All too often we are inundated with the same tragic cycle. An individual with an assault weapon opens fire on a large amount of people. The media talks about mental health problems in the individual, the victims are laid to rest and the story fades away then it happens again and the cycle repeats. Gun laws remain relatively unchanged as does the mental health system. This blog will attempt to shed some light on some of the current issues related to this horrible phenomenon.
Mr. Muncie speaking
While watching the recent events in Parkland, Florida unfold through the media in real time I was struck by an interview with the Parkland schools superintendent Mr. Robert Runcie. The full scope of the calamity as well as the identity of the shooter had yet to be announced, but he made a very ominous and all too familiar suggestion at the end of his interview, “Mental health issues are growing and they are a big challenge and it’s something that’s going to need to certainly be addressed.” As more information came out, we learned the shooter was essentially a ticking time-bomb, who had suffered many losses and displayed many red flags as to his ability to cope with them in the form of maladaptive behaviors. We have heard how the community reached out to authorities to express their concerns relating to this individual and those calls went unheeded. There are many systemic failures in this case and I will attempt to shed light on some of them
Anyone who watches mainstream media, reads alternative media or just bops around social media can see that gun control is a hot topic following these events. The voices of certain groups call for a ban on everything from assault rifles, to a ban on guns altogether while another group rushes to defend the second amendment. Within those two camps are litany of ideas and the one that I think bares the most relevance to this blog post is the idea of stopping mentally ill individuals from purchasing guns. Statistically the mentally ill are more likely to be victims of gun violence than they are to perpetrate it. (Gold, Simon & Knoll, 2015) Yet according to Knoll mass shootings by people with serious mental illness represent only 1% of yearly gun related homicides or 110 individuals killed. Knoll also rightfully discusses the fact that calling out those with a mental health diagnosis reinforces a negative stigma to mental illness, which creates a major barrier to treatment and worsens the overall public health burden of mental illness.
110 people killed per year in mass shooting events is still a high number so what is being done about it? According to Knoll, attempting to bar the mentally ill from owning firearms will yield little return in terms of lives saved as only 1% of mass shooting deaths can be attributed to the mentally ill, yet lawmakers have written and passed plenty of legislation to do just that. Federal law dictates that anyone committed to a psychiatric hospital or anyone deemed incompetent by a court can be barred from purchasing or owning a firearm according to the Gun Control act of 1968. Yet there are many who don’t understand what that means. People can be held in a psychiatric hospital for anywhere from 72 hours to 10 days while they are being assessed. Those individuals are not necessarily barred from owning firearms. Someone may have had a very difficult day, and made a non-fatal attempt at suicide, at which point they were brought to a hospital against their will. After 72 hours they may report that they feel their suicide attempt was an error, they may discuss future oriented goals, and may then be released. These individuals would not be deemed certified and therefor would be able to walk out of the hospital, and barring any other issues, they would be able to purchase a gun. If after they are held, a psychiatrist deems they need to remain hospitalized that psychiatrist must bring that patient to mental health court and ask that the patient be committed to continue treatment. If the court agrees, the patient is then committed and according to federal law, they are now banned from purchasing or owning firearms. Being deemed incompetent similarly requires court action in conjunction with a medical professional who must assess an individual. One must file a petition in court to have an individual assessed for competency through psychological testing and if the court sees fit, they will rely on the results of that competency evaluation. These cases may involve an elderly individual suffering from dementia, or someone who commits a crime, but is unable to understand the court proceedings and/or communicate meaningfully with their attorney secondary to mental illness, developmental disabilities, Brain injury, etc. (“How to Legally Declare Someone as Mentally Incompetent?”, 2018) For example, imagine someone who is involved in a car accident while driving intoxicated and is left in a vegetative state after the accident. That individual would be more than likely deemed incompetent, as they wouldn’t be able to understand the proceedings. This may also be the case in the event someone is deemed a threat to themselves or deemed unable to manage their own affairs.
Now that we understand the criteria for someone with mental illness to be banned from owning a gun, we can see that as long as an individual is not committed or deemed incompetent, then they cannot be barred from purchasing a weapon based on mental health issues.
