Mental Health and Gun Violence

Mental Health and Gun Violence

February 7, 2017

The subject of mental health and gun control is in the news yet again, this time mercifully not in response to another mass shooting. On Thursday, by a vote of 235-180, the House of Representatives overturned, through the use of the Congressional Review Act, the Obama administration’s ban on the purchasing of guns by people who have been diagnosed with a severe mental illness, or an SMI.

This ban was seen by supporters of gun control as a common sense ban, the kind of ban that “we should all be able to agree on.” Those people who supported the ban are now up in arms about its repeal. This outrage has been covered extensively in the media.

The ban, however, had several issues, chief among them was the method used to determine the diagnosis of an SMI. The cutoff used for this determination was whether or not a person received Social Security Disability Insurance benefits, or SSDI, due to a mental health disorder diagnosis. The Social Security Administration, or SSA, was required, under the now repealed law, to provide a list of the names of people who received SSDI due to a mental health disorder to the FBI for inclusion in the National Instant Criminal Background Check System, or NICS.

In applying to the SSA for SSDI benefits, the applicant must provide the SSA with complete medical records. These complete records, as well as a complete 15 year employment history, are the primary pieces of information used to make a determination of a person’s eligibility for SSDI benefits. The now overturned ban required the SSA to, in essence, share these medical records with the FBI. The result of this process is that people who had been diagnosed with an SMI and received SSDI benefits had their medical history literally criminalized with the inclusion of it in the criminal background check used to screen potential gun buyers.

If any other kind of medical records were used to criminalize a diagnosis of a medical condition, it would be likely that the very people who are outraged at the overturning of this gun ban would be outraged at the criminalization of those medical records. However, due to the stigma that surrounds mental health disorders, and particularly SMIs, the outrage has gone the other way.

The cultural conflation of SMIs and violence, particularly gun violence, is nothing new. This conflation might be warranted if there were a correlation between mental illness and violence, especially gun violence. There is, however, no such correlation.

Approximately 3% of all violent crime is committed by people with a diagnosed mental health disorder. Gun crimes by people who live with mental illnesses are even more rare. In fact, people with a mental health diagnosis commit gun crimes at a lower rate than the population at large. Insofar as there is a correlation between mental health disorders and violence, the correlation goes the other way. People who live with mental illness are far more likely to be victims of violent crime than the population at large. The cultural assumptions about mental illness and violence need to be flipped around. People who live with mental illness have good reason to be far more afraid of neurotypical people than neurotypical people have to be afraid of people who live with mental illness.

The incidence of gun violence by people with an SMI diagnosis is vanishingly rare. The trope of the madman with a gun is not supported by any real evidence, no matter how breathtakingly it is presented in pop culture. The truth is that the likelihood of someone being killed by a random mentally ill person is infinitesimal.

85% of gun homicides are committed by persons who are known to the victim. The remaining 15% are committed by strangers. Of that 15%, only 3% are committed by people with a mental health disorder diagnosis, and even fewer than that by people with an SMI diagnosis. These kind of homicides are incredibly rare. Of the 85% of gun homicides in which the killer is known to the victim, it is very common for the killer to have a previous history of domestic violence, often against the murder victim. It would be far more effective for the prevention of gun homicides for gun control efforts to be focused on people with a history of domestic violence rather than at people with a diagnosed SMI.

To provide an idea of how rare gun murders by people with a diagnosed SMI are, the NYPD determined, based on their accumulated evidence, that you are more likely to drown in a bathtub than to be murdered by someone unknown to you, with or without an SMI. Due to the extreme rarity of gun murders by people with a diagnosed SMI, you have an even greater chance still of drowning in a bathtub than you do of being murdered by someone with an SMI diagnosis. And yet there is no cultural call to ban certain segments of the population from taking a bath. That would be seen as being ludicrous.

