Mental Illness and Guns

Ever since the Sandy Hook Elementary School shooting there has been much discussion about improving the nation's mental health care system. But what exactly does that mean? It seems that nearly all of us agree that we should keep firearms away from people who are mentally unstable, but accomplishing that is much more difficult than generally realized.

We must remember that the term "mental illness" is only a general term that refers to more than 300 mental health disorders that are currently recognized. In order to thoroughly analyze this issue, we must differentiate between specific mental disorders, because not all mental illnesses lead to a high likelihood of violence. Thus, there will not be an effective "one size fits all" solution.

Mental illness is much more prevalent than we might realize. In any given year, a full 25% of U.S. adults are diagnosable for at least one mental health disorder, with approximately
6% of the population suffering from a "seriously debilitating mental illness" (SMI). SMI's, which are commonly present in people who commit violent acts, include schizophrenia, bipolar disorder, and autism.

Our current mental healthcare system was primarily established by the U.S. Supreme Court case Lessard v. Schmidt. The Lessard decision stated that people who suffer from mental illness are entitled to the same Constitutional rights as everyone else -- they cannot be illegally detained, are entitled to legal due process, have the right to own firearms, etc. In addition, a law enforcement officer can only take a person into custody, if the officer has probable cause to believe that the person presents an immediate danger to him/herself or others.

However, if the person doesn't present any immediate danger, and has not committed a crime, a law enforcement officer cannot legally take that person into custody. This oftentimes leads to the person remaining in the same environment which may have helped contribute to the problem in the first place.

This is the critical issue regarding our current mental health policy. Law enforcement officers encounter people every day who suffer from mental illness and have not committed a crime. But just because a person suffers from mental illness doesn't mean the officer can take them into custody. If the officer doesn't have any evidence that the person poses an imminent danger then sometimes there is little the officer can do. This means the officer may walk away having done nothing to reduce the possibility of a violent act being committed.

A person who suffers from developmental disabilities and mental illness is 7 times more likely to come into contact with law enforcement. Consequently, officers have a major opportunity to intervene in ways that others will not. If an officer cannot take a person into custody, the officer still should highly consider other actions such as notifying the person's family members, their treatment provider, talking the person into voluntarily seeking treatment, transporting the person to a homeless shelter, etc.

While all states adopted the Lessard standards, mental health laws still vary from state to state. Each state defines "dangerous" and "mental illness" differently. Both federal law and most states' laws are designed to prevent people with mental illness from owning firearms. In addition, people prohibited from owning a firearm by one of these laws can be entered into a national database (NICS) of people who are not allowed to purchase or possess firearms.

However, many states only make it voluntary to report people with mental illness to NICS, and many states choose not to report. Both Sen. Lindsey Graham (R-SC) and Sen. Jeff Flake (R-AZ) have indicated that their states have not entered tens of thousands of mental health records to NICS. A current bill under debate in the Senate encourages states to submit mental health records to NICS, but it doesn't make reporting mandatory. Reporting to NICS should be mandatory, not encouraged. We don't encourage convicted felons to get entered into NICS; indeed it is mandatory. Why would we not do the same with those who are assessed to be at a high risk of committing violence?

Regardless of the state, however, many people with SMI do not receive adequate treatment. A
2008 survey showed that only 58.7% of those suffering from SMI, received treatment. That means 42.3% are not receiving any treatment. In the last 50 years the number of beds in psychiatric hospitals has decreased from 559,000 to 43,000.

Bottom line: there have simply been too many mass shootings in the U.S. for us to think that we don't need to change the way we do some things. One recent study showed that there have been 62 mass shootings in the last 30 years, with 61% of the shooters having shown signs of mental illness prior to the shooting. Three separate studies all showed that mass killings are increasing.

While the majority of people who suffer from mental illness might not be dangerous, a small percentage are incredibly dangerous. Approximately 10% of all homicides are committed by someone with untreated, severe mental illness. Of greatest concern are those who are not receiving any treatment. Dr. E. Fuller Torrey, a research psychiatrist involved with SMI's, recently wrote:

Would we have fewer mass killings in the U.S. if we made sure that individuals with severe mental illnesses were receiving treatment? Examining the other 10 largest mass killings suggests that the answer is yes.

While law enforcement remains on the front lines of dealing with mental illness, another emerging trend is Assisted Outpatient Treatment (AOT). AOT is court-ordered outpatient treatment for people with mental illness who meet certain criteria. AOT is now permitted in 44 states. Several studies have shown that AOT reduces hospitalization, violence, homelessness, and reduced stress for caregivers. Legislators must be passing legislation which allows for the continued expansion of AOT.

We are then left with these questions: Can we predict violent behavior in someone with SMI? Multiple studies have shown that the people who are most likely to become violent have a SMI, along with substance abuse. The most common SMI's present in people who commit violent acts are schizophrenia and bi-polar disorder. Other common factors that increase the risk of violent behavior include: having a past history of violence, paranoia, neurological impairment, antisocial personality disorder, being male, and refusal to take medication.

It should be obvious by now that our mental healthcare system has definite room for improvement. The overall capacity of the mental healthcare system is not currently accommodating the mental healthcare needs of our society. We may never be able to prevent every single mass killing committed by a person with a mental illness. But research points us in the right direction for identifying people at risk of committing violence.

Without a doubt, some of us have a much higher level of interaction with this issue just based simply on our occupation. However, all of us will encounter people with mental illness. Whether we work to combat this issue as part of our occupation, or we simply take steps to ensure our neighbor with SMI gets treatment, we can all do something -- indeed responsible citizenship requires it.

