Sorry, but mental health professionals are not clairvoyant

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By Vivien Burt, Robin Berman and Sonya Rasminsky

Updated: 6 hours ago Published: 8 hours ago

Vivien Burt is Emeritus Professor of Psychiatry at the David Geffen School of Medicine at the University of California, Los Angeles. Robin Berman and Sonya Rasminsky are both associate professors of psychiatry at the David Geffen School of Medicine at the University of California, Los Angeles.

At a press conference last week after the shooting at Robb Elementary School in Uvalde, Texas, Gov. Greg Abbott, R, proclaimed that “anyone who shoots someone else has a mental health issue. , period. As a government, we need to find a way to target this mental health issue and do something about it. Uvalde Mayor Don McLaughlin, R, echoed Abbott’s sentiment: “Maybe we could have caught him. Maybe if we had the counsellors, maybe if we had the mental health specialists, we could do it.

As psychiatrists, we have a message for Governor Abbott and Mayor McLaughlin: We want mental health professionals to solve this problem more than anything. But unfortunately, we’re just not that powerful. We are clinicians, not clairvoyants. We are trained to listen, diagnose complex disorders and even assess the risk of imminent harm to self or others. But despite our training, we cannot predict a person’s future actions.

A diagnosis is not a prophecy. Risk assessment is a matter of probabilities, but probabilities cannot tell us what a person will do on any given day. We know that a history of violence increases the risk of future violence, but we cannot know what form that violence might take, or whether it will happen tomorrow, in five years, or never.

Most troubled teens and young adults do not become violent. In the spirit of protecting individual liberty, we cannot detain young men simply because they have troubling thoughts and abstractly fit the profile of a potentially violent offender. And who would decide which young people should be identified as future perpetrators of school violence? Teachers? Social workers? Comrades? Mental health counselors or psychiatrists? What would we do with those who were selected? What forms of individual control or coercion are compatible with a free society? Do we have the means and the professionals available to work with all the teenagers selected as potential threats in the schools?

Given that psychiatrists cannot reliably predict on an individual basis who will commit acts of violence, what do we learn from neuroscience and epidemiology about adolescents and young adults that can help us develop viable policies to make our schools safer? MRI and other scientific studies have shown that the male brain (specifically the prefrontal cortex, responsible for reasoning, good judgment and impulse control) does not fully develop until the mid-twenties. From epidemiological data, we know that young people are most at risk of psychosis (often with symptoms of paranoia, delirium, mania, hallucinations and impulse dysregulation) between the ages of 18 and 25. We also know that most school shooters are under 21.

So there is a more effective solution than asking mental health providers to predict the future: establish a higher minimum age for purchasing firearms.

Public health policies have reduced risk in other settings by establishing age-based rules for certain groups to protect the general population. States that have established a minimum legal drinking age of 21 in the United States have seen a median drop of 16% in traffic accidents. And recognizing that poor judgment increases the accident rate, many car rental companies limit their liability by prohibiting those under 25 from renting their vehicle. In California, drivers under 18 cannot drive alone between 11 p.m. and 5 a.m. during their first year of license due to their high risk of a crash.

These regulations benefit the whole community, even if they limit the freedoms of young people. Doesn’t it seem reasonable to limit gun ownership to those under 25, given data on brain development and impulse control? The safety benefit of restricting gun purchases by young adults would be an important step towards reducing the alarming rate of mass shootings in schools.

As psychiatrists, we agree that it is useful to have more mental health practitioners available to treat troubled adolescents and young adults, and more resources need to be allocated for this purpose. But it is a mistake to believe that this will solve the epidemic of gun violence. The sad irony is that experiencing school closures, hearing about mass shootings and regularly doing school shooting drills contributes to the epidemic of depression and anxiety among children. school age.

Our kids are begging us to save them — and not just during 911 calls when a deranged gunman storms their classrooms. Children across the country need us to protect them, not with armed guards reminding them that they are at constant risk of abuse, but with laws based on science and epidemiology. Limiting access to guns for those whose brains are still developing would save lives.

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