Running head: GUN VIOLENCE AND MENTAL ILLNESS

Gun Violence and Mental Illness Sara Towers English 321

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Table of Contents Abstract Introduction Purpose Problem Discussion Community Mental Health Government Issues The National Instant Criminal Background Check System Improvement Amendments Act Can the risk of violent behavior be assessed? Risk Assessment Compliance with treatment Glossary References 7 8 9 10 12 13 3 4 4 4 5 5 6

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People with mental illness are often perceived by the public to be dangerous; resulting in federal and state legislation which restricts their ability to purchase, possess, register, license, or carry firearms. There is ongoing discussion in medicine, law, social science, and public safety regarding violence and mental illness. Society needs a health care system that can assess and provide care for the mentally ill who may be at risk for becoming violent. The National Instant Criminal Background Check Improvement Act has severe implications for persons with mental illness. It was designed to expand the reporting practices of states by providing significant financial incentives. Violence is one of the leading causes of death in the United States, killing an estimated fifty thousand people per year, firearms being the primary factor. This includes both homicides and suicides. When a person with a mental illness commits a violent crime with a firearm the public focuses on stronger restrictions. This research will describe the efforts to restrict access to firearms among people with mental illness and the effectiveness and negative consequences.

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Gun Violence and Mental Illness After the tragedy of the Sandy Hook Elementary shooting in Newtown, CT. which killed 20 innocent children, newspapers, television news, internet sites and newspaper articles were flooded with stories of the victims. This created a demand for action and change. But what actions were needed? Who were the victims? Two key areas were the main focus, inadequate gun control and mental illness. Gun violence is receiving a great deal of attention now, but we need to be careful not to create new victims by further stigmatizing mental illness. Stigmas are discriminatory and create barriers, discouraging people from getting help. The ability for people to step back and look at the whole big picture, to see problems at the level beyond just the symptoms, is essential to creating effective solutions. (Gardner,2013) The first question we need to answer is who are the mentally ill? According to the data from the National Institutes of Mental Health indicates nearly half of all Americans qualify for a psychiatric diagnosis at some point in their lives. About 1 in 17 people suf fer from serious mental illness. (Gardner, 2013) The National Rifle Association argues that the lack of a national database of the mentally ill was the real problem, not access to guns. (Gardner, 2013) Mental illness is often used to explain violent behavior; the reality is people with mental illness do not commit the majority of violent crimes in society. Many studies show that crimes committed by people with psychiatric problems are over reported, often with inaccuracies that give the wrong impression of risk. Most people with mental illness are not a threat to anyone other than themselves. How can we understand who is at risk for becoming violent without increasing the stigma?

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Much too often the stigma of mental illness prevents individuals from seeking diagnosis and treatment. We must ensure those who need treatment have access to it. Community Mental Health Centers play a vital role in helping individuals get the care they need to lead healthier, more productive lives. In an effort to strengthen our nations mental health system, U.S. Senator Jack Reed introduced the Excellence in Mental Health Act. This would help build and expand community mental health centers and help pay for the counseling and other services the qualified mental health professionals working in these centers provide. This Act will help address our fragmented mental health system and ensure that more patients have access to the care they need by expand their services. According to a national survey, one -third of the 4.8 million people suffering from mood disorders do not receive treatment, and fewer than half of the people with severe mental disorders receive treatment of any kind in a given year. (Kliff, 2012) We must continue to work to remove the stigma from mental illness in our society and expand care for those living with mental illness. Since the tragedy at Sandy Hook Elementary School, lawmakers said they want to focus on mental illnesses that cause violent behavior. Republicans are avoiding talking about new restrictions on gun ownership. It has been said that the Republicans are using the mental health issue to deflect attention from gun control. Republicans zeroed in on mental health in res ponse to Obamas gun violence plan, which calls for better screening and treatment for potentially violent people but which also includes an assault-weapon ban and robust background checks for gun purchasers .(Johnson, 2013)

