America has a mass shooting problem. That is obvious to almost everyone, with the exception of a group of gun enthusiasts who seem to think we have a mental health problem instead.
The first time I heard mental health reform proposed as a solution to gun violence, I was encouraged. The compassionate care of the mentally ill has the potential to reduce crime, and even if it doesn’t, it will still help people who desperately need psychological treatment.
America has a dreadful mental health system. As bad as our healthcare system is (and it is pretty awful), mental health is worse. Mental health in the U.S. is plagued by underfunding, by non-coverage from insurance companies, and by government agencies that are poorly managed and neglected. No other sector of the American health care system is asked to do so much with so little. Mental health is further hampered by the criminal justice system, which takes some of the mentally ill off the streets and, rather than treating them, locks them up at great expense, only to release them years later in far worse condition.
If America built mental health facilities as fast as it constructs new prisons, our country would be a much better place. Instead, we keep building prisons, and cutting funding for mental health.
The idea of using mental health to prevent mass murder sounds good. A lot of mass shootings seem to be caused by mentally deranged individuals — the recent Florida shooter and the Sandy Hook murderer were two such examples. Perhaps, if these people had gotten better mental health care, the crimes might have been prevented.
But here is the problem: Most politicians, when they talk about using psychiatric services to prevent gun violence, seem to be talking about identifying the mentally ill and putting them on lists to prevent them from buying guns. This isn’t treating mentally ill individuals. It is using the mental health system to find dangerous people and turn them over to the government.
It is not, nor should it ever be, the job of medical personnel to help the government identify criminals. I am a doctor, not a police officer, and I am not comfortable with sharing my knowledge about a patient with the government. People come to doctors, and especially to psychiatrists and psychologists, with the expectation of confidentiality.
Would you see a doctor, knowing the doctor is encouraged by the government to notify the FBI if he finds you suspicious? Far from preventing crime, policy that violates patient confidentiality is likely to result in less mental health, not more, and will therefore increase crime. Patients most in need of help will avoid care at all costs to avoid being turned in.
Every year, I have to fill out a set of forms to continue to receive malpractice insurance in the State of Mississippi. I am asked a variety of security questions, such as if I have been arrested or accused of a crime, if I have substance abuse issues, or if I have been disciplined by a medical staff for misconduct. And I am asked if I have been treated by a mental health professional for anything. Depression, anxiety, marriage difficulties, anything whatsoever. And if I have, I have to get my therapist to write a letter explaining why it is still safe for me to practice medicine.
This always bothered me. While there are some mental health issues, such as substance abuse, that probably are the business of my malpractice carrier, treatment for depression or anxiety is not. If I am seeking help for a psychological problem, that is a good thing. Better to be under the care of a psychologist and practicing medicine than seriously depressed and practicing unsupervised.
The questionnaire does not ask if I have a medical problem that could affect my ability to practice. There are numerous medical conditions — cancer, seizures, chronic pain, Parkinson’s disease — that could have a serious impact on my ability to practice medicine. I could have Alzheimer’s disease, for example. But my insurance company is unconcerned about that. Only if I have a mental illness do I have to have a letter clearing me to practice medicine.
This is what stigmatizing psychological disorders looks like. Somehow, a mental disorder is seen as worse, and more important to single out, than any other medical condition that might afflict a doctor. Given this prejudice, a doctor with a serious psychological disorder would be less likely to seek out psychological help, knowing that he would have to report it to his malpractice insurer, and possibly be told he cannot practice medicine any longer.
This problem is similar to the situation of a mentally ill individual who is reported to the FBI. This person might then have to worry about being able to work for the government or about getting security clearance for a job. He or she might not be able to serve in the military, or on a police force. And because people who travel in certain areas of the world often have to pass security screenings to get back into the United States, a person on a no-gun list might even have trouble traveling abroad.
While it is true that many people who commit mass shootings are mentally ill, it is not true that most mentally ill commit mass shootings. Think of it this way: All sharks are fish. But that doesn’t mean that all fish pose a danger to humans. In fact, not even all sharks attack humans — of the 375 known shark species, only three — the great white, the tiger, and the bull shark — attack humans with any frequency.
In much the same way, it is unfair to blame the mentally ill for mass shootings. Very few people with psychological disorders commit violent crimes, and this is even true of serious mental disorders, such as schizophrenia or antisocial personality disorder. Singling out mentally ill people as dangerous is about as fair as killing all the fish to get rid of the sharks.
It is not clear how many mass shooters meet the criteria for mental illness. Nor is it clear which mental illnesses are most likely to lead to mass shootings. But mass shooters do have one thing in common. They use high-powered assault and semiautomatic weapons.
Seems to me the more obvious place to start is there.