Forbes; Todd Essig, 6/28/2014
(Article received from staff at New York Association of Psychiatric Rehabilitation Services e-list.)
Random gun violence is a terrifying fact of American life, because of both the violence and the randomness. Terror bred by violence does not really require comment; they are twinned. But terror bred by randomness does, especially when it leads people to accept as true a reasonable story that is false, when a myth functions as an explanation. And that is what is happening with the way we talk about mental illness and random gun violence. Thankfully, a just published report in the Annals of Epidemiology pulls together the facts we need to consider if we really want to adopt evidence-based policies to reduce random gun violence.
The article, “Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy,” is a comprehensive, critical survey of the available data (and it is surprisingly accessible and well-written for an academic treatise). It concludes that “most violent behavior is due to factors other than mental illness.” Adding deep sadness to the terror, it finds that “psychiatric disorders, such as depression, are strongly implicated in suicide, which accounts for more than half of gun fatalities.” It also outlines the behavioral risk factors that are associated with random gun violence.
More on those findings in a moment. First I want to note that the article is fighting an uphill battle. Whether it be global warming, vaccinations, health-insurance or basic economics, a respect for data often takes a back seat to ideology in policy debates. Our public discourse is often a fact-free zone.
Also, media images mix with basic psychology so that it is even less likely we will adopt evidence-based policies to reduce random gun violence. Here’s an example of how the media propagates the myth. Benedict Carey, in a recent NY Times, wrote that “(s)hootings in places like Isla Vista, Calif., and Newtown, Conn., have turned a spotlight on the mental health system, and particularly how it handles young, troubled males with an aggressive streak.” He goes on to state, as educated writers now do after first giving voice to the myth, “(m)ost of these young men will never commit a violent crime, much less an atrocity.” OK, but doesn’t that sub-rosa imply that some will? And it only takes one to kill many. Plus, he does not go on to say who just might go on to commit a violent crime. And that uncertainty is intolerable.
The problem is we have a basic need for things to make sense, especially in the face of terror. Our need for a story—any story, as long as it seems reasonable and can make us feel safer—has led to a widespread belief that improperly treated serious mental illness is responsible for random gun violence. In a 2013 Gallup poll 80% of Americans blame the mental health system either “a great deal” or a “fair amount” for mass shootings in the United States. Regardless of fact, people explain random gun violence as the unfortunate consequence of untreated mental illness, of a woefully inadequate mental health delivery system (which is broken and is in dire need of a fix—but that is another story).
The myth is that by fixing the mental health care delivery system we can all then breathe a sigh of relief. People will get the treatment they need and gun violence will dissipate. This would be fine if it were true. But it’s not. Let’s look at the facts.
Jeffrey W. Swanson, a professor of psychiatry and behavioral sciences at the Duke University School of Medicine and lead author of the article in Annals of Epidemiology was quoted in the UCLA Newsroom saying ”but even if schizophrenia, bipolar disorder and depression were cured, our society’s problem of violence would diminish by only about 4 percent.”
That is not very much. When people with mental illness do act violently it is typically for the same reasons that people without mental illness act violently. If you take comfort from the random terror of Aurora, Newton and Isla Vista, or from Chicago’s skyrocketing murder rates, in the myth we can attenuate gun violence by fixing our broken mental health care delivery system then it is time once again to be afraid.
Mental illness is associated with self-directed gun violence. 61% of all gun-related deaths are suicide. While rates vary by racial and ethnic background, as the article succinctly states, “suicide risk is substantially increased in persons with mental disorders.” A few studies have been done showing that gun permit and licensing requirements as well as background checks and waiting periods lowered suicide rates. In other words, part of the price we pay for not enacting what has been called common-sense gun regulations is the preventable suicide of fellow citizens with mental illness.
The Actual Risk Factors
There are behavioral risk factors associated with random gun violence, risks that cut across the presence of absence of a serious mental illness. This where the article recommends regulatory attention. The article states: “Categories of persons prohibited from firearms on a temporary basis should be expanded to include individuals convicted of a violent misdemeanor, subject to a temporary domestic violence restraining order, convicted of two or more offenses for driving while intoxicated or driving under the influence of alcohol or drugs in a period of 5 years, or convicted of two or more misdemeanor crimes involving a controlled substance in a period of 5 years. Focusing on these and other known and identifiable risk factors as the criteria for limiting firearm access, rather than relying primarily on existing status-based mental health criteria, will more effectively target those who are likely to be a danger to others or themselves.”
I’ll leave the final word to Vickie M. Mays, a professor of psychology and health services at UCLA also quoted in the UCLA Newsroom : “We need more evidence-based policies to effectively prevent gun violence … We also need to expand mental health services and improve access to treatment — some people are slipping through the cracks. But mental illness is not the main cause of violence in society. Policies should focus more on limiting access to firearms for people with behavioral risk factors for violence during specific times when there is evidence that risk is elevated.”
And if we buck Washinton’s tendency to legislate in a fact-free zone of ideology so as to adopt an evidence-based approach to gun violence, well, we might just end up not only feeling safer, we actually might be safer.
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