Targeting mental illness won't prevent mass shootings

Following the latest mass shooting at a Florida high school, President Trump bypassed an opportunity to make a bold and progressive statement about this nation's abundant gun culture in favor of a much easier target, specifically people with mental illness. Rather than address the Florida regulation that allowed the shooter to buy a legal weapon without requiring a permit, a license or registration, he chose instead to tweet, "So many signs that the Florida shooter was mentally disturbed, even expelled from school for bad and erratic behavior. Neighbors and classmates knew he was a big problem. Must always report such instances to authorities, again and again!" Speaking later from the White House, he again proclaimed the need to "tackle the difficult issue of mental health." And on Twitter Thursday, he said he would “be strongly pushing Comprehensive Background Checks with an emphasis on Mental Health”

As a psychiatrist I know these pronouncements cause more harm than good. In the public imagination mental illness becomes conflated with criminality, mass violence and other tragic events, and a psychiatric diagnosis becomes a cause for concern rather than support.

Lawmakers are not immune from this stereotype. Following the mass shooting at Sandy Hook elementary school, many states considered legislation designed to liberalize involuntary psychiatric care and to strengthen mandatory reporting of certain patients to the national criminal background check system, the database used by gun dealers to identify disqualified purchasers. New York passed the Secure Ammunition and Firearms Enforcement (SAFE) Act, which required mental health practitioners to report any patient who was "likely" to be violent to the health department, for potential inclusion in the database. According to the New York Times, the number of names on the SAFE Act reporting list now tops 34,000.

This illustrates the underlying fault of using a diagnosis driven policy to prevent mass violence. One in five adults in the United States will experience an episode of mental illness in a given year, but only a small percentage of violent crime is committed by the mentally ill. Laws targeting these people will needlessly restrict the rights and freedoms of people who will never be violent, and stigmatize those willing to seek care voluntarily.

Meanwhile, society disregards a much stronger risk factor for violence. Having an active substance use disorder increases the risk of violence substantially, yet in Maryland an individual can accumulate up to three alcohol-related driving offenses before losing the right to own a weapon. Conversely, a single 30-day voluntary admission to a psychiatric unit is disqualifying. There is a certain perversity to laws that disqualify an individual who seeks help voluntarily while shielding someone who resists rehabilitation.

If society needs a reason to keep guns away from people with mental illness, the only reason we need is suicide prevention. The majority of firearm deaths in this country are suicides rather than murders. According to one national survey, having a gun in the home increases the risk of suicide twentyfold. States with high rates of gun ownership have higher rates of suicide, even after controlling for rates of mental illness. To address the problem of suicide and gun violence some states have adopted laws to allow gun violence restraining orders, a legal procedure to temporarily remove weapons from individuals in the midst of a mental health crisis or who are actively abusing substances. When Connecticut enacted such a law researchers estimated that one suicide was prevented for every 10 guns seized.

The 2018 Maryland general assembly is currently considering 72 bills related to gun ownership and gun safety. One bill would allow police to seize weapons if the owner has been placed under a protective order, while another bill would extend the prohibition on ownership for one calendar for the duration of the protective order. Regardless of the legislative outcome, basing gun restriction upon past violence or imminent indicators of violence rather than mental illness is a common sense approach that is more likely to benefit both public safety and people with mental illness.

Dr. Annette Hanson is an assistant professor of psychiatry at the University of Maryland School of Medicine and co-author, with Dr. Dinah Miller, of “Committed: The Battle over Involuntary Psychiatric Care.”

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