It’s also important that society de-stigmatize mental health so people get the help they need, Schumm said.
“Promoting a culture of understanding that mental health is not something to be ashamed of, mental health is something that most people will have some bad times in their lives, and that’s normal,” he said.
Survivors of mass shootings and other disasters need more attention as they’re likely to experience a range of mental health issues, said Dr. Carol North, a professor at the University of Texas Southwestern Medical Center in Dallas. That includes depression, isolation and avoidance that can lead to post-traumatic stress disorder
North has studied more than 3,500 survivors of major disasters, including the Oklahoma City bombing, the Capitol Hill anthrax attacks, the Sept. 11 terrorist attacks and Hurricane Katrina.
Survivors of all disasters have similar trajectories in terms of how they are affected, she said, but subtle differences exist between those who experienced natural disasters and mass shootings.
“What really makes the difference is the scope and magnitude of the event,” North said.
Related: Oregon District Shooting: Survivors now experiencing PTSD
Twenty-eight percent develop PTSD
The Oregon District shooter killed nine people and injured 27. But hundreds of others who witnessed the carnage and relatives of the victims could be affected, experts said, even if they haven’t shown signs yet.
About 28% of people who witness mass shootings and other traumatic events develop PTSD, and about a third develop acute stress disorder, according to the National Center for PTSD at the U.S. Department of Veterans Affairs.
Although psychiatric disorders such as PTSD tend to take affect in disaster survivors immediately, North said they can’t be diagnosed until about month after the event, noting that it tends to increase over time.
“But we can pretty much predict who’s most likely to get it after a couple of weeks,” she said.
Immediately after a traumatic event, survivors are jumpy, easily startled and hyper vigilant, thinking that they’re still in danger, even though the incident’s over. They may also have trouble sleeping, depression, difficulty concentrating and irritability, North and Schumm said.
Another group of symptoms are avoidance, cognitive or mood changes and recreating the incident in their minds.
“These are all very common,” Schumm said.
Dion Green and his girlfriend Donita Cosey experienced some of these symptoms after his house was damaged by the Memorial Day tornadoes and when his father, Derrick Fudge, was killed in the Oregon District mass shooting.
Green, who witnessed his father’s shooting, said he and Cosey have been diagnosed with acute PTSD.
Erica Kirksey was in the Oregon District with longtime friend Lois Oglesby when Oglesby was fatally shot. Kirksey ignored her doctor’s advice a week later and went to work because she needed the money, she said.
During her overnight shift, she started hearing gunshots, then she’d see images of the shooter. She started screaming for her co-workers to help her and saying, “This man is trying to kill me, I hear gunshots.”
Kirksey was hallucinating, she said, adding that she’s since been diagnosed with PTSD.
Experts are now noticing a relatively new concept called “moral injury” in mass shooting and other disaster survivors, particularly if the’ve been severely traumatized, Schumm said.
It’s the idea that the survivor’s deeply held beliefs of how things are supposed to operate at a moral level have been broken. That could include questioning their belief in God, Schumm said.
There’s a debate among psychologists as to whether or not moral injury is a sub-type of PTSD, he said.
Symptoms of psychiatric disorders tend to become less frequent in the majority of survivors within weeks or months after the traumatic incident, Schumm said. However, for those who develop PTSD, the symptoms will remain, and perhaps get worse if it goes untreated, he said.
In a 2002 study, North followed survivors of a 1991 mass shooting in Killeen, Texas. The gunman rammed his vehicle into a cafeteria full of about 150 people, then opened fire, killing 23 people and injured 27 others. He then killed himself.
North and her team interviewed 116 survivors two months after the incident, and 26% showed signs of PTSD. That dropped to 14% a year later but increased to 18% three years later.
Overall, of the 46 PTSD cases diagnosed, 25 were in remission by year three, North’s study found. She and her team have gotten similar results from survivors of other major disasters, including the Oklahoma City bombing and the Sept. 11 attacks.
“But some people can retain (PTSD) for years or even decades, and you hear about that most often in military veterans,” she said.
Related: Dayton Shooting: Remembering the Victims
Help locally for survivors
Wright State University’s Department of Psychiatry and several other organizations offered mental health counseling to Oregon District mass shooting survivors and victims’ relatives after the incident.
Of the 10 people they saw at their offices within the first two weeks of the shooting, Schumm said 80% screened positive for acute stress disorder, a prelude to PTSD.
Some of those individuals chose to continue getting treatment with Wright State while others stopped coming after one or two visits. Of the people who continued getting treatment at Wright State, some did develop PTSD, Schumm said.
The Montgomery County Alcohol, Drug Addiction and Mental Health Services launched the website DaytonHeals.org in September. The site has information about area counseling services, where to get crisis help, mental health and substance abuse providers, crime victim services and disaster assistance.
Some of the mental health providers on the site offering sliding scale payments for patients without insurance, ADAMHS has said.
The agency also created a free app — GetHelpNow Montgomery County — that instantly connects users to local mental health and drug addiction service providers.
The Montgomery County Prosecutor office’s Victim-Witness Division also has worked with Oregon District shooting victims’ families.
Each family was assigned an advocate from the division immediately after the incident. The advocates have kept the families informed about the legal process and their rights, and provided mental health counseling, said Sandy Hunt, director of the Victim-Witness Division.
Programs such as the Victim-Witness Division and the community play an important role in helping mass shooting survivors, North and Schumm said.
“Even before people have had time to develop a psychiatric disorder, they’re upset, and crisis counselors can help people with that immediate upset,” North said. “Let’s comfort them, and just help them process and try to make meaning of what’s happened.”