Good news and bad news about gun laws, mental illness and violence — Part 2

This is Part 2 in a three-part series on gun laws, mental illness and violence in the United States. Read Part 1.

By Jeffrey Swanson, PhD

It is hard to find good news in our nation’s gun violence statistics, but here’s this: If somebody shoots you today, your chances of survival are about 83 percent — up from 78 percent just ten years ago.  The improving survival rate for gunshot victims has helped nudge the national homicide rate down by about half a percentage point since 2001. Of course, the cloud behind that silver lining is that more people are actually getting shot. The CDC recorded almost 600,000 injuries caused by assault with a firearm in the past decade, as the combined rate of fatal and nonfatal gun assault injuries rose from about 18 to about 21 per hundred thousand.

Now for the bad news: When the shooter and the victim happen to be the same person, the odds of survival and death are reversed: 8 out of 10 die. Suicide attempts with a gun almost always succeed, because they are almost always aimed at the brain at close range, and there is seldom anyone around to call 911.

For those who “get lucky,” surviving a gunshot to the head can be a pyrrhic victory.  We all cheered Gabrielle Giffords’ courageous walk across the stage at the Democratic National Convention, but let’s face it: Her physical appearance was as much a reminder of what she has lost as it was a testimony to the miracles that timely neurosurgery can perform. Most survivors of gunshot injuries — whether self- or other-inflicted — don’t look like much like Gabby Giffords and they tend to have fewer supportive friends. They are often disadvantaged young people who struggle to recover in places where hope runs thin. Could better gun laws, better enforced, prevent their plight?  Perhaps they could, but only as a small piece of complex sociological puzzle.

Depression is the particular psychiatric illness most strongly associated with suicide. Social disadvantage plays a role both in the etiology of depressive illness and disparities in its treatment. Depression is not, however, a disorder that gets most patients a gun-disqualifying record of involuntarily commitment. In other words, people suffering from the one mental health condition that is most closely and frequently linked to suicidality are unlikely to show up in a gun background check.

Even if every state were to report all of its records of mental health adjudications to the National Instant Check System (NICS), this “gap” wouldn’t close. Arguably, then, better access to evidence-based treatment for depression — particularly for poor people, the elderly, and the unemployed (not to mention college students and returning veterans) — might prevent more firearm fatalities than relying on improved NICS reporting to keep guns out of the hands of “dangerous people.”

Read Part 3.