“Somehow this has become routine. The reporting is routine. My response here at this podium ends up being routine. The conversation in the aftermath of it. We’ve become numb to this.”
President Obama delivered a powerful speech in the aftermath of the latest mass shooting at an Oregon community college. He called for greater gun control laws to ensure public safety, noting the similar ways we protect public safety with seatbelt and traffic laws.
Gun violence is a public health epidemic. There are 32,000 fatalities and 74,000 injuries caused by gun violence or gun suicide each year in the United States. Mass shootings, sometimes described as an incident in which four or more victims are shot but without an official definition, are becoming more common, although still account for a very small fraction of gun fatalities annually. In 2015, there have been close to 300 mass shootings.
So what can the public health sector do to prevent mass shootings—or shootings in general? As public health professionals, our efforts should focus on evidence-based preventive interventions.
Often after mass shootings, headlines run that place blame on gun ownership and on the mentally ill. Therefore, many often assume that restricting gun ownership for the mentally ill will help to prevent mass shootings. However, given that there are 40 million people in the U.S. with mental illness and that a miniscule proportion of them ever commit a violent act, it’s not justifiable to restrict their 2nd amendment rights. Gun control advocates in the public-health community should be wary of doing anything that would further stigmatize those with mental health problems.
The federal standard, which most states follow, requires banning gun possession only after someone is involuntarily committed to a psychiatric facility or designated as mentally ill or incompetent after a court proceeding or other formal legal process. Recently, however, some states have passed stricter laws. In 2013, California extended a firearm ban from 6 months to five years for those who have described a credible violent threat to a psychotherapist. New York also passed legislature that requires mental health professionals to report to the state’s Division of Criminal Justice Services anyone who is likely to engage in conduct that would result in serious harm to themselves or others. Maryland also has similar laws.
It is unclear how much good such laws do for population health. Evidence shows that mental illness is not a strong predictive factor for violence. Alcohol and drug use is associated with a far greater increased risk of violent crime than is mental illness, for example, and childhood abuse, binge drinking and the male gender are equally strong predictive factors. For its part, mental illness is more strongly associated with becoming a victim of violence than of becoming a perpetrator of it.
As scientific advocates for the population’s health, we need to ensure that a diagnosis of mental health doesn’t carry such a stigma of association with violence that people are prevented from seeking help when they need it.
A consortium of public health researchers, mental health professionals and gun control advocates suggested three pathways to reducing gun violence. The first is to expand current state mental health firearm disqualification policies. The second is to expand state firearm prohibitions to include people who meet specific, evidence-based criteria that suggest they are at risk of committing a violent act. The final pathway is to introduce new policies to remove firearms from individuals who pose serious risks to themselves or others.
As public health professionals, we cannot become numb to the seemingly ongoing mass violence happening around us. We need to continue to research factors that predict homicidal behavior and draw more support for interventions and policies that have evidence to support their success in preventing future tragedies.