Violence Risk, Not Mental Illness, Should Guide Gun Access

Evidence of an increased risk of harm to self or others, but not mental illness alone, should direct federal and state policies regarding access to firearms to reduce homicide and suicide, said two reports from a group of researchers, mental health practitioners, and gun violence prevention advocates issued last month.

The reports sought to balance public safety with the rights of gun owners, said the authors, members of the Consortium for Risk-Based Firearm Policy.

“This is an important effort to refocus the discussion about gun violence on groups that represent high risks for violence, rather than continuing with a misdirected focus on people with mental illness,” said consortium member and former APA President Paul Appelbaum, M.D., the Dollard Professor of Psychiatry, Medicine, and Law at Columbia University College of Physicians and Surgeons, in an interview with Psychiatric News.

The consortium’s first report, on state gun policies, was released in Charlottesville, Va., December 2, 2013, while the one on federal policies was presented to congressional staffers the following week.

“These reports need to be the basis of any legislative outcome,” Rep. Mike Thompson (D-Calif.), chair of the House Gun Violence Prevention Task Force, told Psychiatric News at the Washington, D.C., briefing. “We need to listen to the experts and make sure we pay attention to their research.”

The mental health aspects of the proposals focus on the times when people are at higher risk of committing violence. Current federal rules disqualify a potential purchaser only if the person is under a judicial or administrative commitment. The new criteria would also temporarily bar possession or purchase at the request of clinicians following short-term involuntary psychiatric hospitalization or when a court sees a “substantial likelihood of danger to self or others.”

Anyone blocked from purchase could regain his or her ability to buy or own firearms after five years. A qualified clinician would then have to certify that the individual would no longer pose a threat to public safety and that any symptoms that elevated their risk were mitigated or were being treated.

Such purchasing restrictions would depend on requiring a background check for all firearm transfers. Background checks are now required at gun stores but not for private sales.

Past Violence More Predictive Factor

“But mental illness is only part of the problem, and so it is only part of the solution,” added attorney Richard Bonnie, L.L.B., a professor of medicine, law, and psychiatry, and neurobehavioral sciences and director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia. “Most people with serious mental illness are not violent, and they account for only 4 percent of violent crimes.”

Evidence shows that a history of violent crime, domestic violence, or alcohol or drug abuse is strongly associated with the risk of committing firearms violence. The existence of those factors—regardless of any history of mental illness—should guide prohibitions against purchasing or possessing firearms, said consortium members.

They identified several groups that they believe should be barred from buying or possessing guns, including people convicted of a violent misdemeanor, those under a temporary domestic-violence restraining order, or those convicted at least twice in five years of either a misdemeanor involving a controlled substance or of driving while intoxicated. They also suggested creating a new class of civil restraining orders to permit families or intimate partners to restrict firearms access, even in cases that do not involve domestic violence.

Allow Law Enforcement to Remove Guns

Finally, the consortium urged that state and local law-enforcement officers be empowered to remove firearms from people they identify as posing an immediate or credible threat, again with appropriate due-process protections for removal and restoration of guns.

Further research can help evaluate these recommendations, said consortium member Beth McGinty, Ph.D., an assistant professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

“There is a potential for unintended consequences of some types of firearms restrictions, like those that focus on involuntary commitment as a means of preventing people with serious mental illness from having guns,” McGinty told Psychiatric News. “Those restrictions might be stigmatizing and might prevent people from seeking treatment because they’d worry about losing their firearms rights, but we have almost no research to tell us if that is the case. And while we have good research on how the use of drugs and alcohol lead to an increased risk of violence, we do not have much research on how policies targeting those risk factors affect future violence.”

“I don’t feel this is about competing rights,” said Brig. Gen. (Ret.) Stephen Xenakis, M.D., who spoke about the problem of suicide among veterans. “We’re about ensuring all our rights so that our country will be safe and our communities will be safe.” ■