The complicated, fraught connection between gun violence and mental health

The unthinkable has become terribly predictable.

An 18-year-old gunman opened fire on a Texas elementary school in Uvalde, Texas, about 85 miles west of San Antonio, on Tuesday afternoon, killing at least 18 children, three adults and injuring others.

It was the deadliest shooting at a U.S. elementary school since a 20-year-old gunman killed 20 first-graders and six educators at Sandy Hook Elementary in Newtown, Connecticut, on December 14, 2012.

Uvalde is located between San Antonio and the southern border, and has a large Mexican-American population. The city’s official site describes it as “at the crossroads of the mountains”.

Once again, lawmakers, mental health professionals, gun control advocates, the National Rifle Association, and people across the country are looking for answers and debating gun control laws. or lack thereof, in the United States.

“People with mental health problems are more likely to be victims than perpetrators,” said Chethan Sathya, a pediatric trauma surgeon and director of the Northwell Health Center for the Prevention of Gun Violence, based in New Hyde. Park, New York.

“We have to be very careful about how we talk about the bond between the two of us,” he said. “When it comes to people with mental health issues, these public health strategies are important because they often involve the same victims.”

More than 50 percent of gun-related deaths were suicides, and more than four in 10 were homicides, the Centers for Disease Control and Prevention said. More than seven in 10 medically treated firearm injuries are caused by gun-related assaults.

In 2020, there were 45,222 gun-related deaths in the United States, according to the CDC, equivalent to about 124 people dying every day from a gun-related injury.

“Every time we see people who are frustrated, angry and hateful and use firearms to attack a particular group.”

– Cassandra Crifasi, Deputy Director of the Johns Hopkins Center for Armed Violence

Cassandra Crifasi, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, said there is a distinction between a diagnosable mental health problem and other problems.

“We see more and more frustrated, angry, and hateful people using guns to take it out of a particular group and do it with a group of individuals through mass violence,” he told MarketWatch.

Strongly linking mental health with armed violence can stigmatize the former. Look at it another way: More than 50% of people will be diagnosed with a mental illness or disorder at some point in their lives, according to the CDC.

It is clear that not everyone with mental health problems is carrying out mass shootings. To put it in context: one in five Americans will experience mental illness in a given year. But could you really say that those who commit mass shootings are in a stable emotional or mental state?

Little is known about the mood, the motivations of the UValde shooter or whether he was motivated by anger and / or hatred, Crifasi said. “As for someone committing a mass shooting like it happened today, people would agree that there is something wrong with that person,” he added.

But he said trying to analyze the shooter’s motivations and mental health distracts him from the most useful actions Americans can take to prevent another suicide or homicide from a shooting, and especially at school.

These factors include requiring a license to purchase a firearm and the right to carry laws in certain states that give people the right to carry concealed handguns away from home without a permit or with a permit issued by a state.

“I think we can all agree that a person with a serious mental health problem should not have access to a gun.”

– Jacquelyn Campbell, national leader in research and advocacy for domestic violence

“Armed violence is certainly a major driver of the rise in homicides, including mass shootings, across the country,” said Jacquelyn Campbell, an academic nurse known for her research on domestic violence and violence against women. women.

He cites “the alarming increase in arms purchases in recent years, partly driven by the pandemic, but also partly by the arms maker and NRA marketing and the perception of a lack of public safety.”

People who have serious mental health and / or anger management problems, or deep frustration with their lives or the world, or other undiagnosed crises come from both rich and disadvantaged communities, he said.

But prevention can also start at home. “I think we can all agree that a person with a serious mental health problem should not have access to a gun. That’s where the ‘red flag’ laws come into play,” he said.

Red flag laws, also known as extreme risk protection orders or ERPOs, allow a family member or law enforcement officer who detects warning signs to apply for a court order to temporarily confiscate firearms. ‘a person.

Sathya agrees that the latest tragedy speaks to the need for responsible possession and access to weapons. “How is secure storage improved so that those who may be at imminent risk to themselves or others do not have access to a weapon?”

“Leakage,” Crifsi said, involves a disturbed or potentially disturbed person saying things about the desire to hurt other people and / or posting those thoughts or intentions on social media, or simply telling others.

A witness would then alert the authorities to the possession of a firearm by that person or the intention to purchase one. “This responsibility will fall on teachers, doctors, social workers, families and friends,” Sathya said. “Families are often the first people to notice problems.”

So far, red flag laws have been enacted in 19 states and the District of Columbia. They may play a role in preventing mass shootings, a study published in 2019 in the Annals of Internal Medicine suggests.

“People with mental health problems are more likely to be victims than perpetrators.”

– Chethan Sathya, director of Northwell Health’s Center for Armed Violence Prevention

The researchers conducted a preliminary analysis of the impacts of the California ERPO Statute, under which the ERPOs are called Weapons Violence Restriction Orders, or GVROs, implemented in January 2016.

They detailed 21 cases in which a GVRO was issued after a person “had made a clear statement of intent to commit a mass shooting” or displayed behavior that suggested it, and had or would soon have access to firearms.

“In these cases, the GVROs allowed immediate intervention to reduce access to firearms, in most cases due to timely reports from threatened parties and members of the public,” the researchers wrote.

As always, the authors added an important warning to their findings. “It is impossible to know whether there would have been violence if GVRO had not been issued, and we do not claim a causal relationship.”

Campbell added, “Texas laws are not as strong as they could be to test whether there are bans on gun ownership by those with convictions for crimes or convictions for domestic violence or protection orders.”

Last year, Texas Gov. Greg Abbott, a Republican, signed a law that allowed residents of that state to carry a gun without having to obtain a license, which effectively allowed most people. over the age of 21 carry a gun.

You must be at least 18 years old to legally purchase a rifle in Texas and 21 years old to legally purchase a handgun from a licensed dealer. Uvalde’s 18-year-old gunman is suspected of killing his grandmother before embarking on the shootings.

The National Rifle Association did not immediately respond to a request for comment.

(Meera Jagannathan contributed to this report.)

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