WASHINGTON -- The U.S. is experiencing two critical public health challenges -- mental health and gun violence -- but few understand these two crises rarely intersect when it comes to homicides, according to a new book now available edited by two Georgetown University Medical Center forensic psychiatrists.
Gun Violence and Mental Illness, published by American Psychiatric Publishing, Inc., reviews research and clinical evidence regarding gun violence and mental illness, and "suggests evidence-based interventions to reduce morbidity and mortality of both problems," says the book's editor, Liza H. Gold, MD.
"Most people with serious mental illness are not violent, most violent individuals do not have serious mental illness, and evidence indicates that individuals with serious mental illness who kill strangers with a gun is one of the rarest types of gun violence in the United States," she says.
"Many believe that the intersection of mental illness and gun violence is found in the tragic mass shootings that grab headlines. That misconception, reinforced by media coverage, comes from the negative stereotype that people with mental illness are dangerous," explains Gold, a clinical professor of psychiatry at Georgetown University School of Medicine. She adds that less than one percent of firearm deaths each year occur in mass shootings.
Gold says most people are surprised to learn that two-thirds of the approximate 33,000 annual firearm deaths in the United States are due to suicide. As many as 90 percent of those who take their own lives have a psychiatric diagnosis "rendering suicide the real intersection between mental illness and gun violence," Gold says.
The vast majority of the 11,000 or so homicides each year are interpersonal in nature, committed "by individuals who are angry, violently impulsive, and often fueled by alcohol or drugs, but are not committed by individuals with mental illness," explains Gold.
The book, co-edited by Robert I. Simon, MD, also a clinical professor of psychiatry at Georgetown, aims to look beyond the inflammatory social and political rhetoric that often surrounds discussions of U.S. gun violence. Contributing authors are leading professionals in the fields of mental health, law and public health who emphasize the need for scientific evidence to guide effective policy.
"There is no one magic fix -- we recognize that people have both a constitutional right and legitimate reasons to own guns," she says. "The goal of this book is to move the national discussion forward with more light and less heat."
The book highlights the need for improved mental health services. "As psychiatrists, we are acutely aware that the U.S. mental health system is 'broken,'" Gold says. "There is a shameful lack of mental health resources available to treat those with serious mental illness. Many end up in jail, often for relatively minor offenses."
Gold explains that the largest institutions now housing people with mental illness are correctional facilities including New York's Rikers Island, Chicago's Cook County Jail and the Los Angeles County Jail.
"Nevertheless, addressing the serious problems in the provision of mental health care could reduce rates of suicide, but will not decrease gun homicide rates," she says.
Gold adds that the book also examines the evidence indicating that the primary cause of all types of firearm violence in the U.S. is access to guns. "However, categorically restricting gun access to individuals based on negative stereotypes is an ineffective approach," she says. "In contrast, restricting firearm access even temporarily to people who are at high risk of fatally harming themselves or others, whether they have a mental illness or not, has been demonstrated to decrease both firearm suicide and homicide rates."
"The intent of the book is to make the research and clinical data, our analyses, and our suggestions for intervention accessible to anyone who wants to drill down and learn more about these complex issues," Gold says.
About Georgetown University Medical Center
Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or 'care of the whole person.' The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health.