A Q&A with an expert who studies the relationship between mental illness and violence
After mass shootings, like the ones these past weeks in Las Vegas, Seattle and Santa Barbara, the national conversation often focuses on mental illness. So what do we actually know about the connections between mental illness, mass shootings and gun violence overall?
To separate the facts from the media hype, we talked to Dr. Jeffrey Swanson, a professor in psychiatry and behavioural sciences at the Duke University School of Medicine, and one of the leading researchers on mental health and violence. Swanson talked about the dangers of passing laws in the wake of tragedy ― and which new violence-prevention strategies might actually work.
Here is a condensed version of our conversation, edited for length and clarity.
Mass shootings are relatively rare events that account for only a tiny fraction of American gun deaths each year. But when you look specifically at mass shootings ― how big a factor is mental illness?
On the face of it, a mass shooting is the product of a disordered mental process. You don't have to be a psychiatrist: what normal person would go out and shoot a bunch of strangers?
But the risk factors for a mass shooting are shared by a lot of people who aren't going to do it. If you paint the picture of a young, isolated, delusional young man ― that probably describes thousands of other young men.
A 2001 study looked specifically at 34 adolescent mass murderers, all male. 70 percent were described as a loner. 61.5 percent had problems with substance abuse. 48 percent had preoccupations with weapons. 43.5 percent had been victims of bullying. Only 23 percent had a documented psychiatric history of any kind ― which means 3 out of 4 did not.
People with serious mental illnesses, like schizophrenia, do have a slightly higher risk of committing violence than members of the general population. Yet most violence is not attributable to mental illness. Can you walk us through the numbers?
People with serious mental illness are 3 to 4 times more likely to be violent than those who aren't. But the vast majority of people with mental illness are not violent and never will be.
Most violence in society is caused by other things.
Even if we had a perfect mental health care system, that is not going to solve our gun violence problem. If we were able to magically cure schizophrenia, bipolar disorder and major depression, that would be wonderful, but overall violence would go down by only about 4 percent.
Federal law prohibits people who have been involuntarily committed to a mental institution from owning guns. Is that targeting the right people?
The criteria we have are both over-inclusive and under-inclusive at the same time. They capture a lot of people who are not really at risk, at least not anymore. For instance, think about someone who had a suicidal mental health crisis 25 years ago, was involuntarily hospitalized, but now they're recovered and fine, they haven't had problems in years. They want to get a job as a security guard and they can't because they can't possess firearms.
Under-inclusive, because think about someone who's in the middle of their first episode of psychosis, but hasn't been treated. This might be a serious, dangerous mental health crisis ― a person with paranoid delusions, believing that everyone else is out to get him, isolated, maybe drinking heavily ― but he is not disqualified from going and purchasing any number of guns.
Then there's another problem: Even if someone has a record of serious mental illness, these records might not actually make it into the background check system.
Reporting [of mental health records] is spotty. Mayors Against Illegal Guns put out this report [which found that, as of 2014, 12 states have still reported fewer than 100 mental health records to the national background check system.]
In one recent study, you found that adding more mental health records to the background check system can prevent some violence ― but only a very small amount. Can you explain what you found?
The state of Connecticut provided a natural experiment. Prior to 2007, they didn't report mental health records to the National Instant Criminal Background Check System, and after that they did.
We compared two groups of people over eight years. Everyone had been hospitalized and had a major diagnosable psychiatric disorder, such as schizophrenia. One group had been hospitalized involuntarily, and was disqualified from buying guns. One group had been voluntarily hospitalized.
The criteria for involuntary commitment are intertwined with dangerousness and violence. Before Connecticut began reporting mental health records [to the background check system], people who had been involuntarily committed had a higher likelihood, month by month, of committing violence. After the period when the gun provisions were enforced, the difference went away ― a 6 percent drop in their likelihood of committing a violent crime.