By Shavonne Potts
spotts@salisburypost.com
SALISBURY — A week after 12 people were killed and dozens injured in a crowded Colorado movie theater, questions remain about the mental state of James Holmes, a former graduate student accused of the shooting.
On Friday, Colorado court records indicated Holmes was under the care of a psychiatrist.
The shooting, called one of the worst in recent history, leads others to wonder if there are signals of someone who suffers from mental illness reaching their breaking point.
Earlene Brown, a psychiatric clinical nurse specialist with Rowan Regional Medical Center, said people should pay attention to their instincts.
Signs and clues
“If the family has concerns, pay attention to their inner voice,” she said.
A change in behavior is a possible clue that something isn’t right.
“If there is a change in sleep habits — not sleeping or staying in bed all day,” Brown said.
Brown said mental health is a continuum — there are ups and downs. But someone who doesn’t eat or overeats, is really sad or cries a lot, or neglects regular hygiene is someone who could be depressed.
“They may do things they wouldn’t normally do,” she said.
Someone who has a mental illness may be schizophrenic. Or they may be bipolar or experience mania.
“They may be fearful, but may not think, ‘I need help,’ ” she said.
Someone may even be depressed.
A person who has a mental disorder maybe delusional or hallucinate.
“A delusion is a little kernel of truth, but blown out of proportion,” Brown said.
If a family member suspects the person would harm himself or others, or exhibits anger or hostility, they should call 911.
Some people described Holmes as a loner. There are people who have closed themselves off from society.
“They’ve lost interest in things they normally do. A person who was active, had social relationships — that’s the big red flag,” Brown said.
With someone who talks about dying, gives away their belongings or says what others would view as cryptic, she advises family to be concerned.
She encourages family members to talk to the person and let them know of concerns, “but be willing to help them make an appointment to see someone.”
A person with mental illness may not speak with a therapist, but may seek guidance from a minister or a family physician. If they refuse, “Keep offering … follow up on it,” Brown said.
Mental illness can affect anyone.
“It does not discriminate,” she said.
There is a stigma that a person who suffers from mental illness is weak. It’s not a sign of weakness, Brown said.
Some people may not have learned coping skills, and what is a stressor for some may have little effect on another.
“A lot of patients feel guilty about feeling a certain way. It’s not that they don’t want to get better,” she said.
First Responders
Oftentimes the first person to encounter someone with a mental illness other than a family member may be law enforcement.
Officers like Salisbury Police Officer Annice Chunn are trained to handle responses with someone who has a mental illness or disorder. She is certified and has received Crisis Intervention Training.
Many other area law enforcement agencies have also undergone similar training.
There are seemingly simple ways that Chunn said she was taught to respond, including not gesturing with her hands and talking slowly.
One key to responding is remaining calm so as to not escalate the situation, Chunn said.
Chunn has gone to calls where she’s had to ask for assistance from a member of the mobile crisis team, which has in the past been provided through Piedmont Behaviorial Health.
About half of the Salisbury Police Department officers have completed crisis intervention training, said Chief Rory Collins.
“The benefit of CIT is it teaches the skills needed to keep the individual calm,” Collins said.
An officer who has received training is able to bring the situation to a “peaceful resolution without resulting in a violent situation,” he said.
Responding to someone who has some type of mental challenge can be dangerous for an officer, Collins said.
There are instances when an officer may be made aware of a situation by a family member.
“The benefit is we know what we are responding to, but even though we may know, it can still be highly dangerous,” he said.
Help Available
“There is help out there,” said Peggy Mangold, president of the Rowan County Chapter of the National Alliance on Mental Illness (NAMI).
NAMI is one of the largest nonprofits in the U.S. that provides mental health education, support and advocates for people affected by mental illness.
Mangold said the organization wants people to know “they are not alone and it’s not their fault.”
Families are encouraged to take a proactive approach, she said.
It’s very hard in today’s society for others to become involved, Mangold said.
“Unless someone saw it, how are you ever going to know,” she said of Holmes.
Co-workers are often with someone for long periods of time when a family member may not be, she said.
If a co-worker believes there’s something to be cautious about then that person could talk with a supervisor. In turn, the supervisor could let the person know they have concerns and suggest they seek a health evaluation.
The organization is sponsoring a program in August to help families cope with caring for a family member who has a mental illness.
The program, Family 2 Family, is an evidenced-based program and is effective in helping anyone struggling to understand what their loved ones are going through, Mangold said.
“We talk about medicine and the effects, Post Traumatic Stress Syndrome and all the medical issues of the day,” Mangold said.
Families and caregivers will also learn how to cope with worry and stress as well as focus on care for themselves as well as those with the mental illness.
Contact reporter Shavonne Potts at 704-797-4253.

Family 2 Family
The Family 2 Family program will be held Aug. 4 from 10 a.m.-12:30 p.m. at the Hefner VA Medical Center, Salisbury, Building No. 6. The program is a 12-week session open to caregivers, veterans and family members. Sessions are kept confidential. For more information, contact Peggy  Mangold at 704-640-8811.