Reference no: EM133422257

Case Study: Abstract: In the current election for presidential nominees, gun regulation is a major topic. Ignited by mass shootings, the public and politicians have revitalized focus on the mental health crisis but for all the wrong reasons. The mentally ill are not criminals responsible for violent incidents, but rather, they are victims of violence. This article has gathered and analyzed research from mostly primary, peer-reviewed literature to provide a comprehensive review of how mass shootings changed the perception of mental illness in America. Through understanding of the media's role in forming public perspective on mental health, of the bias protruding in even the criminal justice system, and of the evidence that supports that the mentally ill are not inclined to violence, false assumptions will be resolved and a clearer direction both for mass shooting prevention and mental health care will be given. Introduction: American media and political discourse have presented the mentally ill as scapegoats for mass shootings. Research, on the other hand, supplies little evidence that there exists a relationship between mental health and violence. In fact, the mentally ill are more likely to be victims of violent acts. In a time in which mass shootings seem like a common occurrence and gun policy is at the vanguard of political debates, clarifying inaccurate assumptions about mental health is important. This ensures that effective strategies are developed to prevent mass shootings and that a vulnerable population is not wrongly criminalized. In this article we aim to resolve misleading presumptions about mental health by identifying the media's role in perpetuating these lies, illuminating the prejudice in the criminal justice system, and presenting evidence in contrast to popular belief. Background: Mass shootings have been all too familiar to the American public in recent decades. Research at Texas State University revealed 84 cases of mass shootings between 2000 and 2010 with an increase in frequency over time. Troublingly, the trend is becoming more severe. An epidemiological study of school shootings by Shultz, Cohen, Muschert, and Flores de Apodaca noted that three incidents, Columbine, Virginia Tech, and Sandy Hook, were responsible for over half of the fatalities in the 215 incidents between 1990 and 2012. The hysteria evoked by these incomprehensible, callous tragedies have reasonably reached educational institutions, which now require students to conduct lockdown drills to prepare for a possible school shooting. In fact, most mass shootings are committed in secondary schools and universities (Lowe and Galea, 2017). In the aftermath of mass shootings, a major concern is mental health. Exposure to violence is associated with a multitude of mental illnesses such as major depression and post-traumatic stress disorder (PTSD). This pertains not only to victims who directly experienced the violence but relatives, the community where the incident occurred, and the general public. Research that gathered and analyzed 49 studies on the mental health impact of 13 U.S. mass shootings between 1984 - 2008 revealed that post-traumatic stress symptoms were seen in 36 studies. It also showed that perceived school safety declined among students and the community after a shooting (Lowe and Galea, 2017). Although there has been renewed focus on the importance of mental health because of media and political discourse, these discussions are proliferated with mischaracterized assumptions of the mentally ill. The popular belief that the mentally ill are prone to acts of violence is rooted in their portrayal as crazed criminals responsible for mass shootings (Ghiasi and Singh, 2019). It is understandable that people would look to psychiatry to explain unfathomable events; who else could execute these atrocities but the mentally ill? In fact, data does reveal that 60% of mass shooters in the United States since 1970 showed symptoms of mental illness (Metzl and MacLeish, 2014). However, this self-evident assumption that mental illness causes mass shootings is problematic because it stereotypes a diverse population of mental health patients. Common mental health illnesses such as attention-deficit disorders, anxiety, and depression have no evidence of correlation with violence. In fact, less than 4% of violence in the U.S. can be blamed on the mentally ill (Metzl and MacLeish, 2014). The assumption also oversimplifies the correlation between mental illness and gun violence. In consideration to the complexity behind the misguided causation between mental health and violence, take the label schizophrenia. Schizophrenia, the mental illness most frequently linked to mass shootings by U.S. media, was considered a mild illness of docility in the first half of the 20th century. It was only in the 1960s that the American media began associating schizophrenia with violent crime. This shift resulted not from an increase in violent crimes by the mentally ill but from modifications of psychiatric diagnosis models. In 1968 the second edition of Diagnostic and Statistical Manual of Mental Disorders (DSM) reintroduced schizophrenia as a mental illness marked by aggression and hostility (Metzl and MacLeish, 2014).To ensure that accurate ideas permeate public thought and that the significance of mental health for well-being is made explicitly clear, this article provides a review of current research detailing the mental health implications of mass shootings. Mischaracterized Assumption: Mental illness is the cause of gun violence Media's Role in Perpetuating the Lie: There is a bias towards the mentally ill as being inherently disposed to criminality (Van Dorn et al., 2005). This mistaken belief is based on the alteration of mental illness from a medical classification to a sign of threat due to the media's portrayal of perpetrators of mass shootings as crazed beings. Content analysis of three of the largest circulated newspapers - USA Today, The New York Times, and the Washington Post - revealed that over time, news coverage of mass shootings became dominated by political figures who directed blame on the mentally ill. The research studied the "explanatory frames" used to contextualize three significant mass shootings between 1991 and 2015 - Royal Oak, Virginia Tech, and Umpqua. Early articles simply condemned the shooter; the most common explanatory frame for the 1991 Royal Oak shooting was the individual character of the perpetrator (66%). Over the years, there was a shift towards framing mental health as a cause of mass shootings; the 2007 Virginia Tech shooting was mainly explained using the mental health of the perpetrator (49%). Presently, the mental health frame is stimulating debates on gun policy and pressuring politicians to act; The 2015 Umpqua shooting was framed using gun policy (56% for pro-gun control and 31% for anti-gun control) and mental health as a public health crisis (19%) (DeFoster and Swalve, 2018). Although the discussion concerning gun ownership and mental competence has reemerged with vigor in recent decades, its origin is