FIREARM VIOLENCE: CAN IT BE REDUCED BY AIMING AT MENTAL ILLNESS?

The spate of recent firearm deaths at schools and public places has rightfully triggered a lively public debate. Among all the clatter, we often hear politicians stating that we can reduce firearm deaths, such as those occurring in public places, if we would simply employ better detection and management of mental illnesses. But this is a flawed concept: At best it would solve only a tiny fraction of the problem, estimated at approximately 3-5%. In reality, most people who are violent are not mentally ill, and most people who are mentally ill are not violent.# Although seemingly logical at its surface, let’s clarify this issue further by applying scientific/numerical analysis.

Since 2009, there have been more than 277 mass shootings in the United States, resulting in 1565 people shot and killed and 1000 people shot and wounded. Since most of these shootings are perpetrated by single gunmen, this means that roughly 277 (or slightly more) individuals carried out these heinous acts.

According to the National Institute of Health, the prevalence of major mental illnesses in the U.S. is approximately 4.2% of the entire population, meaning that about 10.4 million people harbor serious mental disorders. Even if one assumes that this entire group of 277 killers were mentally ill, which is clearly false, this total number would constitute an infinitesimally small percentage (.0027) of all those suffering from mental illness. Unless we had a fail-safe method of detecting 100% of individual would-be killers from this large group of mentally ill, our ability to detect a future killer remains at nearly zero, which represents the proverbial needle in the haystack. Supporting these data, all mental health professionals freely admit that it is virtually impossible to predict accurately—nowhere near 100%—of those with known mental disorders that are likely to perform such acts of violence. Compounding this problem even further, laws in this nation generally preclude forced detention of mentally ill individuals that have not yet performed any act of violence, for more than brief periods, What this means is that, given these extremely daunting numbers, detection and treatment of those with suspected mental illness in the effort to ward off gun violence is a virtual impossibility, notwithstanding the pronouncements by these said politicians.

It all boils down to a simple bottom line: Major efforts must be aimed primarily at sensibly limiting everyone—whether or not mentally ill—from freely obtaining firearms capable of killing—especially of the mass variety.

We must allow numeric principles to guide us, not a bunch of mercenary political figures, often under the thrall of the NRA, who wish to apply so called “common sense measures” to control this national scourge! Detection and treatment of mental disorders is indeed a laudable goal, but not in the effort to reduce firearm deaths!

# Friedman RA. Violence and mental illness—how strong is the link? N. Engl. J. Med. 2013;368:397-99.

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