Enforce the laws, don't add to them

White House/David Lienemann

Vice President Joe Biden listens to Annette Nance-Holt as she holds a photo of her son Blair, who was shot and killed while riding a bus from school in 2007, during a meeting in the Eisenhower Executive Office Building in Washington, D.C., Jan. 9, 2013. The Vice President, along with Attorney General Eric Holder, met with representatives of victims’ groups and gun safety organizations as part of the Administration’s effort to develop policy proposals in response to the tragedy in Newtown, Conn. Colin Goddard, who was shot four times at Virginia Tech in 2007, is seated second from left.

Article Highlights

  • The US needs to revamp its mental health laws, but the relationship between gun violence & mental illness is tenuous.

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  • From a public health standpoint, guns pose a greater risk to those who want to kill themselves, not harm others.

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  • Improving the way we care and monitor the mentally ill is necessary, but it’s not the cure for gun violence.

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Editor's note: This article appeared in the New York Times' Room for Debate on Guns, Safety and Mental Health in response to the question: "Can changes in the American mental health system reduce gun violence without creating more problems?"

Yes, we need to revamp our mental health laws and state policies, but the relationship between gun violence and severe mental illness is a tenuous one: the vast majority of people with schizophrenia, bipolar illness and other psychotic disorders are not violent and most violence is not committed by people who are mentally ill. Though shocking and horrifying, shooting sprees are rare.

It is true that severely ill people whose symptoms are unmedicated (and/or who abuse stimulants or alcohol) are at higher risk for committing violence than treated individuals; but even so, they account for only 3 to 5 percent of violent crimes in the general population. What's more, from a public health standpoint, guns pose a greater risk to those who want to kill themselves, not harm others. According to the Centers for Disease Control, about 6 deaths per 100,000 population — or more than half of all suicide deaths — involved self-inflicted gun shot wounds. The homicide rate by firearm was under 4 per 100,000.

Still, mental health policies are in dire need of revision. For one thing, they need teeth: enforce good laws when they are on the books. In the case of Jared Lee Loughner, who shot Representative Gabrielle Giffords last year, it turned out that Arizona had admirably progressive mental health statutes that permit involuntary evaluation and treatment of someone who desperately needs it. Loughner's delusions of mind control, agitated outbursts, bizarre preoccupations and paranoia were highly compatible with a diagnosis of schizophrenia. 

In fact, under Arizona law, any concerned party can petition the court for an Order for Treatment. If Loughner had been found "persistently and acutely disabled" by severe mental illness and "likely to benefit from treatment" — regardless of whether he had a weapon or was suicidal — an evaluation and subsequent care could have been court mandated.

Of course, hindsight is clear-eyed. As incidents unfold in real time, most people are rightly uneasy about infringing on a person's liberty. But given Loughner's worrisome track record — the number of times the campus police were called to intervene; the pressing concerns of his teacher and of other students; and the very fact that the college would not re-admit him after his suspension without psychiatric clearance — it seems that a court petition could have been justified.

Second, many states have so-called outpatient civil commitment on the books — a practice whereby a patient who is demonstrably helped by medication is required to take it. In 2005, the New York State Office of Mental Health released an assessment of its so-called Kendra's Law, showing marked improvement in a wide range of measurements, including frequency of arrests, hospitalizations, assaults, threats of violence, incarceration, and homelessness. More than twice as many patients took their medication when under court order as before. A raft of studies from states like North Carolina, Arizona, Iowa, Ohio and the District of Columbia have demonstrated similar benefits.

Outpatient commitment needs to be applied rigorously and more extensively. 

So I applaud efforts to improve the way we care and monitor the mentally ill, but it's not the cure for gun violence.

 

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