Mental Illness and Gun Violence

loaded gunMass shootings happen far too often, but have there been too few to allow for statistical modeling and predictability? Whenever such a tragedy occurs, politicians and the media reinforce popular perceptions about the causes of gun-related violence. Yet statements that are accurate in particular instances aren’t universal truths. The relationship between mental illness and violence is complex, as shown in research by Jonathan M. Metzl, MD, PhD, and Kenneth T. MacLeish, PhD. So are the implications for healthcare providers.

In “Mental Illness, Mass Shootings, and the Politics of American Firearms,” an article in the American Journal of Public Health, Metzl and MacLeish question four basic assumptions:  1) mental illness causes gun violence, 2) psychiatric diagnosis can predict gun violence, 3) mentally-ill loners should be feared, and 4) gun control can’t prevent mass shootings. To assess these assumptions, Metzl and MacLeish reviewed literature from psychiatry, psychology, public health, and sociology.

“On the aggregate level,” Metzl and MacLeish report, “the assumption that mental illness causes gun violence stereotypes a vast and diverse population”. This oversimplification isn’t just unfair to patients. It’s not particularly useful to healthcare providers. To be sure, many mass shooters are mentally ill and socially marginalized. But so are other, non-violent patients who, because of their situation, are actually more likely to be victims of crime than to become criminals.

Stereotyping the mentally ill also clouds providers’ perceptions about gun violence itself. According to the National Center for Health Statistics (NCHS), part of the U.S. Centers for Disease Control and Prevention (CDC), fewer than 5% of the 120,000 gun-related killings between 2001 and 2010 were perpetrated by people diagnosed with mental illness. Mass shootings capture the attention of media outlets, but they’re not the full story of gun violence in America.

Sadly, another occurrence of violence happened in San Bernardino, California, on December 2nd. It’s time to weigh in on this issue.

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