The Newtown shooting has many Americans thinking about the role of mental illness in violence. It's an important, much needed conversation. Mental health professionals sit at a unique vantage point in this debate. Many of us have worked closely with both perpetrators and victims of violence. Many of us struggle to protect our clients from stigma, to safeguard confidentiality, and we've grappled with when it should be breached. Meanwhile, as parents, community members, citizens, plenty of us are simply tired of the violence -- and in many cases, outraged by it. Here is some food for thought on mental health and guns:
1. Most violent crime in America cannot be attributed to mental illness. Granted, this data is complex and hard to piece together, but our assumption that violence is always linked to mental health issues is vastly oversimplified. There is one murder every 36 minutes in the U.S. In 2010, over 11,000 Americans were killed with firearms. Now, while it's true that some illnesses like bipolar disorder and schizophrenia have been linked to an increased risk of violence in certain situations, the vast majority of people with mental illness are not violent -- and the majority of people committing violent acts are not mentally ill. For example, one would be hard pressed to argue that gang-related shootings and domestic violence deaths are linked solely to mentally ill perpetrators. In fact, issues like poverty, education, substance abuse, anger and gender roles emphasizing power and control all play an important role in gun-related crime.
2. Mass shootings do not make up the majority of gun crimes in America, but they may have a stronger link to untreated mental health issues than other types of gun violence. A large proportion of these killers display symptoms of serious mental illness. We have experienced 62 mass shootings since 1962, and unfortunately they are on the rise. The United States now averages one mass shooting per month. If we want to curb mass shootings, it does appear that we'll need to invest in better mental health care, support and resources for the mentally ill and their families.
3. Mental health professionals are not very good at predicting who will become violent. When it comes to anticipating physical violence, clinicians are much better at identifying overall risk factors (such as substance abuse, a prior history of violence, lack of social support, current stress) than an individual's specific probability to harm others. What does that mean? It means we can list the general characteristics of someone who is violent -- but if you want to know if a specific person is going to be violent or not, we aren't that accurate. Also, mental health professionals are trained to "err" on the side of caution, that is, we'd rather identify someone as possibly violent (a false positive) than assume someone with several risk factors is not at risk (a false negative). The judgment of mental health professionals alone will never be enough to curb the epidemic of gun violence. It can only be one part of the solution.
4. We should think about household gun ownership in terms of our "risk profile." By now, most of us have seen the overall statistics. For example, in domestic violence situations, having a gun in the household makes it five times more likely a woman will be killed by her abuser. Men who have guns in the home are ten times more likely to die from suicide. Over 38,000 Americans die by suicide each year, and over half of these suicides are committed with a firearm. This is all strong evidence that we've got to start taking a tailored, personalized approach to the way we own guns, guided by individual risk factors. Given the high rates of accidentally injury, suicide and domestic violence, a "one size fits all" clearly doesn't work. We'll need to ask ourselves, do we have little children at home who can easily access our weapons? Is our teen depressed and socially isolated? Do we ourselves have a history of anger, or a volatile relationship? Do we live in a neighborhood that commonly has home invasions? We should let these types of questions -- not myths about self-defense -- guide whether or not we choose to own firearms and how we decide to store them.
5. If we truly want to understand more about mental illness, violence and an individual's risk profile, we must support more research. At present, the data we have is difficult to piece together, even for most mental health professionals. The president's executive order to reinstate funding for this type of research is of paramount importance. We've lost a lot of time and a lot of lives because of the lack of research. We cannot promote health and safety without more information, more studies, more understanding. Thankfully, we can now move forward with that lifesaving endeavor.