Public health and firearms experts assert that focusing on mental illness is unlikely to achieve a significant reduction in gun violence, because the vast majority of shootings are the handiwork of people who do not fit the profile of those deemed dangerous. Moreover, by shifting the debate away from gun control and toward mental health concerns, proponents run the risk of further stigmatizing mental illness, discouraging those who confront it from seeking professional help.
“Gun violence is a mental health issue only to a very small extent and to a much smaller extent than most people assume,” said Paul Appelbaum, a psychiatrist and the director of the Columbia University College of Physicians and Surgeons’ Division of Law, Ethics and Psychiatry.
Despite the earnest discussion of mental illness that follows seemingly every headline-capturing mass shooting, people with mental illnesses are responsible for no more than 5 percent of all violent acts in the United States, according to research published by the Institute of Medicine in 2005.
But in the policy arena, public perception functions as effective reality, given the dearth of data. No thorough study exists establishing a connection between mental illnesses and mass shootings, Appelbaum said. Neither does a database of mass shootings that would allow researchers to flesh out a useful profile of those seemingly prone to horrific violence.
What’s more, experts say many if not most of the gun-related tragedies that have captured national attention in recent years appear unlikely to have been prevented, even had stronger rules been in place barring people with mental illnesses from owning weapons.
Zeroing in on mental health problems in the face of an overwhelming preponderance of shootings involving people without such conditions threatens to mislead the public about the nature of the epidemic at hand, argues Garen Wintemute, the director of the Violence Prevention Research Program at the University of California-Davis School of Medicine.
“We’re focused on mass shootings and those perpetrators are thoroughly investigated and we come away thinking that they’re mentally ill,” when that isn’t always the case, said Wintemute, who is also a medical doctor. “The vast majority of firearms violence is not committed by people who are crazy. It is committed by people like us.”
Those with mental illness are flawed examples of the causes of American gun violence, and putting a spotlight on their cases oversimplifies the problem while effectively demonizing their ailments, said Stephen Hoge, a professor at the Columbia University Department of Psychiatry and a forensic psychiatrist.
“People want to believe that the problem is easy to solve, and that they can somehow insulate themselves from the risks of gun violence by insulating themselves from people with mental illness,” said Hoge.
In reality, gun violence tends to be provoked by commonplace situations faced by people who do not stand out as particularly remarkable in terms of their mental well-being, he added. “In some cases, the perpetrators are motivated by delusions or psychotic beliefs,” Hoge said. “In other cases, they’re motivated by jealousy, rage, feelings of having been intimidated, disrespected, abused.”
In short, they rarely fit neatly into a readily identifiable profile that lends itself to prevention.
“There’s an undeniable stigmatizing impact of discussing mental health in the context of gun violence,” said Appelbaum, of Columbia University. This furthers the stereotype that people with mental illnesses are more violent than the rest of society, he said.
That public perception is reflected in a survey published in the New England Journal of Medicine this week: 46 percent of respondents said they believe those with serious mental illnesses are more dangerous than others, 71 percent said they wouldn’t want to work closely with a person who had a mental illness, and 67 percent said they wouldn’t want a neighbor with a mental illness.
Mental health professionals say there’s no reliable way to predict violence unless patients declare their intentions to hurt themselves or others.
“It is virtually impossible to identify who among the mentally ill are likely to be violent,” Columbia University’s Hoge said. “To have a policy that is based on identifying individuals who are likely to become violent is a failed policy from the beginning.”