Fort Hood, TX – Fort Hood Army Post (April 2, 2014):  Four Dead (including the shooter) and sixteen wounded.   A fellow Soldier goes on a killing spree at the Fort Hood, killing 3 soldiers and wounding 16 others with his 45 caliber handgun until confronted by a female military police officer.  This is the second mass shooting at the same base in the last 5 years.  

Shooter Ivan Lopez

The soldier, Ivan Lopez – 34 yrs old, a husband and father of four, had served in Iraq for four months in 2011. The soldier, according to reports, was being treated for depression and anxiety, and was being evaluated for possible post-traumatic stress disorder.    He had only been assigned to Fort Hood earlier this year after being transferred from another base.  He was working as a truck driver on the Foot Hood base.

According to sources, Lopez (the Shooter) posted on his Facebook page a chilling update, accusing two men of robbing him and possibly hinting that he was on the brink of snapping.   Here is an excerpt;  “I have just lost my inner peace, full of hatred, I think this time the devil will take me,” Lopez wrote in the March 1 post.

According to sources, Lopez had been distraught over the deaths of his mother and grandfather five months ago.    It is reported that the Army initially denied him permission to travel to Puerto Rico to attend his mother’s funeral but later gave him some time.

The shooter undergoing treatment for psychiatric issues, ranging from anxiety to depression to sleep disturbances.   Lopez was taking a psychiatric medication, including Ambien, for these conditions.  He had seen a psychiatrist just one month earlier and it is reported that there were no indications during that examination that Lopez showed any sign of possible violence.  Lopez, was not engaged in combat during a four-month deployment to Iraq in 2011, but he had reported the effects of Traumatic Brain Injury (TBI), was being treated for anxiety and depression (as reported above), and was in the process of being diagnosed for Post Traumatic Stress Disorder (PTSD).

According to a military Doctor and Psychiatrist who has treated 7,000+ PTSD vets;  Lopez’s violent episode is not common behavior for veterans with PTSD.  Other mental illness are more than likely involved in violence, according to this military doctor.

So what are some of the issues that might have contributed to this tragedy?

1.  Are there Similarities between this Fort Hood Shooting and Sandy Hook, Newtown; the Navy Yard; other school and workplace shootings?   YES!!

• Missing Warning Signs!
• Inadequate Training of:      (See FBI Report)
  • Observers
  • Mental Health
  • Risk/Threat Assessment Teams
• None or inadequate “safe guards” in place.  Is my Organization a Safe Place??
• Poor or No Procedures for Risk/Threat Assessment, if Early or Imminent Warning Signs are identified.
• Poor or No mental health delivery of promptness, services, identification, appropriate therapy, recommendations or appropriate notifications.

2.  Is Mental Health Broken or Inadequate?

•  Were there Early or Imminent Warning Signs?  The answer is ALWAYS – YES!!  
  • The real questions are;
    • Were we (Mental Health) looking?    Could it be a lack of funding, or  We don’t care –  until there is a mass shooting.
    • Why did we (Mental Health) miss them??    Could it be  – we lack skills and training to identify them?
    • Since he was identified as having “mental health issues“ then – Did he receive therapy??  or Was he just given medication and sent on his way!!??
    • Are we Training others to be able to see these signs and refer to Mental Health?  “Observers”
      • We train Observes to watch for “Workplace Sexual Harassment“, “Discrimination” – Why not this??
• If  Mental Health had been doing their Job and identifying these Early or Imminent Warning Signs?  What could have been available to them?
  As a Mental Health Therapist (this author), it is believed that  the system is very inadequate and needs reform.  Although, here are somethings available to Mental Health, but many of these options are NEVER utilized:

• Involve Family in therapy and ask them (if concerned about suicidal/homicidal ideations – not a Plan) to check for and remove access to weapons from their loved one in therapy.
• Recommendations by Supervisors to attend Therapy, if available.
• Recommendations from Therapist to Supervisor’s that individual attend therapy for a specific period of time. (If releases are in-place)
• Work with family to obtain a Court Order to attend Out-Patient therapy for a period of time.
• Therapist request Court to order Out-Patient therapy for a period of time.
• Recommend to Patient and/or family a placement in an In-Patient Psychiatric Facility
• Have Family seek an Involuntary Commitment to place a Patient into a Psychiatric Facility against their will.

  *  Remember that their are many hoops to jump through to make these work (inadequate system), but they are available.

3.  In situations similar to this one what may be some compounding issues?

• Un-diagnosed or Un-resolved Mental Health issues.
• Individual’s sense of Entitlement (A distorted view that – I’m owed this or that and the system is keeping it from me)
• Unresolved disgruntlement (more often this is a distortions in their mind) toward others, a system or the world.
• Suicidal or Homicidal Ideations (un-identified or un-noticed by others) that evolves from fantasy – to – planning – to – acting on it (reality)
• A lack of Support:  possibly from family, friends (or no friends), co-workers, Mental Health or the System

4.  We need to look at these areas to find solutions:  Let’s break down areas and ask – What can be done?

• Prevention?  
  • Continue to develop supportive environments for people to live and work in.  Eliminate bullying, harassment, or workplace violence by developing supportive environments.
• Intervention?
  • Fix the Mental Health System: Start Here!! Look at this tragedy and find fixes that may have prevented this one!
  • Training on Early & Imminent Warning Signs with;
    • Observers
    • Risk/Threat Assessment Teams
    • Mental Health Professionals
  • Train on Assessment Techniques to identify suicidal/homicidal ideation or intent and/or severe distortions.
  • Decision Trees: show actions that can be taken when information is learned.
    

    Developing a Risk/Threat Assessment Team

• Crisis Readiness?
  • Rapid Response Teams
  • Drills on Active Shooters
  • Teach Passive Resistance or other Resistance skills based on situation.
  • Develop systems to notify be-standers, Rapid Response Teams and other responders

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