Sandy Hook report: Preventing school shootings

On Dec. 14, 2012, Adam Lanza of Newtown, Conn., used this Bushmaster semi-automatic rifle in the mass killing of 26 children and educators at Sandy Hook Elementary School. The weapon, which is a civilian version of the M-16 military assault rifle, was equipped with a pair of 30-round ammunition magazines. /Law enforcement image

In the United States, few issues are more polarizing than guns. Even the fatal shootings of 20 young children and six educators at Sandy Hook Elementary School in Connecticut two years ago has failed to generate a consensus on ways to curb gun violence.

This week, the commission formed to advise Connecticut authorities about preventing school shootings issued its final report. The premise of the report is indisputable:

"There is at least one place, other than a home, in which every person, whether a child or an adult, should feel absolutely safe and secure from harm: school. Short of transforming our schools into gated communities or prison-like environments, however, no school can be freed entirely from the risk of violence. Nevertheless, through safe school design and operation strategies, and through closer coordination with our educators, local law enforcement, fire departments, EMS, public safety personnel, security experts and mental health professionals, our schools can become much safer environments."

The recommendations in the commission's report fall into three categories: safe school design and operation; law enforcement, public safety and emergency response; and mental and behavioral health.

While the shooter in this mass killing had been diagnosed with severe mental illness, the commission's report makes a key point about the role of mental illness in gun violence: "People with mental health challenges are far more likely to be victims of violence than perpetrators." In my opinion, improving the quality and availability of mental health services in the United States would decrease the risk of mass shootings; but the primary benefit would be boosting the productivity and quality of life for those suffering from mental illness and their loved ones. 

After reviewing the commission's 277-page report, I hope widespread support can be established for these recommendations, which have been edited to remove jargon and verbose prose:

• Requiring classroom and other safe-haven areas to have doors that can be locked from the inside. 
• All exterior doors in K-12 schools should be equipped with hardware capable of implementing a full perimeter lockdown.
• School custodians should be included as members of school security and safety committees. Custodians have a wealth of knowledge and experience to share about the physical school building and grounds.
• Mandatory background checks on the sale or transfer of any firearm, including long guns, at private and gun show sales.
• A ban on the possession or sale of all armor-piercing and incendiary bullets.
• Evaluate the effectiveness of federal law in limiting the purchase of firearms via the Internet to only those individuals who have passed background screening.
• Prohibit the possession, sale or transfer of any firearm capable of firing more than 10 rounds without reloading. This prohibition would extend to military-style firearms as well as handguns. Law enforcement and military would be exempt from this ban.
• To allow, at a judge's discretion, the opportunity to temporarily remove any firearms, ammunition, and carry permits from a person who is the subject of a restraining order, civil protection order or family violence protective order, at the time of the issuance of that order.
• Recognizing that mental health is more than the absence of mental illness, build systems of care that go beyond treating mental illness to foster healthy individuals, families and communities.
• Build a mental health system that targets detection and treatment while building stronger communities of care.
• Addressing a fragmented and underfunded behavioral health system tainted by stigma requires building a comprehensive and integrated approach to care. This approach should stress family involvement and community resilience. Care should be holistic and involve pediatric and adult medical facilities from birth to adulthood, with efforts to ensure continuity of care.
• Many students and their families live under persistent and pervasive stress that interferes with learning. There are many potential resources such as school-based health centers that should provide access to preventive care.
• Schools should form multidisciplinary teams to assess and support children who may pose a risk to others or themselves due to toxic stress, trauma, social isolation or other factors.
• For many children, schools offer the only access to health assessment services. Schools should increase the availability of guidance counselors, social workers, psychologists, and other health professionals during and after school.
• Increase the behavioral health workforce.
• Funding decisions about behavioral health must look beyond the model that has prevailed over the past several decades to embrace psycho-social interventions, services directed toward the achievement of functional skills, and other efforts to engage the whole person, which frequently offer the best prognosis for recovery.
• Commercial health insurance should cover the full range of services available through the public behavioral health system, including programs that provide housing and occupational support for individuals struggling with severe mental illness. 
• A diagnosis of mental illness does not have to mean an end to achieving one‘s life goals. Systems of care that promote wellness generally and recovery for those who struggle with behavioral health challenges and the effects of traumatic stress can help to diminish stigma and its effects.
• For adolescents and adults facing mental health diagnoses, effective psycho-education of both individuals and families can decrease stigma. Psycho-education involves teaching individuals and families about mental illness and its treatment, as well as strategies for handling typical challenges that might arise with a particular condition. The goal of such programs is to recognize that someone considered "different" or "odd" may need professional help.