Mental Health Conditions / A Prescription for Violence?

By Kelly Patricia O’Meara
komeara@InsightMag.com

The recent wave of school-shooting incidents has some concerned parents demanding that the medical records of students taking psychotropic drugs be made public.

In the last 10 shooting incidents at schools, a total of 105 students, teachers and administrators were killed or wounded. Beginning in March 1998 with the shooting at Westside Middle School in Jonesboro, Ark., and ending with the March 22, 2001, shootings at Granite Hills High School in El Cajon, Calif., six of the 12 juvenile shooters are reported to have been on prescribed mind-altering drugs.

San Diego Deputy Public Defender William Trainor announced last week that his client, 18-year-old Jason Hoffman, who is charged with the shooting of five students and teachers at Granite Hills High School, had been prescribed the antidepressants Celexa and Effexor. Whether Trainor intends to use this medical information as part of his client’s defense is unclear, though he said that “the drugs [Hoffman] was prescribed may help explain his actions.” He adds that research “indicates that the drugs that were prescribed are extremely powerful antidepressants with the most dangerous side effects.”

According to Loren Mosher, professor of psychiatry at the University of California at San Diego, “Celexa and Effexor are selective serotonin reuptake inhibitors [SSRIs] in a class with Prozac, Paxil and Luvox” — the same drug prescribed to Columbine shooter Eric Harris.

It appears Trainor believes there is a correlation between the drugs and the shootings. Although he could not provide specific information about his client, he tells Insight that this is a hot-button issue and there are many people who don’t want to look at the connection. “If you say those drugs may be involved,” says Trainor, “you’ll be labeled a kook.” But “with the history of these drugs there is a huge unpredictability factor. When someone goes off while on these drugs it should raise some eyebrows in the community. I’m starting to wonder when the public has the right to this information. What is the balance of rights? It’s his medical rec-ords versus the public right to be safe. Which one has the trump card? It is a legitimate question.”

Although Trainor is not the only public official to consider the possibility that widely prescribed mind-altering drugs may play a role in much-publicized school violence, he is among the few to make public the issue of medical records generally being protected and put off-limits. The privacy of medical records, including mental-health information, is protected by law. The information about the prescription-drug history of an accused perpetrator is only made public when the information is released by the family, school officials, friends and, sometimes, law-enforcement officers and attorneys.

And, of course, such information seems to be of interest to the public only in the wave of concern after a violent event, making it difficult even to consider whether prescribed psychotropic drugs are a chronic cause of otherwise senseless violence.

In fact, so little information has been made public about these mind-altering drugs and their connection to shootings and other school violence that the U.S. Department of Justice (DOJ) isn’t even looking at the possibility. When asked about a community’s right to know if an alleged shooter has been prescribed a psychotropic drug, Reagan Dunn, a spokesman for the DOJ, tells Insight: “There are two issues that you’ve raised — medical-record privacy and criminal records of juveniles. These records are sealed by statute in all states. It [the connection between psychotropic drugs and school shooters] isn’t an issue we’re looking at — there are other priorities we’re focusing on, such as school-resource officers [safety officers] and other programs to reduce school violence.”

But two other federal law-enforcement agencies, the FBI and the U.S. Secret Service, appear to be concerned about the increasing number of school shootings and have invested a great deal of time and effort to look into the possible reasons for them. The FBI published a report last year called The School Shooter: A Threat Assessment Perspective. The 41-page report was the result of a joint effort by the National Center for the Analysis of Violent Crime (NCAVC) and teachers, school administrators and law-enforcement officers involved in investigating each of the school shootings. They were assisted by experts in adolescent violence, mental health, suicidology and school dynamics. Eighteen school-shooting cases were reviewed for the report.

Although topics such as family relationships, school dynamics, social problems, personality traits and behavior, threat management in schools and the role of law enforcement are discussed, there is no mention in the report of increased prescription-drug use by juveniles.

Dewey Carroll of the Clinical and Forensic Psychology Department at the University of Virginia participated in a threat-assessment conference last year during which he was asked if, based on the correlation between psychotropic drugs and the school shooters, this information should be made public. Carroll argued that there was no correlation. “Six out of 12 [school shooters] being on psychotropic drugs is not a correlation, it is an observation,” he said.

“A correlation,” explained Carroll, “would be taking a sample of children on medication and those not on medication and then making the comparison. There are a lot of kids who take these medications who do not commit violence. If you want to look at people that have risk factors, you have to do scientific studies.”

