In My Voice: For Years, I Equated Mental Illness with Violence. I Was Wrong.

“Shedding personal prejudices is an important way to live a more open and inclusive life.”

Throughout Mental Health Month, we will be sharing Q&As with individuals who have experience with different aspects of mental health and gun violence. Today, we share a Q&A with Coalition to Stop Gun Violence Executive Director Josh Horwitz. Josh has spent nearly three decades working on gun violence prevention issues. In 2013, Josh helped found the Consortium for Risk-Based Firearm Policy, a group of mental health and public health experts who examine the intersection of guns and mental health.

  1. How did you think about gun violence and mental illness at the beginning of your career?

I have been working in this field for almost 30 years, so it is hard to remember exactly how I approached this issue at the beginning. For a good chunk of my career, I did not give it a lot of thought. To the extent I thought about it at all, I had a very simplistic, binary, and ultimately stigmatizing mindset; I equated mental illness with erratic and violent behavior.

2. How and when did that change?

That began to change with the mass shooting at Virginia Tech in 2007, and as mass shootings became more frequent, with the tragedies in Aurora, Colorado, Tucson, Arizona, and Newtown, Connecticut. I wanted to learn more about the relationship between firearm violence and mental illness.

I started attending meetings of the American Psychiatric Association and met a whole new group of mental health researchers, including Jeff Swanson, Paul Appelbaum, and Richard Bonnie. This group really opened my eyes to a whole new field of emerging research that showed that the relationship between violence and mental illness was much more complex than I had imagined; I learned that mental illness alone was not a significant risk factor for interpersonal violence.

In 2013, with support from the Joyce Foundation, I helped convene a meeting at the Johns Hopkins Bloomberg School of Public Health. Leading public health and mental health experts — who now form the Consortium for Risk-Based Firearm Policy — gathered to review the evidence around the nexus of guns and mental illness. These experts came to the consensus that mental illness alone is not a good basis for firearm prohibitions. Rather, the emphasis should be on dangerous behavior.

3. What is the most important thing you have you learned about the intersection of gun violence and mental illness during your time in the gun violence prevention movement?

The causes of gun violence — and what puts a person at risk for committing gun violence — are often rooted in a complex set of factors. These factors may or may not include mental illness. Focusing solely on mental illness won’t stop much gun violence and stigmatizes 40 million Americans who live with mental illness, the vast majority of whom will never be violent.

4. What aspects of this intersection are we neglecting the most? What can we do to address them?

For too long, the gun violence prevention community has neglected firearm suicide. Firearms have always played a large role in suicide, but over the last decade, we have seen a dramatic rise in the suicide rate.

While we still have so much to learn about the relationship between mental illness and suicide, policymakers, practitioners, and advocates can do more to limit access to lethal means. Limiting access to guns is not only important for people at immediate risk of suicide; there are millions of households where the risk of suicide greatly exceeds the benefit of having an unsecured firearm.

We also need to do a better job of understanding the cyclical relationship between trauma and gun violence. Trauma and mental illness are not the same, but trauma can adversely impact the mental health of individuals and communities. A young person who experiences the trauma of gun violence can be at risk for future violence. Additionally, those who have experienced such trauma often encounter barriers to care if they choose to seek help. So, in addition to focusing on firearms, we need to focus on accessibility of care as well as root causes of violence, like lack of economic opportunity.

5. Do you have any specific personal or professional experiences that inform how you approach this topic?

When I was a young lawyer, a close friend died by firearm suicide. At the time, people weren’t talking about lethal means counseling and there was no Extreme Risk Protection Order. So now, I am dedicated to the idea that we should have multiple tools and layers of intervention to prevent suicide.

As I have written in the past, to save lives, we need to adopt a social-ecological mode of firearm suicide prevention where there are intervention points at the relationship, community, and environmental levels. Not just one thing will stop suicide. The more we focus on a comprehensive approach, the more lives we will save.

6. Why should the gun violence prevention movement care about mental health? Why should the mental health community care about gun violence prevention?

Those who oppose evidence-based gun violence prevention policies like licensing gun owners or preventing domestic abusers from possessing firearms often try to change the discussion from guns to mental illness. They argue that instead of looking at guns, we need to focus on fixing the mental health system.

The name of the game is deflect and distract; however, this game has serious consequences. This approach increases discrimination and stigma for people living with mental illness while doing nothing about gun violence. Mental health advocates and gun violence prevention advocates need to understand the evidence and stick together in opposing efforts to conflate mental illness with gun violence.

7. How important is self-care when you work in gun violence prevention? Why?

Self-care is crucial. Gun violence prevention is grueling work. In addition to carrying our own stories, gun violence prevention advocates work with grieving families and are immersed in tragedies every day. Authentically listening to survivors is essential to this work, but if you are not taking care of yourself, you can put up a shield that prevents you from engaging empathetically. If you are already hurting, it is hard to be there for someone else.

I try to monitor when I am feeling overwhelmed or angry and make sure I take some time away from work. Getting to the gym or going on a run is a big part of my self-care routine. I am always surprised how even 30 minutes of exercise can completely change my attitude and allow me to refocus.

8. How have you changed as a person and a professional since learning more about mental health and how it relates to your work?

On a professional level, the best thing about gaining a better understanding of mental illness is that it has opened up new partnership opportunities and helped me make a whole new set of friends and allies. I take great pride in these new relationships and never forget that they are based on mutual understanding and trust.

From a personal perspective, learning more about mental illness has allowed me to grow and discard many ill-informed beliefs about people living with mental illness. Shedding personal prejudices is an important way to live a more open and inclusive life. Learning more about mental illness has made me a better person.