Mental health advocates are walking a fine line on the Senate’s bipartisan gun violence package framework — happy that it contains long sought-after provisions to expand access to treatment while stressing that there is little connection between gun homicides and mental illness.
A framework released Sunday calls for expanding access to mental health care across the country, with gun control opponents framing those provisions as part of the solution to reducing mass shootings.
But experts say expanding access to care likely won’t do much to reduce gun homicides because the vast majority of people with mental illness will never become violent.
It could, however, have an impact on suicides, which make up more than half of gun deaths in the United States, and could support survivors of gun violence, who can experience anxiety, depression or post-traumatic stress disorder.
“‘Fix mental health’ is a good slogan for different public health problems that intersects with gun violence at the edges,” said Jeffrey Swanson, a professor of psychiatry and behavioral sciences at Duke University School of Medicine. Clinicians have long described gun violence as a public health problem created by easy access to guns.
Still, it’s hard to say no to any attempt to fix America’s broken mental health care system, which leaves millions of people unable to access care every year.
“It’s complicated to have both of these conversations at the same time, but it’s the conversation we’re stuck with because mental health only comes up when we have a horrible mass casualty shooting,” said Swanson, who has studied the connection, or lack thereof, between violence and serious mental illness.
About 4 percent of community violence can be attributed to people with serious mental illness, Swanson said, and when they do become violent, there are often other factors at play, like poverty, substance use or a history of child abuse.
More often victims than perpetrators
While about 8 percent of people who perpetrate mass shootings have a history of lifetime psychotic symptoms, according to a 2021 study, deaths from such shootings make up less than 1 percent of firearm deaths in the United States.
Instead, people who are mentally ill are more likely to be the victims of violence than the general population, experts say.
But at the insistence of Republicans, mental health overhaul has become a focal point of the gun violence package, said Sen. Christopher S. Murphy, D-Conn., who is leading negotiations on behalf of Democrats.
“I’m always worried about too closely tying a conversation about mental illness to a conversation about gun violence,” Murphy told CQ Roll Call.
“I think we always risk creating the impression that people with mental illness are prone to violence when the opposite is true — they’re actually more likely to be the victims of violence,” he said. “But we shouldn’t forsake the opportunity to put billions of dollars into new mental health services. So there’s a risk, but it’s a risk worth managing, given the benefit.”
Sen. John Cornyn, R-Texas, who is working with Murphy to find agreement on legislation, said it is not his intent to stigmatize mental illness.
“Nobody is suggesting that people who are experiencing mental health challenges are violent, but we do know that most gun deaths are suicides,” he told CQ Roll Call. “Not everyone experiencing a mental health crisis is going to hurt somebody else, but identifying those people and trying to get them some help before they hurt themselves or others is important, and that’s part of what we’re trying to do.”
The main mental health component of the framework is a proposal by Sens. Debbie Stabenow, D-Mich., and Roy Blunt, R-Mo., that would provide states with Medicaid funding for Certified Community Behavioral Health Clinics, which treat patients with mental illness and substance use disorders 24/7 and have been shown to expand access to care and decrease homelessness and arrests.
Senators were hoping to release text of legislation this week and vote on a bill before the July Fourth recess.
Increased worries about mental health
Although experts dispute the link between mental illness and gun homicides, experts are increasingly worried about the state of mental health in the U.S., especially after the pandemic caused isolation, death and illness.
Suicide is a leading cause of death in the United States, according to the Centers for Disease Control and Prevention, and children in particular are seeing increased rates of depression, anxiety and suicide attempts.
“If that is included, that could really be a game-changer for mental health. ... Having that resource available in communities can go a long way to address mental health access issues,” Hannah Wesolowski, chief advocacy officer of government relations for the National Alliance on Mental Illness, said about the Stabenow-Blunt proposal.
Wesolowski said NAMI has been working with congressional offices about not conflating mental illness with gun violence and has received reassuring responses.
“No one would argue that we don’t have a significant mental health crisis in this country we should be making investments in, but we should do it to help save lives, not because it will have a tangible impact on mass shootings,” she said.
Blunt, who is viewed as a strong advocate for mental health in the Senate, cheered the inclusion of his bill in the framework in a statement, writing that “making sure people who are experiencing a mental health crisis can get treatment before they harm themselves or others is critically important to preventing another tragedy.”
He added that “it is important to remember that people who do have a mental health issue are more likely to be the victim of a crime than the perpetrator.”
But on Tuesday, he told reporters, “I think everybody in our conference, and I believe every member of the Senate, has said these problems at some fundamental level are the failure of the mental health delivery system.”
Clinicians have for years called gun violence a public health crisis. And while they support expanding access to mental health care, that hasn’t been a cornerstone of their recommendations when urging Congress to find a way to stop gun deaths.
The American Psychiatric Association has called on Congress to increase research into firearm violence; require background checks, waiting periods and safe storage of firearms; and allow physicians to make “clinically appropriate inquiries regarding access to firearms.”
“A vast majority of firearm violence is not attributed to mental illness,” the APA said in a statement. “Rhetoric that argues otherwise will further stigmatize and interfere with people accessing needed treatment without addressing the root causes of firearm violence.”
Legislation that passed the House last week, mostly along party lines, would raise the age for purchasing AR-15-style guns from 18 to 21 and require safe storage of firearms. Separate legislation, which passed the House last year, would require background checks on all gun sales. Neither is expected to get a vote in the Senate. Neither bill addressed mental health, although a House committee recently approved separate legislation aimed at improving access to mental health care.
Firearms were involved in 79 percent of all homicides in 2020, which saw the largest firearm homicide rate in more than 25 years, with increases in deaths among Black children and young adults, according to data released by the CDC last month.
Of the more than 45,000 firearm-related deaths in 2020, about 53 percent were suicides.
A CDC official suggested poverty, housing instability, social isolation, job loss and structural racism could have led to an increase in gun deaths, as well as increases in firearm purchases, intimate partner violence and strains in relationships between police and the communities they serve.
Still, the inclusion of mental health provisions in the gun package is hard to reject.
“The opportunity we have here is to radically improve availability and quality of mental health and substance use services around the country,” said Chuck Ingoglia, president and CEO of the National Council for Mental Wellbeing.