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Representative Larry Bucshon, R-IND said, more emphasis should be placed on addressing mental health issues. Former House Speaker Newt Gingrich thinks health privacy laws should be put in place so that society can identify and monitor dangerous people. One o f the ideas the Republicans have is information gathering, they want to find out the resources the government has and about the research being put into what the cause of violent behavior is. The Democrats, and mental health advocates are pushing an opposite strategy. They are the ones that want legislation to allow more federal involvement in community mental health centers, creating nationwide standards for access and treatment. According to Johnson, one proposal that has bipartisan potential is Obamas recommendation to offer training to non-physician, teachers and counselors to identify mental health problems in young people and to learn how to de-escalate crisis situations if necessary. An effective program already exists, but it needs federal funding to be offered in schools. (Johnson, 2013) People with mental illness are 10-15 times more likely to commit suicide, showing the importance of restricting gun purchases for those who have mental illness, not only for homicides but suicides as well. (Johnson, 2013) Most people with mental illness are not violent, but some are at high-risk for having suicidal thoughts, dangerous to others, and/or non-compliant with treatment. Guns are the most common method used in fatal suicide attempts, so restricting access would help protect these patients and the general public.

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The National Instant Criminal Background Check System Improvement Amendments Act of 2007 would require the states to update the NICS with the names and other identifying information of people committed to mental institutions so that they could not buy firearms. (Appelbaum, 2007) It is easier for clinicians when gun restrictions are the law. This gives them no choice, patients may not have firearms. By referring to the law, this shows that the clinician is looking out for what is best for the patient without coming across as the one who has to determine if the patient should or should not have a firearm in their possession. It is true that anyone who is motivated can get a gun, but it would be helpful to make it more difficult. More than half the guns used in rampa ge killings were bought legally. According to an article in the New York Times, more than half the guns used in rampage killings were bought legally, the other half were either stolen, illegal purchased, lying on an application or borrowed from a friend. (Appelbaum, 2007) The other half were either stolen, illegal purchased, lying on an application or borrowed from a friend. With legislation aimed at restriction gun purchases by patients who have been committed is unlikely to reduce violence in a significant way. It may cost an enormous amount of money and resources, and will only increase the stigma associated with mental illness. Many studies have been documented to state that only a handful of rampage killers were committed with mental illness. The purchase of guns by the people who have been committed is just not the source of our violent problem. (Appelbaum, 2007) If only a single life would be saved by stopping gun purchase by mentally ill patients, why not do it? The cost would massively outweigh a small likelihood of benefit.

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As we look into mental illness and gun violence further, there are many unanswered questions. Can the risk of violent behavior be assessed? Should therapist be responsible for both treating the patient and policing them or would this put the therapist at risk? For the professional, its not a huge concern for the treatment-report balance, but what is important is if people who need help will get help before they spiral into violence. The seriously mentally ill are more likely to be victims of violence than the perpetrators. (Essiq, 2013) However, several high-profile mass murderers were people who apparently suffered from seriously under-treated mental illness. It seems apparent that increased access to better treatment would help, even though the mental health system is only one part of the much larger part of gun violence. (Essiq, 2013) All aspects of mental health services for both adults and children need to be improved. President Obama created a proposal on January 16, 2013 that attempts to do that. (Essiq, 2013). Improving mental health treatment and education will help reduce the stigma, educate the general public, improve mental health services within the workforce and help separate mental health and violence. The Presidents proposal clarified issues concerning reporting patients assessed for potential violent behavior. It stated that no federal law in any way prohibits doctors or other health care providers from reporting their patients threats of violence to the authorities, and the Affordable Care Act does not prevent doctors from talking to patients about gun safety. (Essiq, 2013) This means the federal law doesnt mandate reporting, but improving access to treatment comes first.