Simply being a white man is a greater predictor of gun violence than having a diagnosed SMI. There is a greater statistical argument to be made for having a blanket ban on white men owning guns than a blanket ban on people with a diagnosed SMI from buying guns. The outrage over white men being banned from owning guns would be deafening. You simply cannot deny Constitutionally guaranteed rights from white men just because they happen to be white men. That would be ridiculous. And yet the denial of those same Constitutionally guaranteed rights to people with diagnosed SMIs has far more support, despite the complete lack of evidence for its necessity. Again, this simply comes down to stigma.

Every time there is a mass shooting people who live with mental illness are stigmatized. You see politicians in the media declare that the “real issue” with gun violence is mental illness. You see calls for better mental health care. You see calls for the kind of gun ban that was just overturned. While there should be a national conversation about mental health care, and a real effort to improve the state of mental health care in the nation, that these calls are made nearly exclusively after a very public incidence of gun violence is incredibly problematic. Rather than advance the cause of mental health care it instead scapegoats people who live with mental illness and advances the kind of stigma that is ultimately counterproductive in the effort to improve healthcare and quality of life for those who live with mental illness.

Even if there were a proven connection between mental illness and gun violence, which there notably isn’t, gun bans like the Obama administration’s one would be wholly ineffective in treating the issue. Perpetrators of gun violence almost never have a mental health diagnosis. There is always a cultural push for a diagnosis after the fact, which is its own issue, but a diagnosis before the violent act is exceedingly rare. Beyond that, a diagnosis of an SMI is even more rare, and a diagnosis of an SMI along with the receipt of SSDI benefits is virtually non-existent. Having the receipt of SSDI benefits due to an SMI diagnosis as the determination for the ineligibility of a person to purchase a gun would not reduce gun violence in any way. Gun violence by people who meet those conditions is statistically non-existent.

There may be a reason to discuss erecting a barrier between people who live with mental illness and the ownership of guns. The majority of gun deaths are suicides, not homicides. 61% of all gun deaths are deaths by suicide, and the suicide rate of people who have been diagnosed with an SMI is considerably higher than the population at large. If the tragedy of deaths by suicide inspired cultural conversations on improved mental health care and gun control, that might be a cultural conversation worth having. There is, however, a condescendingly paternal element to the idea that people with diagnosed SMIs not be allowed to own a gun due to the possibility of suicide, but at least there is data to support that position.

Deaths by suicide, however, are not catalysts for these calls to action. Homicides are. Mass shootings are. And the plain truth is that scapegoating people who live with mental illness will not have any impact on reducing the homicide rate or mass shootings. No matter how breathless the coverage that scapegoats people with mental illness is whenever a public shooting takes place, the numbers say that there is no real connection.

To insinuate a connection between the two is to do nothing to address the issue. Instead it merely unconscionably increases the stigma surrounding mental illness and shifts the national conversation away from the ubiquity of guns in our culture, and the fact that America has more gun deaths than the next 22 nations combined.

This cultural connection between mental illness and gun violence quite simply just needs to go away. It is counterproductive, it is morally indefensible, and it is wholly ineffective in addressing the issue of gun violence. The only thing it accomplishes is to very tangibly have a negative impact on those who live with mental illness.

____________Updated Resources as of 2/16/18:_______________________

SAMHSA Disaster Distress Helpline
Coping After Disaster Trauma
Hierarchy of Needs for the Disaster Survivor
No Plans Survive First Contact with the Enemy: Flexibility and Improvisation in Disaster Mental Health

New York Times Resources for Talking and Teaching About the School Shooting in Florida
New York Times 10 Ways to Talk to Students About Sensitive Issues in the News

Talking to Children About Scary News
Talking ot Children About Tragedies and Other News Events
How to Explain Scary News to Children
Caring for Kids After a School Shooting
Childrens Mental Health Information from MHA National
National Child Traumatic Stress Network Resources
National Association of School Psychologists Linked Resources

Position Statement 72: Violence: Community Mental Health Response
Position Statement 59: Responding to Behavioral Health Crises

Violence Injury Prevention
Violence and Mental Health Fact Sheet