America...We Have a Problem

By Joel Miller posted 13 days ago


The latest mass carnage in El Paso perpetrated by what appears by a man (USING AN ASSAULT FIREARM WITH THE MOST LETHAL KIND OF AMMUNITION) with white nationalism views – and in Dayton where the motive is unclear – although one of the victims is the sister of the killer, is becoming all too common place and is spreading.

The public has always believed that anyone who could such horrific things must have a mental illness which I will get to soon as one myth that must be addressed. Another myth is that gun-related policy is so polarizing that any effort to make changes at the policy and community level is futile. We must get beyond this view quickly.

But now we have another dynamic in play other than mental illness. Anti-immigration, discrimination and racist views may be playing a much larger role in these shootings. Witness the recent killings in the New Zealand mosque, the Charleston church, the Pittsburgh temple, and the murders by an individual at an El Paso Walmart bent on killing Hispanics based on a written manifesto. There is a lot of hate going around.

I used to start these kinds of articles with “Our hearts go out to the families and friends whose loved ones were killed or injured in the latest mass shooting in (you pick the site). It is hard to imagine the incredible grief.” But how many times are we going to start an article with those words until we address the problem of mass shootings and overall gun violence in America.

According to the “AP/USA Today/Northeastern University Mass Murder Database”, there have been 22 mass killings in the U.S. this year in which four or more people, excluding the assailant, have died from various forms of violence. Those killings include 18 mass shootings, six of which occurred in public locations. From 2006 to 2016, the number of public mass shootings each year was relatively flat, with about four or a five a year, according to the mass-murder database. That number has jumped in recent years, with seven public mass shootings in 2017 and 10 in 2018.

One mass shooting can inspire another, leading to a cluster of shootings in quick succession as like-minded individuals are spurred to attack.

Think about all those images of suffering: memorial services, people crying, cellular phone videos of the gunfire, entire communities affected for years. It plays right into the mind-set of a few people who would love to replicate that in their own community. The shootings do build on each other and there is a contagion effect.

Gun Violence and Mental Illness

As you know these sensationalized mass shootings bring gun violence and mental illness into the national discussion, if only for a limited number of news cycles. We don’t know at this time why the perpetrator carried out this horrific mass shooting in Dayton or if he had a mental illness, but it again raises issues we as a society must address.

So let’s have the conversation that these events and their media coverage reinforce the common belief that individuals with serious mental illness are violent and dangerous, especially if they have access to firearms.

Some of the most common misperceptions surrounding gun violence and mental illness include:

  • Most persons with serious mental illness, such as schizophrenia or bipolar disorder, are at high risk of committing violence toward others.
  • Serious mental illness is one of the primary causes of gun violence in the U.S.
  • People with serious mental illness are more likely to perpetrate violent crime than to be victims of violent crime.

But here are the evidence-based facts:
  • Most persons with serious mental illness are never violent. However, small subgroups of persons with serious mental illness are at increased risk of violence during certain high-risk periods, such as during a first-episode of psychosis and the period surrounding inpatient psychiatric hospitalization.
  • People with serious mental illness are rarely violent. Only 3 percent of all violence, including but not limited to firearm violence, is attributable to serious mental illness. The large majority of gun violence toward others is not caused by mental illness.
  • People with serious mental illness are far more likely to be victims of violence, including but not limited to firearm violence, than the perpetrators of violent acts.
  • Rates of violent crime victimization are 12 times higher among the population of persons with serious mental illness than among the overall U.S. population.

A Public Health Model to Reduce the Morbidity and Mortality of Firearms

With emotions running high and the inability of Congress to address the issue through legislation, let’s lower the temperature and develop solutions where we don’t assign blame, which is exactly where we are today.

If we start with the perception – and I am afraid that is where we will begin – that all attempts to reduce firearm violence is through purported government restriction or confiscation of firearms, then we will be stuck in the same circle of “we must protect our

2nd Amendment rights.” Which of course is a non-starter in any conversation about firearms and background checks, eliminating assault weapon and yada-yada. I would say this to the Second Amenders – being able to have a firearm does not mean children are killed with assault weapons in the process because of your right to carry a gun. Tell that to the parents of the Sandy Hook kids.

