We Can End Gun Violence By ‘Fixing” The Mental Health System, Right? Wrong.

Jeffrey Swanson has been conducting important research on violence for as long as I can remember, and now he and his colleagues have published a major study on mental illness and gun suicides with a major finding that people who have been briefly hospitalized for mental issues are more likely to then commit suicide with a gun.

Gun Nut Nation usually denies the existence of ‘gun violence,’ unless it is perpetrated by ‘street thugs’ or people who are seriously mentally ill. As to the former, the solution according to the NRA is to lock ‘em up and throw away the key; for the latter the mental health ‘system’ needs to be ‘fixed.’  Last August Donald Trump told the then-adoring media that two Virginia television journalists wouldn’t have been killed if the mental health system wasn’t ‘broken.’ Which happens to be the subject of Swanson’s research and, no great surprise, happens not to be true.

crime2           Because the problem isn’t whether mentally ill individuals receive proper treatment before or after they commit a violent act against others or themselves; the problem is whether the legal system, not the mental health system, allows such individuals to keep getting access to guns. The research by Swanson, et. al., covered more than 80,000 adults who received mental health treatment in two Florida counties – Dade (Miami) and Pinellas (St. Petersburg) from 2002 to 2011.  Of this total population, roughly one-third were prohibited from owning guns either because of a mental health disqualification (long-term hospital commitment, incompetent to stand trial) or a criminal record; i.e., conviction for a felony crime.  Of the remaining two-thirds of this population that had been treated for mental illness, none were disqualified from gun ownership even if they had been temporarily placed in a treatment facility against their will.

And what was the result of a legal (not a mental) system which allowed such individuals continued access to guns?  The results of the study were ambiguous as to the degree to which such people used guns to commit serious crimes, but it clearly showed a link between access to guns by this population and an increase in gun suicides, and this in a population that was more vulnerable to suicide given the fact that they had been treated for mental problems in the years leading up to their life-ending attempt.

Now I’m not going to spend one second responding to the loony emails I receive all the time from Gun Nut Nation telling me that the 2nd Amendment protects everyone’s ‘right’ to choose whether they want to end their own lives (I actually do receive such crazy stuff) except to say that people who attempt suicide and fail overwhelmingly state that they are glad to still be alive.  But using a gun to commit suicide usually doesn’t give someone much chance of surviving, and what this study found was that a majority of gun-eligible individuals who committed gun suicides had experienced one or multiple short-term, involuntary commitments which, in Florida, are not reportable legal events.

So here we come back not to the mental health system but to the legal system which needs to be fixed if some way is going to be found to cut the suicide rate among people who have not been legally disqualified from owning guns.  And guess which organization stands up and cries – foul! – every time an effort is made to fix the legal system in order to help protect some gun owners from themselves.  Because in case you didn’t know it, back in 1999 the World Health Organization defined violence as “the intentional use of physical force, threatened or actual, against oneself, another person, or against a group or community.”

So let’s cut the NRA nonsense about how the mental health system needs to be ‘fixed.’ And while we’re at it, remember there are 146 days until we have an opportunity to send Donald Trump away for a much-needed mental health fix himself.

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An Important And Compelling New Book About Gun Violence.

Gun Violence and Mental Illness is the most important book on gun violence published since Sandy Hook.  And what makes it important is not only the eminence and research capability of the contributors, but the breadth of the discussions about gun violence itself.  In a sense, the title of the book is somewhat misleading, because the work goes far beyond mental issues.  In fact, this superb collection touches on every aspect of gun violence – causes, mitigations, public policies – even though the authors and editors often define the issue in mental illness and mental health terms.

gold bookIt must be mentioned, however, that Dr. Liza Gold, her co-editor Dr. Robert Simon and the 27 expert contributors, are hardly the only ones carrying on a public discussion about guns and mental illness at the present time.  In fact, none other than such esteemed medical specialists as Donald Trump, Carly Fiorina, Jeb Bush, and all the other know-nothings running for the Republican Presidential nomination have been speaking their empty minds about gun violence and mental illness, and let’s not forget that the Republican field even includes a real-life medical expert, Benjy Carson, who when he opens his mouth and talks about gun violence actually sounds like the dumbest of all.  At least Trump, unlike Carson, hasn’t yet tried to blame the Holocaust on all those unarmed Jews.

But to get back to people who know what they are talking about, or for sure writing about, the format of Dr. Gold’s book lends itself to a very clear awareness just how complicated and diverse gun violence can be, in terms both of understanding it and responding to it.  If there’s one thing above all that spawns my opposition to the current iteration of the NRA, it is the ‘dumbing down’ of every commentary produced by the pro-gun community simply by dividing the world into ‘good guys’ and ‘bad guys.’  From the capable introduction by Dr. Gold, all the way to the concluding essay on public health interventions by Shannon Frattaroli and Shani Buggs, you are made aware that there ain’t no ‘good guys’ or ‘bad guys;’ instead there are many complex issues, each of which must be studied on its own terms.

