On Gun Violence

“Monday Musings” for Monday January 12, 2015

Volume IV, No. 2/210

ban-guns

Gun Violence and Mental Health

By Assad Meymandi, MD, PhD, DLFAPA*

Recent terrorist attack and assassination of 12 journalists in Paris France prompts us to take another look of violence inflicted by availability of guns. It is not the purpose of this discussion to examine the barbarity of terrorist acts which not only kill people, but the freedom of speech. About a year ago, President Obama called the massacre of 20 innocent children and six adults on Dec 27, 2013, in Sandy Hook Elementary school in Newton, Connecticut, the worst day of his presidency. History tells us that every President since GW has had “a worst day”. For George W Bush it was September 11, 2011, for FDR it was Pearl Harbor, December 7, 1941. All our 44 presidents have has the worst day in their presidencies. It would be a meritorious project for some PhD history candidate to compile a volume on US President’s worst days. The December 27 occurrence could have been a turning point in the debate over guns in America. Knowing the history of gun violence, especially since the 1960s, University of Texas clock tower in Austin Texas, in the 70’s, the Kent State University Massacre, in the 80’s Cleveland School mass killing and the 90’s several schools including Columbine high school in Colorado, not counting mass murders in other facilities including temples, army bases theaters (Aurora, Colorado) and others. The numbers are staggering. But none was as gruesome as the Sandy Hook massacre. Every one seems to agree that these tragedies must end.

To understand the current status of gun control a bit of history is in order:

In the first week after Sandy Hook Elementary School massacre, Vice President Joe Biden chaired a task force to examine the issue  by holding extensive public hearings in which expert testimony was given by representative of American Psychiatric Association (APA), American Medical Association (AMA), American Bar Association (ABA), and forensic authorities from academic centers. But the matter became quickly politicized. The National Rifle Association (NRA), Democrats, Republicans, advocates of the Second Amendment to the Constitution all began spinning in the media. Gun control advocates brought in an extensive agenda, namely tougher penalties for illegal gun sales, increase school safety programs, expanded background checks for gun buyers. They advocated keeping guns out of the hands of criminal and folks with history of mental illness. Republicans and NRA saw this as unnecessary interference by government. So a compromise was generated by Senators Joe Manchin, a Democrat from West Virginia, and Patrick Toomey, a Republican from Pennsylvania, focusing attention on background check. It failed.

Issues like gun violence control, abortion, and cloning carry within their constitutional DNA a huge dose of controversy. My focus in this essay is a dispassionate and analytic examination of separating the hype from reality and what cool heads and wisdom would suggest. In this debate mental illness has gotten a bad rap. The alleged connection between mental illness and mass violence is not supported by objective data and science. “Substantial research shows that the vast majority of people with serious mental illness never act violently, and the vast majority of violent crimes -96 % by the best available data-is not perpetrated by persons with mental disorder” said Paul Appelbaum, Past President of APA, Professor of Psychiatry, Medicine and Law at Columbia College of Physicians and Surgeons. What we need to do is to face and design program of mental healthcare instead of warehousing the mentally ill in jails and prisons.

The APA position of which I am advocating is to appoint a presidential commission to develop a vision for a system of mental health care, creating a mechanism for facilitating responses to key mental health issues such as designating a White House point person, improving early identification of youth with mental health problems, and developing sensible, non-discriminatory approaches to ensuring that dangerous individuals cannot gain access to guns. Massive data are available showing that that people with mental illness who are engaged in regular treatment are considerably less likely to commit violent acts than those who need but do not receive appropriate mental health treatment..

Another expert testimony at the Vice-President Task Force was Dr Thomas Insel, Director of National Institute of Mental Health that “Suicide, not homicide, is the most urgent public health problem associated with gun violence. About 90% of suicides involved individuals with mental illness, and only 6 percent association with homicide.” Dr. Insel reported that “the popular association of homicidal violence and mental illness is tenuous at best, despite common public perceptions, there is little connection between gun violence and mental illness.”

What to Do Nationwide, and in NC?

To correctly describe the mental health system in NC and for that matter in America, is that it is a devolving, deteriorating non-system that oversees  jailing and imprisonment of mentally ill by the thousands. It does not have to be this way. For nearly 50 years, I have been involved in various capacities with the North Carolina mental health system. At no time have the services to and for our patients been as chaotic, sparse, and erratic as they are today. Fifty years ago in North Carolina we had a system in place that was truly superb. At the Dorothea Dix Hospital, in the late 50’s and early 60’s, patients had predictable, excellent, and academically cutting edge treatment available to them with ready access. We need commitment from Federal and State government with public-private partnership to revive what we had in the 50’s and the 60’s, namely, quick access to competent and accountable care. The steps being taken by UNC at Chapel Hill and WakeMed brokered by the President Tom Ross to provide 40 psychiatric beds is a good start. We need several hundred psychiatric beds for Raleigh-Wake County region where the population is rapidly growing.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

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