Shooters may have mental health problems in common, but that’s not what’s behind violent attacks, experts say

By Jen Christensen, CNN

After a random shooting in Austin, Texas, left three people dead, Austin Police Chief Lisa Davis said that the suspect had past criminal offenses and “serious issues.” The 32-year-old suspect was arrested after police found him naked, holding a Bible and claiming he was Jesus.

“There were some serious failures here,” Davis said.

Days earlier, a 30-year-old man had fired hundreds of shots at the US Centers for Disease Control and Prevention in Atlanta, killing a police officer. The gunman, who took his own life, had spoken about suicide and had reportedly reached out for mental health assistance ahead of the attack.

And just a few days before that, another gunman with a history of mental health problems shot and killed four people in a Manhattan skyscraper before turning the gun on himself.

Suspects in several recent high-profile attacks were described as having mental health problems, but experts say that doesn’t mean their mental health issues are to blame for the killings.

No mental health system is built to catch such rare and explosive crimes, experts said. But the potential solution is one that many politicians won’t have the stomach to address: limiting access to guns.

“Often we tell the mental illness story because it’s the most obvious or fits into our stereotypes and if we focus only on that, then we’re missing all of these other factors which are much more predictive of mass shootings,” said Dr. Jonathan Metzl, the director of the Department of Medicine, Health and Society at Vanderbilt University and author of “What We’ve Become: Living and Dying in a Country of Arms.”

“Having a mental health problem is not predictive of mass shootings,” Metzl said. “Many have symptoms of mental illness, that’s definitely true, but that’s a different argument than saying that mental illness caused the mass shooting.”

Violence is not a listed symptom of mental health issues, including major depression or schizophrenia, Metzl noted. “In fact, there’s no mental illness whose symptoms are violence toward others or shooting other people,” he said.

Many people in the United States have a mental illness, according to the US Centers for Disease Control and Prevention — 1 in 5 adults experience a mental illness in a given year — and only a “microscopic number of them go on to hurt anyone else,” Metzl said.

People with mental illness are much more likely to be the victim, rather than the perpetrators, of violence, studies show. And if a person with mental health issues hurts anyone with a gun, it’s most likely themselves, said Dr. Jeffrey W. Swanson, a professor in psychiatry and behavioral sciences at Duke University School of Medicine who has also written extensively about gun violence and mental health.

Mental illness is a strong causal factor in suicides, studies show, but only about 3% to 4% of violent acts are attributable to serious mental illness alone, Swanson’s research showed. Even among gun violence, mass shootings are unusual: Of the 150,000 people shot in the United States every year, only about one to 2% of those were victims of mass shootings, research shows.

“If you think about it, we certainly have a problem with gun violence in the US. We have a problem with mental illness. Those are two really big public health problems that intersect on their edges, but mental illness, it’s not exactly the place you would start if you just wanted to try to stop so many people from dying in mass shootings,” Swanson said.

Mass shootings generally don’t stem from one problem but several factors might increase the risk: A history of violence, access to guns, violent social networks, misogyny and substance abuse all make the list.

“Most perpetrators of mass shootings had domestic violence histories or targeted family or intimate partners,” said Lisa Geller, senior adviser for implementation at the Center for Gun Violence Solutions at Johns Hopkins Bloomberg School of Public Health.

“Domestic violence, more than any other issue really played a critical role in mass shootings,” said Geller, who wrote a 2021 study about the role of domestic violence in mass shootings.

And while some may argue mass shootings would be prevented if attackers had better access to the mental health system, J. Thomas Sullivan, professor emeritus at the University of Arkansas at Little Rock William H. Bowen School of Law, said he doesn’t think that’s right, either.

“Putting the burden on the mental health system to provide the help that would be needed to stop these shootings is an inappropriate way to shift the blame,” said Sullivan, who has written extensively about the topic.

Sullivan said several of the mental health experts he has taught said their patients issue threats all the time. “But not everybody can accurately predict when somebody who is making a threat it actually going to follow through,” Sullivan said.

Sullivan and other experts CNN spoke with said the more effective solution would be to focus on the tools used to harm others.

“I think a lot of people aren’t going to like to hear this, but the real problem is access to guns,” Sullivan said.

There are many responsible gun owners, himself included, Sullivan said, but “it’s very difficult to stop someone from firing a gun if they’ve got one.”

Gun restrictions are what countries such as Australia and New Zealand turned to after a mass shooting. The strongest risk factors for violent behavior in general, Swanson said, is being young and being male. “But you know you can’t round them up, right?” Swanson said. Some countries have decided “that the idea that everyone should have easy access to a firearm is just too dangerous. So they broadly limit legal access to guns,” he said.

“Until neuroscientists come up with the magic molecule to eliminate injurious behavior, in the meantime it’s important to focus on the lethal means issue,” Swanson said.

One way to do that is through extreme protection orders, also known as “red flag” laws. Depending on the law, if a family or household member or law enforcement believe a person is at risk of harm to themselves or others, a court can restrict access to firearms for as long as the order is in effect.

Red flag laws are important, Geller said, because they “focus on people’s behavior rather than a diagnosis.”

“Just because someone is experiencing mental health issues doesn’t mean they have a diagnosable mental illness,” Geller said.

Twenty-one states, Washington, D.C. and the US Virgin Islands and have some form of red flag law on the books, according to the non-profit Everytown for Gun Safety.

After Connecticut increased its enforcement of its red flag law, research found it was associated with a 14% reduction in the state’s firearm suicide rate. In California, gun violence restraining orders have been credited with deterring at least 58 potential mass shootings and other types of gun violence in that state, including suicide, research shows.

Polls have shown the majority of Americans favor these kind of restrictions, but the political reality does not always reflect that.

In Texas, where three people — a store employee, a 4-year-old and her grandfather — were killed in the Austin Target parking lot on Monday, the legislature recently passed law that make such gun law restrictions illegal.

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