Why mental healthcare is not the solution to mass shootings/violent crime

[Velocity]

Was going to write a longer post but decided to rein my keyboard-splurging in:

1. Mental healthcare in America is costly, often cliche or useless, and takes too long. There is no equivalent of “911” for mental healthcare (other than 911 itself, which isn’t helpful). If someone is on the verge of snapping *right this moment, *there’s no psychiatric service that fixes the problem right then and there. Furthermore, a lot of mental counseling is just the counselor reading out one cliche out loud after another, or going through the motions, or spouting cheap and meaningless platitudes (take deep breaths and think happy thoughts! That’ll be $120!) …and, of course, is unreasonably expensive. And often takes weeks to wait for an appointment, not to mention much driving and travel and all that time taken out for…what exactly? It’s like waiting three weeks for a $100 Band-Aid when you have a severed femoral artery that needs immediate attention. (No, I’m not some violent psychopath; I’ve been in counseling for OCD and stress/panic and anxiety issues - however, I can’t imagine it’s any different for an Elliot Rodger or Stephen Paddock type.) There needs to be something cheap, impactful, and readily available. Instead, it’s costly, cliche/platitude/trite stuff, and takes a long time to get an appointment for.

2. …speaking of people like Elliott Rodger, Stephen Paddock, school shooters, or serial killer/psychopath types, there is another issue that isn’t addressed - namely, that someone who would be likely to go on some killing spree *probably doesn’t think he is the problem. * If a white supremacist wants to kill blacks, he probably isn’t going to think, “Oh, I have these violent ideas about blacks, this means I need to check myself into therapy ASAP” - no, he’ll probably think, “Yes, I am waging a righteous and just war against these blacks that I hate.” You might as well expect a fox to turn itself in to a farmer when it is outside a chicken coop, rather than go into the chicken coop. **The kind of person who needs mental healthcare the most, is precisely the kind of person who is unlikely to voluntarily seek out mental healthcare. ** You can’t rely on would-be killers to identify themselves as the problem and turn themselves in; that’s utterly unreliable. They don’t see themselves as the problem, they see society and their victims as the problem.

[Wesley_Clark]

Here’s a quicker answer.

They have mental health issues in Japan and South Korea too. But they don’t have mass shootings because those nations have very strict gun control.

Mental health is just a distraction. Easy access to guns is why this only happens in America. Every other nations has mental health issues too.

[Inigo_Montoya]

And once again, the perfect is the enemy of the good. Decent, accessible, unstigmatized mental health care would not prevent anyone from descending into a mental state where suicide and/or mass shootings seem like a good idea. Glad that’s sorted out. Responsibility for crazy people getting crazy help remains in the hands of the crazy people. Good plan.

[Procrustus]

@Velocity

Furthermore, a lot of mental counseling is just the counselor reading out one cliche out loud after another, or going through the motions, or spouting cheap and meaningless platitudes (take deep breaths and think happy thoughts! That’ll be $120!)

Really? How would you know that?

[Quartz]

Have you considered that while mental healthcare may not be a 100% solution, it may be a somewhat less than 100% solution?

Oh yes. In the US you likely have to pay; under UHC, you may not have to pay.

[Voyager]

For every person with a problem who will go out and shoot others, there are lots (40? 100> 10?) who will never do that. How many of them do you want to force into treatment?
Second, I doubt that even mental health professionals will claim that they can detect and cure anywhere near 100% of people with problems.
Third, there is the problem of cost. Mental health providers are hardly well funded, well those serving the poor. It would be nice if those who think that guns aren’t the problem, people with mental health issues are, would start supporting some kind of UHC. Isn’t happening, is it?

[Inigo_Montoya]

@Quartz

Oh yes. In the US you likely have to pay

Which can be tough to do if you’re too unstable to have a good enough job to afford the care. And as a society we are a volatile combination of thin-skinned, undereducated, and narcissistic–stuff that could be tempered with a bit of individualized coaching. Yes, guns & ammo that are easier to purchase than whiskey (only a slight exaggeration) don’t help, but the problem lies in motivation.

@Voyager

It would be nice if those who think that guns aren’t the problem, people with mental health issues are, would start supporting some kind of UHC. Isn’t happening, is it?

** raises hand ** I’m not alone.

[DrDeth]

@Wesley_Clark

Here’s a quicker answer.

They have mental health issues in Japan and South Korea too. But they don’t have mass shootings because those nations have very strict gun control.

Mental health is just a distraction. Easy access to guns is why this only happens in America. Every other nations has mental health issues too.

Not true:
https://www.investors.com/politics/editorials/sorry-despite-gun-control-advocates-claims-u-s-isnt-the-worst-country-for-mass-shootings/
*But a study of global mass-shooting incidents from 2009 to 2015 by the Crime Prevention Research Center, headed by economist John Lott, shows the U.S. doesn’t lead the world in mass shootings. In fact, it doesn’t even make the top 10, when measured by death rate per million population from mass public shootings.

