Mental health factor in trying to reduce mass killings.


Byline: Lee Hammel

At least 56 mass shootings have occurred in the United States in the past four years and a national gun control group found no evidence that even one of the shooters was prohibited under federal law from possessing a firearm for mental health reasons.

Mayors Against Illegal Guns said Friday there was a mass shooting - defined by the FBI as an incident where at least four people are murdered by a firearm - more than once a month over a four-year study period from January 2009 through last month.

"We did not find evidence that any of the shooters were prohibited from possessing guns by federal law because they had been adjudicated mentally ill or involuntarily committed for treatment," said the 800-member mayors' group. Thomas M. Menino of Boston and New York's Michael R. Bloomberg are chairmen of the group.

But, "in 4 of the 56 incidents (7 percent), we found evidence that concerns about the mental health of the shooter had been brought to the attention of a medical practitioner, school official or legal authority prior to the shooting," the organization reported. "In another 4 incidents (7 percent), the shooter's mental health problems were known to friends or family but were not reported or known more widely until after the shooting."

Though still a small percentage of the shootings included in the study, the findings suggest that mental health issues may in some cases be flying under the radar when it comes to screening those seeking to legally acquire a firearm.

Mental health reasons are part of the backbone of a federal system, the National Instant Criminal Background Check System or NICS, designed to keep weapons out of the hands of undesirables and to reduce mass killings.

The mayors' group had sufficient evidence to judge whether the shooter was prohibited under federal law from having a gun in 42 of the 56 shootings.

It found that 15 of the 42 were prohibited because they were felons or certain domestic abusers - but not adjudicated mentally ill - and 27 (64 percent) were not prohibited.

It found that assault weapons or high capacity magazines were used in 23 percent of the incidents. When they were used, more than twice the number of people were shot (15 instead of 7) and 57 percent more were killed (8 instead of 5).

Mass shootings - from the 20 first-graders and six adults killed in a Connecticut elementary school in December to the congresswoman who survived an attack two years ago in Tucson, Ariz., that killed a federal judge and five others - has prompted renewed gun-control efforts at state and national levels.

Last month,

Massachusetts Gov. Deval L. Patrick and President Barack Obama each announced gun control proposals, including closing a loophole so that the people who privately buy an estimated 40 percent of the 300 million guns in America undergo background checks, the same as those who buy their firearms from the country's 55,000 licensed dealers.

While that part of their gun control packages has a chance at passing, there is skepticism that Mr. Obama's proposal banning assault-style rifles and limiting gun magazines to 10 rounds will be anything more than skeet for the National Rifle Association.

With a ban on assault rifles already in place and a system of gun permitting in Massachusetts, Mr. Patrick's plan is more nuanced.

In addition to items such as universal background checks on gun sales, limiting licensed dealer sales to one gun per month per licensed customer, and creating new gun crime categories, it includes $5 million more in mental health spending.

That would create more mobile crisis teams; mental health training for staff in junior and senior high schools; doubling money for training law enforcement and others in crisis intervention; providing psychiatric consultation for pediatricians; and a public education campaign touting the effectiveness of mental health treatment and urging those who need it to get it.

And it would try to succeed this year where the governor has failed twice before in reversing state law that prohibits the state from sending mental health information to the FBI's NICS system.

Mayors Against Illegal Guns says that means that in 2011 there were 153,487 checks on gun sales in Massachusetts in a federal database in which the state did not provide information for the FBI to know if the gun purchaser had been committed involuntarily to a psychiatric facility or adjudicated a "mental defective."

While local police licensing agents can access the information, if Bay State residents seek to buy a firearm in other states, their background psychiatric information is absent from the NICS database.

Mental health advocates are pleased with Mr. Patrick proposing a 3.3 percent increase in the Department of Mental Health budget, but not with a mainstay of the governor's bill: change Massachusetts law so that the DMH and the state courts would forward mental health and criminal information to a state agency that would make it available to not only the state's police chiefs, but to the federal government.

That state agency is the former Criminal History Systems Board, now called the Department of Criminal Justice Information Services.

The governor's bill would require the DMH to forward to the Department of Criminal Justice Information Services "sufficient information to identify all persons known to the Department of Mental Health who had been confined to any hospital or institution for mental illness within 20 years" and update the information quarterly.

But that approach doesn't go far enough for some gun-control advocates who want to see background information on patients of private psychiatric facilities thrown into the mix.

Last year DMH admitted 1,700 people to inpatient facilities, about 1,400 of them committed/confined. By contrast there were 74,000 admissions to private psychiatric facilities in 2011, the most recent year for which statistics are available, and 811 of them were commitments/confinements.

