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After a year of violent tragedies that culminated with the elementary school shooting in Newtown, Connecticut, America is finally having a conversation about gun control. For the many who want to decrease access to firearms in the wake of several mass shootings, new laws being proposed around the country to limit and regulate guns and ammunition represent a momentous first step.
But running through the gun-control debate is a more delicate conversation: how to handle mental-health treatment in America. Among both Democrats and Republicans, in both the pro-gun and anti-gun lobbies, there's a widespread belief that mental-health treatment and monitoring is key to decreasing gun violence. Shining more light on the needs and struggles of the mentally ill would normally be a positive change; mental-health programs and services have been cut year after year in the name of austerity. But in the context of gun violence, those with mental illness have become easy scapegoats. Rather than offering solutions to the existing problems that patients and providers face, policymakers instead promise to keep guns out of the hands of the mentally ill. The trouble is, that often means presenting policies that are actually detrimental to mental-health treatment-threatening doctor-patient confidentiality, expanding forced treatment rather than successful voluntary programs, and further stigmatizing people with databases that track who's been committed to hospitals or mental institutions.
The National Rifle Association has led the charge to blame those with mental illness. "The truth is that our society is populated by an unknown number of genuine monsters-people so deranged, so evil, so possessed by voices and driven by demons that no sane person can possibly ever comprehend them," NRA executive vice president Wayne Lapierre said at his December 21 press conference. "How can we possibly even guess how many, given our nation's refusal to create an active national database of the mentally ill?" Ann Coulter was more succinct: "Guns don't kill people-the mentally ill do."
It's not just the NRA and the right wing who are turning mentally ill Americans into political pawns. See, for instance, New York's new gun-control law, the first passed after Newtown. In addition to banning assault weapons and semiautomatic guns with military-level components, the legislation requires therapists, nurses and other mental-health-care providers to alert state health authorities if they deem a patient is a danger to self or others. That would then allow the state to confiscate the person's guns. The measure broadens the confiscation powers to include those who voluntarily seek commitment to a mental-health facility-in other words, the people who get help without being forced. Finally, it strengthens Kendra's Law, which allows the courts to involuntarily commit the mentally ill.
Other states will very likely follow suit. Legislatures in Ohio and Colorado will both consider measures to make it easier to commit people. Maryland Governor Martin O'Malley wants to broaden the range of people banned from owning guns to include those who have been civilly committed to mental institutions at any time. Policymakers in Louisiana, Massachusetts, Pennsylvania, Rhode Island, and Utah have also proposed measures aimed specifically at keeping the mentally ill from getting guns.
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The new rules and proposals perpetuate the assumption that people with mental illness are dangerous; instead of making people safer, the requirements may hurt efforts to get the mentally ill treatment. For instance, the expanded reporting requirements mean mental-health providers must alert officials if a patient may harm herself or others. Law-enforcement officials can then show up and confiscate any guns the patient owns. Mental-health providers are already supposed to report if a patient seems in imminent danger of doing harm, but the new law broadens that rule. It could easily chip away trust between therapists and their patients. The threat of gun confiscation may make it less likely that folks like policemen and veterans suffering from trauma get help, since many are gun owners. "It's very hard to get people to come forward and get help," says Ron Honberg, the national director for policy and legal affairs at the mental-health advocacy group National Alliance on Mental Illness. "If they're aware that by seeking help they're going to lose their right to have a gun, we're concerned it's going to have a chilling effect."
It's also not likely to slow down the violence. Predicting murderous behavior is extremely difficult and most of the time, the providers can't do it accurately. "We're making an assumption that violence can be predicted," Honberg says. In fact, it's lack of treatment, combined with substance abuse and a history of violence, that tend to be the best predictors of future violence. Yet many of New York's new laws-like the reporting requirements and the push to put more mentally ill people in government databases-target those who are already getting help.
The issue is not that mental-health advocates want to arm more people but that those with mental illness are being singled out by often well-intended gun-control measures, which could increase the stigma around getting help. By focusing on keeping guns out of the hands of the mentally ill specifically-and not those who have histories of substance abuse, domestic violence, and other predictors of violent behavior-these laws perpetuate the idea that the mentally ill are an overwhelming threat. So does a recent report from Mayors Against Illegal Guns, which highlights the gaps in reporting mentally ill people to the NICS database; in red pullout text, it prominently displays examples of mentally ill people responsible for violence.
The stereotype that the mentally ill are very violent is simply incorrect. According to the National Institute for Mental Health, people with severe mental illness, like schizophrenia, are up to three times more likely to be violent, but "most people with [severe mental illness] are not violent and most violent acts are not committed by people with [severe mental illness.]" On the whole, those with mental illness are responsible for only 5 percent of violent crimes.
"People with mental illness are so much more likely to be victims of crimes than perpetrators that it's almost immeasurable," says Debbie Plotnick, the senior director of state policy at Mental Health America, an advocacy group for mental-health treatment. According to one study, people with mental illness are 11 times more likely to be the victims of violence.
Fortunately, the national conversation hasn't been entirely negative. Advocates see an undeniable opportunity to get more funding and attention to mental-health services. For the first time in recent memory, governors and lawmakers across the political spectrum are pushing for more dollars to help those with mental illness. That's particularly important because over the past four years, $4.35 billion was cut in funding for Medicaid mental-health funding, substance abuse, housing, and other mental-health programs at the state and federal level. Now, even Kansas's ultra-conservative Governor Sam Brownback is pushing for $10 million more for mental-health care. South Carolina Governor Nicki Haley, a Tea Party favorite, has also argued for an increase in funding. In Oklahoma, Colorado, Minnesota, and Missouri, legislatures will very likely consider investing more heavily in treatment of mental illness.
The investment is badly needed. Over the years, most states have cut back to only providing emergency and crisis care for mental illnesses. That's both expensive and ineffective. Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitative Services, says the most successful programs are those that focus on getting a patient help wherever they are, while providing other necessities like housing. For instance, the "housing first" model provides housing to people who might not otherwise qualify and then layers on services like mental health and substance-abuse treatment. Such programs, like New York's Pathways to Housing, have an astounding 85 percent retention rate, and according to Rosenthal, they're successful because they tailor to a person's specific needs rather than telling patients, "You're mentally ill and you need medicine."
More attention to the cracks in care for the mentally ill is a good thing. While it may not have much to do with gun violence, there is a serious mental-health-care problem in the country.
