Good News and Bad News About Gun Laws, Mental Illness and Violence — Part 1

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

by Jeffrey Swanson, PhD

Federal and state efforts to restrict firearms access to potentially dangerous people with mental illness have focused in recent years on extending the reach of states’ reporting to the National Instant Criminal Background Check System (NICS). In August, in response to the Colorado movie theater shooting, Mayors Against Illegal Guns released a report tallying the number of mental health records each state has submitted to the NICS and ranking each state’s reporting performance. Nearly five years after Congress enacted the NICS Improvement Act, only about half the states have submitted more than a negligible proportion of their mental health records.

The Mayors’ report mentions the “mentally unstable man” who shot President Reagan and his press secretary, Jim Brady, for whom the Brady Handgun Violence Prevention Act was named. It recalls the deadly rampages at Virginia Tech in 2007 and in Tucson in 2011. It includes an interactive map titled Fatal Gaps: Can dangerous people buy guns in your state?  The not-so-implicit message here is that states’ spotty reporting of mental health records to the background check database is partly to blame for the senseless deaths in mass shootings.

It is easy to say there’s a problem with our gun laws or their enforcement by pointing to isolated cases where mentally disturbed mass shooters were able legally to buy guns. That is probably true. Unfortunately, there is no evidence yet available to suggest that filling the NICS with more records of people with gun-disqualifying mental health histories would have any measurable impact in reducing firearm violence in the population.

A study underway at Duke University, funded by the National Science Foundation and the Robert Wood Johnson Foundation’s Public Health Law Research Program, may soon provide some answers to that question. Whatever the study finds, though, the results will hinge on whether two assumptions underlying our gun prohibitions turn out to be true:  that there is a strong causal relationship between serious mental illness and gun violence; and that our extant gun-disqualifying legal criteria can accurately identify the subgroup of mentally ill individuals at risk.

If the statistical predictors of gun violence are much the same as the predictors of assaultive behavior in general, we can expect that any policy targeting mental illness as a specific risk factor for gun violence will have a limited impact on the overall problem. Epidemiological studies  in the community have found that the vast majority of people with serious mental illnesses do not commit violent acts toward others, and that the vast majority of violent acts are not attributable to mental illness (Fazel & Grann, 2006; Swanson, 1994). These studies would suggest that even if we completely eliminated mental illness as a violence risk factor, the population prevalence of violent acts towards others would go down by less than 4 percent.

Such are the stats that animate the mental health advocacy organizations that defend  “people with mental illness” (PWMI) as if they were a peace-loving tribe that has gotten a bad rap for warmongering. The advocates, like those involved with the NAMI Stigma Busters initiative, cite statistics that PWMI are more often victims than perpetrators — and not only victims of crime but of the ill-informed, media-hyped, misplaced public outrage that emanates from the news of every mass shooting by a troubled young man.

Michael Fitzpatrick, Executive Director of the National Alliance on Mental Illness (NAMI) responded to the report from the Mayors Against Illegal Guns with an aggrieved blog essay decrying the Mayors’ “extreme, broad-brushed rhetoric that ignores medical science, modern definitions and actual risk factors.”

To be fair, the stigma fighters do have a point. The fact is that people with mental illness are mainly just people — ranging from your harmless grandmother to your neighbor’s not-so-harmless intoxicated boyfriend. So when the days and weeks after a Virginia Tech or a Tucson or a Fort Hood or an Aurora mass shooting are filled with the chatter of pundits blaming mental illness — as if “nutjobs” running amok in the land were the main and predictable cause of our societal gun homicide problem — it is worth saying that the pundits and the public opinion they feed are wrong.

Here’s an example of what I’m talking about: Two days after the Tucson shooting that killed six people and wounded 12 more, including Rep. Gabrielle Giffords, Time magazine’s Joe Klein opined in Time’s political blog, Swampland:

“….There was a period, in the 1960s and 1970s, when mental illness was celebrated in films like ‘One Flew Over the Cuckoo’s Nest’ as a plausible response to an insane society. It was an entertaining literary conceit….but it ignored the reality of people like Loughner or the guy who shot up Virginia Tech a few years ago–or the near-weekly nutjobs who attack schools and fast-food restaurants, take hostages at malls, or merely wander the streets babbling incoherently, threatening bystanders and scaring the bejeezus out of everyone. We have a responsibility to protect ourselves against these people…” – Joe Klein, Swampland, January 10, 2011

The aggrieved advocates are right to call out this kind of broadside that sweeps up all kinds of people struggling with mental illness who would never hurt another person. But the stigma fighters are missing something, too. The elephant in the room for a serious discussion of firearm injuries and mental illness is not homicide. It is suicide.

When we bring suicide into the picture of gun violence, mental illness legitimately becomes a strong vector of concern; it should become an important component of effective policy to prevent firearm violence. Suicides account for 61 percent of all firearm fatalities in the US — 19,393 of the 31,672 gun deaths recorded by the CDC in 2010. Suicide is the third leading cause of death in Americans aged 15 to 24, perhaps not coincidentally the age group when young people go off to college, join the military, and experience a first episode of major mental illness if it’s bound to happen. The majority of suicide victims had identified mental health problems and a history of some treatment.

“How did they get a gun?” is an important question to answer. “Where was the treatment, and why did it fail?” may be even more important.

Read Part 2 and Part 3.

Temple University Center for Public Health Law Research

Based at the Temple University Beasley School of Law, the Center for Public Health Law Research supports the widespread adoption of scientific tools and methods for mapping and evaluating the impact of law on health. It works by developing and teaching public health law research and legal epidemiology methods (including legal mapping and policy surveillance); researching laws and policies that improve health, increase access to care, and create or remove barriers to health (e.g., laws or policies that create or remove inequity); and communicating and disseminating evidence to facilitate innovation.

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