New Gun Control Law Takes Aim at Addicts
t is far easier for Americans to buy a gun than to get treatment for mental health or addiction, let alone for both. Our nation's lack of these services is getting an unusual amount of attention right now in the fierce debate about gun control following December's mass shooting at a Newtown, Conn., elementary school. Yet some of the measures being proposed—and passed—are less about treating a vulnerable population and more about a heavy-handed attempt at regulating them. This poses a serious threat for almost half of all people who were or are addicts, as that's the percentage who have depression, anxiety or some other "mental illness."
The debate over how to reduce gun violence is portrayed by the media as polarized, pitting those who support gun rights against those who support gun control. In fact a majority of Americans, and even many gun owners, support a more balanced approach and agree that modest measures to restrict access, such as universal background checks and bans on high-functioning magazines like 15- or 30-round devices, are in order. And all sides agree that such measures should include better screening of mentally ill people who have a history of violence.
President Obama has proposed stricter regulations on not only the people who buy guns but on the guns themselves, such as a ban on assault weapons. But at his State of the Union speech last week, the high point was his emotional appeal to Congress simply to allow a voteon gun control legislation, period. That voting on, rather than passing, a new gun law appears to be the best that reform advocates can hope to achieve makes plain who is winning this debate: the hardcore minority of gun rights adherents, led by the NRA’s Wayne LaPierre, who argue that the main cause of the rising trend in gun violence and mass murders is untreated mental illness. Their advocacy for stricter regulation of these people is already being written into new legislation in even the most liberal states.
Recovering from mental health and substance abuse disorders is difficult enough as it is, with proper and affordable treatment often stymied by a combination of poor access, diagnoses that address substance abuse while ignoring co-occurring mental illness, and the general stigma associated with both diseases. This is why these reporting provisions of state gun control proposals have mental health and addiction advocates digging in for a fight.
But it’s David versus Goliath. The mentally ill, not being a rich and powerful lobby like the NRA but rather a vulnerable and stigmatized minority, are an easy target. And yet an enormous one: annually about 25% of Americans over the age of 18 suffer from a diagnosable mental illness, a total of almost 60 million people.
There is little evidence that focusing attention on mental illness as a cause of gun violence will have any but marginal effects, according to both public health and firearms experts. For one thing, a person with a diagnosis of mental illness is five times more likely to be the victim of violence than to be the perpetrator, experts say. Only 4% of people who commit violence are mentally ill; those who are violent tend to suffer from bipolar disorder, schizophrenia or some other serious problem. According to a large study by the National Institute of Mental Health’s Epidemiological Catchment Area (ECA), 16% of people with a serious diagnosis commit violence, compared to 7% of people with no mental illness.
Addiction and mental health issues tend to go hand in hand—far more often than is generally recognized. According to the just-released 2011 survey by the Substance Abuse and Mental Health Services Administration (SAMHSA), 42% of the 19 million American adults with a substance abuse disorder had a co-occurring mental illness in 2011. By contrast, 17% of Americans without a substance abuse disorder had a mental illness. And the stark difference also holds on the other side of the equation: Adults with a mental illness are three times more likely to abuse drugs or alcohol than adults without a mental illness.
These disturbing public health trends become literally life and death issues when you consider the very strong link between substance abuse and violence. According to the Psychiatric Times, up to “75% of those who begin addiction treatment report having engaged in violent behavior (e.g., physical assault, mugging, attacking others with a weapon and suicide).” The ECA study found that substance abusers with no mental illness diagnosis were almost seven times more likely than nonaddicts to be involved in a violent act. As for people with co-occurring disorders, most studies have found that a diagnosis of mental illness had no measurable effect on the rate of violence by substance users.
Throw a gun into the mix, and you get a status quo in which close to 20,000 Americans commit suicide and another 11,000 are murdered with a firearm every year. Among people with addiction, mental illness or both, the split between suicide and murder is 55% and 45% respectively. And recovering addicts are particularly susceptible to depression and thoughts of suicide, with alcohol and substance abusers four times more likely to have given serious thought to taking their own life in the past year than nonabusers.
