海角大神

Emerging details about the troubled past of the alleged shooter in Santa Monica, Calif., are reopening discussions about the identification of red flags 鈥� and the issues involved in responding to them.

John Zawahri is accused of fatally shooting five people last Friday and was killed by police. In high school, he was deeply interested in assault weapons, which in 2006 led school officials to report him to police, says Sandra Lyon, superintendent of the Santa Monica-Malibu Unified School District.

According to local media reports, a fellow high school student went to Mr. Zawahri鈥檚 house, where Zawahri showed his guest a samurai sword and tried to regale him with a list of people he wanted to hurt. The student informed the school principal of the incident, and Zawahri was sent to UCLA鈥檚 Neuropsychiatric Institute, although released quickly.

Zawahri was also studying video-game production at Santa Monica College, where he did not finish his degree. Behind all this was a home life apparently full of violence. In an application his mother filed for a restraining order against his father, she accused the elder Zawahri of threatening to kill her, according to the Los Angeles Times.

鈥淭his all looks and sounds so familiar,鈥� says Carolyn Wolf, a mental-health lawyer in Lake Success, N.Y. So much of this is about the need to raise awareness in schools, workplaces, and families, she says. 鈥淵ou can teach people to identify what we call red-flag behavior,鈥� she notes.

Such signs could include a sudden change in behavior, say, from outgoing to hiding in a corner; an affinity for violent weapons; strange writing; talk of feeling hopeless; and a desire to hurt someone else.

鈥淵ou can train lay people to recognize these,鈥� Ms. Wolf says, adding that she has helped establish threat assessment teams in many settings.

The question of what to do next is less clear, says Mona Shattell, an associate professor in nursing at DePaul University in Chicago. One problem with responding to red flags is that often these behaviors, while odd, do not clearly meet the requirements for inpatient or outpatient commitment.

鈥淥ur laws, which vary slightly by state, require a person to be an imminent danger to themselves or others,鈥� she notes via e-mail, adding that such a determination is sometimes difficult or is so restrictive that persons do not get treated.

鈥淭his is tricky because persons have rights and involuntary commitment is serious and should not be opened up like during Victorian times when women could be committed simply because their husbands no longer wanted them around,鈥� she says.

Then there are the challenges of societal stigma and discrimination against people with mental-health problems. These do not make it easy to self-identify and seek treatment or support from professionals or even family and friends, Professor Shattell notes.

The first lesson to learn is that mental-health issues need to be discussed and approached in a more open and less stigmatizing way to facilitate the seeking of treatment, says Adi Jaffe, co-founder and executive director of Alternatives Addiction Treatment in Beverly Hills, Calif.

鈥淲e then need to put resources in place to provide that help even for those who cannot afford $200 hourly sessions or long-term residential retreats,鈥� he says via e-mail.

It is also important to realize that the association between psychiatric ailments and violence 鈥渋s actually rare,鈥� says New York University psychiatrist Victor Schwartz, who is also medical director of the Jed Foundation, an advocacy group for student mental health. It is also important to understand that in any given year, roughly 10 percent of the overall US college-student population will have contact with the counseling services on a campus. 鈥淥nly a very small number of those will ever act out in a violent way,鈥� he says.

He cautions against a rush to treat anyone with any of these behaviors. 鈥淭he reality is that you simply cannot put all these people in a hospital,鈥� he says. The most you can hope, he adds, is that you can establish some kind of therapeutic relationship with them and they will get the treatment they need, 鈥渁nd hopefully prevent some bad outcome.鈥