Confronting the Problem of Mental Health and Guns

With every mass shooting, commentary about mental health is quick to follow — the mental health community starts bracing itself as soon as the first panicked tweet from someone on scene hits the internet. “Only a madman would do something like this.” “This is insane!” “Why can’t we stop these crazy gunmen?”

Today, at a Santa Fe, Texas high school, at least ten have been killed with numerous other casualties reported. This most recent mass shooting incident, the 22nd in the United States in 2018, shows how unfortunately common these events have become in modern American society.

These events tend to be followed by attitudes about policy that shape the world we live in. At a time when mental health services are subject to growing cuts and it’s extremely difficult for people to access the care they need, people propose expansions to mandatory commitment laws, forcible medication legislation, registries, and more. All to protect us from “crazy gunmen.”

The facts don’t really support the insistence that mentally ill people are to blame for the epidemic of gun violence in the United States. People with mental health conditions are actually less likely to commit gun violence, and are responsible for comparatively few mass shootings (which make up a tiny fraction of gun deaths). The biggest predicator for engaging in gun violence directed at other people, whether in a mass shooting or otherwise, is a history of intimate partner and family violence.

Discussing the Facts About Guns and Mental Illness

Two thirds of the gun deaths in America every year are suicides. Some are committed with guns people managed to obtain after zero waiting periods and with limited background checks. Others — especially among youth — involve improperly stored and secured guns left in a location accessible to someone in crisis.

Simply pointing to suicide statistics and saying they justify some sort of “exclusion list” for mentally ill gun buyers isn’t a solution. Who defines mental illness? Who determines who should be deemed “too unsafe” to own guns? Who can access this database? How is it updated? How do people appeal if they feel they’ve been unfairly listed? What if someone was suicidal, but got treatment and is doing well now?

These two facts — mentally ill people aren’t to blame for mass violence, but mental illness and guns can still be a lethal combination — sometimes seem to exist in a state of tension. We have to be able to talk about mental health and guns in a way that’s productive, in a way that doesn’t stigmatize mental illness, or gloss over the issues. Can we have a conversation about mental health and gun ownership that’s clear-eyed and factual, rather than an appeal to emotion? If we can’t, it will be very difficult to save thousands of lives every year.

Mental Health Care Providers’ Role in Preventing Gun Violence

One thing people who aren’t in the mental health community may not be aware of is that guns are already a topic of discussion between patients and care providers. People seeking counseling are often asked if they own or can access guns, and that may spark a further conversation: Could you maybe find someone to keep your guns for you while you work on a mental health issue? Can you ask that a housemate obtain and use a gun safe? Can parents do a better job at keeping guns out of the reach of children?

These intimate, individual conversations are designed to protect individual safety, but they also come with a framework of mandatory reporting law. Mental health providers are already required to inform the authorities if they think a client has both the will and the ability to harm themselves or others. Proposals to erode medical privacy with additional reporting laws tend to ignore the existing realities, as well as how difficult it can be to build and maintain a trusting working relationship with a client, who may fear being reported to law enforcement or other entities.

Patients who are afraid to open up about what they’re experiencing cannot get the best possible care. And providers nervous about asking questions for fear of being caught up in a mandatory reporting law likewise can’t provide high quality care to people in need.

But the individual nature of these conversations points at a potentially powerful and productive way of talking about mental health and gun violence: What if the problem isn’t the mental illness, but the factors surrounding someone’s life and experience that push them in the direction of violence?

The Conversation About Guns and Risk

When we focus broadly on whether “the mentally ill” should have access to guns, we miss an important opportunity for a bigger conversation. Many people struggle to find services to help them manage their mental illnesses, which increases the risk of having a severe episode that might end in homelessness, losing a job, or having a violent outburst.

How can we collectively reduce situations in which people — regardless of mental health status — think that resorting to violence will resolve a problem? And how do we limit access to tools of mass violence?

Many of the regulatory solutions to this issue are those that apply more broadly: Universal background check requirements could catch people who might be risks because of past activities known to predict future (or additional) gun violence. Waiting periods would make it harder for people in crisis to buy guns on the spot. Gun storage laws would better secure weapons and ammunition. Advocating for these kinds of requirements allows people to focus not on mentally ill people, but on risks: With every gun sale, what are the risks that gun will be used to kill someone? How can we reduce those risks?

It may be challenging to eliminate gun deaths entirely in a nation that believes very strongly in individual gun deaths, and one that continues to arm its police. But we can collaborate on reducing those deaths effectively, and in a way that doesn’t stigmatize mentally ill people.