In the reinvigorated national debate over the prevention of gun violence, a common theme is how to improve mental health services for at-risk youth.
While both pro- and anti-gun advocates have voiced their support for new mental health initiatives, it's important to remember that mental illness plays a role in only a very small percentage of violent incidents. However, addressing mental illness as part of a gun violence protection plan that also focuses on limiting access to firearms could potentially prevent violence in certain cases.
Among the proposals included in President Obama’s plan to address gun violence is a push to improve access to mental health care. Obama has also called for increased funding to train mental health professionals and youth-targeted mental health programs.
The Washington Post cited a database compiled by the RAND Corporation’s Promising Practices Network that shows the success of various depression and violence treatment programs. RAND representatives, though, are hesitant to claim that the programs will necessarily curb gun violence.
“I am a strong supporter of such efforts, not as a way to reduce gun violence per se, but as a way to produce healthier and more productive youth,” Lisa Jaycox, senior behavioral scientist at RAND, told Campus Progress.
Jaycox pointed to an article on violence and mental health by colleague Terry Schell, who wrote that “suggesting that mental health treatment is the key to preventing gun crimes often mischaracterize the current state of the science.”
Schell argued that the link between an individual being diagnosed with a mental disorder committing violent acts is weak—and that no specific treatment that has been demonstrated to reduce violence among the mentally ill individuals. He also cited cuts to mental health funding as hindering further research into this subject.
Others are more optimistic.
DJ Jaffe, executive director of Mental Illness Policy Org, said that not only is there a link between mental illness and violence, but also that it can be treated successfully. The root of the problem lies in the distinction between mental health and mental illness, he said—as well as where funds are directed.
“The problem is not that there isn’t enough money in the system,” Jaffe said. “If the money that is spent under the guise of mental health were instead spent on serious mental illness, there is more than enough money to help.”
According to Jaffe, between 40 and 50 percent of Americans can be diagnosed with some type of mental disorder. Because this group is so large, with the great majority suffering minor disorders that don’t greatly disrupt their lives, experts are able to claim no link between mental disorders and violent behavior. Additionally, among the five percent of Americans with more serious mental illnesses, including schizophrenia and bipolar disorder, many are receiving treatment that curb extreme behavior.
The focus of any violence prevention plan, he says, should be on individuals who suffer from serious mental illness and are not receiving treatment, a much smaller group that does actually show a higher tendency towards violence, especially when paired with drug or alcohol abuse.
“If more money were spent on the most seriously ill it would be effective in reducing overall violence,” he said.
Jaffe points to state laws like Kendra’s Law in New York, and Laura’s Law in California, as effective and cost-efficient ways to treat mental illness. The laws mandates people with serious mental illnesses and potentially violent behavior to receive treatment, whether they want to or not.
In a study by the New York State Office of Mental Health, those patients showed a marked reduction in negative behaviors including violence, threats of suicide, and drug and alcohol abuse.
However, most states do not have programs that can mandate that the mentally ill receive treatment until after they exhibit violent behavior. And people who do commit acts of violence are often jailed rather than treated.
Making sure that people in need are able to receive treatment is of vital importance, according to Dr. Lloyd Sederer, medical director of the New York State Office of Mental Health.
“Treatment is what’s effective,” says Sederer. “For those people who refuse treatment, AOT is important.”
But forcing patients into treatment is not enough. According to Sederer, comprehensive and continuous care is equally important.
Holistic treatment means that "it doesn’t go on for three months and then stop,” he said. “It needs to go on for years—a minimum of 18 months for people in terms of beginning to contain what often is an illness that’s out of control.”
He has also advocated for involving families in the process of caring for the mentally ill. Laws intended to protect patient privacy make it difficult for doctors to communicate with family members who may be able to provide information that would help doctors provide better care. However, Sederer opposes the type of national mental health database that some participants in the gun violence prevention debate have argued should be part of any plan to reduce violence.
“The idea of a registry of people with serious mental illness is a very thin wire to walk,” he says. “Helping people get into treatment, stay in treatment, have effective treatment, stay clean—that’s the most effective way to keep people with serious mental illness no more violent than the general population."
Sederer is supportive of the president’s plan to increase mental health funding. But he hopes those funds are spent wisely, on initiatives like community services and school-based services for young Americans, and not on high-cost services such as emergency room visits or in-patient care—which are the result of of people not getting the care and early intervention they need in the first place.
How limited mental health funds are spent is also an issue for David Anderson, vice president of the Coalition for Evidence-Based Policy, another group featured in the Post’s article. He advocates using funds to evaluate mental health treatment and strategies.
“The mental health system is likely not performing optimally because many of the services it provides have never been rigorously evaluated, leaving us in the dark as to which of them are effective, ineffective or even harmful,” Anderson told Campus Progress.
Among the executive actions recently signed by President Obama as part of his gun-violence prevention plan was an order authorizing the Centers for Disease Control and Prevention to conduct research into the causes of gun violence.