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Could anything have been done to help Martin Bryant before he turned on a world he decided to hate? In this third extract from their book, Robert Wainwright and Paola Totaro ask whether Bryant's catastrophic decline could have been prevented. MARTIN Bryant's wiring, his physiological make-up, is probably, mercifully, unique. But the alienation and psychological upheaval he struggled with -- and finally railed violently against -- is not. For forensic psychiatrist Paul Mullen -- and his colleagues in Canada, Britain and Australia -- Bryant represents an extreme, and thankfully rare, example of why modern, industrialised nations urgently need to invest in research and management of mental disorders and aggression, both in early childhood and adolescence. Had Bryant ended up in a mental health care unit receiving ongoing treatment when he first developed his suicidal compulsions, it might well have dampened the catalyst that morphed violent fantasies to reality. ``The help just wasn't there. If it had been, I suspect he would have been referred,'' says Mullen, professor of forensic psychiatry at Monash University. Professor Pat McGorry is a world-renowned specialist in adolescent mental health, and has pioneered programs for 15 to 24-year-olds in Australia. Just as medicine has responded to heart disease and cancers by trying to pick up illnesses at the earliest possible point, McGorry and his colleagues have established a twin framework to identify and intervene to manage teenagers and young adults at the times in their lives when most serious illnesses such as schizophrenia tend to emerge. ``We do have significant amounts of evidence now that if we do pick up the early stages of these potentially serious illnesses then the trajectory of life can be changed dramatically, and much more done in terms of recovery and social integration, and that sort of thing,'' says McGorry, professor of youth mental health at Melbourne University. For McGorry, Martin Bryant developed neither as a monster nor a mystery, but rather a child who had been identified to have serious problems as early as toddlerhood but who did not receive timely, individual help. McGorry says the increase in mental disorders among young people in the developed world is inextricably bound up with the often toxic social and familial settings in which they are growing up. ``That is why we are seeing higher rates of this in young people, because the environmental factorshave got worse. The genetic risks have probably stayed the same but the likelihood of them being expressed may have increased.``People have varying levels of intrinsic risk genetically ... but if you are trying to go through this period of life with lead in the saddlebags already and cumulative additional stresses because the way you are makes you more likely to be bullied, to be lonely, poor, disadvantaged, take drugs, get drunk ... all these things are increasing your risk of breakdown. ``For a guy like Martin Bryant, if he had more of the right sort of environment and less of the social disadvantage, then the genetics might not have been so decisive.'' Richard Tremblay, professor of pediatrics, psychiatry and psychology at the University of Montreal, has spent more than two decades studying and tracking more than 25,000 Canadians aged from five months to their mid-20s in a bid to find the roots of physical aggression. He is a world expert on violence prevention, and says that children are at their most violent in their toddler years, and it is the familial and societal setting that "civilises'' them. In a study published in November 2008, titled "Early Learning Prevents Youth Violence'', he reported that a large longitudinal study in Montreal suggested that children who had greater difficulty controlling their aggressive behaviour than their peers when they entered kindergarten were more likely to persist with behavioural problems as they grew older, and that those who remained frequently physically aggressive during elementary school were much more likely to be violent during late adolescence. Similar results have been reported in other large samples in Canada, New Zealand and the US. Martin Bryant's behaviour, identified as disturbed when he was a toddler and later at school, would send warning signs today that might ensure his inclusion in early intervention programs. Tremblay's work suggests that aggression in children is the ``default'' position, and it is the child's ability to learn to control themselves and their impulses that is learned from their environment and parental modelling. A variety of factors have been identified or linked with childhood aggression, including a history of physical abuse within the family and maternal anti-social behaviour.In 2007, Tremblay suggested chronic violent behaviour might have a genetic signature, and genes might play a significant role in the acquisition of language, and delayed development of communication skills -- as occurred with Bryant -- can contribute to increasing frustration levels in children, making them more prone to resort to violence as a tool to be heard. Children who fail to learn self-control can suffer consequences that spread outwards into all areas of their existence, from impaired schooling to loneliness and insecurity, that can last a lifetime. Overly aggressive children are also naturally rejected by their peers, and do not benefit from the normal socialisation that can occur through their better adjusted peers: they become loners, increasingly alienated and resentful. The converse can happen when such children find each other and form groups and gangs in which aggressive behaviour is reinforced, often as a tool of survival. Pat McGorry, who is also clinical director of Melbourne's Orygen Youth Health, says that Martin Bryant's case was additionally complicated, having potentially fallen into a subgroup of kids who are dealt a double-whammy -- with early neurodevelopmental vulnerability and a second surge of biological and social changes following puberty and continuing during adolescence. These children's developmental pathways move away from normality early on in childhood, but when puberty hits, they start to run into trouble as the big changes in the brain that occur during adolescence butt up against their psychosocial vulnerabilities. "So there is that interaction between those things, the gene, the environment ... it is a hugely important area for further understanding,'' he says. "But we can't just wait for another 20 years until we have it all worked out. "We have got to do something now, and there is a tremendous amount that can be done in terms of picking up kids who are clearly having problems and providing much better interventions, and at the moment, you know, even in developed countries, it is pretty pathetic in terms of the level of response.'' Australia, like Canada, is one of the few Western nations that have begun to invest in researching and trialling programs designed specifically for young people. McGorry and his British colleague, Emeritus Professor