Suicide Prevention and Trauma-Informed Care for Survivors and Loved Ones of Active Shooter Violence
According to the FBI, between 2000-2017 there were 250 active shooter incidents across the United States, accounting for 2217 casualties (799 killed and 1418 wounded). This number does not even take into account the thousands of additional physically uninjured survivors who escaped physical harm, but whose psychological wounds are immeasurable and often go unrecognized and unacknowledged in the immediate aftermath and years that follow. Family members and loved ones often tell these survivors how blessed they are to have survived (and they are), so they may feel they don’t have a right to complain about or get help for the nightmares, depression, anxiety, and survivor’s guilt that they may be experiencing.
In recent weeks, three individuals connected to school shootings died by suicide. Two survivors of the 2018 shooting at Marjory Stoneman Douglas High School in Parkland, Florida, and the father of a victim of the 2012 Sandy Hook Elementary School shooting in Newtown, Connecticut took their own lives. Over the years, there have also been a number of suicides linked to Columbine and Virginia Tech.
It is estimated that 28 percent of those who survive a mass shooting develop Post Traumatic Stress Disorder (PTSD). PTSD is a risk factor for depression and both are risk factors for suicide. When we consider all of the injured who have survived, the loved ones of those who perished (and survived), and all of the physically uninjured survivors, the number of those at risk for continued mental health challenges like anxiety, PTSD, or substance abuse is possibly in the tens of thousands. And many of them are at home right now, away from the cameras and news coverage, perhaps struggling with depression, PTSD, and even thoughts of suicide.
Suicide is a serious and growing problem in the United States. According to the Centers for Disease Control and Prevention (CDC), suicide rates have been rising in nearly every state since 1999 and suicide is the 10th leading cause of death among Americans. Suicide is also in the top 4 leading causes of death among people in every age grouping between ages 10 and 54. The good news is that suicide is one of the most preventable forms of death if we learn to recognize the signs and how to respond.
When it comes to active shooter violence, suicide is especially significant. The FBI and U.S. Department of Justice found that 40% of active shooting assailants died by suicide. Moreover, 90% of suicidal assailants showed suicidal ideation prior to the attack. Almost one in four (23%) made an actual suicide attempt prior to the attack and 70% of these behaviors occurred within one year of the attack. Perhaps, for some assailants, the attack was part of their suicide plan.
The recent suicides of survivors of active shooting incidents and findings on pre-attack behaviors suggest that there may be a connection between suicide and active shooter violence. If this is the case, then recognizing warning signs of suicide becomes an important factor in preventing active shooter violence as well as mitigating the impact for innocent survivors in the aftermath.
Suicide Warning Signs
Common warning signs of suicide include threats of suicide and talking or writing about suicide or death and dying. It is a myth that most people keep their plans to themselves, or that people who talk about suicide don’t really mean it. In fact, previous suicide attempts are common in people who ultimately die by suicide. Additional warning signs that someone may be suicidal include expressing hopelessness or feeling trapped, securing lethal weapons or means such as guns or pills, behaving recklessly or engaging in risky activities, withdrawing from others, putting affairs in order, and giving away prized possessions.
If you suspect someone is suicidal, you should ask directly, “Are you having thoughts of killing yourself?” It is a myth that asking someone about suicide will make them do it. If their answer is yes, and they have expressed a specific plan that includes access to a lethal method, they need crisis intervention right away. Ask them if they are willing to let you help them get help and if they are willing to stay safe for now until you’ve found help. If they are unwilling to get help and you are concerned that they are in immediate danger, call 911. If they are open to getting help, you can call your local Suicide Hotline or the National Suicide Prevention Lifeline (1-800-273-8255). If the person you are concerned about is a veteran, you can also call the VA crisis line, a toll free, confidential resource for any veteran in crisis and their family and friends. Call 1-800-273-8255 and press 1 or send a text message to 838255.
Response to Active Shooting Survivors and Loved Ones
Victims, survivors, and loved ones of active shooting incidents are top of mind in the days, weeks, and months following these tragedies, but we must have a more organized response to help survivors and loved ones in the years and even decades to come. This immediate and long-term response includes educating survivors and loved ones about trauma, providing information about coping strategies, and offering ongoing social support.
