The Psychiatrist's Role After a School Shooting: The Emergency Room and Beyond

Abstract

In recent years, our society has witnessed a sharp increase in abusive, violent, and sexually aggressive behavior by our youth. Violent crime by youth decreased for a period in the last few years of 1990s but, once again, is on the upswing. The violent crimes committed by these children and adolescents have been a consistent social problem despite targeted prevention programs and juvenile school-specific interventions becoming increasingly popular around the country. Violent crimes have increased 2.3% from 2004 to 2005 (U.S. Federal Bureau of Investigation, 2006). The Bureau of Justice Statistics (BJS), investigating murders committed during the years 1974 through 2004, found that almost half of the offenders were under the age of 25 years, and 11% were under the age of 18 years. In 1994, FBI national self-report studies indicated that the highest risk for initiation of serious violent behavior occurred between the ages of 15 and 16, and the risk of initiating violent behavior after age 20 was much lower (Elliott, 1994). Between 8 and 10% of US high school students carried guns to school each day. In a typical middle-size city, 35–50 cases of school violence were reported daily and in half of these cases, guns were involved (Shaffi & Shaffi, 2001). Everyday in the USA, 12–13 children and adolescents die of violent death, either from homicide or from suicide (Shaffi & Shaffi, 2001). An additional number of physical injuries at schools occur from gunshot wounds. The spread of endemic school violence from urban settings to suburban and smaller communities has brought this major public health problem to national attention. In the decade between 1990 and 2000, the incidence of tragic school shootings increased across the country. There were school shootings in Pearl, Mississippi, Paducah, Kentucky, Springfield, Oregon, Jonesboro, Little Rock, Colorado, Conyers, Georgia, and Fort Gibson, Oklahoma. Other authors have examined the factors contributing to the increase in school violence, described the changed school environment and the contemporary school community, detailed biological and social causes of school violence, and profiled children and adolescents who may be violent offenders in school systems. In this chapter, after presenting a hypothetical case example, we