There are, on average, 30,000 firearm related deaths in the United States every year. Of those, about two thirds  were suicide and roughly one third are homicides. Obviously a very significant majority of gun deaths are suicide.Mental illness and/or substance abuse is present in a large percentage of those cases.  Since many people who commit suicide have never sought help for mental health problems it is impossible to be precise about cause.

While mass murder attracts the most media attention and is the most shocking and disturbing to the public at large it is only a very small fraction of the carnage. In the wake of the recent mass shooting, the public is again talking about gun safety and laws.  I hope this conversation about guns will also help us to look more deeply at the relationship between guns and mental health.

The largest percent of gun homicides are perpetrated by poor urban youth, age 17 to 24, many related to gang violence and drug wars. This gun violence is stems more from the social environment and poverty than problems with mental health. Domestic violence, which  kills about 1000 women a year in the US, is related to poor mental health both in the abuser and in the victim who is unable to leave her abuser prior to a lethal attack. The presence of a firearm in the home greatly increases the risk that domestic violence will escalate to homicide. Much other gun violence is related to robbery and crime as opposed to mental health.

There is a great deal of discussion currently about the need for greater access to affordable mental health care as a part of the central effort to reduce gun violence but this is a multi-faceted dilemma. Public education and reducing stigma is an essential factor in encouraging people to seek help and to receive the support of their loved ones in persisting with treatment. Sadly, even people who seek help are often too quick to give up on a process that can be time consuming, tedious and expensive especially for those with more severe conditions.  We need to give people the same support in receiving mental health care that we would give them for trying to treat a complex cancer or heart condition.  Family members may feel that the person suffering is causing their own problems or should just snap out of it. Psychiatric medications which are often life saving can be viewed with suspicion by uninformed family members who pressure the depressed person to do it on their own or turn to God or to stop feeling sorry for themselves. Guilt is a very common symptom of depression, integral to the disease and when the person feels at fault for their suffering, feels a great failure, suicide becomes a more acceptable solution.  The presence of a firearm in the home greatly increases the risk that a suicide attempt will prove lethal.

Would better mental health care have made a difference with Douglas shooter Nikolas Cruz, Newtown’s Adam Lanza, Aurora’s James Holmes, Jared Lee Laughner in Tucson?  Probably not.  I do not doubt that these killers were deeply disturbed but the level of psychosis and paranoia that triggers this type of violence  is the same mental distortion that usually causes a severely mentally ill person to retreat from society.Deeply disturbed and paranoid people hide their deranged thoughts from everyone as they feel threatened and in danger.  The homicidal rampage is perceived as how they protect themselves or take revenge for delusional threats. Mass murderers who kill family members may feel they are protecting them from a threatening world.

Seung-Hui Cho, the young man responsible for the Virginia Tech massacre, is an excellent example of the limitations of mental health treatment in preventing mass murderers from executing their plans. Cho was diagnosed and treated early in life for depression and selective mutism. His family was well aware that he had serious problems and tried to get him help but once he was a legal adult he slipped out of mental health care system.  In 2005 his condition did attract attention of outsiders and he was ordered to undergo treatment after expressing suicidal feelings. Since the order was for out-patient treatment he could still legally obtain a firearm. If he had already begun to formulate plans for mass murder, he never disclosed them to anyone. To kill innocent strangers (let alone children as in the Newtown tragedy) requires such a complete distortion of rational thought, such an unwarranted fear of others. These killers, while often appearing bizarre and even frightening to outsiders prior to taking action, are totally unlikely to reveal the hideous extent of their dark and twisted thoughts.Afterward we hear that people were concerned but being unaware of the extent of the danger they are unable to take action in time to prevent the  horrific and calamitous behavior.  Interestingly, these men do seem compelled to express their ideas and often leave copious notes in writings, drawings or, as in the case of Cho and Dylan Klebold-video.

Does that mean that banning semi-automatic weapons, and high capacity ammunition should not be attempted?  Absolutely not! Without access to these weapons mass murders will still exist and will still cause harm but the scale of the tragedy would  be reduced. What shouldn’t be overlooked in this discussion is the wider impact of guns on mental health and the increased risk of suicide and homicide they present. I hope the current national conversation about guns and mental health will lead to ideas that will benefit a wide range of those who suffer and are at risk.