Certainly, it is sad, horrific, and scary that we have come to an age where people commit acts of violence on social media. Even more disturbing is the higher incidence of mass killings and physical violence. Fortunately, Facebook had just put a policy in place necessitated by these heinous acts. They shut down the shooter’s page.  We have learned to avoid giving the shooters or violent actors the attention they are seeking. Now, we focus more on the victims and getting the violent actors off the street.

What we do know so far is that the shooter said “I’m at the point where I snapped”. He also stated that he had experienced some recent stress in his relationship and with his mother. It is not known if he also had experienced stress on his job at a behavioral health agency. His ex-girlfriend had stated that he “really is a nice guy…he is generous with everyone he knows. He was kind and loving to [her and her children]” in an earlier statement to Cleveland19.

Based on that information, it is possible that the shooter experienced a psychotic break in which he became violent. He certainly expressed the wish to kill multiple people. He felt considerable emotional distress, but it is unclear why he felt the need to take the life of an innocent bystander. Depressed men are more likely to be violent and to commit suicide. Often, they use more lethal means for both. According to the National Alliance of Mental Illness, “African Americans are no different when its comes to prevalence of mental health conditions when compared to the rest of the population.”

Furthermore, “African Americans sometimes experience more severe forms of mental health conditions due to unmet needs and other barriers. According to the Health and Human Services Office of Minority Health, African Americans are 20% more likely to experience serious mental health problems than the general population.” The economic hardship, homelessness, the stress of dealing with racism, and exposure to violence may also influence the severity of the mental illnesses that warrant treatment in that community.

Most African-Americans have a distorted or incorrect view of what mental health is. Only about one-quarter of African Americans seek mental health care, compared to 40% of whites.
There is also some cultural bias against going for psychotherapy or taking medications. Instead, research has shown that most African-Americans prefer to deal with issues of stress, depression, anxiety and other mental health issues with the help of trusted community members, family, spiritual leaders, and their faith.

Another issue for African-Americans is access to mental health care. According to NAMI, “Only 3.7% of members in the American Psychiatric Association and 1.5% of members in the American Psychological Association are African American.”  Most people would prefer to be treated by a psychotherapist or medical doctor who looks like them and shares some of the same cultural background. There are good providers available from other backgrounds; but unfortunately, there is also a significant history of misdiagnosis. There is also a history of prejudice and discrimination in the health care system as a whole with this population that reinforces the distrust prevalent about obtaining health and/or mental health services.

Socio-economic status is probably most significant barrier to mental health and primary care for this population. “According to the U.S. Census Bureau, as of 2012, 19% of African Americans had no form of health insurance. The Affordable Care Act is making it easier and more affordable to get insured.” That access is now in danger, with the current administration’s plan to demolish the Affordable Care Act instead of refining the parts that worked and fixing the parts that did not. It is also important to note that even with the Affordable Care Act (ACA), insurers often offered lower premiums if mental health care was not part of the package. If you are on a limited income, it is more likely that you would choose such a policy. It also limited substance abuse treatment which is also needed by many on the ACA.

What should we do? We all should be noticing drastic changes in personality, behaviors, or mood in those around us. As we have learned, there may not be overt signs or clear statement prior to acts of violence or suicide. If you notice that someone you know has become more angry, irritable, tearful, hopeless, negative in speech or thought, has had changes in sleep or eating behaviors; then ask more specific questions about how they are doing. For example, “Jean, you have been a lot more edgy lately and you don’t smile as much anymore. Is something going on with you?” If you begin to get a since that they are depressed or paranoid or overly anxious without a known cause, suggest that they see their primary care physician, go to the Employee Assistance Program for a mental health referral, or invite them to call the insurance company for a mental health referral. If they are voicing thoughts of killing themselves or someone else: (1) ask if they have any weapons on them or at home, (2) ask their specific plan, (3) find out the name of the person(s) they intend to harm and their location if possible, (4) call 911 to get them to the emergency room for immediate evaluation for a psychiatric hospitalization, and (5) if you cannot leave the situation to make the calls, text someone who can call 911 and/or assist with getting them to the hospital.

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