In his address to the nation earlier this week to talk about the latest pair of mass shootings, President Donald Trump laid the blame for the gun violence in part on mental health issues.
“Mental illness and hatred pulls the trigger. Not the gun,” Trump said.
But while the president and a slew of other politicians blame the mass shootings in Dayton, Ohio, and El Paso, Texas—as well as previous killings—on mental illness, experts, including a growing number of physicians, are speaking up to say they are wrong.
“It’s too easy an answer,” said Joe Parks, M.D., co-chair of the Medical Director Institute, in an interview with FierceHealthcare. It’s one that lays blame on a single group of people and also distracts from actions that the country and communities can take to help reduce the violence, Parks said.
“This isn’t a mental health problem. This is more of a social problem,” Parks said, in which individuals who are angry and resentful act out in violence.
That was the consensus of a new report (PDF) released Tuesday by the Medical Director Institute of the National Council for Behavioral Health, “Mass Violence in America: Causes, Impacts and Solutions.” According to the report, “people with serious mental illness are responsible for less than 4% of all violence and less than one-third of mass violence.” Statistics bear out that most people who commit mass violence do not have a serious mental illness.
Following the back-to-back weekend shootings that left 31 people dead, both the American Psychiatric Association and the American Psychological Association stepped forward to dispute the link to mental illness.
“It is important to note that the overwhelming majority of people with mental illness are not violent and far more likely to be victims of violent crime than perpetrators of violence,” the American Psychiatric Association said in a statement. “Rhetoric that argues otherwise will further stigmatize and interfere with people accessing needed treatment. Individuals can also be emboldened to act violently by public discourse and divisive rhetoric.”
"The American Psychiatric Association (APA) today condemns the senseless loss of lives from gun violence that has become all too common in this country, most recently in mass shootings in El Paso, Texas and Dayton, Ohio."— American Psychiatric (@APAPsychiatric) August 5, 2019
The American Psychological Association agreed. “Blaming mental illness for the gun violence in our country is simplistic and inaccurate and goes against the scientific evidence currently available,” said its CEO, Arthur C. Evans Jr., Ph.D., in a statement in reaction to Trump’s statements. Focusing on mental illness prevents the country from focusing on better gun control, he said.
Other countries experience far fewer mass shootings. “The United States is a global outlier when it comes to horrific headlines like the ones that consumed us all weekend. Although the United States makes up less than 5% of the world’s population, we are home to 31% of all mass shooters globally, according to a CNN analysis. This difference is not explained by the rate of mental illness in the U.S. The one stark difference? Access to guns,” Evans said.
“Blaming mental illness for the gun violence in our country is simplistic & inaccurate and goes against the scientific evidence currently available.”— American Psychological Association (@APA) August 5, 2019
Statement from APA CEO @ArthurCEvans in reaction to @POTUS’ comments on gun violence & mental illness: https://t.co/1uxpyGEqB9 pic.twitter.com/WzJUXVhVhH
“As we psychological scientists have said repeatedly, the overwhelming majority of people with mental illness are not violent,” he said, calling for limiting civilians’ access to assault and high-capacity magazines, instituting universal background checks and enacting so-called red flag laws that remove guns from people at high risk of committing violent acts.
Doctors organize against gun violence
Physicians are also organizing to address the issue of gun violence. After the school shooting in Parkland, Florida, last year, three psychiatrists got together to discuss what they might do to bring the perspective and expertise of psychiatrists and other mental health professionals to what they called the public health crisis of gun violence. They formed Psychiatrists for Gun Violence Prevention.
Among the group’s guiding principles is that the association between mental illness and gun violence is a frequent source of misunderstanding. “Psychiatrists have a role to play in helping certain individuals at risk for violence reduce that risk, but policies that keep guns out of the hands of individuals at risk of becoming violent are more effective prevention strategies than psychiatrists' efforts to predict violence,” the group says.
Another group of doctors has formed AFFIRM, which stands for the American Foundation for Firearm Injury Reduction in Medicine, a nonprofit dedicated to ending the epidemic of gun violence through research. That group was launched in 2017, after the Las Vegas mass shooting.
Recommendations for action
There is certainly frustration that there’s a call for action after each of these mass shootings, but then nothing changes. Parks said he hopes people pay attention to the specific recommendations in the 96-page report from the Medical Director Institute that offer steps that can be taken on the federal, state and community levels.
To dispel misconceptions and uncover the real issues surrounding mass violence, the Medical Director Institute brought together a diverse panel of about 30 experts, he said. The group included clinicians who treat individuals with mental illnesses and substance use disorders, administrators, policymakers, researchers, educators, advocates, law enforcement personnel, judges, FBI personnel. and parents to conduct an evidence-based analysis of mass violence.
The report recommendations range from creating threat assessment teams to enacting state extreme-risk protection orders (so-called red flag laws) that allow for the temporary removal of guns from individuals known to pose a high risk of harming others or themselves.
It recommends the training of all clinicians on violence risk assessment and the training of staff within schools, law enforcement, and communities in what it calls Mental Health First Aid, which teaches skills to respond to the signs of mental and substance abuse disorders.
“It’s a public health problem. It’s from multiple causes and it will take multiple solutions,” Parks said.
But along with addressing mass violence, the country needs to provide people with addiction and mental illness with greater access to treatment, Parks said.
The report recommends the expansion of a new clinical model of care called Certified Community Mental Health Centers that provide comprehensive, 24-hour, seven-day crisis response services and extended hours that include night and weekend hours.
While the report stopped short of recommending stricter gun control laws, “we did find on average that states with stricter gun laws have moderately lower rates of mass violence. It’s not a huge effect,” he said.
It’s up to individuals to take action, he said. “Everybody acts kind of helpless. There are 10 pages of individual-specific things people can choose to do in their communities and their organizations that can make a difference. People should read that list and they should pick at least one thing to do," Park said. "If our government isn’t active, we can still be active as an individual. I always try to start with what I can do personally as opposed to starting with what the other guy can do."