Public Health Approach Said to Be Best Way to Reduce Gun Violence
The search for ways to reduce death and injury from firearms in this country could profit from approaches derived from public health models.
“Blaming gun violence on mental illness may be socially and politically expedient, but it is only a way to avoid talking about evidence-based interventions to reduce death and injury,” forensic psychiatrist Liza Gold, M.D., said at a conference last December on reducing gun violence held at the Mother Emanuel A.M.E. Church in Charleston, S.C.
The connection between mental illness and gun violence that is raised after mass-shooting incidents is a myth, says Liza Gold, M.D. Gold is the editor of the new book Gun Violence and Mental Illness from American Psychiatric Association Publishing.
Aaron Levin
The church was the scene of the racially motivated murder of nine African-American worshippers on June 17, 2015. The conference was sponsored by the church, the College of Charleston, the American Bar Association, and the Medical University of South Carolina. APA was a supporter of the event.
While some perpetrators of recent mass shootings (ones in which four or more people died) may have diagnosed mental illnesses, such incidents account for less than 1 percent of all homicides, said Gold, a clinical professor of psychiatry at Georgetown University School of Medicine, who represented APA at the conference.
“Also, the largest number of firearms deaths are suicides, and as many as 90 percent of those individuals do have a diagnosed psychiatric disorder, but that is not what is being discussed,” she said. “We need to stop focusing on mental illness and start looking at the risk of dangerousness based on the evidence.”
“[Death and injury by firearms] is a public health problem, make no mistake about it,” added Wayne Riley, M.D., M.P.H., M.B.A., president of the American College of Physicians (ACP) and a clinical professor of medicine at Vanderbilt University School of Medicine.
The ACP has joined with 52 other medical organizations, including APA, in a statement calling for a reduction in “the health and public health consequences of firearms.”
American College of Physicians President Wayne Riley, M.D., M.P.H., M.B.A., says that while gun violence cannot be eliminated, it can be markedly decreased.
“We think we have a duty to not only cure disease but to improve the health of our patients and our communities,” said Riley. “Our goal is not to stop all mass violence or domestic violence incidents, but we can take steps to reduce them.”
The political debate over guns often focuses on ownership in general, but a more acute risk factor may be a person’s access to firearms at moments of crisis, said Gold.
Several states now permit or require judges to order temporary removal of firearms from the homes of people deemed to be dangerous to self or others, with or without mental illness, said Kelly Ward, J.D., another speaker and general counsel of the Coalition to Stop Gun Violence. Gun violence restraining orders can now be used in Connecticut and Indiana, and California recently passed similar legislation (From the President, Psychiatric News, November 6, 2015).
“These prohibitions are temporary, lasting for 21 days, but can be extended by court order to one year, if necessary,” said Ward. Such laws do not end an individual’s Second Amendment rights.
“Taking the car keys from a friend who has been drinking is not stealing his car,” said Gold.
APA Joins With Other Medical Groups on Gun Violence and Public Health Statement
In February 2015, the American College of Physicians issued a statement calling for a reduction in “the health and public health consequences of firearms.” The original signatories included APA as well as the American Academy of Family Physicians, American Academy of Pediatrics, American College of Emergency Physicians, American Congress of Obstetricians and Gynecologists, American College of Surgeons, and American Public Health Association. Since then, the number of organizations has grown to 52.
Here is the statement’s abstract:
“Deaths and injuries related to firearms constitute a major public health problem in the United States. In response to firearm violence and other firearm-related injuries and deaths, an interdisciplinary, interprofessional group of leaders of eight national health professional organizations and the American Bar Association, representing the official policy positions of their organizations, advocate a series of measures aimed at reducing the health and public health consequences of firearms. The specific recommendations include universal background checks of gun purchasers, elimination of physician ‘gag laws,’ restricting the manufacture and sale of military-style assault weapons and large-capacity magazines for civilian use, and research to support strategies for reducing firearm-related injuries and deaths. The health professional organizations also advocate for improved access to mental health services and avoidance of stigmatization of persons with mental and substance use disorders through blanket reporting laws. The American Bar Association, acting through its Standing Committee on Gun Violence, confirms that none of these recommendations conflicts with the Second Amendment or previous rulings of the U.S. Supreme Court.”
The full statement can be accessed here.
No single intervention will cure everything, but much more could be done to identify people likely to need help.
“The mental health system is hard to navigate, especially when a person is in crisis, but even if we fixed it tomorrow, 90 to 95 percent of the violence would still continue,” she said. “However, we could train people in schools, religious organizations, or social organizations to recognize signs of depression and destigmatize mental illness,” said Gold. Efforts to reduce suicides might perhaps even prevent some mass shootings, since so many of the latter end with the self-inflicted deaths of the perpetrators.
Physicians could play an important role in educating the public about the health consequences of firearms misuse, said infectious disease specialist Robert Ball, M.D., M.P.H., an adjunct assistant professor of medicine at the Medical University of South Carolina. He opposed laws in four states that limit physicians from asking patients about gun ownership and safety. Finally, progress on reducing gun violence could be accelerated by lifting the congressional ban on research on the subject by the Centers for Disease Control and Prevention. ■
The conference website for “Moving From Crisis to Action: A Public Health Approach to Reducing Gun Violence,” which includes speakers’ slides and other resources, can be accessed here.
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Published online: 23 December 2015
Published in print: December 19, 2015 – January 1, 2016
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