Mental Illness and Mass Murder

Guns, violence, and society's neglect of the seriously mentally ill.

Posted Oct 29, 2018

 HarperCollins
Allen J. Frances, M.D.
Source: HarperCollins

This article is co-authored with Allen J. Frances, M.D., professor emeritus of psychiatry at Duke University and author of “Twilight of American Sanity.” He was the chair of the DSM-IV Task Force.

In the wake of yet another tragic mass shooting, it is only a matter of time before the sneaky NRA once again attempts to shift blame away from guns and on to mental illness. Anything to justify America's uniquely toxic gun culture—the product of a fevered media that encourages copy-cat killers and the easy access that comes from having 350 million firearms in circulation.

NRA's bait-and-switch leads to foolish gun policies and unfair stigma. The inconvenient truth is that rates of mental illness are equal around the world, but only we have a mass shooting almost every day. Most people suffering from mental illness are not violent, and the majority of shootings are not done by people with mental illness. Solving our mass murder problem will require both sensible gun reform and voluntary media restraint.

All that said, people with untreated severe mental illness do have an increased rate of violence and are responsible for a significant fraction of mass murders. We compound the risk they pose by shamefully neglecting them. When the big state hospitals were closed fifty years ago, the money saved was meant to go to community treatment and housing. Instead, the states and federal government pulled funds to reduce taxes and/or build prisons. The tragic result is 350,000 mentally ill in prison and 250,000 homeless. Adequate funding for severe mental illness won't end mass murders, but it will prevent some, and it is also the cost-effective and humane thing to do.

The second driver of neglect originated from a much more noble motive. In his crusading 1961 book, The Myth of Mental Illness, Thomas Szasz fought for the civil rights of the mentally ill—then routinely violated by their long-term, involuntary commitment to psychiatric facilities that were more like warehouses than hospitals.

His emphasis on the violated civil rights of the mentally ill was perfectly accurate 55 years ago when psychiatric hospitals were plentiful and stays were often life-long. They are much less pertinent now that 90 percent of psychiatric beds have been closed so that it is almost impossible to be admitted and stays usually last only one week. Excessive concern about civil rights has eclipsed efforts to provide safety and care for those who desperately need them.

We need an approach that balances civil rights protection with the common sense need for occasional, involuntary treatment. Even Szasz acknowledged that government has a right—and duty—to protect citizens from dangerous people. While psychiatric commitment can be a terrible evil when done carelessly and too often, it can also be lifesaving, both for the patients themselves and for those around them, when done rarely and well.

People with severe mental illness need and deserve a decent place to live and easy access to care. Very rarely, and usually briefly, they may also require a period of involuntary treatment. Doing the right thing by the mentally ill certainly won't cure our gun culture, but it would be a great step forward for them and a small step toward reducing violence in our society.