NLM Director’s Comments Transcript
Child Mental Health, Violence, and Preventing Newtown’s Reoccurrence: 02/12/2013

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Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.

To prevent events, such as the deaths of elementary school children and teachers in Newtown, CT., an insightful commentary recently published in the New England Journal of Medicine, suggests there needs to be improved identification and understanding of mental illness among young persons, efforts to remove barriers to care, and new research to understand mental illness’ progression after childhood.
The commentary’s authors suggest the prevention of incidents, such as the Newtown shootings, requires a more multidimensional response than new gun control legislation. First, the authors note it is important to identify and treat young persons who withdraw from life and become isolated.
The commentary’s authors write (and we quote): ‘withdrawn and isolative behavior usually goes undetected or unaddressed until impairment is obvious; at its extreme, it can manifest in a shocking murder and suicide’ (end of quote). The authors counter some social isolation is common among young persons, who usually respond well to early intervention.
The authors explain it is important to distinguish if a young person’s social avoidance and inhibition stem from: autism disorders, traumatic life experiences, or are linked to depression. The authors add it is especially important to identify (and we quote): ‘a very small group of withdrawn and isolated children who lack empathy and are cold and callous toward other human beings’ (end of quote).
The commentary’s authors, who are physicians from the child and adolescent psychiatry divisions at Weill Cornell Medical College and New York-Presbyterian Hospital, clarify it is rare for violent crimes to be committed by mentally ill persons. They write (and we quote): ‘the vast majority of people with psychiatric disorders are not violent, and the mentally ill do not commit a substantial proportion of violent crimes in the United States’ (end of quote).
The authors add when violence is associated with mental illness, (and we quote) ‘…it usually occurs in reaction to an interpersonal provocation and is often charged with emotion’ (end of quote).
The barriers to assist young persons with mental illness or disorders include a disdain to seek treatment that can be shared by a child and family members. The authors explain families sometimes wish to avoid a social stigma that is associated with psychological treatment. Similarly, the authors find physicians sometimes wish to avoid complex civil commitment processes.
The authors add parents and siblings occasionally are discouraged by confidentiality norms that may deter their involvement in a young person’s psychological counseling.
In addition, the authors find a combination of high costs and rigorous insurance standards for psychological treatment reimbursement are barriers to initiate and sustain mental health treatment.
Moreover, the authors explain families and individuals may distrust some of the medications and treatments used to treat mental illness and psychological disorders. The authors add (and we quote) there is an underlying ‘public uncertainty regarding the safety of medications, past malfeasance by the pharmaceutical industry, and political and religious forces that challenge the fundamental brain basis of medical conditions’ (end of quote).
The authors add there should be improved recognition when mentally ill young persons are attracted to (and we quote): ‘a seductive, powerful subculture that celebrates and advocates violence and antisocial behavior’ (end of quote). While the authors emphasize most mentally ill persons are not influenced by mass media violence, they write (and we quote):’ a very small minority of angry and alienated mentally ill persons may gain a sense of belonging and support from this subculture’ (end of quote).
Finally, the authors note there is a dearth of research about how childhood psychological disorders are sustained through teen and adult years. The authors find additional research is needed to better decipher the complex patterns among withdrawal behaviors, social isolation, attraction to an alienation subculture, and violent acts.
MedlinePlus.gov’s teen mental health health topic page provides an overview of child and teen mental health in the ‘overviews’ section (from the National Institute of Mental Health). A primer to help young persons cope with anger (provided by the Nemours Foundation) is available within the ‘related issues’ section of MedlinePlus.gov’s teen mental health health topic page.
MedlinePlus.gov’s teen mental health health topic page also contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the teen mental health health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.
To find MedlinePlus.gov’s teen mental health health topic page, just type ‘teen mental health’ in the search box at the top of MedlinePlus.gov’s home page. Then, click on ‘teen mental health (National Library of Medicine).’ MedlinePlus also contains several related health topic pages, including child mental health, teen violence, as well as mental health and behavior.
Most of all, the commentary reminds us the issues surrounding the prevention of violent behaviors are complex -- and a roadmap to foil another Newtown shooting requires both resolve and diverse interventions.
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