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When a psychotherapist performs a risk assessment for homicide or suicide during treatment they look at five things: Ideation- are they thinking about doing the deed ? Planhave they mapped o ut what and how they will do it? Intent-is there an impulse to act on the idea and plan? Self -control and Impulsivity-can they keep fantasy fantasy? Access to means-do they have a gun? Mental health records contain sensitive information and fear of disclosure may deter individuals from being honest with physicians or even seeking treatment. The Supreme Court has upheld restrictions on access to firearms based on involuntary commitment. Individuals also waive the right to privacy when purchasing firearms from a licensed dealer. Buyers complete firearms transaction records that fully disclose personal information, which the Department of Justice can both access and release freely. (Gostin, 2011) Keeping guns away from the mentally ill sounds like a promising way to prevent mass shootings, but studies show it might have little impact, according to the National Journal. (Gostin, 2011) Psychiatric professionals are not good at identifying people who will go on to commit acts of violence. Many perpetrators of mass shootings had no contact with the mental health system, and when the potentially violent are identified, tre atment for mental illness is not always effective in preventing violent acts. Although people with serious mental illness have committed a large percentage of high-profile crimes, the mentally ill represent a very small percentage of the perp etrators of

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total violent crimes committed. Researchers estimate that if mental i llness could be eliminated as factor in violent crime, the overall rate would be reduced by only 4 percent. That means 96 percent of violent crimes-defined by the FBI as murders, robberies, rapes, and aggravated assaults-are committed by people without any mental health problems at all.(Sanger -Katz, 2013) Solutions that focus on reducing crimes by the mentally ill will make only a small difference in the nations rate of gun -related mass murders. Although people with certain types of mental illness are more likely than the general public to commit violent acts, the rate is still small. An international study found that among people with Schizophrenia, a disease with the highest rate of violent behavior, only one person in 140,000 will kill a stranger. (Sanger-Katz, 2013) Treatment can be helpful in alleviating the symptoms that drive some mentally ill people to harm others, however, such interventions is not always effective. Many patients with psychotic illness have poor rates of compliance with a treatment plan. Professionals also can only treat the patients who seek out help for mental illness. It appears risk for violence in psychotic illnesses is highest early in the course of illness, frequently before people are identified as mentally ill and receives treatment. (Appelbaum, 2007) Jared Loughner, the shooter in the Tucson massacre in 2011, had no psychiatric diagnosis at the time, but was later diagnosed with schizophrenia. In conclusion, it is evident that between the stigma and the lack of knowledge surrounding mental illness makes it easier for people to place labels first and consider all the factors last. Gun violence appears to have no boundaries, which includes affecting the

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mentally ill. With increased funding for the community mental health services and new laws being made, early interventions may not only decrease violence, but broaden the spectrum of education to others.

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Glossary Interventions Is an arranged meeting by one or more people, helping others seek professional help. Involuntary commitment A legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment either in a hospital or in the community. Mental illness A medical condition that disrupts a persons thinking, feeling, mood, ability to relate to others and daily functioning. Mood disorders A category of mental health problems that include all types of depression and bipolar. Perpetrator A person suspected of committing a crime. Psychotherapist A person who interacts with patients to initiate change in the patients thoughts, feelings, and behavior. Schizophrenia A mental disorder characterized by a breakdown of thought processes and by a deficit of typical emotional responses. Stigma A mark of disgrace associated with a particular circumstance, quality, or person.

13 Gun Violence and Mental Illness References Appelbaum, P. S. & Binder, R. L. (2007, December 15). Should the civilly committed mentally ill be precluded from buying guns? Internal Medicine News, p8. Essiq, T. (2013, January, 17) Gun violence and the mental health system: Why treatment must come first. Forbes. Gardner, D.B. (2013, January-February). Madness in America: holding a rational converation. Nursing Economics, 31(1), p50 Gostin, L.O. & Record, J. (2011, May, 25). Dangerous People or Dangerous Weapons: Access to Firearms for Persons with Mental Illness. JAMA. 2011;305(20):2108-2109. doi:10.1001/jama.2011.688 Johnson, F. (2013, Janua ry 24). We need to talk about mental health even if its only a sideshow to the gun control debate. NationalJournal. Kliff, S. (2012, December 7). Seven Facts about Americas Mental Health Care Systems. The Washington Post. Sanger-Katz, M. (2013, January 30). Why improving mental health would do little to End gun violence. NationalJournal.

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