Senate gun bill includes solid mental health policies — but must focus on serious illness

On Sunday, U.S. senators working toward bipartisan gun legislation announced a framework agreement in response to several mass shootings this spring. Provisions so far include additional rational barriers to gun purchases and funding for state red flag laws, mental health, and school safety. As legislation is written, lawmakers should continue to prioritize mental health policies that target individuals with serious mental illness, who are most at risk of violence, over broad funding for mental health education and prevention programs, which don’t work.

Mass shootings are rare, and violence from any mental illness is rarer still. But among a narrow group of those with untreated serious mental illness, violence is more likely. Treatment, services and intervention targeted toward people with serious mental illness, then, is key to preventing violence from mental illness.

While the details will matter, the Senate proposal includes funding that likely will get resources to the seriously mentally ill: red flag laws, reviews of juvenile mental health records for gun buyers, and, importantly, mechanisms for expanding access to treatment and services for families with loved ones in crisis. These are all solid policies because they target individuals who need considerable intervention.

Families deserve this support. They often desperately seek help for members they know are mentally ill but can’t access appropriate treatment and services. Often, those families end up becoming victims of violence themselves.

In fact, the more the bill includes to get treatment to the seriously mentally ill, the better. For example, funding could incentivize red flag laws to act as mechanisms for not only restricting gun access but triggering treatment and services. This would make gun restriction more effective and would be compassionate to those who need medical attention.

On the other hand, some provisions won’t prevent tragedies and should be minimally prioritized. Unless targeted to youths with serious mental illness or serious emotional disturbances, most school-based mental health services are likely to be ineffective. Most common are mental health awareness, identification and prevention programs that are delivered to the masses, but they already receive too much money — which is any amount, because evidence doesn’t show they work.

After the Sandy Hook Elementary School shooting in 2012, President Obama responded with funding (that has continued) for a program representative of this type of ineffective approach. The program, called Mental Health First Aid, essentially acts as a public screening test for mental illness, by training everyday citizens, such as teachers, how to recognize mental illness or mental distress — however minor and unlikely to result in violence. Public health might justify screening if we didn’t recognize disease without it and therefore would miss opportunities to prevent or treat cases. But we do recognize mental illness without training, even symptoms of specific diagnoses.

Most school shooters had known serious mental illness, including those accused of the Sandy Hook shooting and the Feb. 14, 2018, shooting at Marjory Stoneman Douglas High School in Parkland, Fla., and perpetrators of school shootings almost always have told others what they plan to do, as did the gunman at Robb Elementary School in Uvalde, Texas — who was likely mentally ill but not diagnosed. The 18-year-old man accused of killing 10 people at a Buffalo, N.Y. supermarket in May also reportedly posted his violent intentions, but he was not monitored after a psychiatric evaluation that he essentially complained was short. 

Mental illness going unrecognized is not a problem. Mental illness going untreated or without intervention is.

We miss opportunities to stop acts of violence by trying to prevent mental illness in the masses. Prevention is not possible because the causes of mental illness are not known. There are no single biomarkers, lab tests, or imaging tools confirming mental illness, just factors that can increase risk. In any case, serious mental illness is rare — the prevalence rate of schizophrenia, for example, is less than 2 percent among adults worldwide — and almost no one who experiences common, transitory mental distress will go on to develop a severe psychiatric disorder, shoot up a school, or both.

As Manhattan Institute fellow Robert Verbruggen writes, for authorities trying to intervene and stop the next mass shooter, “there isn’t enough time to investigate every young man with a chip on his shoulder.” School-based mental health awareness and prevention programs don’t even narrow it to that — instead, they cast the widest net possible by suggesting it’s useful to identify and monitor anyone with any level of anxiety or depression who may or may not benefit from consulting with a therapist. Isn’t that basically everyone affected by tragedies?

It’s important to recognize that not all individuals with serious mental illness will engage in violent behavior, and many non-mentally ill people will, so gun violence needs solutions outside mental health policy. But targeting mental health resources to the seriously mentally ill is still worthwhile. These individuals face tragedies aside from violence that are costly to society: They are disproportionately represented in homeless and incarcerated populations, and are the subject of hundreds of thousands of 911 calls annually. They also persistently experience higher mortality rates, are less likely to be accepted by health care providers because their treatment is poorly reimbursed and not profitable. They are commonly boarded in emergency rooms, turned away from hospitals, or released from hospitals too soon.

Sens. Chris Murphy (D-Conn.) and John Cornyn (R-Texas) surely know all this — they have been leaders on mental health reform for years. There is hope for effective mental health policies as part of gun violence legislation if they can convince their colleagues to prioritize serious mental illness when getting to the details.

Carolyn D. Gorman is an adjunct fellow at the Manhattan Institute and the author of a forthcoming report examining the evidence for mental health first aid.