Wednesday, January 13, 2016
Mental Health Reform Will Not Reduce US Gun Violence, Experts Say
The report below appeared in JAMA, a leading medical journal. It contradicts Obama's view that a crackdown on mental illness is needed
Charleston, South Carolina. Lafayette, Louisiana. Roseburg, Oregon. Colorado Springs, Colorado. Although these towns have little in common, they will be forever linked. In each of them in 2015, an individual with a gun opened fire in public places where people gather: a church, a movie theater, a college campus, and a health clinic.
Because the perpetrators of these and other widely publicized mass shootings are often described in news coverage as mentally ill outcasts, many people and their representatives in Congress view improving mental health services as the key to reducing gun violence.
But while few people would disagree with the need for mental health reform, scientists who study gun violence say it won’t make much of a dent in the number of homicides and attempted homicides committed with firearms. That’s because although mass shooters are likely to be mentally ill (but not necessarily diagnosed), high-profile mass shootings represent only a small fraction of US gun violence, the vast majority of which is committed by people who are not mentally ill. In addition, most people with mental illness are not violent; they are far more likely to be the victims than the perpetrators of shootings.
People should realize that “even though it feels that mass shootings happen all the time, they’re still extremely rare,” said Jeffrey Swanson, PhD, a professor of psychiatry and behavioral sciences at Duke University.
Through early December 2015, about 450 individuals died in mass shootings in the United States last year, according to Mass Shooting Tracker, a crowd-sourced website that defines a mass shooting as one in which at least 4 people have been shot but not necessarily killed (http://bit.ly/1MuHpVL). Compare that with 11 208, the number of people killed in homicides committed with firearms in 2013, the most recent year for which the Centers for Disease Control and Prevention (CDC) has US data (http://1.usa.gov/1GEJ0TN).
“The link between guns and mental illness is a link that needs to be debunked, because at least 95% of violent acts are committed by persons without serious mental disorders,” said American Psychiatric Association President Renée Binder, MD, founding director of the psychiatry and law program and forensic fellowship at the University of California, San Francisco.
Only mass shooters might be more likely to be mentally ill, psychiatrist Jonathan Metzl, MD, PhD, noted in a recent article (Metzl JM and MacLeish KT. Am J Public Health. 2015;105:240-249). Reports suggest that up to 60% of the perpetrators of US mass shootings since 1970 displayed such symptoms as acute paranoia, delusions, and depression beforehand, according to Metzl.
But the typical description of a mass shooter, “a young, alienated, isolated, troubled young man who might be somewhat delusional,” matches tens of thousands of other men who would never kill anyone, Swanson said.
“People refer to that as a needle-in-a-haystack problem,” said Binder, citing a meta-analysis of studies from Australia, Denmark, Finland, Germany, and the United Kingdom that estimated the annual risk of a person with schizophrenia killing a stranger to be 1 in 70 000 patients, assuming that 0.5% of the population has the illness (Nielssen O et al. Schizophr Bull. 2011;37:572-579).
And it’s virtually impossible to dig out those needles, said Metzl, director of the Center for Medicine, Health, and Society at Vanderbilt.
“There’s no real psychiatric diagnosis that psychiatrists can use to predict which patient is going to commit a violent act and which isn’t,” he said. By blaming gun violence on mental illness, Metzl said, “we lose the sense of the larger contextual factors that surround the violence,” such as drinking, arguing with a spouse or neighbor, having access to firearms, and having a history of violence, all of which are statistically correlated with gun violence but not linked to mental health disorders.
JAMA. 2016;315(2):119-121. doi:10.1001/jama.2015.16421