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How do we keep guns away from the mentally ill?

Tribune News Service • May 6, 2018 at 2:00 PM

Psychiatrists say mass shootings follow a "script."

In that script, there invariably comes a point when we as nation reflect and look where to cast the blame.

America found itself at that point once again after a man allegedly shot and killed four people at a Tennessee Waffle House on April 22. The 29-year-old had previously displayed bizarre behavior that pointed toward mental-health issues. He'd also had several run-ins with law enforcement and wasn't supposed to have access to firearms.

Once again, mental illness and gun violence were at the forefront of our national gun dialogue.

The issue was also brought up for discussion in "Guns: An American Conversation," an initiative by Advance Local newsrooms from across the country in partnership with Spaceship Media.

The month-long project has brought together 150 engaged readers with a broad spectrum of opinions to talk about guns in an honest and civil way. The conversation has been ongoing since the beginning of April inside a closed Facebook group where participants post links to articles, ask questions and discuss issues.

Today's topic: How do we keep guns away from the mentally ill?

Mass shootings account for a very small percentage of gun deaths each year compared to the daily "drip, drip, drip" of daily firearm-related deaths, says Dr. Jeffrey Swanson, a Duke University Professor of Psychiatry and Behavioral Sciences and the lead author of the 2015 study on mental illness and gun violence.

The real gun-violence crisis related to mental illness is suicide, which accounts for about two-thirds of all firearm deaths, according to Swanson.

The extraordinary nature of mass shootings leads to more media attention than daily gun violence, however.

"It's a such a frightening and disturbing, irrational event, people want an explanation for it. They want a sort of master, simple explanation," said Swanson, "And they get one. We hear these voices in the public square, whether it's lawmakers or the NRA (National Rifle Association) come out and say this is about mental illness, so let's fix the mental-health problem so we can solve gun violence."

Is the gun lobby right to say mental illness is the problem and not access to firearms?

Swanson and other psychiatrists who have studied gun violence and mental illness say no.

"We don't have more mental illness in the United States than in any other comparable country," said Liza Gold, Clinical Professor of Psychiatry at Georgetown University School of Medicine. "We don't have more angry or impulsive people than any other country. What we do have are more firearms ... that can shoot a lot of people more quickly."

The doctors see gun violence as a public-health problem that should be studied.

Both doctors lament the so-called Dickey Amendment that since 1996 has prevented governmental agencies from doing just that. New language in the most recent budget, signed by President Donald Trump in March, allows the Centers for Disease Control and Prevention to start conducting research into gun violence again, but experts interviewed by NPR say it still lacks funding and are skeptical anything will change.

Swanson and Gold said gun policy should be crafted from evidence-based studies and not by lobbying groups like the National Rifle Association.

"They make a lot of money by curating the belief that the solution to gun violence is more guns in the hands of more people in more places, so we'll all just shoot it out," Swanson said about the NRA. "I think we need a change in our culture over time. Private gun ownership is embedded in our culture. They're not going away. Over time, I think there will be a shift."

The perception that mentally ill people are violent is false, the doctors said. Studies show that people with mental illnesses are more likely to be victims of a violent crime, Swanson said.

Both doctors cited statistics from the privately funded MacArthur Violence Risk Assessment Study that revealed 1 percent of people with diagnosed mental illnesses like schizophrenia and bipolar disorders commit a violent act involving both a gun and a stranger in a given year.

People who have been adjudicated as "mentally deficient" or involuntarily committed to a psychiatric institution have been prevented from owning guns by federal law since the Gun Control Act of 1968. This includes defendants found not guilty by reason of insanity and incompetent to stand trial.

But how do we and how should we define mentally ill? Isn't carrying out a mass shooting evidence of mental-health issues?

"It doesn't sound like it makes any sense when you say that this person who massacred a bunch of strangers might not be mentally ill," Swanson said. "Just on the face of it, that just is not the act of a healthy-minded person."

Swanson said some of the shooters, like the one who killed 12 people at an Aurora, Colorado, movie theater in 2012, are severely mentally ill, but that for the most part, society is dealing with something different with major mass shootings.

"They tend to be really angry, alienated, isolated, maybe emotionally disturbed young men, who for reason we don't really understand, decide to follow this really deviant cultural script that we have, and have access to this really efficient killing technology," he said.

So what can be done?

The laws that are in place should be bolstered, according to the doctors.

That includes improvements made to the National Instant Criminal Background Check System, created by the Brady Handgun Violence Prevention Act of 1993. States are currently not required to report to the NICS database, however. One major issue is privacy. Releasing the names of people found mentally ill to the database can be perceived as a violation of the Health Insurance Portablity and Accountability Act or HIPAA.

Swanson said there's no good answer to the privacy issue.

"It's a balancing of risk and rights," he said.

The doctors were optimistic about so-called "red flag" laws that many states have adopted since the February shooting at Marjory Stoneman Douglas High School in Parkland, Florida. These laws allow family members and law enforcement to seek a civil action through the courts to separate individuals from their firearms.

Gold calls for new gun policy to be crafted from evidence-based research, similar to how the nation tackled the problems of car crashes and smoking. She said it's unfair that the gun lobby has dominated the narrative, which generally ends with the nation saying there's nothing that can be done about gun violence because the Second Amendment protects our individual rights to bear arms.

