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Why addressing mental illness isn’t enough to reduce gun violence

How do we explain and stop mass shootings like those in El Paso and Dayton? Some Americans point to guns, saying they're too common and easy to obtain, while others emphasize the mental and emotional conditions that could drive perpetrators to inflict such horror. Amna Nawaz talks to Dr. Garen Wintemute of UC Davis Medical Center and Duke University's Jeffrey Swanson for analysis of both theories.

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  • Judy Woodruff:

    So, as has happened before in the aftermath of gruesome mass shootings, once again this week, two principal and competing narratives have emerged, as people try to grasp how such things can happen and what might be done to prevent them.

    As Amna Nawaz reports, some point to guns, their large numbers and easy access in this country. Others, often voices on the right, including President Trump yesterday, urge a greater focus on mental health treatment, saying that that could identify potential shooters before they act.

  • Amna Nawaz:

    Judy, guns kill an average of 100 people each day in this country, about 36,000 a year total.

    For a look at the role guns play in our lives and in violence we live with, I'm joined by Mr. Garen Wintemute. He's an emergency medicine physician at University of California-Davis Medical Center, where he's the director of the Violence Prevention Research Program. His research for decades has focused on injuries and the prevention of firearm violence.

    Dr. Wintemute, welcome to the "NewsHour."

    Thank you for making the time.

    I want to ask you about the laws,because you have looked extensively at them. In the wake of these mass shootings, people want congressional action. They want legislation.

    What is being done on the federal or state level to improve gun safety and reduce gun violence?

  • Garen Wintemute:

    I think one promising strategy is the extreme risk protection order, or, as we call it here, a gun violence restraining order.

    It has a number of virtues. It is effective. It is very tightly focused on people who exhibit high-risk behavior, such that there is a threat in the near future. It's temporary. It is designed to lessen risk at a time of crisis.

    We are today in the wake of a series of mass shootings. And it's important to point out that ERPOs, as we call them, while they were thought to be primarily useful for prevention of suicide, were generally enacted at the state level following mass shootings, and have been and are being used in efforts to prevent mass shootings.

  • Amna Nawaz:

    And I want to be clear about these. These are the same as the so-called red flag laws people have heard so much about recently?

  • Garen Wintemute:

    It is the same. Those of us who work in the field don't like the term red flag laws, so we use a term that actually describes what it is we're talking about.

  • Amna Nawaz:

    Can I ask why you don't like it? What's inaccurate about it?

  • Garen Wintemute:


    So, first off, it's, as we say, very nonspecific. Red flag about what? Bugs in the basement?

    It's also — I think this concerns me the most. It is a term that inspires fear. And we don't want to make people afraid. We want them to feel empowered. So we use terms that describe what the intervention is and convey a sense that this is something that people can do, which is precisely the point.

  • Amna Nawaz:

    So, there's two additional bills that have had some kind of bipartisan support behind them.

    One is expanding background checks to include every gun sale or transfer. And the other is concealed carry related, that states who have and allow concealed carry would recognize permits from other states.

    Would either of those contribute to reducing gun violence in America?

  • Garen Wintemute:

    Let me take expanded background checks first.

    There is very good evidence, from our work and others, that denying the purchase, denying access to firearms by people who are prohibited from having that access substantially reduces their risk of violence in the near future.

    We and others have identified a series of concrete flaws in the way background check policies are written and implemented that I think need to be fixed in order for them to have their maximum effectiveness.

    I will give you one example. There are at least nine of these. Prohibiting events very often are not reported, even when they are required to be reported. Mass shootings in Sutherland Springs, Texas, in Charlottesville, South Carolina, at Virginia Tech, all occurred because shooters who were prohibited persons were able to pass background checks and acquire their firearms because the prohibiting events were not in the data the background checks were run on.

    Now, reciprocity — let me just use recent events. Both Texas and Ohio, where we have had mass shootings just in the past few days, are places with concealed carry, at least one with open carry, where it's hard for me to imagine that among the people wisely running away from that shooting scene were a substantial number of people who were themselves armed.

    We have this collective adolescent fantasy, if I may, that an armed civilian is going to step up and prevent these events. The data show that that almost never happens.

    And the reason I said that it might be counterproductive is this. States vary widely in their criteria for issuing CCW permits. Some states set the bar quite high. Others set it quite low. High bar states, with good reason, would just as soon not have people with low bar permits inside their borders.

  • Amna Nawaz:

    Well, you mentioned states having different rules. Of course, that means that guns can move across different state lines as well. How much of a problem is that?

    And if you could, if there is one piece of legislation that you think would have an immediate effect to reduce gun violence, what would that be?

  • Garen Wintemute:

    I think the one thing I would put at the top of the list would be to expand background checks and make — at the same time make them much more thorough and effective.

    I have to say, however, firearm violence is a very complex problem. And the correct answer to what's the one thing is, there is no one thing. We need to do a bunch of things simultaneously in order to have the effect that we want.

