Maurice Sarvis arrived at North Charleston High School last week decked out in an all-white suit and patent leather white shoes as part of a campuswide show of condolence to those massacred at Sandy Hook Elementary.

For Sarvis, it was a very personal show of understanding. His beloved grandma was shot and killed in front of him by a man who then killed himself.

Yet as questions swirl about Connecticut shooter Adam Lanza’s mental state, Sarvis also hopes that sharing his own journey through mental health treatment will encourage others to get help long before violence or other consequences arise.

Because after tragedies like the Sandy Hook shooting, everyone from the police to the average parent wonders: Were there signs of a mental health break? Could intervention have helped?

Would we notice symptoms in the people around us? News reports have indicated that Lanza’s mother urged her son to get out more, and possibly took him to a psychiatrist as he withdrew to a world of violent video games.

Yet the decision she might have faced is wrought with social stigma and fear, experts said. Nobody wants their loved one to join the one in 20 Americans diagnosed with a serious mental illness, according to the National Institute of Mental Health.

But seeking help can save lives and dramatically improve their quality.

Just ask Maurice Sarvis.

At 19, Sarvis knows that without counseling and medication, he could return to his highly impulsive ways. He could even wind up in jail.

Instead, he is proof of what mental health intervention can yield — a life transformed to productivity.

His long journey began when he was 6 years old and awoke to a man kicking in his family’s front door. Sarvis ran to his grandma just as she emerged from her bedroom.

A gunman, perhaps looking for a neighbor who had slept in Sarvis’ living room that night, strode toward them. Everyone else was able to escape.

Sarvis’ grandma pushed him behind her.

“What’s going on here?” she asked.

The gunman fired. His grandma collapsed.

The man went outside and killed himself, for reasons Sarvis doesn’t know, leaving the young boy alone with his dying granny. Sarvis held her as she passed away.

Red flag violence

At the Charleston Dorchester Mental Health Center, home to the state’s only 24/7 psychiatric emergency response and intake team, calls for help funnel into a nondescript room with a long, S-shaped table of cubicles. The folks with phones pressed to their ears are experts in spotting red flags and directing people to resources. They also can send counselors directly out to people in crisis.

Their No. 1 warning: Contact police right away if someone is in imminent danger, if weapons are involved or if a person might have overdosed or attempted suicide, said Esther Hennessee, the mental health center’s special-operations director.

From there, two things make them act quickly — a history or threat of violence and easy access to weapons.

Has the person been violent before? Are outbursts worsening? Is the person exposed to violence through abuse or crime? Has the person harmed animals? Cut himself?

Throw in drugs and alcohol, and you have the basis for many of the calls they take, and for critical red flags that a mental illness might be at play.

The diagnosis

After his grandma’s death, Sarvis began to disrupt class, blurting out words he couldn’t control. He became agitated and picked fights.

He pushed a girl down the stairs at elementary school and was expelled.

He simply couldn’t control himself. Small slights elicited large outbursts, and and he could not get the image of his dying grandmother out of his head.

Then his mother died in front of him, the result of heart problems.

“I was tired of going to sleep and dreaming about it,” he said.

He entered mental health care with a diagnosis of attention deficit hyperactivity disorder, or ADHD, a genetic disorder, likely combined with post-traumatic stress disorder.

“I was confused,” Sarvis recalled about his diagnosis. “I didn’t know what it was. My first thought was that I was going to die. Then I wondered if I would be different from other children.”

Worry if ...

Another major red flag for mental illness is a big change in a person’s behavior. Is the person lashing out more aggressively or at smaller triggers? Abusing drugs and alcohol? Seeing or hearing new things?

Or is the person suddenly withdrawing inward, as Lanza’s mother might have feared? (Lanza might have had Asperger syndrome, which is a developmental disability and not a mental illness.)

Hennessee pointed to paranoid behaviors as “the big daddy.” Paranoia is based on a delusion that people are trying to demean or harm someone.

“Things are blown out of proportion,” said Marisa Osterman, a mental health counselor at North Charleston High. “Everyone is out to get them. Everyone hates them.”

Imagine your worst fears and multiply them by 100 to understand how a paranoia-based mental illness feels, Hennessee said.

And what do people do when they are desperately afraid? Flight or fight. That can lead to violence against others or one’s self.

Yet with adolescents and other children, deciphering normal behavioral changes from worrisome ones is difficult because they go through so many phases.

Osterman encourages parents to keep tabs on their children’s Facebook statuses and other social media where they might express feelings or threats.