John Gunn, and Professor Stan Kutcher in Nova Scotia, Canada, have urged, lobbied and fought for governments to recognise that investment in adolescent mental health is a protective measure, one that could save the public purse hundreds of millions in losses later. It is estimated and accepted globally that 70 per cent of all major mental disorders emerge in people before the age of 30. And yet the vast majority of medical research --Kutcher estimates up to 90 per cent of the therapeutic work and research -- focuses on adults over 30. Professor Gunn, a pioneer of forensic psychiatry in Britain, is now retired but his work over a lifetime has created a cornerstone of modern understanding of the links between mental illness and violence. Gunn says he has long been puzzled by the fact that the period known for life's maximum disturbance -- adolescence -- remains one of the least of interest to psychiatrists and government. "The neglect of adolescent psychiatry is a special form of self-harm undertaken by adult society,'' he says. He echoes the calls from his colleagues in other continents for a rethink about resources for research. He says the money spent in Britain on his speciality is minuscule, and while the state builds institutions to house people who have committed crimes and recognise they need help, little is done to understand the origins of their behaviour."Society doesn't take ownership of people such as (Bryant) because he is seen as alien -- he's not one of us and our society didn't produce him ... the very word `evil' means it comes from outside, and isn't part of us. "I understand that it isn't easy for us to accept that this kind of thing is part of our society, but it is. All the words like monster and evil produce political reactions. What the politicians fail to grasp is that while they think there are no votes in spending money on criminal lunatics -- or whatever other awful phrase they choose to use -- there might be some mileage in saying, `We are spending money on understanding how we can prevent crime'.'' Gunn is now working with colleagues to establish a charitable fund to research aggression, mental disorders and the origins of violence. "Almost every other branch of medicine has quite big research funds; think about the huge advances in prevention of heart disease, cancer and so on, butthis is also important. And yet it is difficult to persuade people that this is a good and charitable way of spending their money.'' Kutcher says a big problem globally is that while we know that the environment and genetic expression are interwoven, there is simply not enough rigorous research across the human lifespan. ``You know we are way past the point where we are looking at social determinants of health as explanatory models _ that is old news. And we are way past the point where we look at genetics as the explanatory model ... it is too complicated for simple gene explanation ... So what we need is large cohort studies of young people carried out from conception, to the time of uterine development, to early development, through to early adulthood.'' One of the greatest frustrations for mental health experts working with young people is that governments tend to respond to critical incidents such as Port Arthur or the US school shootings by making public health policy on the run rather than strategically and based on well-grounded evidence. In Australia, a federally funded program of care for young people with mental and substance use disorders was established in 2006 and there are now 30 "headspace'' centres around the country where people between 12 and 25 can access a new style of mental health services. But even this initial stage of reform reaches only 10 per cent of the youth population, a kind of ``base camp'' with funding from government that is still not recurrent or guaranteed. Martin Bryant's final journey was characteristic of most suicidal people in that he wanted to be stopped even as he drove to Port Arthur. "With all suicidal people there is a part of them that wants to be saved,'' McGorry says. "That is why, if you can get to them, they have a chance. Someonewho is depressed, who has suicidal thoughts or plans, if you can access them, it is always preventable.'' Equally important, say the psychiatrists, is re-engaging young people in the workforce or schooling after they have emerged from a period of depression or other kind of mental illness. One of the most significant observations of Bryant was his further isolation from society when he was deemed to be entitled to a lifetime on a pension and therefore stopped his odd jobs, gardening and little business ventures with his father that gave him a working place in society. Had he found a place where he felt useful, it might have changed his increasingly negative view of himself and the world. "Interestingly, they almost gave up on Martin Bryant ever having a chance of employment,'' Paul Mullen says."In fact, he does have literacy and numeracy and he does have some qualities, and with the right influences, he might very well have been able to occupy a relatively menial task in open employment. He was physically able; in fact, he had a number of pluses physically.'' Bryant was also failed by the system in the period after his friend, Helen Harvey, and then his father, died. Disintegrating in the face of such loss is a normal human response, let alone for an individual already so stressed and struggling emotionally in such a dramatic way. Young men also appear to respond differently when psychologically vulnerable. Unlike young women, who tend to externalise and express their distress, young men are less likely to seek support or help and are much more difficult to engage and treat. Experts agree that an examination of Bryant's life could foster a more sophisticated public debate about mental health, violence and young people. "The terrible consequences of failed care and support for Martin Bryant could be repeated and, indeed, has been in many places since 1996,'' McGorry says. "(People) have to understand that it might happen to them or it might happen to their kids ... In the case of Bryant, it is society that is at risk.'' McGorry cites the case of a 16-year-old boy he has seen at a headspace centre recently: ``He had a very similar story thus far to Bryant. The young man is headed for jail unless he receives specialist help, and has a long history of ADHD and conduct disorder. He wants help and the expertise isnow available, however the specialist services are so under-resourced they cannot accept him due to large waiting lists. The message is that there can be more Bryants if something is not done about this issue. And positive things can be done, and even with the present state of knowledge we have, it just requires the community and political will to actually do it.'' This is an edited extract from Born or Bred? Martin Bryant: the making of a mass murderer, by Robert Wainwright and Paola Totaro, published by Fairfax Books on April 28, RRP $35.CLICK here to get your copy of Born or Bred? Martin Bryant: the making of a mass murderer: