By Mike Bachhuber, Co-Chair, NCIL Mental Health Task Force
Our nation mourns last week’s massacre in Newtown, Connecticut. While we mourn, many of us have been wondering what we can and should do as a society to prevent this senseless destruction. It seems as though mass shootings have become the modern epidemic. Because they make so little sense, people throw around terms demeaning to trauma survivors and others labeled with mental illness.
We must look to history to ensure that our mourning does not lead us down the wrong path. In the labor movement, there is a saying: “An injury to one is an injury to all.” It means that when an employer acts unjustly against a worker, all workers are diminished. It is a challenge to collective action on behalf of a movement.
Since the incident, we have seen suggestions for psychological testing before gun purchase. Previously, we have seen legislation to create a registry of people who have ever been committed for forced “treatment” and limit sales of guns to those listed on the registry.
Discrimination is usually the easy solution. However, we must look beyond discrimination if we want an effective solution. Here are some facts leading to that conclusion.
- One in four American adults (26.2%) experience mental illness in a given year (Kessler, Chiu, Demler, & Walters, 2005) although only 1 in 17 can expect the experience to endure or repeat and cause disability.
- People with mental illness diagnoses are no more likely than other members of their community to commit violence unless they also have a substance abuse diagnosis. People with both a mental illness and substance abuse diagnosis are no more dangerous than those with a substance abuse diagnosis alone (Elbogen & Johnson, 2009); (Monahan, et al., 2001).
- People with a mental illness diagnosis are about four times more likely to be a crime victim than the general population (Teplin, McClelland, Abram, & Weiner, 2005).
- Clinical predictions of violence are often notoriously inaccurate (Monahan, et al., 2001).
As the discussion moves to the policy arena, advocates must be careful. President Obama said in the October 16 debate, “We’re not going to eliminate everybody who is mentally disturbed, and we’ve got to make sure that they don’t get weapons.” In case we didn’t notice, he mentioned three times how criminals and “the mentally ill” are responsible for gun violence.
For those who noticed, some were concerned with what this meant for gun owners. As a person labeled with “mental illness,” the language used by the President, “mentally disturbed” and “mentally ill,” concerned me. Unlike some advocates, the President’s failure to use “people first” language was not the issue for me.
It wasn’t just that he was associating criminality with mental illness labels. While malignant, such attitudes mostly show the ignorance of those who express them.
The real problem is that the President was advocating for discrimination against “the mentally ill.” He was suggesting that “the mentally ill” deserve to have their access to guns limited in ways that others will not.
We fought so hard for the concept that discrimination based on actual or imagined disability is wrong. We continue to fight so that the “direct threat” exception is limited. Discrimination may only be tolerated when a person perceives a threat that meets the criteria stated in the ADA regulation: “based on reasonable judgment … [relying] on … the best available objective evidence, to ascertain: the nature, duration, and severity of the risk; the probability that the potential injury will actually occur; and whether reasonable modifications of policies, practices, or procedures or the provision of auxiliary aids or services will mitigate the risk.”
Our community must know the facts. We must also make sure that policy-makers know the facts and use them to assess the various policy options.
Most publicized gun violence cases involving a perpetrator perceived to have mental illness involve people for whom no professional believes that the person is dangerous. More often than not, the perpetrator has no history of mental illness. Even when the person has been treated for “mental illness,” two reasons lead to no prior belief of dangerousness: the limited ability of professionals to predict future violence and civil commitment laws.
The perpetrator would not be free to commit acts if believed dangerous because of commitment laws in every state which allow the person’s liberty to be denied. When a professional believes a person with a mental illness diagnosis to be dangerous, they consider it their duty to report the person. When civil authorities agree with the professional, proceedings cause the person to be held against their will where they are not free to commit violence.
In short, there is not a bright line that can be used limit guns only for “the crazies.” There is no way to prevent the violence without violating the civil rights of innumerable people.
Existing laws, like the National Instant Criminal Background Check System already incorporate the discriminatory belief that we can do so. The system requires states to provide records of those “adjudicated as mentally defective, or [who] have been committed to a mental institution.”
The term “mentally defective” is outside of the experience of those who work in the system. It also ignores the purpose of guardianship laws, to protect those whose ability to make good decisions is limited.
The bigger concern is with those who have been committed. The laws of every state allow courts to commit people to institutions in cases where they are adjudicated “mentally ill” and “dangerous.” While deprivation of liberty is often too easy, there is a great range in what constitutes “mentally ill” and “dangerous.” Most people found to be “dangerous” are suicidal or believed to be a danger to themselves in some other way. Only a small fraction is believed to be a danger to others.
There are also significant differences in how the laws work. For instance, it is common in Wisconsin for people to be committed to the custody of their county of residence rather than to an institution.
In any case, most laws require that the subject be “fit…for treatment.” There is an assumption that recovery is normal for people who experience symptoms diagnosed as mental illness. Because a person may have been dangerous in 2005 does not mean that he is dangerous in 2006, let alone 2012 (I use “he” since men commit much more violence than women).
I have enjoyed shooting but have never owned a gun. Still, I know that members of my family and friends do. It would be a shame if gun laws limited hunters from that pursuit. All the more shame if those hunters are limited because of a mental illness diagnosis.
Let’s work to stop violence. Let’s make sure that people who are depressed or experience extreme mental and emotional states have access to treatment if they choose it. Let’s address glorification of violence on TV, in games and in other media. Let’s also address the disparity between rich and poor that increases the sense of desperation so many feel.
While our nation works to prevent more senseless violence, our President and others in the public arena express attitudes that support discrimination against those of us with mental and emotional disabilities. We need to make sure they know that such discrimination is both bad policy and hurtful. That is our duty as people with disabilities. After all, an injury to one is an injury to all.
Elbogen, E. B., & Johnson, S. C. (2009). The Intricate Link Between Violence and Mental Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry, 66(2), 152-161.
Kessler, R., Chiu, W., Demler, O., & Walters, E. (2005, Jun). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6), 617-27.
Monahan, J., Steadman, H., Silver, E., Appelbaum, P., Robbins, P., Mulvey, E., et al. (2001). Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence. New York: Oxford University Press.
Teplin, L. A., McClelland, G. M., Abram, K. M., & Weiner, D. A. (2005, August). Crime Victimization in Adults With Severe Mental Illness: Comparison With the National Crime Victimization Survey. Arch Gen Psychiatry, 62(8), 911–921.