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Thursday, March 22, 2018

Let's Get Aware

Let’s Get “AWARE” of Preventing Violence through Good Mental Health Promotion
David Leake, PhD
University of Hawaii at Manoa
In February 2018, the United States experienced yet another devastating mass shooting, this time at a high school in Florida with a total of 17 people left dead. Once again, many politicians who are opposed to stricter gun control shifted the blame to “mental illness” despite themselves having records of seeking cuts to programs that promote good mental health and/or opposing parity between physical and mental health coverage in health insurance.
In fact, people with serious mental health challenges are much more likely to be the victims of violence rather than the perpetrators. There are relatively few with a psychosis or highly distorted thinking that might lead to a deadly shooting.  Of course keeping guns out of their hands should be a priority, but real solutions would focus on reducing factors that make some students feel unwanted and alienated, which is true of nearly all students who perpetrate violent acts in their schools.
It is notable that there are evidence-based practices that can be used in schools to promote good mental health and greatly reduce the likelihood of violence. Many of these practices are being promoted through the US government’s Advancing Wellness and Resilience in Education (AWARE) grant program for states and school districts. This program was part of the Obama administration’s response to the notorious 2012 mass shooting at Sandy Hook Elementary School in Connecticut, which remains the United States’ most deadly school shooting with 26 victims. As with the recent Florida shooting, the Sandy Hook perpetrator had a serious emotional disturbance.
The AWARE approach seeks to head off such events through prevention and early identification and treatment. A guiding principle congruent with the disability studies perspective is that students of all abilities need to feel socially valued and accepted if they are to reach their best possible mental and physical health status and gain the most possible benefit from their educations. Social inclusion and mutual respect are therefore strongly promoted.
Key AWARE elements being demonstrated and tested include:
  • Raise awareness and conduct program planning through collaboration among families, schools, and communities.
  • Establish school teams that collect and use data to identify and address high priority behavioral challenges on campus.
  • Increase school and community early intervention capacity.
  • Identify and attend to symptoms of trauma.
  • Promote social-emotional learning, thereby enhancing overall social skills and mutual acceptance.
  • Ensure mental health services are culturally relevant and developmentally appropriate.
  • Implement positive behavioral interventions and supports (PBIS), which consist of rules, routines, and physical arrangements that channel students away from negative behaviors without the use of alienating punishments.
When effectively implemented, these practices are known to lead to more welcoming school climates, as reflected in reduced bullying and fighting, fewer students thinking about or attempting suicide, greater mutual respect and acceptance, fewer suspensions and expulsions, and improved academic performance.
Another notable aspect of the AWARE initiative is a focus on increasing interpersonal contacts between students who may be seriously troubled and caring adults. To this end, a required component of all AWARE projects is to train school personnel and community members in Youth Mental Health First Aid (YMHFA), which is modeled on the CPR training approach for cardiopulmonary resuscitation. The eight-hour course enhances the capacity of people to recognize symptoms of distress in youth and to know when and where to make referrals or otherwise provide support.

Mental health first aid courses were developed for the adult population in Australia beginning in 2000, with a youth version added later. Courses are now offered in at least 23 countries. We can all contribute to this movement by completing either or both the youth and adult courses, or even the more intensive train-the-trainer courses. In the United States, you can find courses scheduled near you at