Guns and Mental Health

Vice President Joe Biden, accompanied by, from left, Rep. Robert Brady, D-Pa., Sen. Bob Casey, D-Pa., Philadelphia Police Com
Vice President Joe Biden, accompanied by, from left, Rep. Robert Brady, D-Pa., Sen. Bob Casey, D-Pa., Philadelphia Police Commissioner Charles Ramsey, and Philadelphia Mayor Michael Nutter, speaks after a round table discussion on gun control, Monday, Feb. 11, 2013, at Girard College in Philadelphia. (AP Photo/Matt Rourke)

As we debate the steps to reducing gun violence in the society a couple points need to be understood: 1. The link between violent crime and mental illness is weak, and 2. Mental health professionals are poor at predicting anyone's propensity for any specific behavior, including homicide.

Although it is mass shootings, particularly the massacre of school children in Newtown, that capture our attention and have accelerated the current discussion, Americans for the most part kill each other with guns in ones and twos. Of the total number of gun deaths in this country, around 30,000 a year, the majority are not the result of mental illness, but of ordinary human emotions like anger, hate, greed, and despair. In fact, about half of all shootings are suicides.

It is certainly true that our mental health system is in critical need of improvement, specifically in the area of funding. Twenty-eight states and D.C. reduced their mental health funding by a total of $1.6 billion between 2009 and 2012. With the "deinstitutionalization" movement of the '60s and '70s, many inpatient facilities were closed or reduced in size. It was assumed that a network of outpatient mental health clinics would take care of those previously hospitalized. This assumption has proven to be unattainable, largely because of inadequate public funding; instead many of the mentally ill are now on our streets or in our jails. (A 2010 report by the Treatment Advocacy Center found that there are more people with severe mental illness in prisons than in hospitals.) Inhumane and scandalous though that may be, few of them present a danger to public safety.

The fact that we are even talking about the mental health system as we consider the problem of gun violence is because a couple of the recent perpetrators of mass shootings have evidently suffered from psychotic illness. AND those who don't want to talk about the proliferation of guns in our society would prefer we discuss other subjects: mental illness, video games, the demise of school prayer, to name a few.

In order to appear even-handed, those proposing laws that would require universal background checks for gun purchases, or limits on access to assault weapons and high-capacity magazines believe they must address the issue of keeping guns out of the hands of the mental ill. (Psychotherapists are already obligated to warn any person whom a patient might specifically threaten with bodily harm.) New York has recently passed a law requiring therapists to report to police anyone who they believe might be dangerous to themselves or others. Presumably, the police could then search the patient's house and remove guns. The governor of Maryland has proposed a similar piece of legislation. From a therapist's point of view it is hard enough to win the confidence of people seeking mental health assistance. Such a requirement for breaching confidentiality in this manner could have a serious and irreversible effect on treatment without any concomitant increase in public safety.

The college psychiatrist in Colorado who was treating the Aurora theater shooter is already facing lawsuits from families because, while she notified the school's threat assessment team of his dangerousness, she did not involuntarily commit him to a mental hospital, a short-term remedy at best.

The only real predictor of future violence in anyone turns out to be a past history of violent behavior. Absent this, professionals are little better than the average citizen at identifying those likely to harm others. Many people report violent fantasies (remember your reaction to the last person to cut you off in traffic); few act on them.

It is true that our under-funded mental health system is broken and that many who require care are unable to receive it in a timely or affordable manner. It is estimated that 7 to 10 percent of emergency room visits are for psychiatric reasons. If it is determined that they need inpatient care, people may spend hours or even days in the emergency room before a bed can be found. This is not acceptable. A civilized society can be judged on the way it treats its most needy and powerless citizens.

As we confront the reality of these systemic deficits, however, we ought not to do so under the illusion that we are responding to the problem of gun violence. These are separate and largely unrelated issues, both of which deserve our immediate attention and informed response.