So who’s tops? Surprisingly, Norway is, with an outlier mass shooting death rate of 1.888 per million (high no doubt because of the rifle assault by political extremist Anders Brevik that claimed 77 lives in 2011). No. 2 is Serbia, at just 0.381, followed by France at 0.347, Macedonia at 0.337, and Albania at 0.206. Slovakia, Finland, Belgium, and Czech Republic all follow. Then comes the U.S., at No. 11, with a death rate of 0.089.

That’s not all. There were also 27% more casualties from 2009 to 2015 per mass shooting incident in the European Union than in the U.S.

“There were 16 cases where at least 15 people were killed,” the study said. “Out of those cases, four were in the United States, two in Germany, France, and the United Kingdom.”

“But the U.S. has a population four times greater than Germany’s and five times the U.K.'s, so on a per-capita basis the U.S. ranks low in comparison — actually, those two countries would have had a frequency of attacks 1.96 (Germany) and 2.46 (UK) times higher.”

Yes, the U.S. rate is still high, and nothing to be proud of. But it’s not the highest in the developed world. Not by a long shot.*

And that’s just mass shootings. Mass killings with bombs, machetes and such are common.

[Wesley_Clark]

France and Norway seem to be on that list due to isolated mass shooting events with lots of victims. I don’t know about Finland and Belgium. The other nations aren’t developed nations.

[rat_avatar]

You are making a very common mistake equating “mental health services” with “mental illness”

The OP is correct in one way, “Mental Illness” is not responsible for gun violence.

Canadian Mental Health Association Durham

In today’s media reports about mental illness, there is a tendency to emphasize a supposed link between violence and mental illness. News stories regularly suggest that there is a strong connection between mental illness and crime. But the majority of people who are violent do not suffer from mental illnesses. In fact, people with a mental illness are more likely to be the victims, rather than the perpetrators of violence.

https://jech.bmj.com/content/70/3/223

However, this perception is not borne out by the research literature available on the subject. Those with mental illness make up a small proportion of violent offenders. A recent meta-analysis by Large et al4 found that in order to prevent one stranger homicide, 35 000 patients with schizophrenia judged to be at high risk of violence would need to be detained. This clearly contradicts the general belief that patients with severe mental illness are a threat.

What can be attributed is a pervasive social stigma against mental health and mental illness and those effects on help seeking and or resources.

http://cahealthequity.org/wp-content/uploads/2014/02/Impact-of-mental-health-related-stigma.pdf

Results. The review identified 144 studies with 90 189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d=−0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier.

Most people who advocate for reducing stigma on health seeking or increasing accessible are not trying to place responsibility for stopping mass killings at the hands of psychiatric professionals, they are seeking to improve the chances of an individual will seek help vs resorting to violence.

The crappy situation is not that addressing mental health issues will solve our gun violence problem but that due to limitations on what gun control laws can be passed and due to the social stigma against mental health people who do suffer are being thrown under the bus.

While it is hard to generalize many mass murders are related to suicide and suicide is the greatest cause of gun deaths in our country.

https://afsp.org/new-cdc-vital-signs-report-shows-importance-of-help-seeking/

Effects of a comprehensive police suicide prevention program - PubMed

The suicide rate in the intervention group decreased significantly by 78.9% to a rate of 6.4 suicides per 100,000 population per year compared to an 11% increase in the control city (29.0 per 100,000)

In general I am not against gun-control, but if the people who actively want to push for new legislation would quite using social stigmas that are based in ignorance to blame mental health for the violence and would quite passing legislation that actively attacked those who suffer from mental illness you wouldn’t have to even have this thread.

Reducing gun availability and improving mental health services while reducing the stigma for suing mental health services are not orthogonal concepts.

The pro and anti-gun crowd leveraging bigotry against people with mental health issues is what forces people who are advocates for that need to even get involved in this topic at all.

Reduced stigma on health seeking and improved access to services will reduce violence and it doesn’t matter if it solves the gun question at all. By targeting a group of individuals who currently do not have enough social capitol to protect their interests the pro-gun control groups make opponents from potential allies while re-enforcing social biases that do contribute to the problem.

It doesn’t matter what the right is, if you say some group no longer has a right to due process you should expect them to fight to be treated as fairly as any other group. I am not sure why anyone would be surprised that discriminating against a group would cause that tension even if it is socially acceptable to debase that group.

[DrDeth]

@Wesley_Clark

France and Norway seem to be on that list due to isolated mass shooting events with lots of victims. I don’t know about Finland and Belgium. The other nations aren’t developed nations.

What’s a “developed nation”, and why isnt that cherry picking?

Still that totally refutes your argument that “this only happens in America”.

[Shodan]

Another factor is that doctors aren’t that good at predicting who will become violent.

Over the years, studies have shown that psychiatrists’ accuracy in identifying patients who would become violent was slightly better than chance…

People who reported that they’d had both “severe mental illness” and substance abuse problems in the year before the first interview had the highest rate of violence; 9.4 percent had committed a violent act. The next most violent were people with other types of mental illness (mostly antisocial personality disorder) accompanied by substance abuse — 7.2 percent of them reported violent behavior.

