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