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According to the World Health Organization, the prevention of violence is a multifaceted public health mandate, which requires strategies that are adapted to local and national social contexts (Eisenman & Flavahan, 2017). Brian Owens paper on the role of physicians to address gun violence emphasizes not only the much needed role of physicians in developing policies on gun safety, but also the existence of social and political obstacles to this form of advocacy in North America.
Now, if the objective, as he rightly proposes, is to stop shooters before they shoot, then gun safety and gun control, although absolutely necessary, need to be complemented with policies and programming that reflect and address other social determinants of violence and the precursors of violent acting out identified across the scientific and threat related literature (Silver, Simons, & Craun, 2018).
Violence by lone actors is associated with identifiable and modifiable social and psychological factors that can be targeted by prevention and intervention programs. First, the well-known imitation and contagion phenomena after mass killings (school shootings for example), are associated with media coverage of these events. The Quebec National Institute for Public Health just released guidelines to equip the media in order to minimize these effects (Institut National de Santé Publique du Québec, 2019). However the influence of the internet and social media, fueling hate discourses and the glorification of active shooters, still needs to be addressed. Second, researchers in education and sociology have suggested a relationship between histories of interpersonal violence and pervasive uncertainties for the future and attraction to extreme forms of violent action among youth, with violence providing a sense of purpose and intense feelings of excitement for isolated and socially disengaged individuals. Finally, as suggested by the over-representation of persons with mental disorders among lone actors, some psychologically distressed individuals are more vulnerable to these social trends and may be more likely to move from the legitimation of violence to perpetration of violent acts.
Thus, health professionals should become involved in broader violence prevention initiatives. These initiatives include promoting more effective gun control and firearm safety, supporting guidelines for media reporting of gun violence by lone actors (as is the case for suicide), developing partnerships with the education system to address youth psychosocial wellbeing and, as always, addressing individual level psychological distress with an awareness that it may, in some cases, lead to desperate and violent gestures.
Eisenman, D. P., & Flavahan, L. (2017). Canaries in the coal mine: interpersonal violence, gang violence, and violent extremism through a public health prevention lens. International Review of Psychiatry, 29(4), 341-349.
Institut National de Santé Publique du Québec. (2019). Tueries de masse et traitement médiatique: outil à l'intention des professionnelles et des professionnels des médias d'information (pp. 20). Québec: Gouvernement du Québec.
Silver, J., Simons, A., & Craun, S. (2018). A study of the pre-attack behaviors of active shooters in the United States between 2000 and 2013 (pp. file:///C:/Users/deslyn01/Downloads/pre-attack-behaviors-of-active-shooters-in-us-2000-2013-2002.pdf): Federal Bureau of Investigation, U.S. Department of Justice,Washington, D.C. 20535.