What percent of Americans support prohibitions for people w/ mental illness?
87%
What percent of people blame a failed mental healthcare system for mass shootings?
83%
What percent of American adults suffered from mental illness in 2020? But how many experience Serious Mental Illness (SMI)?
21%
5.6%
SMI results in…
serious functional impairment, which substantially interferes w/ or limits 1+ major life activities
schizophrenia
psychosis
bipolar (severe)
severe, major depression
What percent of suicide victims experiences mentla health problems?
46%
Risks
schizo: 15x
bipolar: 13.2x
depression: 7.2x
anxiety: 5.8x
ADHD: 2.4x
Role of Substance Abuse
“deaths of despair”
overlooked correlate: increases impulsivity
alcohol abuse 10x more likely to commit suicide
substance abuse 14x more likely to commit suicide
dual diagnoses or comorbidities
Guns are used more often in suicides ___ prior mental illness
WITHOUT
Mental Illness and Interpersonal Violence
SMI increases risk of violent behavior 3-4x BUT only for minor forms
SMI violence remains rare
diagnoses w/ highest risk
substance use disorder
antisocial PD
command hallucinations/delusions
Homicide
5% involve offenders w/ SMI
treated individuals do not have heightened risk
rates of SMI are consistent across nations…homicide rate are not
SMI increases victimization by 2.6x
Substance Use and Homicide: Alcohol
approx 1/2 of all offenders and victims
heavy intoxication: average of 5 drinks immediately prior
Substance Use and Homicide: Drugs
1/3 of all offenders
typically cocaine and stimulants
often at same time as alcohol
Substance Use and Homicide: Why?
decreases inhibitions
increases impulsivity
even serial killers abuse drugs/alcohol before killing
Mass Shooters
12-15% diagnosed w/ psychotic disorders
2-3x more likely than other homicide offenders
4-5x more likely than general public
most common:
depression
anxiety
suicidal ideation
Challenges
circular reasoning
data quality concerns
medical record availability
retrospective and armchair diagnoses
untreated or undiagnosed?
Antidepressants cause homicide
Myth
Anecdotal “evidence”
Eric Harris (Luvox)
Jeffrey Weise (Prozac)
Joseph Wesbecker (Prozac)
context: 13% of Americans take SSRIs
disproportionately women and elderly
use increased between 1999-2014, when homicide rate decreased
People suffering from SMI are much more likely to hurt who?
themselves
strong predictor of suicide, weak predictor of homicide/interpersonal violence
convenient scapegoats
policy implications create stigma
Federal law prohibits purchasing a gun if a person…
has been involuntarily committed to mental hospital
“adjudicated as mental defective” (1968 terminology)
does NOT include people
who are diagnosed w/ SMI or SUDs
voluntarily go to mental institution
Problems: Theoretical
archaic and offensive language
false positives
ignores temporary or episodic nature of SMI
commitment policies vary widely across states
violent offenders w/ SMI most likely to offend during first episode
Problems: Implementation
loopholes
private facilities fail to report
private sellers
involuntarily commitments have declined since 1960s
enforcement woes
background checks not implemented until 1998
mental health records largely unreported until 2007
Accumulation of Mental Health Records in the NICS
2007: mental health records account for 7% of federal gun-disqualifying records
2013: mental health records account for 28% of federal gun-disqualifying records
Impact of NICS Improvement Act
Violent crime risk was reduced by 53% for those disqualified with comprehensive reporting to NICS
overall result >1% reduction in violent crime
Baker Act (1971)
involuntary evaluation for 72 hours
no fixed policy whether guns are seized
discretion
no clear policy on how guns are returned
not submitted to NICS unless formally committed
Mandatory Reporting
Recent legislation requires psychiatrists to assess and \n report patients for potential to harm themselves or others to restrict gun ownership
New York, Tennessee, Illinois, California (2013)
Predicting future violence is extremely difficult