TALLAHASSEE, Fla. – Better integration of data, coordination of care and services and early screening and assessment were among recommendations a panel of mental health experts offered Tuesday at a workshop organized by Gov. Rick Scott in response to last week’s shooting rampage by a troubled 19-year-old that left 17 people -- including 14 teenagers -- dead.
Nikolas Cruz was charged with 17 counts of premeditated murder after gunning down students and faculty at Marjory Stoneman Douglas High School in Parkland. Cruz had a lengthy history of mental-health issues, and the FBI received at least two reports that he posed a threat to others.
In response to the mass shooting, Scott ordered workgroups focused on education, law enforcement and mental health, with the aim of proposing legislation before the annual 60-day session ends March 9.
Lt. Gov. Carlos Lopez-Cantera posed the first question at the meeting Tuesday about mental-health issues led by Florida Department of Children and Families Secretary Mike Carroll.
“What is it about the young males in their development or external factors or media or society that drives them to do these unspeakable horrific things? Because It’s males. They’re doing it. And I haven’t heard anything about that,” Lopez-Cantera asked.
The experts said that just a fraction of mentally ill people -- between 1 and 4 percent -- become violent.
“The angry young men is a pretty big group, but we’re talking about a very small group that present a risk in our schools,” said child psychiatrist R. Scott Benson.
But Dean Aufderheide, director of mental health services for the Florida Department of Corrections, said sociopaths need to be identified through screening before they can commit heinous crimes like the Parkland massacre.
“Who are these people? People who tend to have no empathy. No remorse. No guilt,” Aufderheide, a psychologist, said.
Telltale behaviors include isolation, alienation, ostracization, escape and anger, Aufderheide said.
“If you don’t measure for this… to identify these traits you’re doing a disservice,” he said.
But Florida State University College of Medicine professor Heather Flynn warned against contributing to the stigma of mental illness.
“We have to be careful not to inadvertently contribute to the notion that people with mental illness are dangerous. That’s something we’ve been trying to get away from for all these decades and centuries,” Flynn, a clinical psychologist, said.
Carroll, too, was cautious about branding children with mental-health issues.
“How do you integrate that (assessment) into a school system but do it in a way that’s positive, that doesn’t ostracize or target kids?” he asked. “Parents don’t want their kids labeled. Parents don’t want their kids ostracized. Parents don’t want their kids put in some other group. Because we do that.”
Early intervention and identification is critical, several experts said.
“When they reach high school, there are so many other factors that have contributed to them not wanting to be in school, dropping out and having resentment. There are all these different factors that eventually lead to something that kind of becomes out of control,” child psychiatrist Bhagi Sahasranaman said.
The experts all agreed that delivery of services, as well as the identification of families and children who may be at risk, are fragmented.
Paying for treatment is also problematic because the state doesn’t spend enough on mental health treatment. Also, services that aren’t “face-to-face,” such as psychiatrists calling parents to discuss their children, aren’t reimbursed by Medicaid.
Mary Armstrong, executive director of the Louis de la Parte Florida Mental Health Institute at the University of South Florida, suggested that caseworkers, parents and others need to “all be in the room” together to share information about children with mental-health problems.
“Funding’s a huge issue. But it’s structural,” Armstrong said. “It’s broken. It’s got to be put back together. … That, to me, it’s disturbing. And we can fix that. We don’t need new resources. We can fix that.”
Early identification and intervention, even for pregnant mothers, could help steer services to families before children begin to act out, according to clinical psychologist Heather Flynn, a professor at the Florida State University College of Medicine.
“You can predict pretty well which families will have this forward trajectory even before the child is born,” Flynn said, saying that behavioral health and physical health need to be combined.
But identifying and treating every would-be school shooter like Cruz may not put an end to tragedies like the one last week in Parkland, Carroll conceded.
“It is very difficult to develop targeted assessments that are going to be 100 percent foolproof,” Carroll said in an interview during a lunch break.
That’s why the workgroup is working on broader strategies, the secretary said.
“You’ve got to lift the level of water in the tank, because if we get involved with kids earlier and we can get them treatment, hopefully less kids end up at that place and you have less of a chance of going down this avenue,” he said.
Early assessments can significantly cut down the possibilities of people like Cruz committing similar atrocities, Carroll said.
“We are in the people-helping-people business. So we do the best we can with people, but people do things sometimes that you just can’t explain, that are unspeakable,” he said.