Groups with lower rates of violence included people suffering only from severe mental illness, 2.9 percent of whom reported having been violent; those only with substance abuse problems (2.5 percent); and those with other mental illnesses alone (1.4 percent). People without any of these problems had just a 0.8 percent rate of violence.

Cite.

Obviously 9.7% is a lot more than 0.8. But if you predict that people in the highest risk group are going to be violent you will be wrong more than nine times out of ten.

Regards,
Shodan

[Velocity]

@Procrustus

Really? How would you know that?

Personal experience. Although, yes, the plural of anecdotes is not data.

[Crafter_Man]

If someone goes on a shooting spree or commits a violent crime, does it necessarily mean they have a mental disorder?

I’m not a psychiatrist, but I think it’s probable that many bad people have no mental disorder whatsoever. They’re simply bad.

[rat_avatar]

As an example, note the following restriction on who can obtain a permit in New York.

New York Consolidated Laws, Penal Law - PEN § 400.00 | FindLaw

And the related “Mental Hygiene” definitions.

https://www.nysenate.gov/legislation/laws/MHY/1.03

Under Federal law, which is constitutional people who have been adjudicated by a court of law as mentally ill are prohibited, in these state cases the owners have not been adjudicated by a court of law.

Recent gun-control legislation has actually resulted in pro-gun lawyers suggesting their clients not seek treatment for mental health issues. It also increases the costs of pro-gun folks from seeking treatment. Laws that intended to improve reporting for people who had been adjudicated as unfit have recently been extended to requires a mental health professional to report. These professionals have an incentive to over-report to protect themselves.

As Shodan mentioned these individuals don’t have a reliable way to make these predictions but are legally culpable if they do not. So this adds fear for those gun owners and prevents them from seeking any help in mental health. I don’t have answers on what legislation would work, but if you want effective gun-control laws passed and want to avoid the Mental Health need quit basing legislation on myths about mental health and quit passing laws which will be found unconstitutional when challenged in the courts.

While I am not in the pro-gun group myself, I hear these blatantly unconstitutional laws used by people I do know who are pro-gun to justify their fears about total confiscation.

You won’t convince moderate NRA members that your intent is to reduce violence when the laws that are being pushed are blatantly a violation of a persons right to due process. Violating other core rights isn’t a good way to sell the claim that you don’t want to take away their hunting rifle. You will need to convince at least some of these folks to pass significant legislation.

I get that it is harder to pass real legislation vs just extending valid reasonable temporary restraining order laws. But if you claim that mental health services won’t help why target this group in the first place?

To be clear again, I am not even arguing a position that we shouldn’t pass more restrictions. But you can’t just scapegoat a group of people when it is convenient then wonder why it is an issue when it is no longer convenient to your needs.

[rat_avatar]

@Crafter_Man

If someone goes on a shooting spree or commits a violent crime, does it necessarily mean they have a mental disorder?

I’m not a psychiatrist, but I think it’s probable that many bad people have no mental disorder whatsoever. They’re simply bad.

No, nor does visiting the doctor after your beloved wife of 50 years dies and you need to deal with the grief. Nor does seeking help for your social anxiety or fear of spider or your obsession with cleaning.

But in the case of NYC, if you are a gun owner or even a skeet shooter seeking help for those problems would result in you losing your firearms. While Eric Harris and Dylan Klebold may not have changed their actions by talking to a counselor, they wouldn’t have given up their firearms to see if talking to someone would have helped either.

The majority of violent crimes and homicides are committed by people who do not have mental health problems. Even a crime is committed by someone with mental illness that mental illness often plays no part crimes committed.

It is just simply socially acceptable to deride people who have medical challenges that are mental in nature.

[doorhinge]

@Quartz

Have you considered that while mental healthcare may not be a 100% solution, it may be a somewhat less than 100% solution?

Oh yes. In the US you likely have to pay; under UHC, you may not have to pay.

Medical care still has to be paid for. You may pay out-of-pocket, you may pay thru insurance coverage, you may pay via taxation. If you have no income, taxpayers will be expected to cover your expenses, or volunteer groups such as Shriners will provide coverage.

[PastTense]

More prisoners (14%) and jail inmates (26%) met the threshold for Serious Psychological Distress in the past 30 days than the standardized general population (5%).

Home

Most of us feel that adequate mental health care is part of the solution to violent crime, not the total solution.

[doorhinge]

@rat_avatar

While Eric Harris and Dylan Klebold may not have changed their actions by talking to a counselor, they wouldn’t have given up their firearms to see if talking to someone would have helped either.

(post shortened)

The monsters Harris and Klebold were bombers. They intended to use firearms to murder any students who fled the school after their bombs had exploded.

[thelurkinghorror]

Because mental health doesn’t appear have a strong correlation with mass shootings. And mental illness is a category of convenience, perpetrators don’t have much commonality. Paddock in particular had no mental history or “typical” signs.

But it would probably help the #1 group of people getting shot, people who commit suicide (including non-gun means).