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Mental Health is the Wrong Target

For preventing gun violence, mental health screening is a red herring

By Elaine Meyer

Published May 9, 2014

Gun laws are historically difficult to pass in the U.S., but if there were ever a time to pass them, it would be now, in the wake of a spate of mass shootings—rare events that seem to have become disturbingly commonplace. Yet hostility toward regulating guns is worse than ever, as the Obama administration has been shut down, both in Congress and at the executive-level, from banning assault weapons and large capacity magazines and closing background check loopholes.

Only one area has received strong and perhaps surprising bipartisan support: early detection of mental illness.

In fact, the connection between mental illness and guns has crowded out the issue of gun control. According to a 2013 Gallup poll, the American public now believes the biggest cause of gun violence is not easy access to guns but the failure of the mental health system to identify individuals who pose danger to others. Only half of those surveyed said that gun laws should be stricter, down from 58 percent after the Sandy Hook tragedy in 2012.

Although it sounds like a sensible idea to try to keep guns out of the wrong hands, the connection between mental illness and violence is weak.

The media covers the personality angle of mass shootings more than they do the gun control angle. According to a study by researchers at the Johns Hopkins University’s Bloomberg School of Public Health, who looked at national and regional news reporting between 1997-2012, news sources were more likely to report on “‘dangerous people’ with severe mental illness” than “dangerous weapons.”

Reporters typically cover gun control policy in the wake of mass shootings, which draws public attention to the problem in a way that ‘everyday’ gun violence does not, according to the study. Reports that the perpetrators of the Virginia Tech, Tucson, and Aurora massacres had schizophrenia or bipolar disorder have drawn attention to a link between mental illness and gun violence.

Although there are many reasons to invest more resources in our mental health system, there is little evidence that focusing on mental health screening—especially at the expense of gun control—will prevent shootings.

By focusing so much on a killer’s mental health, the American media, whether or not intentional, has taken a cue from the NRA, which in recent years has quickly turned the discussion after mass shootings from talk of access to guns to talk of the “bad guys” behind them. The organization has even advocated for a national registry for the mentally ill despite being staunchly opposed to any federal involvement in gun regulation. (A majority of states have background checks that draw on mental health records.) Others on the right have argued that mass shootings are caused by relaxation or repeal of laws that commit people to psychiatric institutions against their will.

Although it sounds like a sensible idea to try to keep guns out of the wrong hands, the connection between mental illness and violence is weak.

Mental health issues are widespread in the U.S. Forty-six percent of American adults meet diagnostic criteria for a mental illness such as depression or bipolar disorder over the course of their lifetime, and 9 percent meet diagnostic criteria for a personality disorder. Many people will seek help from a psychiatrist, psychologist, or other mental health professional. Most are simply struggling and if anything are at greater risk of harming themselves, not others. Only a tiny number will ever hurt someone else.

For these reasons, “mental illness is simply not a very specific predictor of violence,” say Drs. Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, and Richard G. Frank, an economist at Harvard Medical School in the Department of Health Care Policy, in an article in the American Journal of Public Health.

Screening for potentially violent individuals, they say, would result in many “false positives”—instances in which people with psychiatric issues might be flagged even if they had no violent intentions—as well as wasted energy and resources. This is true even if screenings were to focus only among those with a chronic severe mental illness like schizophrenia. People in this category are much more likely to be the victims of violent crime than perpetrators, according to a 2001 study in the Lancet by psychiatrists at the University of Manchester in England.

Linking mental illness to gun violence can do serious damage, especially if done imprecisely, as is often the case. Take a recent headline in the Kansas City Star: “Preserve a mental health patient’s gun rights, or protect the public?” This seems to imply that people with mental illness are ticking time bombs.

In states where mental health professionals are required to notify authorities of potentially dangerous individuals, that often is not enough, according to an article by two psychiatrists who examine what the focus on mental illness and violence means for their profession. For instance, a psychiatrist who saw James Holmes notified police at his college as she was legally supposed to that he was dangerous and had homicidal thoughts. The campus police deactivated his school identification card but did nothing further. He shot and killed 12 people at the Century movie theater in Aurora, Colorado, one month later.

Not only will mental health screening likely not help, it could hurt. Linking mental illness to gun violence can do serious damage, especially if done imprecisely, as is often the case. Take a recent headline in the Kansas City Star: “Preserve a mental health patient’s gun rights, or protect the public?” This seems to imply that people with mental illness are ticking time bombs. Such coverage runs the danger of stigmatizing and deterring people from seeking help, for fear others perceive view them as deranged and violent.

Unlike mental health screenings, research shows a strong connection between availability of guns and gun violence. The U.S. far exceeds other rich nations both in firearm ownership and firearm homicides, according to the Council on Foreign Relations. Although we are less than 5 percent of the world’s population, an estimated 35-50 percent of the world’s civilian owned firearms live here, according to the 2007 “Small Arms Survey” at the Graduate Institute of International and Development Studies in Geneva, Switzerland. We are also the only rich country that does not license gun owners and register weapons, according to the website GunPolicy.org.

Lowering rates of gun violence by regulating guns should be similar to the way the health system approaches infectious disease epidemic—by fighting the “exposure,” or cause of the disease.

Controlling guns makes a difference. After South Africa passed a firearm control act in 2000, which requires every firearm be licensed and which bans automatic guns, gun homicides in five major cities decreased by nearly 14 percent each year between 2001 and 2005, according to a study from researchers at the University of Capetown and the University of Washington.

Loosening gun restrictions makes a difference as well. For instance, Missouri’s murder rate climbed 16 percent after the repeal of a state law that required anyone purchasing a handgun to submit to a background check and obtain a permit, according to a study from the Johns Hopkins Center for Gun Policy and Research.

Interestingly, our overall rate of violence is comparable to Australia, Canada, and Western Europe—we just have many more gun injuries and deaths. “That’s a weapon effect. It’s not clear that guns cause violence, but it’s absolutely clear that they change the outcome,” Dr. Garen Wintemute, of the University of California, Davis, Medical Center told the Huffington Post in late 2012.

Lowering rates of gun violence by regulating guns should be similar to the way the health system approaches infectious disease epidemic—by fighting the “exposure,” or cause of the disease, says Dr. Sandro Galea, chair of the Department of Epidemiology at Columbia University.

“Firearms are what we would term in epidemiology an ‘ubiquitous exposure.’ Their availability means that they are a ready recourse for the resolution of disputes, or for anyone with suicidal thoughts,” Dr. Galea says. “When exposures are ubiquitous, the fundamental approach to prevention is removal, or at least minimizing that exposure.”

It is hard to imagine that the cruelty to kill is within the capability of most humans, and as a result, it may be tempting to think that violent people can be easily identified. But as a practical matter, mental health screening is little more than a red herring in a highly charged debate that has been shaped substantially by people who vehemently oppose even the most minimal regulation of guns.

Read more about gun violence as a public health issue as part of Gun Week, our week-long series on the subject.

Edited by Dana March

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The views and opinions expressed on this website are solely those of the authors and do not represent those of the Department of Epidemiology, the Mailman School of Public Health, or Columbia University.