"We have to be looking at why we have acquiesced allowing our society to become paralyzed by this very narrow special interest," she said. "We have many rights in this country; all of them are regulated."

Inside the conversation

The participants in the "Guns: An American Conversation" closed Facebook group have also been discussing various aspects of mental illness and gun violence. Here is just a small portion of what they've said:

Jen Partica of Moon Township, Pennsylvania

Nashville's recent mass shooting was an example of how third-party storage is unsuccessful at keeping our communities safe.

The alleged shooter was ill enough to have already shown up on police radar in an incident that did result in his firearms being removed from his possession. But rather than have law enforcement, or a licensed gun dealer, or some other regulated party store the guns until they could be returned (if ever), they were given to the father who handed them back to his ill son.

We've seen this tragedy in other states that allow this kind of third-party storage and it is often ineffective. So even when we have a way of identifying the dangerously mentally ill, we need to have procedures in place to keep everyone safe, the patient included.

I would also include the closing of state-level background check loopholes that allow anyone identified as unable to own a firearm to go around this restriction.

Robert Davis of Winter Haven, Florida

The problem is: How do you define a "dangerous" mental illness from one that is not?

For example, there's PTSD from being the victim of a crime, and there's PTSD from being a soldier in combat. Either one can take a violent turn. And at the same time both can be harmless.

What reasoning would there be to define a dangerous mental illness? How would the courts, or a judge, be able to rule on it?

Daniel Kennamore of Killen, Alabama

Here (in the Waffle House shooting), we had a history of erratic behavior. That should be a simple litmus test. A person that has been diagnosed but treated in a way that they are functional and responsible shouldn't suffer the consequences of trying to retroactively fix obvious problems.

If a person has been diagnosed, but they aren't following up with treatment, or (worse) self-medicating, they shouldn't have access to dangerous objects.

Dave Roth of Auburn, New York

The problem with receiving treatment is it only works as long as it is taken as directed. Sadly, people quit the drugs and therapy that help them. There have been many court cases over this issue. States have flirted with civil confinement as a way of dealing with this.

Reba Holley of Pennington, New Jersey

While it's not a surprise to anyone that I am for tightening up gun laws, the mental illness part is hard for me because I am not comfortable with deciding who gets to decide.

Imagine if Trump got to decide???

So if there's been some kind of clear episode, who do you get to decide? It can't be anyone who ever sought help. I posted earlier that my family had counseling when one of my kids was struggling as a teen. Would that be enough? And would these types of restrictions prevent someone from getting help?

I don't know what the answer is. I'm no psychologist, but isn't a mental-illness diagnosis decided by one person who has the opportunity/responsibility?

Peter Lotto of Fayetteville, New York

I have familial experience with mental illness. Three of my extended family members have been diagnosed with diseases like manic depression, bipolar disorder, schizophrenia and others (not all in one person, but a gamut).

One of them had displayed a penchant for violence and irrational acts and was banned from buying guns in (Pennsylvania), her home state. So she drove to (Virginia) and bought an arsenal. She went home, barricaded herself in her house and started shooting. She was shot and killed by the police.

The other two have shown suicidal tendencies, one has tried twice. They are under the care of psychiatrists who would absolutely not want them to have access to guns. Neither one of them would want access to guns either, for fear that they might do something. They would voluntarily be placed on a "no buy" list and they would not see this as a rights issue, they would see it as a safety issue: Theirs and their loved ones.

Their cases are easy - they have diagnoses and would volunteer to go on the list. Not so easy are those who have no diagnosis and/or would not volunteer. That's why "red flag" laws are so hard to write. That's why it's so hard to get an adult involuntarily committed to an inpatient facility.

Don Alley of Brighton, Michigan

How do you legislate caring and looking out for one another? Because that's what needs to happen.

We can call for more regulations that wouldn't have stopped this, but we're being quite disingenuous and agenda-driven if so. We can call for better mental health checks, but we would have to be careful that asking for help (for instance, seeing a psychologist after experiencing a traumatic event) will not have repercussions on our rights.

If a shooting sport hobbyist that just lost his family thinks his guns will get stolen by the government because of some "mental-health policy," then he's unlikely to go to the psychologist and get help.

Ruth Grunberg of Cortland, New York

Red-flag laws are the best way to intervene. Degrees of mental illness have to be judged on a case-by-case basis. Thirty-nine visits by cops is enough of a threshold to take guns away temporarily.

Maybe it gets the attention of the person in distress and they are more willing to accept the help they need. It should be easier for courts to order a psych evaluation, at least. This is only useful if mental health treatment is actually available if needed.

Some places have laws to force people to take their meds, but they still have their freedom. Let the person scream and curse and blame the guy that comes to their house to dispense the meds. What counts is that the meds are keeping him from being a danger to himself and others even if he is telling the world he no longer needs them.

Alexander Covan of Livingston, New Jersey

If there are highly reliable predictors for rampage killers, we need a broad response that equally prevents the next Toronto van killer, Florida slumber party knife massacre, or mass shooting.

What do you think?

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