Few professionals who are familiar with the data would argue with that criticism, but one may question how such a study can be conducted, as suggested by Carroll, if the information about whether a student is on prescribed mind-altering drugs is regarded as a state secret. And, even when such information is made available for study, it appears that little use is made of it.

Take, for instance, the Secret Service, which in collaboration with the U.S. Department of Education and the National Institute of Justice last year produced a report on how to prevent school violence. The Interim Report on the Prevention of Targeted Violence in Schools was made public in October 2000, involving “systematic analysis of investigative, judicial, educational and other files and interviews with 10 school shooters.”

Although researchers reviewed primary-source materials such as investigative, school, court and mental-health records and conducted supplemental interviews with 10 of the attackers, no mention was made in the report about prescription medications of the kind that Insight has collected. Nor did the Secret Service respond to Insight’s questions about why that issue was not addressed at the conference or made part of the report.

Despite the fact that two federal law-enforcement agencies had the opportunity to view the personal files of many of the school shooters, important medical data gleaned from those files apparently was ignored. This has caused many interested in this issue to wonder, like San Diego’s public defender, when the public has the right to know such information.

Not surprisingly, while every professional interviewed for this article expressed concern about the privacy rights of children, there also was concern about the use of mind-altering prescription drugs. Most are beginning to wonder at what point communities into which disturbed children are sent while on psychotropic drugs should be alerted to a potential problem.

JoAnne McDaniels, acting director for the Center for the Prevention of School Violence, an organization focusing on keeping schools safe and secure, tells Insight, “There is concern on the part of some in the education community that we are overmedicating our youngsters — that it is easier to drug them into appropriate behavior.

“It is important to recognize that the schools today have children that are being medicated in ways that children were not years ago. We shouldn’t be too quick to isolate psychotropic drugs as a causal factor, but it is an important factor in trying to understand what is taking place. In a general sense, in a school population, parents should be able to see this information,” McDaniels says. “If a parent moves to a community and wants to know the numbers of children who are on these drugs, making such numbers available would not necessarily violate confidentiality of children. I think as long as the information is not individualized it should be information a principal is comfortable providing. It may force the principal to explain how the school handles the entire violence issue and the use of medication to control behavior in the school. It’s reasonable for a school to share that information and a parent to ask for it. It’s part of the school community and part of the school’s fabric.”

“The message,” concludes McDaniels, “is that we need to develop youngsters without stimulants and other foreign substances. Too often we are opting for a way of treatment that is a lot easier to implement than sitting down and working out the problems. This is a public-health issue and it seems reasonable to look at it.”

James E. Copple is vice president of the National Crime Prevention Council, a nonprofit organization that focuses on creating safer communities by addressing the causes of crime and violence and reducing the opportunities for crime to occur. He is a former principal and superintendent of schools in Wichita, Kan., and sees the merits of both sides of the issue. “I tend to lean on the side of doing everything possible to protect the student’s right to privacy,” he says, “but when they commit an act of violence all the factors involved in the crime — including medications — need to be known by that community.”

As Copple sees it, “Communities need to know if large numbers of children are on psychotropic medications. It is increasingly being talked about by educators, and it has put schools in the position of creating mini health clinics for drug management on top of having to teach the children and all the other responsibilities. Why all of a sudden do we have to be a pharmacy? Principals are forced to choose between hiring another much-needed teacher or another nurse to dispense drugs.”

The executive director of the National School Safety Center, Ronald Stephens, isn’t convinced that releasing information about the number of students being prescribed mind-altering drugs necessarily is a violation of a child’s rights. “It’s legal and it’s become common practice to search lockers whenever the student is involved in an incident, and there are some states now mandating that teachers be given information about the reasons behind a student who is returned to school on probation. It’s the thought that if you’re going to put Charlie Manson in my class I have a right to know that.”

According to Stephens, “We tend to get what we measure. But if we don’t ask we’re not going to get real answers. We have kids so medicated it’s incredible. I don’t see parents asking the question about the numbers of children on psychotropic drugs as being all that invasive. The public would be shocked at the number of file drawers of prescription drugs that teachers are asked to dispense.” Stephens says he thinks “it would be a great study for someone to go back and see how many of the kids who committed these violent acts were on these drugs. The community should know who is taking them, and I think teachers will want to know which kids are on these drugs. Knowing what I know about school violence, I would support having that information shared. Of course, there will be a huge outcry that someone’s rights are being violated, but at what point do they lose those rights?”

That is of course the question, and with 6 million to 8 million children already taking Ritalin, and unknown millions being prescribed the much stronger mind-altering SSRIs, many are starting to ask it.