Targeting Mental Illness Will Not Prevent Mass Shootings

As the trial begins for the mass shooting at a synagogue in Pittsburgh that killed 11 people in 2018, hearts and lives are still shattered from the recent mass shootings at an Alabama birthday party and the Louisville bank. Ongoing are calls for gun reform along with cries to “deal with mental illness” by lawmakers, as happened in Nashville. In the January California shootings, a congresswoman speculated that if older Asian Americans were able to access appropriate mental health treatment, “things could have been different.”

In my work as a psychiatrist who sees many people with serious mental illness, I know that focusing on mental health will not reduce mass shootings. It is extremely rare for a person with mental illness to kill a group of strangers.

Not all mass shootings are random acts of violence. Shooters have been provoked by racism, homophobia, homegrown terrorism and crusades against abortion providers. By definition we do not categorize these “socially deviant behaviors” motivated by political, religious, or sexual reasons as mental illness.

Research tells us that only a small portion of active shooters are diagnosed with a serious mental illness. Schizophrenia, a very debilitating mental illness, has become a symbol for aggression and unprovoked violence. However, the risk of violence in schizophrenia is mediated largely by other factors like substance use.

Risk factors for violence in severe mental illness overlap with risks in the general population. Risk levels can be estimated, but there are no tools to predict who among the higher risk people will commit violence. Nor can we predict when such violence will be triggered. In fact, many shooters were evaluated in the days preceding the incident and sent on their way.

To be sure, the mental state of a shooter is undeniably important. Common characteristics of past mass shooters are poorly controlled moods, impulsivity, poor judgment, and lack of empathy. These characteristics inform risk, irrespective of a diagnosed mental illness. A majority of shooters were reacting to grievances.

Shooters often experience a crisis and show change in their behaviors in the weeks leading to the attack - over half die at the scene of the crime, having never sought mental health treatment. An individual’s past history of violence also matters because it is a strong predictor of future violence.

Mental illness is a term used loosely in common vocabulary. Poor mental health is not the same as having a diagnosable mental disorder. Mental health is a state of mind that changes over time. People cannot be neatly divided into the mentally ill and the mentally well. About half of the U.S. population has had some mental disorder at some point in their lifetime. This means almost half of the country could be labeled as mentally ill and considered more likely to commit violent acts.

Recently, I did a risk assessment for a colleague’s patient. Instead of asking for his diagnosis, I gauged his impulsivity, anger, feelings of vengeance and suicidality, and evaluated for active use of substances that alter mood and impair judgment. Most importantly, I wanted to know if he had access to a weapon. Possessing a weapon is essential to carry a destructive plan to completion - and firearms make it easier to cause destruction on a large scale.

Instead of defaulting to mental illness as the reason for mass shootings, we can look at countries with far fewer gun deaths and mass shootings. Since Australia instituted a massive gun buyback program in the 90s, firearm deaths reduced by half, and no mass killings have occurred since then.

In addition to a buyback program, UK Parliament passed legislation to ban private ownership of certain firearms and to require owners to register their weapons. The number of gun homicides in the U.S. is now more than quadruple in comparison to the UK.

It is obvious on a global scale that more firearm ownerships closely correlate with more firearm deaths. However, there is a deeply entrenched culture of guns in the U.S. Attempts to legislate gun ownership are often noted as an infringement of rights - but reducing gun violence is not the same as promoting gun control.

Stronger firearm policies reduce firearm deaths. But since that is so challenging to implement, research can be part of the solution by engaging local communities to better understand complex gun culture and build knowledge of best practices for gun safety.

Furthermore, there needs to be more federal funds than what was allocated after a partial repeal of the Dickey Amendment. Ultimately, everyday citizens and the highest levels of government need to come together on legislation that reasonably controls gun access and ownership.

Relying on mental health professionals to prevent mass shooters is an exercise in futility that will not save lives or prevent the heartache and trauma caused by mass shootings.