How to tackle violence and mental illness in schools

January 16, 2013

As part of the gun control initiatives President Obama announced today, the administration is pushing for greater access to mental health services, especially for adolescents.

Specifically, the White House wants $50 million to train new mental health professionals, $25 million for school-based trauma treatment and violence prevention programs, $25 million for state-based mental health programs targeting youths ages 16 to 25, $15 million to train teachers to deal with mental illness, and $40 million to help school districts direct students to the mental health services they need.

This is a tricky area. While many mass shooters suffer from depression or other mental illnesses, the vast majority of individuals with mental illnesses are nonviolent. In many cases, people with mental disabilities, such as those on the autism spectrum, are far likelier to be victims of violence than to perpetrate it, as autism rights activists have stressed since the Newtown shooting. (The perpetrator was widely reported to have Asperger's Syndrome.) But in rare cases, mental illnesses can lead to behavioral problems including violence, and expanding access to mental health care is valuable regardless of its effect on violence.

So what programs work with young people who might be at risk for mental illness or violence-related conduct disorders? The RAND Corp.'s Promising Practices Network maintains an excellent database of proven and promising interventions dealing with problems affecting children and families, including programs meant to curb depression and other mental illnesses and those meant to combat violence. Here are some themes that emerge from the programs they tout.

Therapy works


Okay, so therapy didn't reduce violence for Robert De Niro in "Analyse This," or for Tony Soprano, but in general it works! (Phillip Caruso)

Study after study has shown that talk therapy, and in particular "cognitive-behavioral therapy" or CBT, is effective in combating depression and mood disorders. CBT, which has largely displaced Freudian psychoanalysis among mental health practitioners, focuses on training patients to identify thought patterns that give rise to depressive episodes and defuse them before they become a problem.

Promisingly, the research on CBT suggests that it works among the 16- to 25-year-old population Obama is targeting. The Coalition for Evidence-Based Policy touts two randomized studies that found that programs that provide CBT to at-risk youths reduce the incidence of moderate depressive episodes by 36 percent and 39 percent, respectively. Those studies both used adolescents, with the former looking at a group of 18-year-olds and the latter focusing on college freshmen of varying ages.

Group programs work, too


Group therapy targeting trauma sufferers, such as this group for shooting victims, is generally quite effective (Whitney Shefte/The Washington Post)

Group therapy can also work. RAND highlights a program called "Multisystemic Therapy" or MST, which works with families as a group, often in their own homes, and which randomized studies have found reduces arrests, drug abuse and violent behaviors among teens, and improve family cohesion as well.  MST often incorporates individual-level CBT as well. "Attachment-based Family Therapy" (AFT), another family-based therapy program, has also proven effective among teens. One program, called the "Coping With Stress" course, takes a classroom approach but is effective at reducing depression as well.

Perhaps the program most suited to Obama's goals is "Cognitive Behavioral Intervention for Trauma in Schools," a group therapy program for middle and high school students who've recently experienced a major trauma, such as witnessing an act of violence. That program reduced depression by 17 percent and PTSD by 29 percent, compared to students who didn't receive therapy.

Start early


(Katherine Frey / Washington Post)

While MST and CBT can combat depression and violence among teens, it's better if you start earlier. RAND identified 17 programs that are proven or promising at reducing violent conduct among youths, and of those, only two specifically target adolescents, while 11 focus either on elementary or middle school students.

What's more, many of these programs feature violence reduction as a side effect rather than their main purpose. High-quality preschool, nurse-family partnerships to aid first-time mothers and children-parent centers for preschool-aged kids all reduce violent conduct when their beneficiaries grow up. Home visits meant to discourage child abuse work at reducing depression. So just making sure kids grow up healthy and well-educated yields dividends in terms of violence prevention and mental illness avoidance.

Yes, you can stop kids from doing drugs


(Ted S. Warren/Associated Press)

School-based anti-drug programs get a bad rap, not least because DARE, the most famous such program, has been found in some studies to actually increase drug use among suburban youths. But some programs actually work. The "LifeSkills" drug prevention program has been shown in randomized trials to reduce both drug and alcohol use among the middle and high school students it targets, and to reduce violent behavior as well.

Be all you can be


(Doug Dreyer/Associated Press)

It's something of a cliché that going into the military can help a kid grow up. But you might be surprised to learn that there's solid research backing that up. The National Guard's Youth ChalleNGe (get it? "NG"? yeah, you get it) program, a 17-month, partially residential program conducted largely at military bases, is effective on just about every metric. Its participants, all of whom are high school dropouts upon enrollment, are more likely to be taking college classes and to be employed than the control group, and less likely to be obese, overweight or arrested.

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