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Editorial: Guns and the Mentally Ill; Focus Could Do More Harm Than Good

Advocates for the mentally ill may certainly be forgiven for wondering why it took a massacre of schoolchildren to put their issue high on the political agenda. After all, the treatment of those suffering from mental illness has been for many years a national scandal, one in which Vermont and New Hampshire are fully implicated.

The reason the cause is receiving new prominence, of course, is that talking about improved screening and treatment for mental illness is a way of not talking about the need for stricter regulation of guns, an aversion shared by many Democratic as well as Republican lawmakers.

In any case, we hope that this new emphasis will not revive and reinforce stereotypes about mental illness that it has taken many years to dispel. The main one is that the mentally ill are more prone to violence than the rest of the population. Since the Newtown shootings, any number of commentators have been at pains to point out that the link is tenuous at best. As Dr. Richard A. Friedman, a professor at Weill Cornell Medical College, wrote in The New York Times in December, “only about 4 percent of violence in the United States can be attributed to people with mental illness.” While mental illness is a risk factor, Friedman wrote, the risk is actually small. Only the most serious psychiatric illnesses are associated with a higher risk of violence. Even then, the lifetime prevalence of violence among people with serious mental illnesses such as schizophrenia and bipolar disorder was 16 percent as compared with 7 percent for people without any mental disorder, according to one large national study cited by Friedman.

Moreover, many mass murderers are not overtly psychotic but are rather, in the words of Dr. Michael Stone, a professor at Columbia, “paranoid loners who hold a grudge and are full of rage.” Obviously, anyone who guns down first-graders is by definition mentally ill, but maybe not with the kind of mental illness that is readily identified in advance by family, friends, neighbors and co-workers. Moreover, as Dr. Benjamin Nordstrom, assistant professor of psychiatry at the Geisel School of Medicine at Dartmouth, pointed out in an interview with the Valley News in December, the ability of psychiatrists to predict which patients will become violent in the community is quite limited.

Nor should anyone forget that the mentally ill are far more likely to be victims than perpetrators of violence. One can only speculate on what role mental illness or cognitive impairment played in the shooting deaths of Joseph Fortunati in Corinth and Macadam Mason in Thetford by Vermont State Police in recent years, but it seems likely to us that tragedy resulted when their impaired ability to understand and follow commands was confronted with troopers’ misapprehension of what was actually transpiring during these encounters.

This is not at all to argue that keeping firearms out of the hands of people suffering from severe mental illness ought not to be a priority. Federal law already prohibits selling or otherwise transferring a firearm to anyone who has been “adjudicated as a mental defective or has been committed to any mental institution.” There may be room to strengthen those prohibitions, but it won’t be easy. There are so many kinds and degrees of mental illness that it would be hard to write broader regulations. As just one example, should an Iraq war veteran diagnosed with post-traumatic stress disorder be prohibited from acquiring a firearm? If that prohibition were in place, would fewer veterans seek treatment for their symptoms?

So while there are many good reasons to improve the nation’s mental health system and make access to it easier, we’re far from convinced that the effect would be any dramatic decrease in mass gun violence. Nor should the need for reforming the mental health system deflect attention from the need for sensible gun control measures.