Fixing Mental Health Care Will Not Stop Mass Shootings, But That’s Okay
As mass shootings become the focus of public attention after two high-profile incidents in the span of a couple of days, more and more people are demanding a response from Congress. Speaker of the House Paul Ryan recently faced a question about how to address mass shootings to which he responded saying that the focus needs to be on mental illness. Ryan then pointed to a bill from Representative Tim Murphy, a Republican from Pennsylvania, which seeks to overhaul the American mental health system. While nearly everyone agrees that the United States needs a better approach to mental health, the connection between mental illness and mass shootings is much more complicated than it may seem.
Before we get into the validity behind associating mental health with mass shootings, it is important to acknowledge the fact that most Americans see it as an important underlying problem. According to an ABC/Washington Post poll from October, Americans are nearly split on whether the government should prioritize passing new gun laws or protecting gun rights, but nearly two-thirds believe that improving mental health treatment is necessary to address mass shootings. When asked whether mass shootings are a reflection of problems with identifying and treating people with mental health issues or inadequate gun control laws, 63 percent believe mental health is the issue. There is a partisan difference in opinions–Republicans overwhelmingly focus on mental health while only 46 percent of Democrats focus on mental health alone. But despite those differences, only 23 percent of respondents said inadequate gun control laws were more concerning than mental health issues.
While Democrats often criticize Republicans’ reluctance to talk about gun control after mass shootings, it’s fair to say that addressing mental health problems is a greater concern for their constituents than stronger gun laws are. So in the wake of the tragic Sandy Hook shooting in 2012, the Republican Party looked to Rep. Tim Murphy, the only psychiatrist in Congress, to come up with a response. Murphy traveled across the country to speak with communities and mental health experts to determine the best way to fix the current system. While Murphy’s bill, the Helping Families in Mental Health Crises Act, marks the most comprehensive approach to overhauling the U.S. mental health system, it’s important to ask how doing so will affect mass gun violence.
In a review of research on mental health and gun violence, Vanderbilt University professors Jonathan M. Metzl and Kenneth T. MacLeish find that there is little evidence to suggest that mental illness causes gun violence. While it is true that in the aftermath of mass shootings reports often indicate that the perpetrator experienced some sort of paranoia, delusion, or depression prior to the attack, suggesting that mental illness caused the shooting is another matter. Metzl and MacLeish cite the finding that less than 3 to 5 percent of crimes in the United States are committed by people with mental illness, and that proportion may be lower in terms of gun crime.
In fact, people with mental illness are far more likely to be the victim of a crime than the perpetrator. For example, one study found that people diagnosed with schizophrenia are victimized at rates 65 to 130 percent higher than the general public. The authors concluded, “In general, the risk associated with being in the community was higher than the risk these individuals posed to the community.” Saying that all people diagnosed with mental illnesses are likely to commit mass shootings is about as useful as saying we should take away the gun rights of white men because most mass shooters also fit that demographic. In reality, the vast majority of white men and people diagnosed with mental illness will not commit mass violence.
Metzl and MacLeish also question the claim that mental health professionals can predict and prevent gun crime. While efforts to prevent the next mass shooting are well intentioned, basing that off of psychiatric diagnosis is remarkably difficult. The authors argue that psychiatric diagnosis is primarily a matter of observation, and they note that for that reason “research dating back to the 1970s suggests that psychiatrists using clinical judgment are not much better than laypersons at predicting which individual patients will commit violent crimes and which will not.”
In some ways, the difficulty in using psychiatric diagnosis to predict mass violence is a matter of math. Public health research can be used to determine a person’s risk of heart attack based on large-scale studies and randomized trials, but when it comes to mass shootings and mental health, the data is limited. As Jeffery Swanson, a professor in Psychiatry and Behavioral Sciences at Duke University School of Medicine, notes in his research on predicting rare acts of violence:
In a U.S. city the size of San Jose, California, (population about 1,000,000), about 4,000 people every year will have a heart attack; perhaps one or two will be killed by someone with mental illness wielding a gun. Treatment evidence for preventing death from myocardial infarction has piled up from hundreds of clinical investigations over several decades, involving more than 50,000 patients in randomized trials by the early 1980s . When it comes to persons with mental disorders who kill strangers, there is nothing remotely resembling such an empirical evidence base.
The Republican mental health bill marks an ambitious effort to address a growing problem in the United States, but saying that it is a plan to prevent future mass shootings is misleading. According to the Treatment Advocacy Center, there are 350,000 Americans in state jails and prisons who have been diagnosed with a severe mental illness–that, among other things, is what Rep. Murphy’s bill seeks to address. The bill would restructure the funding for mental health care and change health privacy rules to allow family members to get information about a loved one’s treatment. On the other hand, the bill does not address whether or not someone with a mental illness should have access to guns.
Instead of advertising Murphy’s bill as a means to solve mass shootings, Congress should focus on the need for mental health reform by itself. The Helping Families in Mental Health Crises Act does have controversial provisions, notably whether states should be encouraged to develop Assisted Outpatient Treatment programs, which allows courts to compel treatment for individuals before he or she has a mental health crisis. And whether Murphy’s plan to move funding from the Substance Abuse and Mental Health Services Administration–which he views as wasteful and ineffective–to a create an Assistant Secretary for Mental Health is the best way to spend money on mental health treatment.
Murphy’s bill is certainly ambitious and he already has some bipartisan support and backing from important mental health groups, but it also has some controversial provisions. For this reason, the debate on its passage should focus on whether or not it will improve and expand treatment for the 10 million Americans who experience severe mental illness in a given year–not whether it will prevent mass shootings.