Often, the smoke has barely cleared from the scenes of recent mass shootings when policymakers propose restricting access to firearms by people with serious mental illness.
The implication is that the perpetrators were mentally ill and that keeping guns out of the hands of other mentally ill people will thus reduce mass murders or violent crime in general. Those who argue for or against such action base their views on a slender base of evidence, said researchers in a study published July 15 in Psychiatric Services in Advance.
Surprisingly little solid research exists on the relationship between firearms possession and mental illness, says Emma McGinty, Ph.D., of the Johns Hopkins Bloomberg School of Public Health.
Konrad Crispino/Johns Hopkins Bloomberg School of Public Health
Too often, research on the intersection of gun policy and serious mental illness is hampered because it is often carried out by different disciplines with little overlap, said Emma McGinty, Ph.D., M.S., an assistant professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.
“Firearms injury research comes from the public-health community, while studies of mental illness and violence derive from the psychiatry and law sectors, and they haven’t been talking to each other,” said McGinty in an interview with Psychiatric News. “They have separate audiences and journals and focus on separate goals, either safety or taking care of people with mental illness.”
In addition, gun restriction for people with mental illness is a relatively new policy issue, dating only from the early 1990s, she pointed out. “There is little public attention to the subject until a mass shooting happens, so it is not a research priority.”
A recent report from the Institute of Medicine calling for research “to reduce the threat of firearm-related violence” offered dozens of suggestions but only two directly mentioned mental illness. “We need a comprehensive approach that looks at a broad range of risk factors,” said McGinty.
Assessing dangerousness is still an uncertain avenue, she said. “We’re pretty good at ruling out potentially dangerous people but not in figuring out who will become violent.”
Another key issue for psychiatrists is whether stricter standards for background checks required to purchase firearms will deter those with mental illness from seeking treatment. Despite oft-repeated hypotheses, McGinty has turned up no research supporting that position.
“That’s a bit of a surprise because it is so prominent an assertion within the mental health community,” she said. But measuring treatment avoidance is difficult, because it is hard to identify people who do not seek care. Qualitative approaches or natural experiments might be one creative way to get around that obstacle, she suggested. For instance, recent changes in New York’s firearms laws might present an opportunity to see if treatment patterns change.
For an analogous case of possible treatment deterrence, the researchers looked at laws passed in the 1970s in the wake of the Tarasoff duty-to-warn case. But McGinty “found no studies in the peer-reviewed literature examining the effects of duty-to-warn laws on either mental health treatment seeking or violent crime.”
More is known about suicide and guns. “Household gun ownership is a risk factor for suicide,” she said. However, studies evaluating whether gun-restriction policies affect suicide rates are lacking as well.
The authors suggested that policies proposing gun restrictions for people with mental illness should spark research among those with mental illness regarding their views on such policies.
A 2012 study—the only one McGinty found—showed that veterans asked about temporary removal of guns during periods of high suicide risk voiced some support for the idea, tempered by questions about where the guns might be held, when and how they would be returned, and who would make decisions about gun removal or restoration.
All of which suggests caution in moving to enact laws in the heat of the moment, as too often happens. “Policies targeting people with mental illness have just sprung up, but we have little information about them or if they work,” said McGinty. “There very well could be unintended consequences in taking that approach.” ■