As executive director of the Charleston Dorchester Mental Health Center, Deborah Blalock has heard many parents say, “I just had an inkling something was wrong.”

Use friendships as one indicator, she said, especially if a child suddenly withdraws.

“The job of being a kid is to go to school and make friends. When a disorder or something else interferes with that is when you know you have a problem,” Blalock said. “It could be a medical issue, could be depression, anxiety, they’re being bullied. But parents should err on the side of caution. Don’t try to walk that road alone.”

Students who withdraw might paint, draw and write poetry about self-hatred, despair, delusions and other signs of a mental illness. Others try to hide symptoms, especially if they equate mental illness with shame.

“Society tells us in overt and covert ways that mental health is something to keep secret and be ashamed of,” Hennessee said.

DeLynn Bates, Mobile Crisis team leader, noted that few people hesitate to take a loved one with a broken bone or chest pain to the doctor or hospital. Families should be just as proactive if they see mental health changes.

“It can be difficult to decide what’s driving the bus,” Hennessee said. “So call us and let us take a look.”

Turning around

In middle school, Sarvis was placed in a self-contained special-education program where his volatile behavior continued. He also began to face bullying.

“You ain’t gonna be nothing.”

“I started to believe it,” he recalled. “It was like I was separate from everybody else.”

So he tried to conform. He smoked marijuana and drank. He cut class and failed. He began to steal.

Osterman sat him down with the school principal and guidance counselor, who also noticed the changes.

“If you don’t straighten up, you aren’t going to graduate,” they warned.

Plus, Sarvis needed to take his medication regularly, perhaps for the rest of his life. He struggled with that because he hated the side effects, namely a loss of appetite.

“You will be the same person you were. Medication won’t change who you are,” Osterman assured. “But it will help to change your reactions.”

Sarvis decided two things: He would prove he could succeed outside of special education, and he would take his medication.

Once medicine addressed the brain chemistry that causes ADHD, he calmed. He could concentrate. He could stop his impulsive reactions to think.

He also could apply what Osterman taught him about deep breathing, releasing negative thoughts and thinking before reacting. The school switched him to regular classes.

On-site help

Identifying students with mental health problems and having Osterman on campus to treat them is as much a priority to North Charleston High Principal Robert Grimm as having police to ensure safety.

His school is one of the few that pays to have a full-time mental health counselor on the 800-student campus, where Osterman treats everything from severe ADHD to psychosis to suicidal behaviors.

Often teachers refer students they notice become highly disruptive or withdrawing socially.

Osterman points to one student who was lashing out and leaving class. When she spoke with him, the student was hearing voices that made him increasingly agitated.

His wasn’t a disciplinary problem, it was a mental health one. But it could have gone undiagnosed, dismissed as mere disobedience.

Grimm wishes his budget allowed him to hire more counselors like Osterman, because families might not notice red flags or know how to access care.

“Without her, a lot of our students would go unserved,” Grimm said. “And we can’t have that.”

Age and stress

Soon, Sarvis will head off into a time of life that worries mental health experts — young adulthood.

Local mental health staff are reaching out to college campuses including The Citadel and the College of Charleston because many people diagnosed with mental illness, especially men, experienced their first breaks with reality as young adults.

Experts want college faculty, staff and students to be aware of big behavioral changes in others, especially those who have gone through extreme stress or traumas. Those events in young adulthood play a key role in triggering mental health symptoms, experts said.

Deciphering problems is made trickier because young adults tend to move away from family who might notice big behavioral changes. College drinking or drug use also can mask or accentuate symptoms.

“It’s that stressful event,” Hennessee said. “Throw substance abuse in, and it throws up the likelihood of mental illness rearing its head.”

Reach out

Today, Sarvis is a school mascot. He works as a clown at birthday parties. He’s a youth minister at his church, and he started a school club to boost other students’ self-esteem.

For Osterman, students like him are the reward of effective mental health care.

“This young man is completely different from the one who first came in here four years ago,” Osterman said.

But without access to medication and therapy, “I wouldn’t even be in school right now. I’d probably be in jail for disruption,” Sarvis said.

Instead, he should graduate in June. He wants to join the Navy or Army.

“The world is not built in a day,” he said. “But you have all of these counselors, all of these medications. So if you feel unsure or have things going on, go talk to someone.”

Reach Jennifer Hawes at 937-5563 or follow her at www.facebook.com/jennifer.b.hawes.