The Problem with a Mental Health Approach to Gun Control

By Aden Siebel (PO ’21)

The gun control debate in America has pivoted to a focus on mental health. Prominent politicians, especially Republicans, have framed the increasingly common mass shootings as an issue of mental health, not gun control.[1] President Donald Trump in particular has used such rhetoric after school shootings, issuing statements after the Florida attack that “[w]e are committed to working with state and local leaders to help secure our schools, and tackle the difficult issue of mental health,” and, “I don’t want mentally ill people to be having guns. Take the guns first, go through due process second.”[2] These statements highlight some key approaches to gun access for the mentally ill, with the first quote treating school shootings as primarily an issue of mental health, and the second illustrating a desire to take rights from the mentally ill in order to more promptly address gun control. This isn’t only a Republican position, however, as the data show restricting gun access for the mentally ill is one of the most popular gun control suggestions in America from people of both parties.[3] Regardless, reconciling the complex and divisive legislative challenge of gun control with the similarly controversial history of mental health will require significant legislative work on both of these issues on their own, as well as a reckoning with our complex cultural attitudes toward the mentally ill. This paper first analyzes the history of America’s approach to mental health and how it has shaped legislation. Secondly, I explain the current bipartisan attitudes toward both modern mental health policy and its intersections with gun violence. I also contextualize the currently proposed policy in terms of historical legislation and the disappointing and limited existing policy around gun control for the mentally ill. Ultimately, while combining these two partisan priorities seems like a creative solution to two difficult problems, America’s unwillingness to confront either of these problems individually makes this merged approach inherently flawed and decidedly unlikely to be implemented.

The history of mental health policy in the United States reflects this country’s continually indecisive and ineffectual approach to healthcare in general. Up until the 1950s, American mental health policy embodied eugenics ideals, forcing the mentally ill into sub-par living situations—often asylums and other facilities that provided little to no real treatment.[4] In the 1960s, a focus on improved treatment led to the development of Community Mental Health Centers (CMHC), which overrode varied state policy in favor of a standardized federal model in order to create mental health support systems that were local and worked with resources already present in communities.[5] This sharp turnaround reflected a shift in U.S. values from marginalizing the mentally ill to trying to provide meaningful help, but this support didn’t last and never really translated into effective treatment for the mentally ill, who continue to be at greater risk for homelessness and criminalization.[6] This policy, and the political fallout that accompanied it, led to a decades-long back and forth of ideological and political debates that have failed to address the core mental health problems of early intervention and effective treatment, reflecting the cultural and legislative struggle to determine the importance of mental health support in America.[7] Recently, the Affordable Care Act of 2010[8] and the Mental Health Parity and Addiction Equity Act of 2008[9] tried to significantly broaden insurance coverage for mental health support, but a lack of specific funding for mental health and no attempts to build up long term systems for treating the substantial number of mentally ill Americans meant that this policy was largely ineffective.[10]

Recent legislation has done little to address mental health support or gun control individually, as healthcare and gun access are currently two of the most highly debated and slow-moving areas of policy. Mental health is largely absent from new Republican healthcare proposals.[11] It is important to note that some policies around mental health, such as the Comprehensive Justice and Mental Health Act of 2015[12] and the Caring Start Act of 2015,[13] have been introduced or passed. The Comprehensive Justice and Mental Health Act focuses on helping direct the mentally ill out of the criminal justice system and into mental health support systems,[14] while the Caring Start Act focuses on early mental health intervention for students and children with early trauma.[15] While these bills are important steps forward, they have largely been seen as ineffectual in fully addressing mental illness as their scope is limited and they don’t provide substantial resources.[16] In terms of gun control, there has been very little progress as partisanship and special interests have brought debate to a hopeless standoff. Given that not much has been done for either mental health or gun control, creating policy that combines them becomes a near impossible task.

Additionally, this policy risks creating negative perceptions of the mentally ill, hurting an already vulnerable community and moving mental health progress backwards significantly. The Consortium for Risk-Based Firearm Policy, a group centered around the synthesis of these two policy areas, notes in a 2013 briefing that not only is mental health not the best indicator for gun violence, creating policy that targets the mentally ill for gun control could stigmatize and criminalize this already at-risk group.[17] Multiple studies have shown that media portrayals of the mentally ill in shootings cause a negative public reaction towards the mentally ill.[18] The concern that mental health gun control legislation would create further stigma is one reason why mental health advocacy groups like Mental Health America and the National Alliance on Mental Illness are reluctant to move forward gun control laws that target the mentally ill.[19] Ultimately, a lack of motivation to comprehensively address gun violence and mental health from the right and a fear of the criminalization of the mentally ill from the left have meant a complete halt in the progress of this outwardly-appealing strategy of restricting gun rights for the mentally ill.