In his film entitled “Bowling For Columbine” Michael Moore went after the pharmaceutical industry and their role in the current spate of mass shootings. Moore suggests that the Columbine shooting occurred for no other reason than the fact that the shooters were prescribed Prozac. If we consider that claim we find a mixed bag of data. According to Yasmina Molero and her research, the data regarding homicidal behavior is inconclusive and individuality cannot be ruled out. She did report an interesting observation regarding dosing of Selective Serotonin Reuptake Inhibitors IE: Prozac, Zoloft Etc. and increased potential for violence. She found that adolescents on low doses of SSRI medications are at a greater risk for the potential to violence and suggests further study on this topic. She did not find the same risks in older patients or adolescents on higher doses of SSRI’s. Since 2004 Fluoxetine also known as Prozac carries a black box warning regarding increased risk of suicidal ideation. When we combine the black box warning with the observation of Molero, one may see an easy leap to the conclusion that Prozac was to blame for Columbine, but like many areas of information in the modern world this is only a superficial correlation. A study from Hungary showed the exact opposite to be true. The authors of this study found contradictory data to the FDA warning and rather than seeing a decrease in completed suicides, the countries where the black box warning was displayed saw decreased usage of antidepressants and increased numbers of completed suicides. In Hungary where the black box warning was not issued the authors found increased usage of antidepressants and decreased numbers of completed suicides. (Ekundayo et al. 1-18). In the case of mass shooters who are taking psychotropic medications it is important to realize that they were prescribed these medications for a reason. Someone was concerned enough to take these individuals to a Doctor and that doctor saw enough behavioral symptoms (maladaptive behaviors) to decide to try a medication to help alleviate those symptoms. In other words, theoretically the behavior of the individual was already outside the societal norms and the current medical model is to treat maladaptive behaviors with therapy and/or medicine.
When we look at mass shooting events we need to remember one thing, At the end of the day, an individual carries out an act. That individual may be suffering from a mental illness, they may not be. They may or may not be able to manage their thoughts or their moods. They may be on specific medication, they may not be, but for all mass shooting events two variables remain the same. The individual who perpetrates a mass shooting needs a gun and themselves to complete the act. Without that combination there is no mass shooting. That to me is the area where we have the most pressing need to make changes. The media plays a very important role in pushing agendas after these tragic events, whether filling the airwaves with pundits calling for more gun control, or calling for more guns. It is very difficult to find answers and I hope this blog helps one to understand at least some of the mental health debate that often comes up. At the end of the day, we will never know who is going to perpetrate a horrendous crime such as a mass shooting. We can certainly look for warning signs, but how to decipher a cry for help versus an imminent threat remains an area where we must be vigilant. We also must be vigilant not to make assumptions about someone because they have a mental illness. Mental illness is a disease like diabetes, or heart disease. Sometimes lifestyle choices may have led them into it, sometimes it is completely organic and there was nothing anyone can do. We must remain empathetic if we are to create avenues to treatment and healing as opposed to pathways to a police state. In the early 1960’s Bob Dylan penned his song “Blowing in The Wind” “/” as I worked on this blog I was reminded of the line “How many times must the cannonballs fly, before they are forever banned.” We all know, the answer is blowing in the wind.
References:
Ekundayo, Otuyelu et al. “ANTIDEPRESSANT DRUGS AND TEENAGE SUICIDE IN HUNGARY: TIME TREND AND SEASONALITY ANALYSIS.” International Journal of Psychiatry in Clinical Practice (2015): 1-18. Web. 6 Feb. 2018.
Gold, L., Simon, R., & Knoll, J. (2015). Gun violence and mental illness (1st ed., pp. 81-99). Arlington Virginia: American Psychiatric publishing.
How to Legally Declare Someone as Mentally Incompetent?. (2018). The Law Dictionary. Retrieved 20 February 2018, from https://thelawdictionary.org/article/how-to-legally-declare-someone-as-mentally-incompetent/
Molero, Yasmina et al. “Selective Serotonin Reuptake Inhibitors And Violent Crime: A Cohort Study.” PLOS Medicine 12.9 (2015): e1001875. Web.