Gun violence, mental health link complex

Crayon drawing of black gun and red circlesIt’s an all too familiar story: Another mass shooting occurs and innocent lives are lost. In the aftermath, the media reports, yet again, that the shooter has, or had, a mental illness.

We feel all at once sadness, grief and outrage. And the headlines make it easy to believe people with mental illness are violent. But in fact, the causes of gun violence and how to stop it are much more complex issues.

Social workers solve complex problems every day and want to play a role in regulating access to guns. But not at the expense of those with mental illness, who are often scapegoats in the wake of gun violence tragedies.

At the same time, there are admittedly certain circumstances where mental illness leads to violence, and the individual involved should not have access to firearms. How social workers navigate this tricky debate to enact real change will make a difference.

“The majority of violence is committed by people who do not have a diagnosis, however there are certain incidences when this does occur. When it does, there is big publicity pulled to this issue (of gun violence and mental health),” said Will Francis, the government relations director for NASW’s Texas Chapter. “We need to keep a conversation going beyond the response to gun violence, and have two distinct and separate discussions around supports for mental health and gun control.”

Research points away from mental illness alone as a factor in gun violence, despite the opinions of some to the contrary. According to statistics from the Centers for Disease Control, of the 33,169 people in the U.S. who died by gun violence in 2013, 62 percent (21,175) were suicides. An American Journal of Public Health article, “Mental Illness, Mass Shootings, and the Politics of American Firearms,” by Jonathan M. Metzl and Kenneth T. MacLeish, says only about 4 percent of all violence in the U.S. can be attributed to people diagnosed with a mental illness.

Gun-rights advocates, at times, have mischaracterized the realities of how mental illness influences gun violence. In 2012, the National Rifle Association came out forcefully after the Newtown, Conn., tragedy — calling people with mental illness “monsters”.

NRA spokesman Lars Dalseide said, “Comments on individual cases should not be applied to a group as a whole,” when he was asked for this article if past statements by the NRA contributed to stigmatizing those with mental illness.

Gun-regulation advocates, on the other hand, view comments like this as a distraction from focusing on real gun-access issues. The Coalition to Stop Gun Violence broadens the conversation beyond mental health, and highlights many predictors of gun violence and dangerous behavior — and is more aligned with the thinking in the mental health community.

In 2013, The Consortium for Risk-Based Fire Arms Policy’s Evidence Based Approach for State Policy Report pointed to several key risk factors associated with firearm violence, including violent crime, domestic violence, and alcohol and substance use.

“Our approach is to look at all of these other risk factors so we don’t start classifying dangerousness on the basis of a mental illness diagnosis alone,” said Josh Horwitz, executive director of the Educational Fund to Stop Gun Violence.

This organization also advocates for laws such as the California Gun Violence Restraining Order, which allows law enforcement to remove guns from someone’s possession when violence seems likely and not just imminent.

Current Laws, Positions

The effectiveness of current gun laws in stopping gun violence and keeping individual gun rights intact has been hotly debated. The Gun Control Act of 1968 prohibited those who were involuntarily committed or “adjudicated as being mentally defective,” from buying or possessing guns. To restore the gun rights of those committed or adjudicated, a person must petition a court.

The Brady Act in 1993 established federal background checks to identify felons, people involuntarily committed to mental health treatment, and domestic abusers who try to obtain guns — and established a five-day waiting period on purchases for those individuals. In 1998, the NRA pushed for the creation of The National Instant Criminal Background Check System (NICS), which currently replaces the waiting period required by the Brady Act and provides instant background checks for gun purchases at the point of sale.

On the surface, these laws might appear to keep people with a variety of risk factors for violence (not just mental illness) from obtaining a gun, but they have not always worked as intended. As social workers know, involuntarily committing someone to treatment is difficult — with criteria varying from state to state and a lack of psychiatric hospital beds available.

Even when social workers are able to secure court ordered treatment, many states are slow to update NICS. A National Center for State Courts study found there should be roughly twice as many mental health records in the national database as there currently are, based on responses from 42 of 56 states and territories.

But to put the number of mental health records into perspective, a Wall Street Journal article from January 2011 states that between Nov. 30, 1998, and Dec. 31, 2010, only 6,103 attempted gun purchases at federally licensed dealers were stopped because of mental illness prohibitions. That was just .74 percent of all NICS denials.

