In May 2016, NAMI released a guide for police leaders, Preparing for the Unimaginable, to prepare for mass casualty events and to support emotional resiliency for first-response personnel as well as their communities.

The guide was developed at the request of the U.S. Department of Justice and Chief of Michael Kehoe (ret.) of the Newtown, Connecticut police department during the aftermath of the Sandy Hook Elementary School tragedy in 2012. Chief Kehoe states in its first pages that the guide:

…will provide chiefs and sheriffs with awareness and guidance on best practices for safeguarding mental health and wellness of first responders in the early moments of critical events and during the long aftermath.

Download the guide at www.nami.org/cops

Despite recent unfortunate events, police officials and mental health professionals involved in developing the guide agree that mass casualty events are unlikely in any specific community. But preparation is essential in case the unimaginable ever does occur.

The guide has three sections and eight chapters:

Why Mental Wellness Matters

• Understanding Trauma and Resiliency

Preparing for a Mass Casualty Event

• Recommendations for Enhancing Resilience
• Planning the Incident Response for a Mass Casualty Event
• Building Your Media Team and Strategy for a Mass Casualty Event

Managing a Mass Casualty Event and its Aftermath 

• Immediate Incident Response
• The First Weeks: From Chaos to New Normal
• The First Months
• The Long Haul

According to a new study by Theresa Wimberley, MSc, Henrik Støvring, PhD, Holger J Sørensen, PhD, Henriette T Horsdal, PhD, James H MacCabe, PhD, and Christiane Gasse, PhD, “Predictors of treatment resistance in patients with schizophrenia: a population-based cohort study,” published online February 24 in Lancet Psychiatry, treatment-resistant schizophrenia might be a distinct subtype of schizophrenia rather than merely a more severe form.

The study, funded by European Community’s Seventh Framework Programme, included thousands of patients, 21% of whom were classified as “treatment resistant”–either (a) needing early therapy clozapine (commonly used when other treatments fail), or (b) hospital admission for schizophrenia after two failed treatment attempts. The study found key factors related with treatment-resistant schizophrenia that were different from known risk factors for treatment-responsive schizophrenia, signaling the potential that they are separate disorders.

“These findings are consistent with the possibility that, rather than representing a severe form of schizophrenia, the treatment-resistant subtype could have a fundamentally different cause than the treatment-responsive subtype.”

The study does not draw a definite conclusion. An accompanying editorial by Mathias Zink, MD, and Susanne Englisch, MD (Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany) acknowledges that the study identifies a possibility, but warns against jumping to conclusions.

“…more research involving comprehensive psychopathological examinations, neurogenetic profiling, and functional magnetic resonance imaging will be necessary to provide a sound basis for this hypothesis.”