Guns and Mental Health Care: Finding the Right Solutions

As you’ve probably been hearing, Congress is at an impasse in the debate over guns. They have retreated, for the moment, from the issues that divide them, including whether limits should be imposed on assault weapons, if the loophole should be closed that exempts individuals who purchase firearms at gun shows from background checks, and other divisive issues.

There is one area though in which the gun control and the pro-gun lobbies appear to have reached an agreement: that mental health background checks should be expanded. Some of the rhetoric has been inflammatory and highly offensive.

For example, in the days following the tragedy at Sandy Hook Elementary school, Wayne LaPierre, the executive vice president of the NRA, attempted to deflect attention away from calls to ban assault rifles and automatic weapons by focusing on what he regards as the “real problem”: the large numbers of dangerous people with mental illness walking our streets.

LaPierre said, “How many more copycats are waiting in the wings for their moment of fame—from a national media machine that rewards them with the wall-to-wall attention and sense of identity that they crave—while provoking others to try to make their mark? A dozen more killers? A hundred more? How can we possibly even guess how many, given our nation’s refusal to create an active national database of the mentally ill?”

But these offensive quotes are not limited to the NRA and their allies. Consider this statement by Mark Glaze, Director of Mayors Against Illegal Guns, a leading organization advocating for gun control, that appeared this January in an article in The Washington Post.

“The system looks like Swiss cheese. It stops a lot of bad guys from getting guns, but it lets a lot of bad guys through. Every mental health record that isn’t in the system is a ticking time bomb waiting to go off in another community.”

There is certainly little disagreement that guns should be kept out of the hands of people who are violent. But focusing the debate solely on expanding mental health background checks misses the point. After years of neglect, coupled with huge budget cuts since the recession began in 2008, mental health services are frequently not available to those who need them most. On any given day, six out of 10 people living with serious mental illness do not have access to any mental health treatment.

Moreover, most people living with severe mental illness are not violent. Thomas Insel, M.D., director of the National Institute on Mental Health (NIMH), recently testified on this point at a Congressional hearing:

“Research has suggested that persons with schizophrenia whose psychotic symptoms are controlled are no more violent than those without serious mental illness (SMI). Nonetheless, when untreated psychosis is also accompanied by symptoms of paranoia and when it is associated with substance abuse, the risk of violence is increased. Importantly, the risk of violence is reduced with appropriate treatment. Moreover, people with serious mental illness are 11 times more likely than the general population to be victims themselves of violence.”

Despite these research findings, existing laws take a broad, categorical approach to mental health background checks rather than focusing on predictors of violence. The Federal Gun Control Act states that “persons adjudicated to be mentally defective or who have been committed to a mental institution” are prohibited from possessing firearms and ammunition. And, states are directed to report the names of individuals who fall into these categories for inclusion in the National Instant Background Check (NICS) system. A recent report by Mayors Against Illegal Guns shows that some states have reported thousands of records and others none at all.

NAMI has testified that federal legislation should eliminate highly offensive terminology such as persons “adjudicated as mentally defective” and provide clearer guidance on who should and should not be included, based on current scientific understanding.

The real solutions however lie in improving America’s broken mental health system. A system that does not enable people to get mental health care until their symptoms deteriorate to the point of constituting acute emergencies is no system at all.

NAMI has recommended a number of steps in the aftermath of Newtown, including:

• Early identification and intervention in mental health care.
• Training of school personnel, law enforcement and other first responders on crisis intervention.
• Implementing school based mental health services and supports.
• Increasing the qualified mental health workforce.
• Fully implementing Medicaid expansion and other key components of the Affordable Care Act, including mental health parity.
• Providing support for families who function as primary caregivers.
• Achieving proper balance in federal and state privacy laws.

There are several bills in Congress that would take steps towards achieving some of these objectives, including the Mental Health Awareness and Improvement Act, which would put resources into school based mental health services, suicide prevention and other areas, and The Excellence in Mental Health Act, which would establish a funding stream for Community Mental Health Centers (CMHCs) that achieve certain core competencies in treating people with mental illness.

However, at the same time that these new programs are being considered, vital areas of federal funding such as housing and research on mental illness are slated for cuts.

Taking one step forward and two steps backwards is not going to get the job done. And, limiting the debate solely to how mental health reporting requirements can be expanded in gun background check systems will not solve the problem either.