The reporting of mental health and criminal records to NICS has been a problem. After the 2007 Virginia Tech shooting, a law, backed by the Brady Campaign and the NRA strengthened states’ reporting of mental health and criminal records to NICS. The shooter in the Virginia Tech tragedy was found by the court to be a danger, but still passed a background check to purchase a gun.

Mental Health America and the National Alliance on Mental Health’s position statements articulate the danger of creating violence-prevention measures and gun laws based on mental illness, which perpetuates stigma and could create a barrier for seeking treatment. Also stressed is the need to focus on prevention and early intervention.

Looking Ahead

In President Obama’s recent executive action to reduce gun violence — which NASW praised for the proposed new $500 million in funding for mental health and closing the loopholes for background checks for gun sales — the push for better reporting to the NICS system continues.

“This executive order doesn’t have teeth, but it is symbolic and stresses we need to have a conversation about this,” said Miriam Nisenbaum, executive director of the NASW Texas Chapter. “This issue has been so polarizing, and having no real discussion or legislation has been the outcome.”

“The president put his voice in a place where it needs to be, and this is just the beginning of the conversation, not the end,” Francis said.

While the mental health community welcomed Obama’s actions, it also raises concerns about the potential weakening of confidentiality protections when mental health records are reported to NICS.

Of additional concern is the recommendation that the Social Security Administration shares with the FBI the names of beneficiaries who have a mental illness and do not manage their own affairs. It is feared that compromises in confidentiality will deter people from seeking treatment, and that narrowly defining people with mental illness or disabilities as potentially violent and sweeping them into NICS is unfairly singling out those with disabilities.

While NASW and the mental health community express concern over confidentiality, others have a different opinion.

“We respect that people’s mental health record should be confidential, but I think the fears of reporting to NICS are little bit overblown,” said Horwitz, of the Educational Fund to Stop Gun Violence. “First, it’s a misnomer that whole records are sent to NICS. It is only a notice of mental health adjudication and not the confidential mental health information. Second, the gun dealer just gets a yes, no or wait message with no details as to why.”

The NRA’s Dalseide agrees.

“Concerns regarding HIPAA are minute, as the person running a background check will never see why a prospective buyer was denied, only that they were denied,” he said.

But Nisenbaum isn’t so sure.

“I think anytime you are reporting things about people’s medical history, it touches on confidentiality,” she said. “I don’t really know if the concerns are unwarranted or warranted, but I’m always concerned about releasing people’s history. We have to weigh protecting the public with the right of an individual.”

Obama’s executive order is not the only policy that addresses mental health and gun violence. Sen. John Cornyn, R-Texas, introduced The Mental Health and Safe Communities Act last fall. The NRA backs this legislation, and it’s also praised by NAMI for diverting people with mental illness from jails and bolstering assertive community treatment options.

But it’s also been reported that this bill — and other previous efforts — have provisions which make it easier to restore the gun rights of those who have been involuntarily committed immediately after discharge from a hospital. This is highly controversial given brief hospitalizations do not necessarily stabilize someone’s mental health.

“The Mental Health and Safe Communities Act doesn’t change federal law when it comes to the reinstatement of rights, it only ensures that state laws conform with federal law so that everyone is playing with the same rule book,” Dalseide said. “You have to remember that … a deliberate adjudicated process was taken to remove those rights, so there must be a deliberate adjudicated process to restore them. The current process mandates an order and a finding for each.”

“We [NASW Texas Chapter] have some concerns about that bill because it mentions specifically about those adjudicated mentally ill and committed to a psychiatric hospital, but doesn‘t say anything about people hospitalized who were not adjudicated mentally ill and are not in any condition to have a gun,” Nisenbaum said. “We don’t want to take away people’s rights for no reason, but this needs some clarification. Regardless, linking the two issues of mental health and gun violence together is a slippery slope.”

It’s important to note there is much more to learn about gun violence, given that the CDC was barred in 1997 from conducting empirical research on the causes and prevention of gun violence. It was not until the Newtown, Conn., school shooting and Obama’s executive order that the CDC was permitted to do limited research.

If you look at these two issues, there is not a lot of overlap between gun control and mental health, and everyone is jumping into this tiny little sliver in the middle. The reality is, most of the discussion happens in the larger contexts, Francis said.

Nisenbaum adds, “There is always a problem for social workers to put these two issues [gun violence and mental health] together. We need to ask ourselves what does it mean to link these two things together? Why do we need to do this?”

These are questions every social worker should consider as they play a role in helping to stop gun violence while protecting the rights and caring for people with mental illness.