I mention the chapter by Frattaroli and Buggs because it happens to focus immediately on one of my own pet peeves in the whole gun violence universe, namely, the notion that children can and should be taught safety procedures around guns.  This represents the single most pernicious attempt by the pro-gun community to remove the whole notion of lethality from the discussion about guns, and unfortunately, some of the GVP adherents subscribe to the alleged mitigating effects of childhood gun safety education as well.  Basically, what the authors conclude is that interventions based on educating children about gun risk are, at best, a mixed bag, with most of the studies producing results that are too ambiguous to be of any real outcome-predictive value at all.

I concur.  There’s only one way to guarantee that your children won’t shoot themselves or someone else with a gun in your home.  Either the kids get out or the guns get out.  And the idea that all those responsible gun owners will always lock up their guns has no empirical basis at all; we are human, we are careless, we forget. Thank you Shannon, thank you Shani.

All 14 chapters treat different aspects of the problem (mass shootings, school shootings, youth violence, suicide, etc.) and each compellingly begins with a list of ‘Common Misperceptions’ about each topic followed by ‘evidence-based facts.’  A book on gun violence held together by facts?  What an interesting, new approach. Hyperbole notwithstanding, I did a quick calculation and it appears that the pro-gun community’s mis-perceptions about gun violence lead GVP mis-perceptions by better than two to one.  It’s too bad that the folks who really need to know what’s in this book probably won’t be reading it.

 

Is There A Connection Between Gun Violence And Mental Illness? That’s Not The Right Question To Ask.

Over the last several months, the intersection of horrific shootings and Presidential politics has once again ignited the debate over mental illness and guns.  After Sandy Hook, the pro-gun forces took the position that mass shootings could be stopped if we ‘fixed’ the mental health system.  In the wake of Roseburg, however, even that tepid (and meaningless) strategy has been abandoned by the gun gang and their Republican allies with Shlump Trump advising us that too many mentally-ill people “slip through the cracks.”  Meanwhile, mental health professionals and researchers continue to hold to the belief that, with the exception of suicide, that there is little, if any connection between mental illness and violent behavior involving guns.

shooter               What both sides seem to be saying is there’s no real solution to the problem of gun violence from a mental health perspective, because either there are too many crazies walking around or there’s no necessary connection between being mentally ill and using a gun in a violent way .  But deciding that a certain kind of behavior does or doesn’t reflect mental illness is one thing; understanding the behavior itself is something else.

If the evidence about gun violence tells us anything, it’s that using a gun to hurt yourself or someone else is an overwhelmingly impulsive act.  It is impulsive because in perhaps 90% of all gun violence, the shooter and victim not only knew each other before the gun was pulled out, but there had been continuous and angry or abusive contact between the two parties often for a lengthy period of time.  Obviously this is the case in gun suicides, which comprises two-thirds of all gun mortality; it’s true in most gun homicides, particularly for every gun homicide that grows out of a domestic dispute.  As for gun morbidity, which is so noticeable between the ages 15 and 25, most of the young men who present themselves in ERs and clinics with gun violence injuries previously sought medical assistance for other, less lethal injuries committed by the same assailants again and again.

Gun violence is not the usual way in which disputes are settled. In situations where two people get involved in a continuous dispute, four out of five of these arguments are eventually resolved violently or not – and here’s the critical point – without anyone pulling out a gun.  As Lester Adelson says in what remains the most brilliant article ever written about gun violence: “With its peculiar lethality a gun converts a spat into a slaying and an argument into a killing.”  But for every act of gun violence there are hundreds, no doubt thousands of spats and arguments that do not end up with someone being shot with a gun. And for the 20,000 law-abiding gun owners who use a gun to end their own lives each year, there are tens of thousands of seriously-depressed men and women who obtain counseling and assistance without ever thinking of taking out a gun.

Gun violence, particularly mass shootings, tears deep wounds in our cultural and emotional frameworks and shouldn’t be the subject of nonsensical and cynical sloganeering by entertainers masquerading as Presidential candidates who spend a few months on the national media circuit shamelessly promoting their names.  By the same token, those who are genuinely trying to do something to eliminate gun violence need to understand what is really at issue when it comes to defining a response to this national shame.

The word ‘impulsive’ means that someone engages in behavior without first spending one second considering the consequences of the act.  The good news is that nearly all of us learn how to express anger, even rage, without yanking out a gun.  Pardon the pun, but we still don’t know have a good fix on the trigger mechanism that turns violent behavior into gun-violent behavior. And if you want to yank out a piece, believe me, it will be there to yank out. Believe me.