Every time the country is shaken by a tragic mass shooting and the lack of innocent lives, mental illness and its role within the actions of the mass shooter come under scrutiny.
Mental illness again became a central theme after the mass shooting in Maine on Oct. 25, 2023, wherein records suggest that the shooter had a history of great mental health issues. Months before the tragedy, the family of gunman Robert Card, in addition to Army Reserve staffers, had contacted law enforcement expressing high levels of concern about his mental health and noting his access to guns.
Since 1999, 19 states together with the District of Columbia have passed lawscommonly referred to as red flag lawsthat allow law enforcement and other people in an individual’s life to petition for removal of firearms when there are imminent safety concerns a couple of gun owner. However, reports suggest that this law isn’t used.
Maine, though, has what’s referred to as a yellow flag law. It requires reporting to local law enforcement that an individual poses an imminent threat, however it then relies on the police to take the person into custody, order a mental health evaluation and request a court order to have that person’s guns removed. The yellow flag law was not used in Card’s case.
The relationship between mental illness and guns, and risk mitigation, is complicated. Specifically, there isn’t a clear and uniform consensus on who should determine when to limit access to firearms – should or not it’s a psychiatrist, an independent forensic psychiatrist, a committee of psychiatrists or a judge? The majority of individuals with mental illness don’t seek treatment.
In that light, it’d make sense to mandate a psychiatric examination into the background check process for purchasing a gun. As severe mental illness can start at any point in life, will gun owners need periodic psychiatric assessment, akin to a vision exam for renewing a driver’s license? If so, who can pay for the visits?
I’m a trauma psychiatrist who usually deals with the end result of gun violence, whether in victims or first responders. In my book “Afraid: Understanding the Purpose of Fear and Harnessing the Power of Anxiety,” I actually have examined mental health issues related to gun violence and the social consequences of mass shootings.
The complexity of defining mental illness
The term “mental illness” covers a wide selection of conditions, and there are greater than 200 diagnoses listed in probably the most recent version of the Diagnostic Statistical Manual of Mental Disorderswhich is the gold standard for psychiatric diagnosis within the U.S. Mental illness includes diverse conditions like phobias, social anxiety disorder, post-traumatic stress disorder, hair-picking disorder, gambling disorder, schizophrenia, dementiavarious types of depression and personality disorders, reminiscent of antisocial personality disorder.
Mental illnesses are also quite common: Nearly 1 in 5 people experience clinical depression during their lives; 1 in 5 people experience an anxiety disorder; 1 in 100 experience schizophrenia; and nearly 8 in 100 of the overall population experiences PTSD. People with higher exposure to trauma, reminiscent of veterans and first responders, have higher rates of PTSD, as much as about 30%.
So when suggesting that gun access ought to be restricted for individuals with mental illness, does that mean all of those conditions? Or just a few, or some in defined circumstances? For example, should all veterans with PTSD or those with social anxiety disorder have their guns removed? Neither of those conditions is understood to commonly impair judgment.
Defining the particular conditions that may impair judgment or significantly increase risk of harm to self or others is a vital step on this process, which needs serious involvement of mental health professionals, stakeholders, law enforcement and policymakers.
Knowing when an individual may very well be a risk of harm
The majority of mental illnesses don’t pose a risk to others. When there may be a risk, in the vast majority of cases when someone is involuntarily admitted to a psychiatric inpatient unit, it isn’t since the person poses a risk to others. Rather, it’s more often the case that the person is at risk of self-harmas within the case of a depressed, suicidal patient. Sadly, individuals with severe mental illness are often the victims of violence and abuse.
In psychiatric disorders, concerns typically arise in acutely psychotic patients with paranoid delusions that persuade them to harm others. This may occur in – but isn’t limited to – schizophrenia, dementia, severe psychotic depression or psychotic bipolar illness.
These conditions are slightly strongly related to increased risk of suicidenot homicide. Therefore, more realistic gun laws with regard to mental illness could also save many lives from suicide.
Substance use is a major contributor to violence in mental illness, and it must be included within the calculations relating to gun restriction. Other situations with increased risk of harm to others are personality disorders with a high level of impulsivity or lack of remorse, reminiscent of antisocial personality disorder.
But the fact is that the majority individuals with personality disorders don’t seek treatment and are usually not known to mental health providers.
It can be value noting that the majority countries have an analogous prevalence of severe mental illness compared with the U.S., yet they’ve much lower rates of mass murder than the U.S.
The harms of using ‘mental illness’ so vaguely
Every time mental illness is linked by the media or politicians to acts of violencethe highly charged emotions of the moment can affect those with mental illness and their families, and that may perpetuate stigma.
When “mental illness” is vaguely addressed in gun debatesthose with a psychiatric condition reminiscent of anxiety or phobia but without an increased risk of violence or impairment in judgment may avoid looking for treatment.
Mental illness gun laws that may have real preventive impact
In my view, to show the deal with the role of mental illness in gun violence into meaningful actions, the next steps are needed:
– Clear, uniform criteria have to be established on when mental illness justifies restriction of access to firearms. Would this be specific mental disorders or specific mental disorders in crises? This requires defining signs of imminent threat to self or others, and likewise defining how and when an individual is relieved of that status. An incredible deal of dialogue and coordination will likely be needed between mental health, legal and law enforcement experts.
– As it was noted before, the vast majority of patients with mental illness don’t seek care. A comprehensive preventive plan would necessitate screening everybody who applies to buy a firearm. This step ensures meaningful screening, in addition to avoiding discrimination. Other countries reminiscent of Japan, Canada, New Zealand and Austria have such requirements.
– Since potentially dangerous psychiatric conditions can begin at any age in an otherwise healthy person, regular mental health screening for gun owners can be justified, much like eye exams for drivers.
– There ought to be clear mechanisms for determining lack of mental fitness for access to firearms when concerns are raised by those that know the person or by law enforcement. Red flag gun laws are an excellent starting for this path.
The bottom line is that determining who may or may not have access to firearms based on mental illness, as outlined, is indeed very difficult and requires more serious work. And the common denominator in all these tragedies still is the access to assault rifles.