Updated on May 23, 2022.
Every time a mass violence incident occurs in the United States, there’s a tendency to blame it on mental illness. In many cases, this blame is misdirected and oversimplifies the problem.
People with mental illness are not likely to harm others using firearms, says Art Caplan, PhD, founding head of the Division on Medical Ethics at NYU Grossman School of Medicine in New York City.
“There are lots of people with mental illnesses,” he explains. “Many are not in any way violent. Some are afraid to come out of the house. Others are so dysfunctional it’s impossible for them to hurt anyone.”
“That said,” Caplan notes, "whenever mass violence takes place, we immediately pronounce the person who did it as mentally ill, with or without a psychiatric diagnosis.”
Putting the number into perspective
A 2021 analysis by the RAND Corporation of gun violence research found that mental illness plays a relatively small role in incidents of gun violence. Researchers found that, of 951 people discharged from a mental health facility, 2 percent perpetrated gun violence within one year and 1 percent committed an act of gun violence against a stranger. When it came to mass violence, the researchers found that about 20 percent of these shootings are perpetrated by someone with a mental health condition.
Someone who is experiencing an acute psychotic episode as part of schizophrenia, for example, may feel threatened by unknown entities and these symptoms may lead them to be violent toward others, says Beth McGinty, PhD, professor at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. But, she says, this is rare. “Most people with these types of disorders are never violent toward other people.”
Why we scapegoat mental illness
Mental illness is easy to blame, says Caplan, because most of us think, “Well, you’d have to be crazy to go in and shoot up a school or a church."
Caplan says blaming gun violence on mental illness doesn’t hold people accountable for what they do.
“If you’re just a hate-filled bigot, you may not be mentally ill and you may kill people because of your hatred, not because of an illness,” he says.
Furthermore, committing a violent crime involves a certain level of planning and coordination. Some people with serious mental illness, such as schizophrenia or psychosis, may not have that capacity.
“You need to have enough coherence to follow through on what’s often a fairly complicated plan,” he says.
It’s reasonable to assume that someone who commits a mass shooting or other type of gun violence isn’t mentally healthy, but it doesn’t mean they have a diagnosable mental health condition.
“They could have high levels of stress, have a lot of anger, or have impulsivity issues that contribute to mental unwellness that are not necessarily meeting the definition for mental illness,” McGinty says.
If it’s not mental illness, what is it?
There’s not usually one risk factor, but a number that contribute to gun violence, McGinty says. Substance abuse, for instance, is strongly associated with interpersonal firearm violence. In fact, alcohol and drug abuse may raise the risk of violent crime by as much as 11 times, according to a 2004 Swedish study in the British Medical Journal. Being male and having a history of incarceration are also predictors of gun violence.
There are other socioeconomic risk factors as well, McGinty says, such as poverty, lack of employment, few educational opportunities, and stressful life situations.
“Anger and impulsivity are also personality traits very strongly associated with an increased risk of gun violence,” she says. "We usually see multiple risk factors all interacting with one another in perpetrators."
How to address gun violence
Caplan and McGinty say that improving the mental health system would help millions of people and is the right thing to do. But even if we had a perfect mental health system and everyone who needed help received it, McGinty says, it would only reduce interpersonal gun violence in the U.S. by a small percent.
“It’s not an effective solution to the firearm problem,” McGinty says.
One option, McGinty says, is to enact policies that restrict firearm access to people who may be a harm to themselves or others. A number of states have enacted red flag laws, also called extreme risk protective orders. Family members, intimate partners, or law enforcement can petition civil courts to temporarily restrict firearm purchases or remove firearms from someone’s possession in 19 states including California, Illinois, Florida, and the District of Columbia.
These laws are relatively new, so we don’t know yet if they’re effective, but McGinty says they’re promising and proactive. You can learn more about where your state stands on these laws at the Giffords Law Center to Prevent Gun Violence.
Another approach is to keep people with a history of domestic violence from getting access to guns. According to Everytown for Gun Safety, an average of 70 women in the U.S. are shot and killed every month by an intimate partner. In fact, most mass shootings occur at home and involve family members.
McGinty says although assault weapons are disproportionately used in mass shootings, the vast majority of violent firearm incidents involve handguns. “To have really meaningful reduced rates of overall gun violence in the U.S., policies need to limit handgun possession among people at high risk of violence,” she says.
How to get help for a mental illness
It's important to seek help if you or someone you love is dealing with mental illness. Speak with a healthcare provider or a mental health professional. They can help with a diagnosis and begin treatment.
For more information and support, visit the National Alliance on Mental Illness online, call their helpline at 800-950-6264, or, if it's a crisis, text NAMI to 741741. The National Suicide Prevention Lifeline can help, as well, whether or not you're having thoughts of suicide. Call 800-273-8255 any time to talk to a counselor.
