So-called “orphan diseases” impact a small percentage of the population. They’re very rare. Most are life-threatening or debilitating. These illnesses can be genetic, infectious, toxic, or from unknown causes. Orphan diseases get little research funding. They’re seldom discussed during medical training, medical conventions, or shown on the evening news. Their rarity can make clinical trials difficult. The lack of research and lack of awareness hobbles proper diagnosis and treatment. It’s a vicious circle.
Examples of rare, orphaned diseases are Potocki-Lupski syndrome, Trisomy; Microdeletion Syndrome; 2-hydroxyethyl methacrylate sensitization, and Pseudok-Angelman Syndrome. About 7000 orphaned diseases are known to exist in the U.S. Together they afflict fewer than 200,000 people per condition. In an extreme example, Fields Condition is known to impact only three people in the world. Most have no treatment.
Is The Aftermath of Homicide Like an Orphaned Disease?
Is the aftermath of homicide similar? There are about 20,000 known homicides per year in the U.S. with an average of eight to ten people that are deeply and immediately impacted by each death. This approaches 200,000 new homicide survivors per year. There is little research, or even discussion of the needs of this group, and how best to meet them. The realities of living with the repercussions of a loved one’s violent death are not addressed in graduate training nor on the agenda of conventions for mental health providers. The long-term aftermath of murder for survivors is seldom shown in the news or the subject of Netflix docudrama. Instead, they focus, on the perpetrator. Out of the handful of quality studies carried out on this public health issue, most come from grassroots support groups or the National Institute of Health.
Lack of Professional Preparation
Most healthcare providers today, both in mental and physical health, receive no training in helping people cope with the aftermath of murder. Not even one seminar. So, to become skilled providers must seek out and master whatever training they can collate post-graduation. This may stem from workshops, attending support group meetings, being tutored by an experienced clinician, becoming a homicide survivor, reading, or slowly amassing experience by working with patients willing to be treated by an inexperienced clinician.
If healthcare providers receive no training, they won’t anticipate the six ways survivors are impacted (emotionally, physically, financially, cognitively, socially, and spiritually). Nor will they know how to address these after-effects.
Without proper training, they won’t ask important questions (“Did you contact the American Biorecovery Association for help finding a bio-recovery company?” or “Do you have access to your victim advocate?” or “Do you have safety concerns?”). They’re also unlikely to be aware of valuable resources (such as Parents of Murdered Children or Homicide, Inc.).
How can this be reversed? Well, taking a cue from medical orphaned diseases, the following four strategies could be implemented to get this topic on the agenda in graduate training and in the public eye.
Strategy One: Raise Public Awareness
There are several ways of educating the public. One is to mention a resource for homicide survivors when a homicide is reported on the news.
Second, communities could promote September 25th – National Day of Remembrance for Murder Victims by listing it in the town calendar. Citizens would become aware of this underrecognized date set aside by Congress.
Third, while homicide survivors sometimes come together to display a traveling exhibit of murder victim photos (via an “honor wall”), few permanent exhibits exist. There is a need for permanent displays in cities with high homicide rates (such as St. Louis, Baltimore, New Orleans, and Detroit). Doing so raises awareness in people who walk by, personalizes the names of the victims, and is supportive of all homicide survivors. The first step is to get signed petitions from voters, get some financial backing and then present the idea at city council meetings.
Examples exist. One is a beautiful display in Atlanta for the children murdered between 1979 and 1981. It was completed in 2021.
A second memorial wall is on the drawing board. It is being designed to honor the slane children of Kansas City.
A third well-known display is the 911 Memorial emblazoned with nearly 3000 names in bronze. For that moment in time, we were all homicide survivors.
In addition to these ideas, a fourth way to raise public awareness would be to hold public Q and A meetings about Marsy’s Law in states where Marsy’s Law has not yet been passed into law. Similarly, cities could establish “homicide prevention hotlines” much like we have for suicide awareness and domestic violence prevention.
Strategy Two: Homicide Awareness Programs for Employees and Students
Many schools and places of business have assemblies, in-services, posters, and hotlines devoted to domestic violence, hate crimes, and suicide awareness. Sex trafficking is beginning to get needed traction. But there is no such resource for homicide awareness. It could be carried out in three phases.
First, prevention. What resources are available? What are the facts versus the myths associated with homicide? What is a common profile of a perpetrator? Who is the most common person to be killed (inside or outside of school and work)? Firearms safety needs to be addressed as a prevention strategy. What are some red flags to look for in social media posts? An anonymous tip line could be developed to raise concerns to administrators and supervisors of possible problems ahead. Pamphlets and posters could be developed to address these matters. (We quickly got it done to address COVID.)
Second, intervention. In the immediate aftermath of a homicide (inside or outside of the school and work setting), several things could take place. Valuable time could be shortened by knowing to call 988 or Crime Stoppers in the local area. WeTip also guarantees anonymity for tips that will be passed on to law enforcement. Children and teens dealing with the homicide of a friend or family member can be helped at the Dougy Center in Portland in person or virtually. Peers and colleagues could be coached in how to help intervene both directly to the person impacted and as a “bridge” to others more removed from the situation.
Third, postvention. Speakers could be brought in to help tie up loose ends. Speakers could consist of homicide survivors, mental health personnel, and law enforcement. The focus is “What can we learn from this tragedy?”
Strategy Three: Raise Academic Awareness
There is a need for the training of future attorneys. At this point, there are very few victim rights attorneys in the United States. This specialty ensures that the rights of crime victims are upheld in the courtroom. Law schools could make this obscure specialty visible to attract current and future law students, thereby increasing the number of victim rights attorneys.
Graduate programs in mental health, clergy and corrections could offer an entire course on homicide survivors. Even one unit in an existing class is better than what we have now.
Strategy Four: Raise Treatment Provider Awareness
Medical training could consist of at least one lecture on the aftermath of murder and how it impacts a person physically. Primary care providers could add one question on their regular health intake forms: “Have you ever had to cope with the murder of someone you were close to?” (This practice is already being done to assess substance abuse, suicide, and domestic violence risk.)
Mental health continuing education programs could offer a self-directed learning module about the diagnosis and treatment of trauma specific to the aftermath of homicide.
Strategy Five: Build a Network of Specialist Providers
Any practitioner with experience, post-graduate training, and interest in treating homicide survivors could build a national network of providers within and between each professional group (such as APA, AAMFT or NASW). They, in turn, could be linked with the Red Cross, FEMA and other local emergency response groups to help with mass casualty situations (such as Robb Elementary). What if all school superintendents or university presidents had a centralized phone number to call to reach such a network if a mass school shooting occurred in their district?
Strategy Six: Establish an Advisory Group
A committee of homicide survivor treatment providers could come together periodically to advise the National Institute of Health, professional groups, law enforcement or other governmental bodies about the needs of this population.
It would also be a great way to introduce new resources, build collegiality among providers and attract other change agents.
Taking any of these actions would reduce the tendency for PTSD, divorce, substance abuse, stress-related illnesses, and suicide among this ignored population. It would support parents trying to help their children cope with the change that has come. It would highlight the need for certain overlooked resources (such as financial help and consumer rights in the death care industry). It may even help prevent future homicides. In time, these actions would motivate a larger percentage of survivors to get assistance and move toward advocacy.
Individually we are one drop. Together we are an ocean.