Trauma and Active Shooting Survivors
For those individuals who have been involved in or who have directly witnessed an active shooting, exposure to a traumatic incident can cause Acute Stress Disorder (ASD)orPost Traumatic Stress Disorder (PTSD). Individuals diagnosed with ASD and PTSD can experience a range of symptoms such as anxiety, flashbacks, nightmares, avoidance of stimuli related to the event, numbing, detachment, loss of memory related to aspects of the event, difficulty sleeping, irritability, poor concentration, and an exaggerated startle response.
Not everyone exposed to trauma will develop ASD or PTSD; it depends on how the event is perceived and other risk factors such as previous trauma or ongoing stress and mental health concerns at the time of the trauma. While it’s common to show short term stress reactions, and some will be diagnosed with PTSD, many survivors of a mass shooting will show resiliency and bounce back. In fact, some may even experience what is called Post Traumatic Growth––thriving following a traumatic experience.
Nevertheless, it is good practice to be alert to the possibility of ASD or PSTD if someone undergoes a traumatic event and to be proactive if they show signs of continuing distress. After an active shooting incident, those who were shot, witnessed someone being shot, lost a close friend or loved one in the shooting, or who perceived that their own lives were in danger were most likely to experience PTSD and have other long-term impacts on their mental health and wellbeing.
According to the CDC, more than half of the people who died by suicide did not have a known diagnosed mental health condition such as PTSD at the time of death, so we must be even more vigilant in recognizing common warning signs of suicide even in those without a diagnosed mental illness. Certainly, following a critical incident such as an active shooting, we should carefully monitor survivors for signs of suicide as well as PTSD, depression, and/or other signs of mental and emotional distress.
Self-Care and Professional Help
If someone experiences a traumatic incident, they should take care of themselves by following these recommendations: limit exposure to media reports and images about the event; eat healthy foods and avoid alcohol and drugs; get adequate amounts of regular sleep and exercise; practice stress management and relaxation techniques; engage in enjoyed activities/hobbies including social activities with friends and loved ones; participate in spiritual and faith based practices; and reestablish routines as soon as possible. It would also be important for the loved ones of victims and survivors of active shooting incidents to follow these same recommendations.
We can expect children to exhibit some of the same signs of trauma as adults, and therefore we should help children cope with the aftermath of trauma by following the same recommendations noted above. In addition, reassure children that they are safe, but honestly discuss their fears; offer children additional social support by spending more time with them; give children permission to express their feelings, whatever they may be; discuss the details of the trauma in developmentally appropriate language; help children to understand and cope with “survivor’s guilt”; engage children in activities they enjoy such as reading, drawing, music, sports, and other social activities; seek professional help if signs of trauma (e.g., nightmares, acting out, crying, trouble sleeping, fear of separations, bedwetting) don’t subside.
Recovery takes time and occurs at one’s own pace. If a traumatized individual (as well as the loved one of a victim or survivor) continues to experience distress after a few weeks, they should seek help from a trauma specialist, especially if they are: having trouble functioning at home, work, or school; suffering from severe fear, anxiety, or depression; experiencing terrifying memories, nightmares, or flashbacks; avoiding more and more things that remind them of the trauma; emotionally numb and disconnected from others and relationships; or using alcohol or drugs to feel better.
Bottom line: Developing coping strategies and having strong support systems in place for the long-term following an active shooting incident are vital for the wellbeing of survivors and loved ones, and we should all learn the warning signs of suicide and feel empowered to help.
Blair, J Pete, and Schweit, Katherine W (2014). A study of active shooter incidents, 2000 - 2013. Texas State University and Federal Bureau of Investigation, U.S. Department of Justice, Washington D.C..
Centers for Disease Control and Prevention (n.d.). 10 leading causes of death by age group, United States – 2017. Retrieved on March 28, 2019 from https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_by_age_group_2017_1100w850h.jpg
Novotney, A. (2018, September). What happens to the survivors. APA MonitorVol 49, No. 8. Retrieved on March 28, 2019 from https://www.apa.org/monitor/2018/09/survivors
Silver, J, Simons, A, & Craun, S (2018). A Study of the pre-attack behaviors of active shooters in the United States between 2000 – 2013. Federal Bureau of Investigation, U.S. Department of Justice, Washington, D.C. 20535.
©2019 Peggy Mitchell Clarke