I’ve prayed. Here are my thoughts.

As is the case whenever this happens, which sadly is too often, mental illness is brought up as the cause of mass shootings, including by Donald Trump after one man killed twenty six people at a church in Sutherland Springs.

It is true that suicide by gun is the leading cause of death by guns every day, so there’s your link between mental illness and guns.

A completely separate issue with death by guns is the second leading cause of death by guns every day, which is homicide.

Homicide and suicide are different. This is a simple distinction, but an important one because the relevant mental illness factors regarding one type of gun death is very different than the other.

There is a higher risk of suicide with depression, bipolar disorder, schizophrenia, substance abuse, anxiety disorders and personality disorders. The consensus among experts is that 90% of completed suicide involves a psychiatric diagnosis. All of these diagnoses are treatable. The best solution is treatment.

Mass shootings are a type of homicide. The worst kind of homicide. They are “mass” shootings because many homicides are committed in a short amount of time. In terms of psychiatric diagnosis and homicide in general, the highest correlations are with paranoid subtype of schizophrenia, alcohol abuse, and antisocial personality disorder. The vast majority of people with these diagnoses are not violent, ever. Regardless, schizophrenia and substance abuse are treatable – provide treatment. As for antisocial personality disorder, or commonly known as psychopathy or sociopathy, don’t let convicted criminals who have committed non-drug related crimes have any guns – EVER.

Should we address mental illness and guns? Yes, to prevent completed suicides and homicides, but the risk for suicide is much greater than the risk of homicide and mass shootings. Also for homicide, substance abuse (somewhat) and sociopathy (a lot) are specifically the greatest risks. So to prevent all gun violence – we need better mental health care because the best solution regarding the associations with mental illness and gun death is TREATMENT. So let’s keep affordable health care without restrictions for mental health and substance abuse treatment. Let’s not criminalize substance abuse, including for people of color. GOT THAT REPUBLICAN SENATORS AND TRUMP?

That still leaves the large majority of homicides committed by someone with no mental illness or known sociopathy, so we can’t just say that even if all of the above was implemented that we’ve addressed the main problems and risk factors. So, we still need to address the straightforward fact that the raw number of deaths by guns by suicide, homicide, and mass shootings are all related to the disproportionate sheer number of guns owned and available in the United States as compared to other countries, including when adjusted for population size. We need to address the number of guns (WAY LESS), gun access (WAY HARDER), and improve responsible gun ownership (WAY MORE REGULATED, EDUCATED, MONITORED, AND RESTRICTED).

We can’t get to the point of no suicides, no homicides, and no mass shootings. No reasonable person is saying this is possible. But if the goal is LESS completed suicides, LESS homicides, LESS mass shootings – this is very achievable and meaningful.

Yes, all of this is somewhat complex, but the solutions worth pursuing are actually straightforward if you are willing to look into the details and come up with complex solutions for complex problems.

Written by Joseph Lee, M.D.

I'm a Psychiatrist in private practice in Redondo Beach, CA. I completed both medical school and residency training at UCLA. My practice is psychotherapy based with a health-oriented focus on personal growth and wellbeing. I also teach about mental healthiness and advocate for social emotional learning (SEL) in all contexts.

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