Kurt Cobain could be the posthumous poster boy for the most serious gun danger facing people with co-occurring disorders. In the twilight of his 27-year life, the Nirvana front man, who had a diagnosis of bipolar disorder, was in a continual fight with heroin and alcohol addiction. The allure of that quick fix dogged him right up until the day in Seattle when he put a shotgun—one he had bought out of state—in his mouth and ended his life. The rock star's tragedy spoke to the silent struggles suffered by millions of recovering addicts every day.
But as so often on Capitol Hill, reality must yield to politics in partisan battles over policy, dinging the likelihood of an actual solution to actual problems. From the get-go, the NRA’s LaPierre has pursued a take-no-prisoners strategy, vowing retribution on any legislator who votes for increased controls, even background checks. His own proposal? To establish a “national registry” of people with a mental illness while adamantly opposing a national registry of gun owners—or even a universal background check for all gun purchasers.
In early January, New York state governor Andrew Cuomo, one of the nation’s most progressive presidential aspirants, signed a sweeping gun law that includes a provision requiring mental health professionals to inform their county directors of any patient who exhibits “harmful thoughts” to self or others. If the police are informed, they can then void the patient’s Second Amendment rights. A month later, a Georgia senate health committee unanimously passed legislation allowing licensed mental health professionals—including ordinary counselors—to involuntarily commit patients they deem potentially dangerous (to themselves or others) to an institution for 72 hours.
In reality, almost all mass shootings are done in family or workplace contexts by a perpetrator with no mental illness—or an undiagnosed and untreated one. “Most of these killers are young men who are not floridly psychotic,” Michael Stone, MD, a clinical psychiatry professor at Columbia University and an expert on mass murderers, told The New York Times. “They tend to be paranoid loners who hold a grudge and are full of rage.”
A paranoid loner is unlikely to end up in the office of a psychotherapist, while the people in treatment—now possibly coming under tighter surveillance—pose little risk except to themselves. If anything, mental health experts say, stricter regulation will discourage a paranoid-loner type from even considering treatment.
Fixating the gun violence debate on the issue of mental illness may have emerged as a tactic to change the subject from gun control, but it could do a lot of real-world damage. It threatens to intensify the stigma surrounding the mentally ill by popularizing the false notion that they are violent—and this goes double for people with a dual diagnosis.
f the New York state law is any indication, the provisions are likely to be written so vaguely as to only stoke the fears of someone who is in, or who needs, treatment. Questions like whether you will end up in the state’s criminal background check database, whether prospective employers will have access to this information, and whether a diagnosis can ever be expunged following treatment could have a chilling effect on addicts—especially those who use an illegal substance—with a dual diagnosis.
That's bad news for recovering addicts in need of mental health treatment, who already tend not to receive care. The 2011 SAMHSA numbers show that less than a third of Americans with a substance abuse disorder received any mental health care at all. An additional 4% received such treatment in rehab. A mere 7% of addicts accessed both mental health care and rehab services. While laws such as the one in New York are intended to preserve public safety, they might have the adverse effect of instilling mistrust between patients and their doctors, exacerbating this public health crisis even further. And the worse the substance abuse, the worse the co-occurring mental illness and risk of suicide.
President Obama's gun-control proposal is relatively uncontroversial as far as its provisions for reporting mental health status to background check databases, as those laws are already on the books (though poorly enforced). But the president's insistence that mental health care providers "get in the game" when it comes to reporting potentially violent individuals has already become a sticking point for doctors—not to mention a needless obstacle to addicts who genuinely want to recover from their illnesses. The president has insisted that such provisions will not violate patient privacy, and are only meant to target truly risky individuals. Current and prospective mental health patients had better hope he is right. Otherwise, they face a healthcare landscape in which they're discouraged from talking about, say, thoughts of finding happiness at the end of a warm gun.