The field of public health focuses on associated with significant levels of morbidity and mortality. Public health officials are interested in devising broad strategies to prevent or ameliorate injury and disease.

A public health approach involves addressing complex problems systematically and developing multiple types of interventions with a focus on the following:

  1. Prevention as far upstream as possible (prevention efforts provide huge benefits NOW, and down the road)
  2. Scientific methodology to identify risks and patterns
  3. Multidisciplinary, broad and inclusive collaboration

Public health approaches emphasize cooperation and mutually shared obligations in pursuit of the greatest good for the greatest number of people. The goal of public interventions is not to find fault or assign blame but to eliminate preventable causes of death or injury.

Defining firearm violence as a public health concern is not “anti-gun” or anti-gun-owner”. Such mischaracterizations oversimplify the legitimate interests of all stakeholders concerned with gun violence in our country.

The mission of a public health strategy is to unite diverse groups of people with the goal of improving overall health and the conditions that promote safety for everyone. Despite significant areas of disagreement between “pro-gun” and “anti-gun” groups, common ground that can form the basis for collaboration does exist. For example, recent surveys show that 80 percent of gun owners, 85 percent of people living in gun-owning households, and 86 percent of people in non-gun-ownership households support making private gun sales and sales at gun shows subject to background checks. Nearly 70 percent support maintaining a federal database to track gun sales.

We believe that as a society, we can agree that more than 35,000 deaths a year from firearms, many of them involving children and young adults, is unacceptable.

The data strongly suggests that when the dialogue about gun policy moves beyond broad statements to specific policies, broad support exists for many gun violence prevention policies like those mentioned above. Over 8 in 10 Americans want solutions.

The complete eradication of firearm violence and elimination of mental illness are not practical goals and are not likely to be achieved.

However, the success of a public health approach to these problems is calculated by considering every life saved from individuals intent on mass murder, homicides, suicide or injury and by considering every life affected or improved by ameliorating the pain associated with firearm violence.

A public health approach to the problems of gun violence offers the hope of just such successes.

Another promising policy initiative is a gun violence restraining order or GVRO, allows for the temporary removal of firearms at times of crisis, initiated by family members or law enforcement and based on individualized assessment of due process – as a response to the 2014 Isla Vista, California mass shootings.
Various stakeholders at all levels can influence and deliver public health interventions to reduce gun violence and are vital voices in the discussion about guns and the lives lost to firearm violence in the U.S.
  • At the individual and family levels, interventions that encourage and facilitate safe gun storage are most promising and should be pursued based on the available evidence and evaluated.
  • Guns that can be fired only by an authorized user are being developed and are available for sale and we need more promotion to help people understand the potential of these guns to reduce gun death and injury.
  • Community-level interventions that use outreach by trained community members to intervene when violence is imminent have been demonstrated to be effective in reducing shootings. New sites for replication should be pursued.
  • Evidence-based gun violence prevention policy interventions should be adopted and implemented, and promising policy interventions should be enacted, implemented, and evaluated. Attention to unregulated private gun market that is responsible for an estimated 40 percent of gun sales in the U.S. is needed,
  • Investments in public health programs, policy and research are needed in order to realize potential significant and sustained reductions in gun violence.

And here are some more suggested policy and program interventions:

  • Firearm prohibitions should be expanded to include:
    • More individuals with a history of violent behavior, which greatly increases the risk for perpetration of future violence toward others.
    • Specifically, individuals convicted of violent misdemeanor crimes and those subject to ex parte domestic violence restraining orders should be temporarily prohibited from purchasing or possessing firearms.
    • Individuals with a history of risky substance use, which heightens risk of violence toward others.
    • Specifically, individuals convicted of multiple DWIs or DUIs and multiple misdemeanor crimes involving controlled substances should be temporarily prohibited from purchasing or possessing firearms.

And the federal Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) should review available behavioral health resources and their effectiveness, and recommend changes to reduce barriers to accessing behavioral health care and increase integration of existing resources.

I believe that one major misconception is that firearms policy is so polarizing that any effort to make changes at the policy level is futile.

The time is now for key stakeholders – families, communities, and government at every level to come together who are committed to reducing firearms morbidity and mortality.

Let’s work the problem people. Failure is not an option!