Screening for mental illness isn’t the best way to identify potentially violent people.
What could have been done? What can be done now? These are the questions on most people’s minds after another senseless mass shooting, this one near the University of California, Santa Barbara, in Southern California by another loner who left a trail of online threats and violent fantasies the world is now reading in disbelief.In many respects, these are the same questions that were raised and answered after the Sandy Hook grade school shooting in late 2013. Now though, the killer’s anger toward attractive women and other young men—especially non-whites—raises different issues about sexism, stereotyping and scapegoating. After Sandy Hook, the small universe of people who work at the crossroads of mental illness and government responses made numerous observations and suggestions about this type of angst and gun violence.“The mass shootings that break our hearts are not representative of the behavior of most people with mental illness,” Liza Gold wrote last September in the Journal of the American Academy of Psychiatry and The Law. “Similarly, mass shootings are not representative of the much broader problem of gun violence in the United States.”Suicide, not mass shootings, is where most gun deaths occurs in the U.S., Gold said, after people struggle with deep depression. From 1983 to 2013, there were 78 public mass shootings with 547 deaths, compared to more than 250,000 gun-related killings in the past decade alone, including more than 90 percent of suicides. Not surprisingly, the states—and countries—with the strictest gun controls have the fewest gun-related deaths of any kind.Stigmatizing mental illness after mass shootings makes it harder for people who need help to get it, Gold said. Moreover, screening for mental illnesses is not even the best way to identify potenially violent people and positively intervene. But that’s been the course many states have taken since Sandy Hook.As of last September, 66 gun control laws that limited access to mentally ill people had been introduced by legislators following Sandy Hook. Most were not helpful, Gold said, adding that 95 percent of mentally ill people are not violent. The other 3 to 5 percent who become violent are almost always drug addicts, she said, saying that was a more telling indice. Her bottom line is that confusing and stigmatizing mental illness with assessing who is dangerous is a big mistake. It disrupts treating the ill, and doesn’t spot the violent individuals.Instead, Gold said familes, physicians and social agencies should look for the very clues we are now reading about the Santa Barbara shooter—his long trail of online rants, fantasies and plans that attacked women, minorities and his peers.“Public health interventions to reduce the risk of gun violence should focus, not on mental illness, but on dangerousness, with or without mental illness,” she said. “Even temporary restrictions can reduce firearms-related injury or death, since many acts of violence, including many suicides, are impulse driven and fueled by substance use, both conditions subject to changing relatively quickly.”Other warning signs—such as the social media posts—should be used by public health agencies and police as sufficient evidence to intervene, she said, which means forced psychiatric hospitalizations. Ironically, she praised California for having that standard on its books, saying it should be adopted nationwide.“Some states have begun incorporating violence risk assessments into criteria for removal or restriction of firearms,” Gold said. “California permits removal of firearms from people during mental health emergencies and restricts access during periods of commitment, which are periods of high risk, primarily for suicide. Indiana and Connecticut allow law enforcement officers to remove firearms from imminently dangerous individuals, regardless of whether they have mental illnesses or a history of involuntary commitment.”This is where the “what could have been done?” conundrum gets tricky. The shooter also stabbed his roommates to death before heading outside with his firearms. That means he was bent on destruction, no matter what weapon he held in his hand. His parents had seen online posts and alerted the local police. They knocked on his door and spoke to him, but he was polite and did not give a probable cause to search inside, which they could have done under state law. His weapons were in his room.Given those facts, the question that remains is how does one stop twisted thinking? The circle of people in the killer’s life did not, or could not, get through to him, whether his parents, family, physicians, classmates or teachers. Instead, from what we know, he found an online world of people who shared his misogynist, racist and deeply violent views. America’s relatively easy availability of guns then amplified the carnage.Maybe the smartest question is not just how to intervene, but when? And what can be done to lessen the stigma of dealing with the issues that can escalate to suicide, or even mass murder. It’s easy to say everything that’s brutal about America made this guy into a loner killer: fantasies about violence and sex, racism and easy access to guns. That’s what filmmaker Michael Moore said when asked to comment this weekend.There is no one answer to what could have been done near Santa Barbara and what can be done now. But if the future will hold fewer mass shootings, then, at the very least, we have to think about earlier interventions and not just assume violent fantasies and mental illness are one and the same. That conclusion can keep us from understanding what’s really going on, Gold said.“Media coverage and legislation based on the false premise that individuals with mental illness are a root cause of gun violence dehumanize patients, compromise patient privacy, threaten confidentiality, and interfere with the therapeutic relationship,” she said. “Most people with mental illness are not dangerous, and most dangerous people do not have a severe mental illness.”
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