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Joshua HorwitzExecutive Director
[email protected] x1001
Guns, Public Health & Mental Illness
June 10, 2016
2
Suicide63%
Homicide33%
Other/Undetermined4%
US Firearm Deaths in 2014
More than 33,000 gun deaths and
81,000 non-fatal gunshot injuries
per year
Source: CDC’s WISQARS™ (Web-based Injury Statistics Query and Reporting System). Fatal Injury Reports, 1999-2014, for National, Regional, and States; Nonfatal Injury Reports, 2001 - 2014
Source: CDC’s WISQARS™ (Web-based Injury Statistics Query and Reporting System). Fatal Injury Reports, 1999-2014, for National, Regional, and States3
0.
3.5
7.
10.5
14.
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Age
-ad
just
ed F
irea
rm D
eath
Rat
e p
er 1
00
,00
0
Year
US Suicide US Homicide US All Intents
Age-adjusted Firearm Death Rate:United States
4
Legal Context: Supreme Court recognizes legal right to a gun in the home for self defense
But that right is not unlimited.
Who can exercise the right safely?
5
Federal Prohibitors:
• Felons; fugitives• Persons who have been involuntarily committed to
a mental institution• Those convicted of a misdemeanor crime of
domestic violence• Those subject to permanent domestic violence
restraining orders• Unlawful users or those addicted to a controlled
substance
Who should be prohibited from purchasing and possessing firearms?
Can evidence help us do a better job identifying risk?
I Turned to the Experts…
March 2013: Convened at Johns Hopkins Bloomberg School of Public Health, Baltimore MD
• Public Health Researchers
• Mental Health Providers
• Medical Professionals
• Gun Violence Prevention Advocates
• Policy Experts
• Law Enforcement
Evidence ConsensusRecommendat
ions
8
Jeff Swanson
Duke University,
School of Medicine
Shannon Frattaroli
Johns Hopkins
Bloomberg School of
Public Health
Richard Bonnie
University of
Virginia School of
Law
Beth McGinty
Johns Hopkins
Bloomberg School of
Public Health
Daniel Webster
Johns Hopkins
Bloomberg School of
Public Health
Paul Appelbaum
Columbia University
School of Medicine
Renee Binder
University of California,
San Francisco, School
of Medicine
Consortium for Risk-Based Firearm
Policy
9
Amy Barnhorst
UC Davis
Psychiatry and
Behavioral
Sciences
Garen Wintemute
UC Davis Emergency
Medicine, Violence
Prevention Research
Program
96%
4%
Attributable Risk of Minor or Serious Violent Behavior Towards Others:
Other Risk FactorsSerious Mental Illness
96% of violence occurs due to reasons other than serious mental
illness alone
Serious mental illness, on its own, contributes very little to overall violence towards others (a bigger risk factor for suicide)
10
There are certain times, in certain settings, when those with a serious mental illness are at increased risk of violence
2%
8%
23%
36% 37%
0%
10%
20%
30%
40%
Generalpopulation
without mentalillness
Outpatients intreatment
Emergencydepartments
Involuntarilycommittedinpatients
First-episodepsychosispatients
Percent Violent Within 6 – 12 Months
11
12
Age (Young)
Male
Low socioeconomic
status
Alcohol abuse
Drug abuse
History of violence
Serious mental illness
Significant Risk Factors for Dangerousness
Note, some of these risk factors cannot constitutionally be used for gun prohibitions
• Older• Female• Middle to upper SES• No serious mental illness• No substance abuse• No psychiatric hospitalization• No arrest history
• Younger• Male• Lower SES• Serious mental illness• Substance abuse• History of psychiatric
hospitalization• History of arrest
CU
MU
LATI
VE
VIO
LEN
CE
RIS
K
<1 % violent
65 % violent
Predicted Probability of Violence in a One-year Period: Data From a Three City Study (Swanson, 1990)
Violence risk is multi-factorial and cumulative:
Risk linked to mental illness is embedded in other
factors
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Population Attributable Risk of Suicide
Serious mental illness, on its own, contributes significantly to suicide
MentalIllness
47% - 74%
Other factors
26%
47-74% of violence
toward self attributable
to mental illness alone
Gun Ownership & Suicide
• Access to firearms is correlated with the risk of suicide.
• Case-control studies in the US have found that the presence of a firearm is a strong risk factor for suicide.
Restricting firearm access on the basis
of certain dangerous behaviors is
supported by the evidence; restricting
access on the basis of mental illness
diagnoses is not.
A new tool to help individuals in crisis
• Gun Violence Restraining Order (GVRO)
– Temporarily removes firearms from individuals who pose an immediate threat of harm to self or others
– Based on Domestic Violence Restraining Order
– Enables law enforcement and families to intervene when individuals are exhibiting dangerous behavior
Governor Brown Signing the Bill
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CA GVRO – Factors Courts Must Consider
• A recent threat of violence or act of violence by the subject of the petition directed toward another, or himself or herself
• A recent violation of a protective order of any kind
• A conviction of a violent offense
• Mental health diagnosis is NOT a factor
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A gun-safety group announced Thursday it is going back to voters after Washington state lawmakers failed to pass a bill creating extreme-risk protection orders that take guns from people who pose a serious risk of hurting themselves or others.
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