DMH Commissioner Marcia Fowler said the department provides information to police chiefs, who make 10,000 requests per year, on people who have been admitted to a DMH facility, whether voluntarily or involuntarily.

DMH "does not collect, and does not have the authority to collect, information on individuals who are admitted to private psychiatric hospitals," spokeswoman Anna Chinappi said.

A bill by state Rep. David P. Linsky, D-Natick, would require all gun permit applicants to waive their right of privacy and disclose all providers of mental health treatment or services going back 20 years and grant "access to any records that have a bearing on the mental health of the applicant."

The National Alliance on Mental Illness of Massachusetts supports "steps to keep highly lethal weapons out of the hands of any dangerous individual, whether or not they have mental illness," Executive Director Laurie Martinelli said.

But NAMI objects to using "a broad brush to implicate millions of individuals with mental illness, through distribution of databases, with names" she said, when "most violent crimes, including gun crimes, are committed by people who do not have a mental illness, and the overwhelming majority of people with mental illness are victims of crimes, not perpetrators."

With one in four Americans having a mental health problem at some point, Ms. Martinelli said, "Creating a database of up to 75 million people is not the answer. An all-encompassing database reinforces stigma and labels, and creates fear."

Requiring disclosure of confidential treatment information could undermine the trust between a patient and therapist, the NAMI official said.

Professor James Alan Fox, a Northeastern University criminologist, does not disagree with gun-control efforts that have sprung up since the school massacre in Newtown, Conn. "Some of them are quite worthwhile, good policy. But they're not going to stop mass shootings," he said. "Mass murders are extremely deliberate and determined. They'll find a way in spite of the impediments that we place in their path. An extremely small percentage of them have been institutionalized.

"They may suffer from mental health issues, they may be oddballs, hostile, they may be unfriendly, loners, misfits, they may never smile, may have no friends," Mr. Fox said "But generally they are not restricted from buying guns. You can't deny someone because they're a jerk or you think that they're crazy. That's the problem."

He added that banning gun possession for people who go to psychiatrists "would only discourage people from getting treatment."

Charles W. Lidz, a research professor of psychiatry at the University of Massachusetts Medical School, said that of the 75,000 annual admissions to psychiatric facilities in the state, "maybe a few dozen would be people you would want to keep from having guns."

After years of research, he said, he knows of no technology to predict who will take up a gun. The best predictor of violence in people with mental illness is to ask them, Mr. Lidz said.

There's "not much" the Gun Owners' Action League, the NRA's Massachusetts affiliate, can agree with in the proposals of either Mr. Patrick or Mr. Linsky, Executive Director Jim Wallace said. But, he said, "one thing we need to look at is the mental health aspect.

"We would agree that someone should be barred from having guns if they have been adjudicated mentally incompetent or a danger to themselves or others," he said. "But the governor's bill doesn't use the word `adjudicated.' It uses `confined,' and there's no definition as to what that means."

While public attention is focused on mass murder, Ms. Fowler said for her the most important part of the governor's bill is reduction of suicide by firearms. She said that only 4 percent of violent acts are committed by people diagnosed with a mental illness, and that people with mental illness are four times more likely to be victims of violence than to be perpetrators.

On the other hand, the commissioner said, about half of the 38,000 U.S. suicides each year are committed with firearms. In 2010, 48 percent of suicide victims in Massachusetts had a current mental health problem such as depression, according to the state Department of Public Health. In 2011, the number exceeded homicides in Massachusetts by 2.7 times, DPH found.

Addressing privacy concerns, Mr. Linsky added that mental health records that would be collected under his bill would be used only for gun licensing purposes and then quickly destroyed.

He said that the mental health portion of his bill is only one step of many needed to bring gun violence under control.

Rep. George N. Peterson Jr., R-Grafton, assistant minority leader, does not expect House action on the governor's proposal until early next year to await a pending study sought by Speaker Robert DeLeo.

Legitimate gun owners have long objected to being in a database, Mr. Peterson said, and "the shoe is on the other foot" now that people with mental illness face proposals to include them in databases.

He also said he is concerned that even getting marriage counseling could threaten Second Amendment rights under Mr. Linsky's proposal.

The American Civil Liberties Union of Massachusetts needs "to take a close look at these proposals," said legislative counsel Gavi Wolfe. "In our effort to protect public safety we need to ensure we don't compromise the confidentiality of mental health services. It's critical for people to get the care they need, and not to avoid care for fear that private counseling will become the subject of government scrutiny."


CUTLINE: (1) Charles Lidz (2) Marcia Fowler (GRAPH) Suicides and homicides, Mass. 2003-2011


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