with a ceremony for the victims.

JEFFREY BROWN: We hone in now on some of the mental health issues involved.

Among the president’s proposals, adding new psychologists to schools, asking teachers to help identify which students may need mental health treatment and easing the process for states to make information about individuals with mental illnesses available to the background check system.

To look at some of this, we’re joined by Dr. Paramjit Joshi, director of psychiatry at the Children’s National Medical Center in Washington, D.C., and president-elect of the American Academy of Child and Adolescent Psychiatry. And Barry Rosenfeld, professor of psychology and director of clinical training at Fordham University, he is a clinical forensic psychologist whose recent work has focused on assessing the risk of violence in patients.

And, Barry Rosenfeld, I would like to start right there. What’s the problem that we need to understand in trying to determine in advance who might be capable of violence as we saw in Newtown?

BARRY ROSENFELD, Fordham University: Well, the essence of the problem is that it’s a needle in a stay stack. So we have got almost an infinite number of people — I shouldn’t say infinite — a very large number of people who are going to fit any profile that we might generate, and we want to find the one person who’s potentially going to be homicidal.

There just isn’t really a way statistically to identify or clinically to identify that person with any real accuracy.

JEFFREY BROWN: Dr. Joshi, same question to you. Does that mean such limits — we can’t know? What can be done then?

DR. PARAMJIT JOSHI, Children’s National Medical Center: The issue, however, is that — young children and adolescents who sometimes will have aggressive behaviors early on.

And I think whole issue of trying to access care early on would go a long way in trying to prevent some of the more aggressive and violent behaviors as these youngsters get older. So I really applaud President Obama’s recommendations and proposals that he’s put forth about early intervention, early identification, and increasing the number of resources, both in schools and also generally in the mental health system.

JEFFREY BROWN: Well, just to put a little bit more detail on there, in schools, for example, what in what he said would most help, do you think, would be most important?

PARAMJIT JOSHI: I think the most important thing is really to provide the services in the school systems by having counselors, by having psychologists, mental health social workers in the school setting, because that’s where children spend most of their day.

It’s easily accessible. And, in fact, there was a mental health in school act that was proposed in the 112th Congress that put forth funding for this particular intervention. And I’m hoping that this sad, horrific event will make us rethink supporting this particular bill, so we can put the resources in the school system.

JEFFREY BROWN: What about that, Barry Rosenfeld? What are the possibilities there? What are the limitation there?

BARRY ROSENFELD: Well, I certainly would agree and applaud the president for the idea of expanding mental health services.

It’s an indirect solution to a much more present problem. I think that, of course, the more we can improve general mental health functioning among kids, among young people, among adults, among our returning war veterans, the better we are at the macro level.

But we still have that same problem of individuals who most need these services being very, very hard to identify. And once the difficulties have started to crystallize, I don’t know that we are going to have very much success by having an extra counselor in the school.

I think we have got to put a lot more resources into understanding violence to begin with. I’m always shocked by how little of our, for example, National Institutes of Health money goes towards understanding violence and understanding the causes and the treatments for it.

We have just not prioritized the understanding side of things and the prevention side of things. So I certainly applaud the mental health services.

JEFFREY BROWN: Go ahead, Dr. Joshi.

PARAMJIT JOSHI: But, at the same time, it’s a well-known fact that 50 percent of those who have eventually a mental illness start before the age of 14, and about three-quarters have mental illnesses by the time they reach 24.

So, in my mind and from my perspective, mental health is really a children’s issue. And so if we can catch them young and we can intervene early on, I think we will go a long way in not seeing adults becoming aggressive, violent, because we will be able to treat some of the illnesses early on.  

JEFFREY BROWN: Well, let me ask both of you, starting with you, Barry Rosenfeld.

All these things we’re talking about, about identifying people with problems, then there’s the question of reporting and how that might work and if you get the right people and if you cast too wide a net. Tell us a little bit what you see in what the president talked about, what in your state, in New York, they’re looking at. What is possible and what are the concerns there?

BARRY ROSENFELD: Well, I think there’s a lot of concerns and I think there’s a few possibilities.

And, of course, we all want to identify potentially violent people. The idea, though, that we’re going to cast this very wide net of anyone that raises any concern and have limited resources as to what to do with that, I worry quite a bit that we’re going to be increasingly infringing on people’s rights out of this fear that, well, what if this is the one person? What if this is the needle in the haystack?

So, I think there’s a lot of potential ramifications. I think there’s a lot of concerns that it will inhibit people from getting mental health treatment if they feel like going and talking to their doctor about, for example, thoughts to hurt themselves. Well, we know that there’s a link between the desire to hurt oneself and the actions against other people.

So are we going to deter people from seeking treatment for their depression because they don’t want to be hospitalized as potentially homicidal? I certainly don’t — I certainly think that it’s a well-intentioned approach, but I don’t know that it’s going to solve a lot of these problems in terms of capturing the one person, that needle in haystack, as it is, that we’re really interested in.

JEFFREY BROWN: Well, Paramjit Joshi, what do you think about the concerns about reporting?

PARAMJIT JOSHI: You know, I would agree that the net is being cast really wide, and it very well may deter people from coming forth to talk about how they’re feeling.

It’s sort of walking a really fine line about keeping the public safe and at the same time protecting their privacy. And with children and adolescents, we get consent from the parents to be able to treat young patients. So, in some sense, it’s a little less of an issue with our children and teenagers as it is with the grownups.

But I do agree that it might really deter people from speaking very openly to their psychiatrist and their other mental health providers about what’s really going on in their mind.

BARRY ROSENFELD: If I could add something…

PARAMJIT JOSHI: Sure, please.

BARRY ROSENFELD: If I could add something, I think that we do have a real risk with children and adolescents.

Someone is identified in the school, and now are they going to be sent out of the school, so now they’re not able to return to the school because the psychologist expressed concern? That could impact an incredibly large number of children, I think, many of whom, the vast, vast majority of whom aren’t a risk.

JEFFREY BROWN: Let me just — just briefly, Dr. Joshi, of course, at the same time, there’s all this need to find these people and to identify them and to let authorities know.

PARAMJIT JOSHI: Again, as I said earlier, it’s sort of walking a fine line, balancing the individuality and the privacy of the patient and at the same time keeping folks safe.

So, I think we have to be deliberate. We have to be thoughtful about how we proceed. And we will have to see how best to really identify, at the same time be able to provide services. But my sense is, before we even get to the point of severe aggression in some of these youngsters, hopefully, we can catch it early so it doesn’t get to that point. And that’s where early identification and prevention comes in.

JEFFREY BROWN: OK. We will leave it there.

Paramjit Joshi, Barry Rosenfeld, thank you both very much.

PARAMJIT JOSHI: My pleasure.