rooted in history. Psychiatric articles dating from the 1960s deliberated methods to assess the level of mental capability needed to possess a gun (Metzl and MacLeish, 2014). Prejudice Extends Even to the Justice System: This deeply rooted bias and lack of education extends to the justice system, in which the mentally ill are more likely to be arrested, indicted, and imprisoned longer than the general population (Ghiasi and Singh, 2019). In 2008, while the Supreme Court favored broad gun ownership laws, they also endorsed limitations to felonies and the mentally ill "for their tendencies towards violence". Furthermore, several states passed bills that require mental health professionals to report potentially dangerous patients to police, who could then confiscate their firearms (Metzl and MacLeish, 2014 Little Evidence to Support that the Mentally Ill Are Predisposed to Violence: However, there is little evidence that the mentally ill are inclined towards gun violence. Less than 3% - 5% of U.S. crimes involve the mentally ill with the percentage of gun violence committed by the mentally ill being less than that of the non-mentally ill (Metzl and MacLeish, 2014). Though to specify, certain psychological situations do increase the risk for violence including a lack of mental health treatment, delusions, and a history of mental illness with substance abuse. Untreated profound mental illness significantly increases the risk for homicides, especially mass murders, but these numbers are slight in comparison to the senseless acts of violence by those with criminal intent (Ghiasi and Singh, 2019). In actuality, predictive indicators for violence do not include mental illness but rather involve being male, experiencing childhood abuse, and having an alcohol or drug history, with the latter itself causing a seven-fold increase in the risk for violence (Metzl and MacLeish, 2014). In Fact, Family Is More Likely to Hurt You; In contrast to the crazed loner stereotype labeled on mass shooters, people are more likely to be shot by those they know, especially intimate partners and relatives. The National Violent Death Reporting System (NVDRS) reported 31 mass casualty incidents, defined as events resulting in more than four deaths, in the U.S. between 2003 and 2012. 45% of these incidents involved an intimate partner or relative. In the remaining 17 cases that involved strangers, only 6.35% were associated with mental health (Abolarin et al., 2019). Although mental illness has little correlation with homicide, it is strongly linked to suicide, which constitutes for more than half of all gun-related deaths in the U.S. annually (DeFoster and Swalve, 2018). The Mentally Ill Are Victims: Despite common notion, the mentally ill are more likely to suffer from victimization than to perpetrate such acts. (Metzl and MacLeish, 2014). A six-month study of the prevalence of perpetration and victimization among the mentally ill, of which a majority were schizophrenics - the mental illness most associated with mass shootings -, demonstrated that perpetration was significantly less than victimization. 23.9% of the patients admitted to perpetrating at least one violent incident. However, 63.5% of these altercations happened in residential homes rather than in public areas where mass shootings are set. 30.9% of patients report at least one victimization incident with 43.7% of these victims citing multiple incidents. The study also found a strong correlation between perpetration and victimization with a 11-fold increase in one if the other occurred (Desmarais et al., 2014). This finding suggests the presence of a never-ending cycle in which one event instigates another and negative consequences build on one another. Conclusion: The U.S. media has framed mass shootings to blame the mentally ill, producing mischaracterized assumptions that result in policy being incorrectly centered on limiting gun ownership by the mentally ill. This prejudice extends even to the criminal justice system, resulting in the criminalization of the mentally ill. Despite popular belief, violent acts committed by the mentally ill are very small. Truthfully, violent incidents usually involve intimate partners or kin. The mentally ill are more prone to victimization than perpetration. Future Implications: Endorsing legislation that limits the mentally ill's ability to possess firearms are unfounded, ineffective, and serve only to develop barriers to treatment. Many of these policies were developed after the Sandy Hook and Aurora shootings when the political environment was emotionally charged and void of evidence-based deliberations. Regardless of the substantial research that demonstrates the insignificant relationship between mental illness and violence, the national government and multiple state governments have passed bills to restrict gun ownership by the mentally ill. These bills also urge mental health professionals to report potentially dangerous patients to the National Instant Criminal Background Check System (NICS), the federal agency that regulates firearm property in America (Rosenberg, 2014). Basing gun violence prevention on uncommon events such as mass shootings is impractical. Mass shootings occur too infrequently for statistical modeling or medical professionals to provide predictable indicators such as that mental illness causes mass shootings. Jeffrey Swanson, a professor of psychiatry and behavioral studies at Duke University, asserted that "psychiatrists using clinical judgment are not much better than chance at predicting which individual patients will do something violent". After all, psychiatric diagnosis is not an extrapolative tool but an observational one (Metzl and MacLeish, 2014).Requiring mental health professionals to notify enforcement agencies about possibly threatening individuals slackens HIPAA privacy laws and deters people from seeking treatment that is already difficult to find (Rosenberg, 2014). Despite greater public awareness of mental health, there has been little progress in providing byaccessible mental care. Mental health hospital beds per capita in the U.S. presently are lower than that in the 1850s (Ghiasi and Singh, 2019). Obtaining firearms should not be easier than obtaining mental health care. Improvements are direly needed in the mental health sector, specifically in addressing the stigma associated with seeking care and the barriers to accessible care. Investing in mental care has long-term benefits such as reducing unnecessary prison costs and developing productive members of society (Ghiasi and Singh, 2019). In respect to the prevention of mass shootings, research and policy should focus on substance abuse, the most predictive indicator of violence, instead of mental illness (Metzl and MacLeish, 2014). To redirect this focus, educating the public, journalists, and policy makers on the false assumptions concerning the mentally ill is vital. The Centers for Disease Control and Prevention (CDC) is in a unique position as the nation's health protection agency to help citizens make informed decisions.

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