  • Amna Nawaz:

    Dr. Garen Wintemute of the University of California-Davis, thank you very much.

  • Garen Wintemute:

    Thanks for having me.

  • Amna Nawaz:

    And to help us assess the role mental health plays in gun violence and gun-related deaths, we turn to Jeffrey Swanson. He's a professor of psychiatry and behavioral science at Duke University School of Medicine.

    His research was part of a report released today by the National Council for Behavioral Health titled "Mass Violence in America: Causes Impacts and Solutions."

    Professor Swanson, welcome back to the "NewsHour."

    I want to begin with what the president has said in the wake of this latest round of mass shootings.

    This is a quote. He said: "Mental illness and hatred pulls the trigger, not the gun."

    How should we understand the overlap between mental illness and people who perpetuate gun violence in America?

  • Jeffrey Swanson:

    Well, mass shootings, I mean, we're just in this national nightmare. Everybody wants it to stop. And mass shootings are so frightening and so irrational, and we want an answer to why they happen.

    And what the president said is a very simple answer, it's mental illness.

    And I understand why he said that, because it resonates with what lots of people already believe about mental illness.

    But the facts are that the vast majority of people with mental illnesses are not violent towards other people, they never will be. And our report just released today, which suggests that the prevalence of mental illness among perpetrators of mass shootings or mass violence is about the same as it is in the general population, so it's a very complex problem.

    Fix mental health is a slogan. It's not a solution to anything. And if it is, it's a solution to a quite different public health problem, which is the problem of people with mental illnesses out in the community who need better mental health care.

  • Amna Nawaz:

    Let me ask you about something we have heard, though, from other people on the president's team as well, which is that, look, in order to be someone who carries out this kind of heinous attack, you have to be mentally ill in some way.

    What do you say to that?

  • Jeffrey Swanson:

    Yes, I understand that too.

    To say that someone who goes out and massacres a bunch of strangers, I mean, that's not the act of a healthy mind. It might be a person who's alienated and troubled and angry and resentful, who's marinating in hate, someone who is indifferent and hopeless, who has all kinds of problems with all kinds of causes.

    But it doesn't mean that they have one of the mental illnesses defined by psychiatry, as, you know, a disorder of thinking or mood, like schizophrenia or bipolar disorder or depression. Tens of millions of Americans have these illnesses, and the overwhelming majority of them are not violent towards other people.

    They would love to have a conversation about improving mental health care. And it's too bad we have it on the day when there's a mass shooting.

    There are many solutions, I think, that we could talk about to try to address mass shootings. Mental illness is one contributing factor. But it's just one of many. And if we cured mental illness, our problem of violence in society would go down by about 4 percent.

    So it's not that there's no relationship at all. It's just it's not quite the place you would start. But we can certainly talk about it.

  • Amna Nawaz:

    Well, let me ask you — let me ask you about one of the proposed solutions we have heard about so far, which is these so-called red flag laws, right, the idea that you can identify someone who's potentially violent in advance and make sure they either don't have a weapon or take away the one that they have.

    What do you make of those — of those possible solutions?

  • Jeffrey Swanson:

    Well, I think they're a good idea. I think they're an important piece in the puzzle of gun violence prevention, because the fact is that we have kind of a disconnect between the laws that are designed to prevent certain people from accessing guns at the point of sale and actual risk.

    There are lots of people who are prohibited from guns, maybe because they had an involuntary commitment 25 years ago, and they aren't posing a risk to anyone.

    Meanwhile, there are lots of people who do pose a risk, angry, impulsive people who would pass a background check because they don't have any gun-disqualifying record.

    So a tool like this is focused not on mental illness. It's focused on behavioral indicators of risk. So, if you're a neighbor, and the person next door is acting in a really threatening, menacing way, and is amassing firearms, in many states, there's nothing you can do about that if that person isn't criminally accused, hasn't done anything or committed a crime.

    In one of the states that has an extreme risk protection order law, you can reach out to law enforcement. They can investigate it. And if there's probable cause, they can get a civil court order to remove that person's firearms temporarily, for their own good. It's not criminalizing.

    And you can do the same thing if your family member, under the most of the statutes — if let's say a relative of yours is in a suicidal crisis and has guns. Your loved one is, let's say, depressed and bereaved or drinking heavily and has guns, and this might save their life, because lots of people attempt suicide.

    If they use anything else, they're very likely to survive. If they use a firearm, it's so lethal, that they almost never survive. If we just want to stop so many people from dying, we could focus on limiting access to lethal means.

    And I think this law actually is one of the few things that can find some common ground and bridge the gap between people who want to do gun control and people who think that it's people and not guns who kill people.

  • Amna Nawaz:

    Common ground, something we're all looking for these days.

    Professor Jeffrey Swanson, Duke University School of Medicine, thank you very much.

  • Jeffrey Swanson:

    Thank you for having me.