Recent shootings have called attention to mental illness and the shortcomings of our mental health system. Improving America’s response to mental illness may not prevent the majority of mass shootings, but it will stop some of them and save lives. This may be a time when America does the right thing for the wrong reason.
The overall contribution of mental illness to violence is exceptionally small, and part of that contribution comes from some persons with mental illness who also abuse drugs or alcohol. Even those with the most serious mental illnesses show only a slight increase in violence, but most of that is directed at family and friends, not strangers. The association with mass shootings, which account for only a tiny percentage of violence in this country, may be stronger. A recent study shows that 38 of the last 64 mast shooters (defined as people who killed 4 or more people in public) showed signs of mental illness before the incident. In any given year, however, 4.5% of the U.S. population shows signs of a serious mental illness. Of these, 39% get treatment. We cannot force the remaining 61% into treatment, let alone the 26.2% who have a diagnosable mental illness. For some people, involuntary treatment is a traumatic experience. Mental health treatment, or treatment for any major illness, is nowhere close to 100% effective.
The true value of improving our response to mental illness does not lie in reducing mass shootings. People with mental illness are the largest and quickest growing group of people on Social Security disability programs. 90% of the approximately 30,000 people who kill themselves every year have a mental illness. At least one major mental illness, bipolar disorder, becomes more resistant to treatment the longer someone goes without treatment.
In many ways, we are not moving in the right direction. At the state level, 4.35 billion has been cut from mental health services since 2009. It can be "virtually impossible" to get treatment for some of those who need it; what we need is less stigma and more treatment. Many people reject treatment because they are insulted by the suggestion that they might have a mental illness. Those same people would not be insulted by the suggestion that they have cancer or heart disease.
Dubin and Fink have highlighted the pervasiveness of stigma regarding mental illness. An age-appropriate public discourse could help minimize stigma, making it more likely that people will seek treatment. Reducing stigma would also improve their access to housing and employment. Expanding treatment would mean that people aren’t pushed out of hospitals too soon because beds are needed for other patients. It would mean better crisis prevention and aftercare programs. People who are ambivalent about getting help would get care immediately, rather than being forced to wait until others change their minds.