Mental Health Providers Can’t Stop Mass Shootings

Most mentally ill people are not violent. In fact, they’re more likely to be victims than perpetrators.
November 2, 2018, 3:28pm
The AR-15 often seems to be the killing machine of choice in America.

Every time America is terrorized by another episode of mass gun violence, gun lobbyists and their Republican allies swoop in to divert any action that could curb access to guns. Often, they attempt to pivot the conversation to an even more fraught problem: mental health.

While GOP orthodoxy has actually favored cutting access to mental healthcare for years, these shootings—and the attendant outrage—produce the rare moments in which the party’s leaders might deem the issue one of national urgency. After the tragedy at Marjory Stoneman Douglas High School in Parkland, Florida, for example, Republican lawmakers at the state and national level pushed laws to expand the government's response to mental-health emergencies in schools and report mentally-ill people to law enforcement. Shortly after, Florida Governor Rick Scott signed a bill that, among other things, requires students to disclose mental health issues on school forms.

Republicans have been doubling-down on this rhetoric during the midterm campaign. In the Ohio gubernatorial race, for example, Republican Mike DeWine’s approach to gun control has consisted of pushing for more law enforcement in schools and expanding mental-health services, while Democrat Richard Cordray has touted bump-stock bans and background checks. The GOP approach, it often seems, means pushing mental health providers to the front-lines of the gun control debate. But is that where they belong?

Psychologists, psychiatrists, and social workers have been legally tasked with reporting homicidal and suicidal people for decades, according to Susan B. Sorenson, a professor of social policy at the University of Pennsylvania who studies the epidemiology of violence. And the Gun Control Act of 1968 has long prohibited the sale of guns to individuals who have been committed to a mental institution or deemed mentally "defective."

But Sorenson pointed out what tens of millions of Americans with a family member or friend dealing with a condition like depression already know: most mentally-ill people are not violent. In fact, they’re far more likely to be victims of violence than perpetrators.

That understanding can get lost in the wake of mass shootings, where gunmen are often described as depressed or angry loners left untreated until it was too late. This was how Americans discussed Nicolas Cruz, the confessed shooter in Parkland, who had received mental-health treatment before the attack, and Stephen Paddock, who killed 58 people in Las Vegas and whose physician said he believed he may have been bipolar. Some of the same rhetoric has been applied to Robert Bowers, the man charged with killing 11 people at a Pittsburgh synagogue last week, with prominent public officials labeling him “deranged.”

But while there may be warning signs that a person is dangerous—Bowers had long raged against Jews online—there is no psychological test or diagnosis capturing the risk someone might carry out a mass shooting. “We know a lot of gun violence happens when someone is impulsive, despondent and angry,” Sorenson told me. “But those are all universal human emotions and conditions. It’s not unique to anyone who has any diagnosed disorder.”

To be clear, mass shooters may be disproportionately mentally unwell, but that isn’t the whole picture—one Columbia University study found that 22 percent of the mass shooters in a database of over 200 were mentally ill. And trying to force the public (or private) health system to identify potential shooters can backfire, according to Jonathan Metzl, a professor of sociology and medicine, health, and society at Vanderbilt University who advocates for gun reform. For one, it can create a stigma around the mentally ill, who already suffer from society’s misconceptions, and discourage people from accessing treatment.

And it can threaten providers' evidence-based practices. “For practitioners, the laws make them liable, so they might overcompensate,” Metzl said. That creates potential for false positives: patients who are labeled as violent or homicidal even if they are not, because their doctors fear being deemed neglectful after some potential future tragedy.

In the states that have imposed expansive mental-health intervention requirements within the broader context of gun reform, the impact remains unclear. The New York Safe Act, for example, was signed into law in 2013 to address firearm violence. One of the strictest state gun laws in the country, it included an expanded mental-health reporting system through which the state can revoke gun licenses from the mentally ill, as well as a broad ban on assault weapons.

“The legislation was created as emergency legislation in response to the Sandy Hook shootings,” a spokesperson from the state’s Office of Mental Health told me through email. “To date, more than 550,000 licensed medical professionals have received training and support regarding their roles under the SAFE Act.”

Since it was enacted, New York’s crime and shooting rates have remained about the same, the spokesperson added. Where it may have had a greater impact, they suggested, was in slowing down the rate of suicides—the state had the second-lowest suicide rate in the country in 2016.

Some advocates have argued this can be attributed to the legislation identifying more mentally ill people—at least 34,500 people lost their gun licenses from the mental-health screening in less than two years under the SAFE Act. Others said it was simply that there were fewer guns available. “Make it hard for people to get a gun and you will see fewer gun suicides. There’s no mystery,” Metzl told me.

Either way, these laws do not necessarily make the mental-health system more comprehensive. They do not produce more mental health practitioners for marginalized or at-risk populations. They don’t strengthen the relationship between the health system and justice system—which is crucial given that vulnerable people might avoid seeking care for fear of incarceration.

The laws could also subject citizens to privacy breaches. Both major political parties have been concerned about this, as efforts to add mentally-ill people to a larger database in the context of gun purchases—which has been happening in some states since 1968—have been broached at the federal level over the past decade.

Republican Congressman Sam Johnson from Texas led passage of a resolution last year undoing an Obama-era regulation that prohibited some Americans receiving government disability benefits from purchasing guns. Backed by the ACLU and various disability-advocacy groups, Johnson was able to axe a policy he said threatened the privacy of American citizens and infringed on Second Amendment rights. Critics argued it was just the usual GOP pro-gun mantra disguised as a privacy concern.

No matter where you come down on the most contentious issues at the intersection of privacy and gun policy, mental-health reforms could and should still be part of the solution to mass gun violence. But those reforms should reflect the data we have on what the most effective interventions actually are.

Sorenson pointed out specifically that providers needed to better understand the use of guns to threaten or intimidate partners in domestic violence incidents. After all, gun violence doesn’t just impact people living in any given home: men who carry out domestic violence have been linked to other types of violence as well, as was brutally evidenced in the recent Kroger shooting in Louisville, Kentucky. Some laws are already in place to restrict gun access from domestic-violence perpetrators, who kill an average of 50 women a month in the United States, according to one estimate.

“If [providers] haven’t been asking about these issues, it would be good if they started,” Sorenson said. “We focus on these huge public events, but there’s also a lot of gun violence that happen in the home.”

If nothing else, mental health experts tended to agree that while access to services was important, there remained just one proven strategy for curbing gun deaths: restricting access to guns. This has long appeared to be the case in the US—where states with stricter laws experience fewer deaths—and by way of various global examples, from Canada to Japan to Australia.

“We need mental health services period,” Sorenson said. “We also need to do something about the guns. They needn’t be in competition.”

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