The question, ultimately, is how to use already lacking mental health policy as a solution in our stagnated gun control debate. Gun control decisions from Republicans and currently existing policy illustrate the difficulties of combining mental health and gun control, and make Republican statements seem more like an easy way to place blame than like a real attempt at regulation. Federal law bans sales to those with “adjudicated mental defective or involuntarily committed to a mental institution or incompetent to handle own affairs,” but it relies on states to give this information.[20] States usually lack the institutional structure to maintain these records in any meaningful way, or are reticent to share this information either because they want to expand gun rights or are unwilling to share incomplete and shoddy data.[21] President Trump recently signed a measure that undid an Obama-era regulation adding the mentally ill to background check lists.[22] This decision serves as another example of the difficulty mental health gun control policy faces, as Republicans like Trump who have publicly argued for limits for the mentally ill are simultaneously pressed by supporters and interest groups like the NRA to dismantle gun control policy in whatever way possible.[23] Again, although the NRA has publicly called to restrict gun access for the mentally ill, in practice their efforts are almost completely focused on dismantling all forms of gun control, and many critics have called this stance a ruse to appear more moderate.[24]

Florida’s detainment policy, one of the few attempts at a gun control measure that incorporates mental health, showcases exactly how gun control policy can be damaging to the mentally ill. Florida HB 1355 was passed into law in 2013, and allows doctors and other officials to restrict gun ownership rights of institutionalized persons or anyone determined to be a danger to themselves or others.[25] In practice, however, this law creates a bureaucratic nightmare for doctors and has frightening consequences for the way that the mentally ill are dealt with in the criminal justice system. The law has essentially allowed police to determine, without significant outside oversight, who they consider to be mentally unstable and institutionalize those people.[26] In a state that is fiftieth overall in mental health spending, this creates a dangerous pattern that frames mental health in a criminal context and allows for abuse of police power.[27] Other states have moved forward with similar policies, like New York, where legislation has broadened the scope of people who had to be reported by psychiatrists.[28] These have states have received significant pushback from mental health professionals, who say that laws like these end up hurting the mentally ill, tainting the methods for support that already exist, and doing little to actually crack down on gun violence.

Ultimately, gun control policy for the mentally ill will always be at a deadlock until our government is willing to confront mental health separately from gun violence. Using the mentally ill as scapegoats for gun violence has dangerous implications for their perception in mainstream culture, and does little to actually prevent the tragedies of mass shootings. Current laws that exist have their own complications and have yet to be shown to be effective, and the idea that gun control for the mentally ill can be addressed without a confrontation with the general national culture on mental health is naive and short-sighted. Until lawmakers are willing to fully confront the mental illness problem in America and the government’s lack of success in addressing it, their tactic of turning to the mentally ill as a catch-all explanation for gun violence is insulting to both the victims of these attacks and to all the Americans who suffer from mental illness. Let’s not pretend anymore that mental health policy can be an easy solution to the question of gun control. Mental health is complicated, and fixing gun control and mental health problems in America is going to require comprehensive legislation and action, not a hasty amalgamation of these two serious debates.

[1] Peter Sullivan, Dems Say GOP Focus on Mental Health Is Redirection from Gun Control, The Hill (Feb. 17, 2018), https://thehill.com/policy/healthcare/374304-dems-say-gop-focus-on-mental-health-is-redirection-from-gun-control

[2] Peter Baker, Trump Says Issue Is Mental Health, Not Gun Control, N.Y. Times (Nov. 6, 2017), https://www.nytimes.com/2017/11/06/us/politics/trump-guns-mental-health.html (describing mass shooting by a mentally ill man, Nikolas Jacob Cruz, of 17 students at Marjory Stoneman Douglas High School in Parkland, Florida, prompting enormous gun control protests).

[3] See, e.g., Margot Sanger-Katz & Quoctrung Bui, How to Reduce Mass Shooting Deaths? Experts Rank Gun Laws, N.Y. Times (Oct. 5, 2017), https://www.nytimes.com/interactive/2017/10/05/upshot/how-to-reduce-mass-shooting-deaths-experts-say-these-gun-laws-could-help.html (providing data for the popularity of mental health focused gun control legislation).

