The U.S. Secret Service, which studies "targeted violence", provides insight on the urgency of the need in its 2002 "Safe School Initiative" report:【F1】
School attacks, instead of being the random impulsive acts of noisy and cruel fellows, are well-planned events mostly carried out by a single student—who is not evil but mentally ill.
Except for being male, the 41 attackers studied fit no profile of family background, race, ethnicity, or even academic performance. Many were A and B students. Few had a history of violent or criminal behavior. But their thoughts were of violence, and their behavior was often frightening.【F2】
They frequently expressed violent themes in their writings, in one instance portraying killing and suicide as solutions to feelings of despair.
The criminals often had telegraphed to other students and teachers to express their depression or desperation and either talked about or had attempted suicide. Feelings of persecution by others were common and led to growing resentment and anger.
【F3】
Psychiatrists and psychologists recognize that these are red flags demanding medical intervention.
Yet one of most striking findings in the report was that the vast majority of these students never had a mental-health evaluation. No wonder only 17 percent were diagnosed with a psychiatric illness—it wasn't looked for. That alone points to a huge mental health gap: If the distress of these students didn't trigger medical attention, it's unlikely that less severe struggles that are seen in as many as 15 to 20 percent of other students will do so.
【F4】
Only recently have we learned that these are neurodevelopmental disorders whose early signs might well be picked up in routine podiatric screening.
For example, a classic behavior in a child that can precede psychosis later in life is speaking to almost no one, even family, says Nasrallah.
Genes are known to confer vulnerability, but equally important is the environment. Stress or great disappointment can aggravate symptoms; Connecting with an adult in an ongoing relationship can do the opposite. Interventions like social-skills training combined with talk therapy and targeted medication can make a huge difference.【F5】
Early treatment can lessen the frequency and intensity of psychotic episodes, leaving many patients with only the mildest of symptoms.
And the younger the brain, the more malleable is. The ultimate goal is to not only modify evaluation of disease but keep it from arising in the first place. This is achievable, and the path to get there is becoming clear.