We can do more to prevent gun-related mental health deaths. But probably not the deaths you’re thinking of.
You’re probably thinking of all those high-profile, media-driven mass shootings that apparently are becoming more and more common. You might even think the shooter’s mental health is a big component of identifying and preventing similar future shootings.
But the title of this headline isn’t referring to just those deaths. It’s referring to the estimated 300,000 people killed by gunshot wounds in the past decade that were due to mental illness.
And the reason so few people care about these deaths? Because the vast majority of them — more than 95 percent — are suicides.
There is an excellent interview over at ProPublica with Dr. Jeffrey Swanson, who is perhaps one of the most eloquent experts I’ve heard describe the relationships between violence, guns and mental illness. Dr. Swanson is a professor at the Duke University School of Medicine.
All this focus on a person’s mental health and mental illness kind of misses the point, according to Dr. Swanson:
But the risk factors for a mass shooting are shared by a lot of people who aren’t going to do it. If you paint the picture of a young, isolated, delusional young man ― that probably describes thousands of other young men.
A 2001 study looked specifically at 34 adolescent mass murderers, all male. 70 percent were described as a loner. 61.5 percent had problems with substance abuse. 48 percent had preoccupations with weapons. 43.5 percent had been victims of bullying. Only 23 percent had a documented psychiatric history of any kind ― which means 3 out of 4 did not.
You get that? The research suggests that if we target mental illness alone as a risk factor, we’re going to miss most of the people. So if we can’t target the mentally ill, who can we target? “We want to focus more on behavioral indicators of risk, and not so much on “mental health” and “mental illness” as a category,” says Swanson.
If someone has a history of any kind of violent or assaultive behavior, that’s actually a better predictor of future violence than having a mental health diagnosis. If someone has a conviction for a violent misdemeanor, we think there’s evidence, they ought to be prohibited [from owning guns.] Things like a history of two DUI or DWI convictions, being subject to a temporary domestic violence restraining order, or convicted of two or more misdemeanor crimes involving a controlled substance in a five-year period. […]
Katherine Newman’s book Rampage, which looks at school shootings, identifies five common factors. Every shooter in her study had some kind of “psychosocial problems,” which may include mental illness.
The other factors: Shootings tend to happen in smaller communities, where everybody knows everybody, and the person who does the shooting perceives himself as purely marginal. And there are cultural scripts that give them a model: the idea that if you go out and shoot people, you’re going to become this notorious anti-hero, on the front pages of every newspaper.
Then there’s the failure of surveillance systems ― a teacher might have seen that the shooter was troubled, or it might be another kid. If everybody had been able to sit down together and connect the dots, they might have realized what was happening.
And the fifth factor is the availability of the weapons.
And finally, getting back to the real tragedy about having easy access to guns in America without any regard to how such guns may be misused…
Everyone has been through our National Mall and seen the Vietnam Memorial ― what a sobering sight it is to look at 58,000 names, over a 10-year period of time, U.S. military deaths. But if we were to build a monument to commemorate all the people who died as a result of a gunshot in the last 10 years, we would need a monument five times bigger than the Vietnam Memorial.
I’ve done these back-of-the envelope calculations. If you were to back out all the risk associated with mental illness that’s contributing to the 300,000 people killed by gunshot wounds in the last ten years, you could probably reduce deaths by about 100,000 people. Ninety-five percent of the reduction would be from suicide. Only 5 percent would be from reducing homicide.
“Mental illness is a strong risk factor for suicide. It’s not a strong risk factor for homicide,” Swanson concludes.
“But just because someone has a mental illness and they committed a crime ― the illness isn’t necessarily why they did it,” Swanson says. “Among these people with serious mental illness, the risk factors for committing a violent crime appeared to have more to do with the overall risk factors for violence: being young, male, socially disadvantaged, and involved with substance misuse.”
Wise words indeed.
Read the full interview (well worth your time): Myth vs. Fact: Violence and Mental Health