[4] Zeb Larson, America’s Long-Suffering Mental Health System, Origins: Current Events in Historical Perspective, Ohio State Univ. & Miami Univ & History Dep’ts (2018), http://origins.osu.edu/article/americas-long-suffering-mental-health-system.

[5] Id.

[6] See, e.g., Gerald Grob, Public Policy and Mental Illnesses: Jimmy Carter’s Presidential Commission on Mental Health, 83 Milbank Q. 425, (2005) (providing general background of U.S. mental health policy in the 20th century and of the CMHC program)

[7] Larson, supra note 4 (As legislative control shifted from party to party, resource spending and prioritization of mental health shifted as well, as those who were against expanded healthcare spending tried to strike it down as a non-necessity).

[8] Affordable Care Act, 42 U.S.C. § 18001 et seq. (2010).

[9] Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, Pub. L. 110-343, Stat. 3881 (2008).

[10] See, e.g., Thomas Weil, With Additional Insurance Available, Why Are Not More Mental Health Services Being Provided?, 203 J. Nervous & Mental Disease 906, (2015); David Mechanic & Mark Olfson, The Relevance of the Affordable Care Act for Improving Mental Health Care, 12 Ann. Rev. Clinical Psychol. 515, 516 (2016).

[11] American Health Care Act of 2017, H.R. 1628, 115th Cong. SEC 112. (2017) (Cuttings down on Medicaid, which is the biggest source of support for mental health)

[12] Comprehensive Justice and Mental Health Act of 2015, S. 993, 114th Cong. (2015).

[13] Caring Start Act of 2015, H.R. 2217, 114th Cong. (2015).

[14] See Comprehensive Justice and Mental Health Act of 2015, supra note 12.

[15] See Caring Start Act of 2015, supra note 13.

[16] See, e.g., Thomas Weil, Insufficient Dollars and Qualified Personnel to Meet United States Mental Health Needs, 203 J. Nervous & Mental Disease 233, 244 (2015) (arguing that because of lacking money, effective treatment methods, and qualified personnel, American mental health policy is ultimately ineffective at helping improve mental health in any sort of significant way)

[17] Consortium for Risk-Based Firearm Pol’y, Guns, Public Health and Mental Illness: An Evidence-Based Approach for State Policy 10-13 (2013).

[18] See, e.g., Emma McGinty et al., Effects of News Media Messages About Mass Shootings on Attitudes Toward Persons With Serious Mental Illness and Public Support for Gun Control Policies, 170 Am. J. Psych. 494, 496-498 (2013) (showing a negative reaction towards the mentally ill when tied with gun control); Colleen Barry et al., After Newtown — Public Opinion on Gun Policy and Mental Illness, 368 New England J. Medicine 1077, 1078 (2013).

[19] See, e.g., Anand Pandya, The Challenge of Gun Control for Mental Health Advocates., 19 J. Psych. Practice 410, 410–412 (2013).

[20] Gun Control Act of 1968, H.R. 17735, 90th Cong. (1968), see e.g. Sarah Kliff, The NRA Wants an ‘Active’ Mental Illness Database. Thirty-Eight States Have that Now., Wash. Post (Dec. 21, 2012), https://www.washingtonpost.com/news/wonk/wp/2012/12/21/the-nra-wants-an-active-mental-illness-database-thirty-eight-states-have-that-now/?utm_term=.8719f011aab6.

[21] Id.

[22] Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Social Security Administration relating to Implementation of the NICS Improvement Amendments Act of 2007, H.J.Res.40, 115th Cong. (2017)

[23] Ryan Sit, Here’s Why The NRA is So Powerful, Newsweek (Feb. 22, 2018), https://www.newsweek.com/nra-gun-control-parkland-florida-school-shooting-campaign-donations-813940

[24] See, e.g., Sullivan, supra note 1.

[25] Purchase of Firearms by Mentally Ill Persons, Fla. H.B. 1355 (2013), amending F.S.A. § 890.065 (West 2018) (current through 2018 Second Regular Session of the 25th Legislature).

[26] See, e.g., Jenny Staletovich, Florida Law Is Supposed to Keep Guns from the Violent and Mentally Ill. It’s Not Working., Miami Herald (Feb. 23, 2018), https://www.miamiherald.com/news/local/article201835374.html.

[27] Id. (Citing lack of spending on mental health).

[28] See, e.g., John Rozel & Edward Mulvey, The Link Between Mental Illness and Firearm Violence: Implications for Social Policy and Clinical Practice, 13 Ann. Rev. Clinical Psychol. 445, 445 (2017)

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