 

Ever since the Sandy Hook Elementary School shooting there has been much discussion about improving the nation's mental health care system. But what exactly does that mean? It seems that nearly all of us agree that we should keep firearms away from people who are mentally unstable, but accomplishing that is much more difficult than generally realized.

We must remember that the term "mental illness" is only a general term that refers to more than 300 mental health disorders that are currently recognized. In order to thoroughly analyze this issue, we must differentiate between specific mental disorders, because not all mental illnesses lead to a high likelihood of violence. Thus, there will not be an effective "one size fits all" solution.

Mental illness is much more prevalent than we might realize. In any given year, a full 25% of U.S. adults are diagnosable for at least one mental health disorder, with approximately
6% of the population suffering from a "seriously debilitating mental illness" (SMI). SMI's, which are commonly present in people who commit violent acts, include schizophrenia, bipolar disorder, and autism.

Our current mental healthcare system was primarily established by the U.S. Supreme Court case Lessard v. Schmidt. The Lessard decision stated that people who suffer from mental illness are entitled to the same Constitutional rights as everyone else -- they cannot be illegally detained, are entitled to legal due process, have the right to own firearms, etc. In addition, a law enforcement officer can only take a person into custody, if the officer has probable cause to believe that the person presents an immediate danger to him/herself or others.

However, if the person doesn't present any immediate danger, and has not committed a crime, a law enforcement officer cannot legally take that person into custody. This oftentimes leads to the person remaining in the same environment which may have helped contribute to the problem in the first place.

This is the critical issue regarding our current mental health policy. Law enforcement officers encounter people every day who suffer from mental illness and have not committed a crime. But just because a person suffers from mental illness doesn't mean the officer can take them into custody. If the officer doesn't have any evidence that the person poses an imminent danger then sometimes there is little the officer can do. This means the officer may walk away having done nothing to reduce the possibility of a violent act being committed.

A person who suffers from developmental disabilities and mental illness is 7 times more likely to come into contact with law enforcement. Consequently, officers have a major opportunity to intervene in ways that others will not. If an officer cannot take a person into custody, the officer still should highly consider other actions such as notifying the person's family members, their treatment provider, talking the person into voluntarily seeking treatment, transporting the person to a homeless shelter, etc.

While all states adopted the Lessard standards, mental health laws still vary from state to state. Each state defines "dangerous" and "mental illness" differently. Both federal law and most states' laws are designed to prevent people with mental illness from owning firearms. In addition, people prohibited from owning a firearm by one of these laws can be entered into a national database (NICS) of people who are not allowed to purchase or possess firearms.

However, many states only make it voluntary to report people with mental illness to NICS, and many states choose not to report. Both Sen. Lindsey Graham (R-SC) and Sen. Jeff Flake (R-AZ) have indicated that their states have not entered tens of thousands of mental health records to NICS. A current bill under debate in the Senate encourages states to submit mental health records to NICS, but it doesn't make reporting mandatory. Reporting to NICS should be mandatory, not encouraged. We don't encourage convicted felons to get entered into NICS; indeed it is mandatory. Why would we not do the same with those who are assessed to be at a high risk of committing violence?

Regardless of the state, however, many people with SMI do not receive adequate treatment. A
2008 survey showed that only 58.7% of those suffering from SMI, received treatment. That means 42.3% are not receiving any treatment. In the last 50 years the number of beds in psychiatric hospitals has decreased from 559,000 to 43,000.

Bottom line: there have simply been too many mass shootings in the U.S. for us to think that we don't need to change the way we do some things. One recent study showed that there have been 62 mass shootings in the last 30 years, with 61% of the shooters having shown signs of mental illness prior to the shooting. Three separate studies all showed that mass killings are increasing.

While the majority of people who suffer from mental illness might not be dangerous, a small percentage are incredibly dangerous. Approximately 10% of all homicides are committed by someone with untreated, severe mental illness. Of greatest concern are those who are not receiving any treatment. Dr. E. Fuller Torrey, a research psychiatrist involved with SMI's, recently wrote:

Would we have fewer mass killings in the U.S. if we made sure that individuals with severe mental illnesses were receiving treatment? Examining the other 10 largest mass killings suggests that the answer is yes.

While law enforcement remains on the front lines of dealing with mental illness, another emerging trend is Assisted Outpatient Treatment (AOT). AOT is court-ordered outpatient treatment for people with mental illness who meet certain criteria. AOT is now permitted in 44 states. Several studies have shown that AOT reduces hospitalization, violence, homelessness, and reduced stress for caregivers. Legislators must be passing legislation which allows for the continued expansion of AOT.

We are then left with these questions: Can we predict violent behavior in someone with SMI? Multiple studies have shown that the people who are most likely to become violent have a SMI, along with substance abuse. The most common SMI's present in people who commit violent acts are schizophrenia and bi-polar disorder. Other common factors that increase the risk of violent behavior include: having a past history of violence, paranoia, neurological impairment, antisocial personality disorder, being male, and refusal to take medication.

It should be obvious by now that our mental healthcare system has definite room for improvement. The overall capacity of the mental healthcare system is not currently accommodating the mental healthcare needs of our society. We may never be able to prevent every single mass killing committed by a person with a mental illness. But research points us in the right direction for identifying people at risk of committing violence.

Without a doubt, some of us have a much higher level of interaction with this issue just based simply on our occupation. However, all of us will encounter people with mental illness. Whether we work to combat this issue as part of our occupation, or we simply take steps to ensure our neighbor with SMI gets treatment, we can all do something -- indeed responsible citizenship requires it.