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Your Healthy Family: Is mental illness the only issue driving gun violence in the U.S.?

Posted at 3:56 AM, Aug 27, 2019
and last updated 2019-08-27 13:38:36-04

COLORADO SPRINGS — As our county continues to battle with the question of how to reduce gun violence, I wanted to share a conversation I had with a local mental health provider on the topic.

Many say that the real problem behind mass shootings in our country is mental health. But if we press mental health providers to become the solution to stopping gun violence in America will it be effective?

Dr. John Fleming, MD, is a psychiatrist and a distinguished life fellow of the American Psychiatric Association, who points to data when it comes to red flag laws and reducing gun violence.

Dr. Fleming says, “The solution has got to be a comprehensive one. The problem with red flag laws is while they seem like they might work, the available research suggests that they don't really work. If you eliminated every mentally ill person who committed violence from owning a gun you would still have ninety-five percent of the violent acts happening. So while it may be a good role for limiting certain people from having guns to reduce violence – that alone is not going to get us as a society where we need to be.”

Dr. Fleming cited a 2013 study on red flag laws saying, “When there are comprehensive red flag laws what we have seen is that in Connecticut, they looked very carefully over several years and what they determined is that the number of violent incidents that would have been reduced was like 612 to 598. Now having that reduction is worth having, but you can't rest all your hope on something that is a small percentage of what's going on.”

Dr. Fleming also says looking to mental health providers to raise the alarm and prevent mass shootings also isn’t realistic, because he says not all mass shooters are mentally ill.

“Gun violence, particularly mass assault gun violence is a complicated problem. At best mentally ill people only are one and five of mass shooters, so four out of five aren't. Not all of these people are mentally ill with a diagnosable condition like depression, or schizophrenia or paranoia. Common sense would say, ‘They are not like the rest of us.’ but that doesn't mean they have a mental illness.”

Dr. Fleming also says he has seen other studies that show no matter how helpful mental health providers may want to be when it comes to raising concerns about patients and preventing gun violence with-in the bounds of current law, it's just not something they are good at.

“Mental health providers are not good at predicting which of their patients are likely to commit violence. We're better at predicting which of our patients are likely to try to harm themselves or commit suicide, but even in those cases our judgment is not perfect. A number of studies have shown that psychiatrists are no better than a flip of a coin, at predicting which patients in their care will be violent.”

Dr. Fleming adds that even among the mental health patient population where concerns are raised about possession of guns, it depends on who is expressing that concern.

“When psychiatrists or other mental health professionals are working with somebody, we are much better at working with people who want help, and want to change a particular problem. If somebody comes in to me and says, ‘I'm afraid I'm going to hurt members of my family.’ that's a whole different kettle of fish from when a family comes in and says, ‘We think so-and-so is at risk,’ and the person says, 'oh no, not me. I would never do that'.”

So where can we look for answers when it comes to reducing gun violence? Dr. Fleming says looking in the right place is a very important piece of finding some answers.

“It's a very easy to attribute blame when we’re scared and when we’re afraid. It's very easy to place blame on others whether it's the mentally ill, or whether it's a certain political party or whatever, let's slow it down a little bit.”

Dr Fleming says mental health providers do have a role to play, but a much broader approach is needed.

“What we have to figure out is how do we relate to these complex decisions that people make in an effective way to reduce gun violence? Not in a quick knee-jerk or blaming manner without any real data. It doesn't matter if we just do something to do something, and get nowhere.”

Dr Fleming feels mass shootings have become a public health crisis in our country and working to reduce them will require them being treated like a public health crisis, not just a mental health or gun problem.

“We need a comprehensive approach that looks at hatred, looks at cultural factors and looks at the influence of peers, and looks at all kinds of factors. The one example I can think of is motor vehicle accidents. What happened there is The Centers for Disease Control took a concentrated look using a public health perspective, epidemiology and came up with a whole series of factors that overtime reduced motor vehicle deaths. Some of that was changing cars, some of this was changing laws, some of this was looking at substance abuse, but it was a comprehensive approach. I think we need to do the same thing with gun violence. We need to ask the CDC to take a look at these mass shootings and other gun violence deaths and figure out what are the things we can do? Maybe some of that will be working with those who are mentally ill, but it's going to take a lot more than that. Maybe there would be a variety of recommendations. Currently and unfortunately the CDC is prohibited by Congress from looking at gun violence. Not only are they not funded – they're prohibited. One good thing that Congress could do at this point is to say, ‘Here's an organization that specializes in helping us resolve these very complicated problems, and let's get them and their recommendations to come forward and we'll take a look at what we can do’.”

You can view the studies referenced in this article in the Annals of Epidemiology (CLICK HERE)

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