In response to the horrific Newtown shooting, there has been an urgency on the part of many politicians to call for legislation that would impact those in mental health treatment, for fear that individuals with psychological problems are more likely to commit heinous acts such as what occurred in Newtown. The problem with this second goal is that the type of legislation that is being discussed will likely create more difficulties than it will solve.
Though many politicians and pundits (with no training in mental health) have pronounced Adam Lanza to be mentally ill, we have no information confirming a mental illness. Other than conflicting stories from neighbors and relatives of the Lanzas, we know little about the presumed perpetrator.
While the Connecticut state police indicated that investigators had “very good evidence” that would answer questions about the motives of the shooter, that there was an “immense” number of witnesses to interview, and that the alleged shooter’s father (Peter Lanza, a high-level GE executive) and brother (Ryan Lanza) were both cooperative with the investigation, the state police report has yet to be released, and may not be released until June. Indeed, there remains a plethora of questions about the events of that tragic morning.
Yet federal and state legislation affecting mental health treatment is being proposed, and even passed, with this tragedy in Connecticut as its launching pad. President Obama’s own “executive action” clarifies that the Affordable Care Act does not prohibit doctors from asking their patients about guns in their homes.
Oddly enough, many of these proposals would likely not have prevented the Newtown shooting, as we understand it to have occurred at this point, as well as other shooting massacres; in most cases, the perpetrators were not receiving mental health treatment prior to their crimes.
According to a study in the American Journal of Psychiatry, only about five percent of violence can be attributed to those with mental illness, and only some very serious mental illnesses are associated with an increased risk of violence. Between 2001 and 2010, 120,000 gun-related homicides were reported, according to the National Center for Health Statistics, yet few were perpetrated by people with mental illnesses.
A National Institute of Mental Health’s Epidemiologic Catchment Area Study that followed nearly 18,000 subjects found that the prevalence of violence among individuals with serious mental illness, such as schizophrenia and bipolar disorder, was 16%, compared with 7% among people without any psychiatric illness. Perhaps more importantly, the NIMH study also found that substance abuse is far more likely to lead to violent behavior than mental illness on its own.
With regard to Lanza, there were conflicting reports whether he had consumed any alcohol, medications, or drugs prior to the shooting. These substances can have cognitive side effects that are capable of altering perceptions of experiences.
Jeffrey Swanson, a professor of psychiatry at Duke University and an expert in the origins and patterns of violence, said:
Can we reliably predict violence? “No,” is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not… You can profile the perpetrators after the fact and you’ll get a description of troubled young men, which also matches the description of thousands of other troubled young men who would never do something like this.
Charging mental health providers, then, to automatically ask all their patients for information about guns seems an overreaction, at best, and an intrusion into the therapeutic relationship that could prevent those who have problems with anger and aggression from seeking treatment at worst.
Indeed, more than several mental health experts have warned that legislative overreach in attempts to deal with gun violence could prevent those with emotional problems from seeking help because of fear of being reported.
Without a doubt, the severely mentally ill who have shown violent tendencies should not have access to guns, knives, and other objects that could be used to harm themselves or others. But there are many individuals who seek mental health treatment, even those who are deemed severely mentally ill, who have never shown violent tendencies and who do not require discussions about guns to even enter into conversations with their mental health professionals or other health care providers.
The only thing that may have saved the children and staff at Sandy Hook Elementary School is an adult with a gun who could have shot the killer before he began shooting. That said, better background checks of those with known serious mental illness who purchase firearms could prove to be helpful, as could encouraging parents of young people with a history of serious aggression to file for guardianship to enable health care providers continued access to parents even after the age of majority (18 in most states).
It is probably wise for mental health practitioners to broach the subject of guardianship with adolescent patients with backgrounds of concern and their parents in advance of reaching the day when privacy laws require restrictions of shared health information.
In the long term, however, the nation ultimately needs to confront a culture in which parents often abandon the teaching of self-control and responsibility, and offer fewer role models who demonstrate the same.
In the meantime, following these rare but overwhelming crises, lawmakers often apply a one-size-fits all rule that allows them to appear concerned and responsive to constituents, while at the same time that they pass the enforcement details off to a group of bureaucrats. A rush to judgment and legislation, however, could bring about an outcome that will merely lull people into the false notion that they are safe from violence.