Mental Illness

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