The complicated and tense link between gun violence and mental health

The unthinkable has become horribly predictable.

On Tuesday afternoon, an 18-year-old gunman opened fire on a Texas elementary school in Uvalde, Texas, about 85 miles west of San Antonio, killing at least 19 children, two adults and injuring others.

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

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

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

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

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

More than 50% 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 firearm-related assaults.

In 2020, there were 45,222 gun-related deaths in the United States, according to the CDC, which equates to about 124 people dying from gunshot wounds every day.

“More and more we see people who are frustrated, angry and hateful and who use guns to target a particular group.”


— Cassandra Crifasi, associate director of the Center for Gun Violence at Johns Hopkins

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 condition and other conditions.

“Increasingly, we see people who are frustrated, angry and hateful and use guns to go after a particular group, and go after a group of individuals with mass violence,” she told MarketWatch.

Directly linking mental health to gun 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.

Obviously, not everyone with mental health issues carries out mass shootings. To put this into context: one in five Americans will suffer from a mental illness in any given year. But can we really say that those who commit mass killings are in a stable emotional or mental state?

Few details are known about the Uvalde shooter’s state of mind, his motives or whether he was motivated by anger and/or hatred, Crifasi said. “As for someone who would commit mass shootings like what happened today, people would agree that there is something wrong with that person,” she added.

But she said trying to analyze the shooter’s motivations and sanity distracts from the most helpful actions Americans can take to prevent another shooting suicide or homicide — and especially at a school.

These factors include the requirement for a license to purchase a firearm and right to carry laws in some states that give people the right to carry concealed handguns outside the home without a license or with a state-issued license.

“I think we can all agree that someone with a serious mental health issue shouldn’t have access to a gun.”


— Jacquelyn Campbell, national leader in domestic violence research and advocacy

“Gun violence is certainly a huge 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 children. women.

She cites “the alarming increase in gun purchases in recent years, partly due to the pandemic but also partly due to marketing by gun manufacturers and the NRA and perceptions of lack of public safety”.

People who have serious mental health issues and/or anger management issues, or deep frustration with their life or the world, or other undiagnosed crises come from both communities affluent and disadvantaged, she said.

But prevention can also start at home. “I think we can all agree that someone with a serious mental health issue should not have access to a gun. This is where the ‘red flag’ laws come into play,” she 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 request a court order to temporarily confiscate a person’s firearms.

Sathya agrees that the latest tragedy speaks to the need for responsible gun ownership and access. “How do you improve secure storage so those who might be in imminent danger to themselves or others don’t have access to a weapon?”

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

A witness then alerted the authorities to the possession of a firearm by this person or to his intention to buy one. “That responsibility will fall on teachers, doctors, social workers, families, friends,” Sathya said. “Families are often the first people to notice problems.”

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

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


— Chethan Sathya, director of the Gun Violence Prevention Center at Northwell Health

The researchers conducted a preliminary analysis of the impacts of California’s ERPO law, under which ERPOs are called non-violence firearm orders, or GVROs, implemented in January 2016.

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

“In these cases, GVROs enabled 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 caveat to their findings. “It is impossible to know whether any violence would have occurred if the GVROs had not been issued, and we make no claim to causation.”

Campbell added, “Texas laws aren’t as stringent as they could be in verifying prohibitions on owning guns on those with felony or domestic violence convictions or restraining orders. protection.”

Last year, Texas Governor Greg Abbott, a Republican, signed a law allowing residents of that state to carry a handgun without first obtaining a license, effectively allowing most people over the age of 21 from carrying a handgun.

You must be at least 18 to legally buy a gun in Texas and 21 to legally buy a handgun from an authorized dealer. The 18-year-old shooter from Uvalde is suspected of killing his grandmother before launching into the shooting.

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

(Meera Jagannathan contributed to this report.)

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