Mental health and gun violence
Conflating the two hurts those who need help most
After Columbine High School, Sandy Hook Elementary, or the recent mass shooting at Marjory Stoneman Douglas High School in Florida, many people question the link between mental health and gun violence. The connection is not what these reports would have you think.
Research shows that mental illness is deceptively common, while violence by people who are mentally ill is exceedingly rare.
One in five Americans experience mental illness in a given year. People with mental illness are actually dramatically less likely to inflict gun violence than those considered mentally healthy. Instead, they are more likely to be victims. People with severe mental illness are eleven times more likely to be victims of violence than the general population. This risk is particularly high when it comes to interactions with police. One study found that at least half of the people shot and killed by police each year have mental health issues.
Drawing associations between mental health and gun violence, particularly in the case of mass shootings, is commonplace after these events. Seeking answers in the wake of tragedy, many are comforted by the idea that “only a mad man” could carry out such an act. Gun rights advocates focus on this stereotype to stymie the passage of effective methods of preventing gun violence. Using demonstrably false information, the National Rifle Association has long blamed violence on “insane killers,” and advocated for a national registry of the mentally ill. As a result, the disabled community has long been battling policies that ignore evidence and instead stem from long-held fears.
In truth, the biggest mental health issue associated with gun violence is suicide. Suicides with guns are both the most common method of suicide and comprise the majority of all gun-related deaths. Most people with serious mental illness are never violent, but are at dramatically higher risk of suicide.
Far more than mental illness, gun violence is linked with a history of intimate partner violence, while white supremacist beliefs are associated with higher rates of gun ownership.
The shooter’s race also factors into allegations of mental illness. The picture of a lone gunman with a mental illness is a recent development following the rise of mass shootings — shootings perpetrated predominantly by white men. Prior to this development, in the 1960s and 1970s, the media linked mental illness and violence to black political activists, laying the blame at the feet of “black culture.” Now, as we experience the rise of spree killings — at the hands of white men — the popular diagnosis has changed to suggest that these are individuals suffering from individual illnesses. This has allowed policymakers to focus the discussion solely on limiting gun rights to people diagnosed with mental illness and avoid addressing the broader associations between white males, gun violence, and gun availability.
Despite attempts to fight the stigmatization of mental illness, media coverage of general mental health issues has declined over time, instead highlighting stories that link mental illness and violence.
Casting mental health in this light — with close associations to deadly violence — actually makes people less likely to support proposals to strengthen mental health care. This stigmatization has been codified: the federal regulation prohibiting the sale of weapons or ammunition to people who are mentally ill uses the language “those adjudicated as a mental defective.” This is exacerbated by media reports. Over the past twenty years, news reports have grown consistently more likely to refer to mental illness while reporting on gun violence stories. Additionally, reports mention mental illness as a possible cause for a mass shooting far more often than is actually the case.
While the majority of media coverage links mental illness and gun violence as cause and consequence, evidence suggests that the causal arrow points in the reverse direction. Exposure to gun violence is an increasingly frequent root cause of post-traumatic stress disorder. Just as soldiers involved in combat suffer PTSD, studies suggest that the majority of people exposed to mass shootings will later meet the criteria for PTSD. Children exposed to gun violence commonly show symptoms of trauma later in life, including anxiety and depression.
As a preventive measure, placing responsibility for stopping mass killings at the hands of psychiatric professionals and social workers by identifying potentially dangerous patients is not a tenable solution. It serves to turn individuals into scapegoats instead of addressing the complex societal causes of violence or easy accessibility of deadly weapons. Legal requirements to report ask mental health professionals to make challenging predictions that run counter to their efforts to treat patients, and are accurate at a rate only slightly better than chance. Even in instances where these reports are correct in retrospect, they rely on full cooperation from law enforcement. Failure to follow up on such reports was recently seen in the recent shooting in Parkland, FL.
However, we can take definite steps to improving mental health care in the U.S. One avenue is strengthening the mental health “safety net,” making mental health care easily available and affordable to those who need it. 60% of people with mental illness won’t receive treatment each year, often as a result of access and affordability issues or fear of stigmatization. People with mental illness are more likely to be uninsured than those without, making care harder to come by. Particularly in rural areas, patients face shortages of behavioral health providers. Simultaneously, addressing mental health issues is a challenge for the health care system, as often providers must address the presence of one or more comorbid conditions.
There are also proactive measures we could take using the public health model that improve learning and mental health for children. Introducing mental health promotion into school curriculums or after-school activities is an investment in kids’ social and emotional learning. This serves to promote health mental and social development for all children and provide easily-accessible support to at-risk children or demonstrating early signs of mental health problems.
Bolstering the health care system to support mental health patients would improve care and quality of life for millions of Americans. As Monica Kriete says, “our emotional environment is the equivalent of John Snow’s water pump.” However, this addresses issues broader than gun violence and does not address the omnipresence of firearms. It doesn’t ‘feel’ like gun control, and despite calls to improve mental health, is a low priority. As an example, the Trump administration has proposed eliminating $400 million in federal funding used to provide mental health assistance to students, as well as defunding the School Emergency Response to Violence program. Instead, in the panic after mass shootings, politicians opt for strict prohibitions for people with mental illness, which serves to further stigmatize mental illness.
Instead of the common picture of mental illness leading to gun violence, they are two interdependent problems. If anything, widespread firearm deaths lead to a greater mental health burden in the rest of society. The real issue at hand is that our mental health system is not suited to the task of preventing gun violence, and should not be expected to. By strengthening mental and behavioral health resources, making care affordable and providers accessible, we can improve the country’s mental health care. To curb the epidemic of shooting deaths, we have to take steps to correct for a uniquely American problem: living in a country with nearly as many firearms as people.
A great source for more of this information comes from S.E. Smith, who has compiled a list of resources here.
