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Not enough articles examine mental illness and gun violence in the United States. What is the connection between mental illnesses and gun violence? In recent months, the United States has experienced a rise in gun violence. The current surge in violence is highly concerning and the reason highly contested. Regardless, the connection between gun violence and mental illness continues to be misunderstood.

Even more troubling is the stigma around patients exhibiting homicidal ideation (HI) and suicidal ideation (SI) in the public mental health system. No one can say SI is without its privileged status in the HI/SI binary, and they are viewed as less of a public safety issue. Call centers, warmlines, and hotlines are all geared to target SI. When someone is suicidal, it is considered a mental health issue that needs urgent and careful clinical attention. However, people presenting as homicidal or dangerous to others are considered a substantial public safety issue requiring police intervention.

Are the sick or mentally ill more likely to kill people? Not at all. However, if mentally unwell people are not given the right outlets and resources like hotlines and walk-ins without a clinician calling 911, people with mental health disorders will continue to hurt people unnecessarily. There needs to be a helpful and stigma-free treatment for people suffering from homicidal ideation.

Consider the loose nature of established and commonly agreed-upon definitions, especially within the mental health discourse. The terms “disorder,” “illness,” and “diagnosis” are sometimes used interchangeably despite having different meanings and applications. Even the word “mental health,” the most generic and monolithic of all terms in the discipline, is commonly confused and rarely talked about in a way where everyone is on the same page. Therefore, let us move past a post-modern take on the issue.

First, let us probe into recent gun violence in the US. Mentally ill people can be violent and use weapons as a direct or indirect result of a heightened or mistreated condition. Untreated symptoms can make people or anyone (mentally ill or just resource-deprived) more dangerous, unpredictable, and desperate. The violence can be manifested inward. Mentally ill people can be destructive or exhibit harmful behaviors toward themselves because their condition and symptoms are misdiagnosed or mismanaged concerning their mental health treatment. Mentally healthy people can also be dangerous and hurt people, such as on a political level concerning the military-industrial complex. Wars, mutually agreed upon violence, and permissible killing present a massive hiccup in the debate.

People aren’t mentally ill when committing violent crimes like murder or assault. However, these people continue to make up many people committing violent crimes. Let’s face it. People will kill anywhere and in any condition, for almost any reason, whether they are sick or healthy.

Sadly, the more we crosswalk and compare, the more it seems that people are built to kill, hurt, and harm others with guns or other violent means. Why am I suggesting this? Because only truly engrained harmful actions can carry out human instincts and behaviors proficiently at any level of human cognition, health status, sex, gender, age, religion, and intersection of humanity.

Humans kill people for a variety of reasons. Humanity can and is dangerous at times, either because a person is sick mentally or someone hell-bent is claiming life and harming others. The issue is how to assess which reason, why, and to what degree is lethality or suicidality? For tragedies such as the school shooting in Texas or any other school shooting, clinicians need to read the red flags a little closer or at least not miss them altogether.

Let's explore a few caveats. Using myself as a case example, I have done many unfathomable things during my time of struggling with mental health issues. I still cannot express regret for many of the behaviors I feel were wrong. Since my diagnosis, I have also done wonderful, beautiful acts in my lifetime and would never want to forget these memories. The light outshines the darkness every time my freedom is involved. People with mental health issues can never give up the right to fail.

Some societies grant people with mental illness this privilege. Other cultures, states, and countries place limits on weapons and the movement and freedom of people with mental health conditions. Suppose we continue allowing guns to circulate in the market. In that case, there will need to be more guidance from the current regulations and laws that guide psychotherapy and the treatment of people with mental health disorders in the US.

In New York, as in many other states in the US, unless you are mandated or in a forced treatment program, you can fail out of society and be admitted to a psychiatric hospital for rehabilitation. This is commonly called assisted outpatient treatment (AOT). People labeled violently and persistently mentally ill cycle back into the system. The pattern should go from being a patient in the hospital to independent living. However, sometimes lives and mental conditions take their turn.

Some states operate differently and offer people fewer freedoms. Some states provide more privileges but less supportive services. The endorsement of the right to fail must be a national human right for public mental health care recipients. For the modern mission of the New York Office of Mental Health and other states, mental health regulatory bodies profess dignity, hope, and recovery.

The sickest irony (no pun intended) is when people pay attention to the history of our mental health system. The all-important pendulum or risk continuum is called “dignity in risk” or “risk of harm.” By basic definition, the dignity of risk is the right to take chances when engaging in life exploration experiences and the right to fail in these activities or life without harming oneself or someone else.

For many Americans, the risk of harm is an impending threat. People with mental illnesses are not trusted. Their judgment and insight may be impaired, and the public risks substantial physical injuries to themselves or others. Healthy people aren't always trustworthy and could put the public in harm’;s way just as much as their mentally ill counterparts. And so, the debate still rages on in 2022.

The truth is, publicly, since deinstitutionalization, society isn’t sure about the future of people living with diagnosed mental health conditions in the community. Unfortunately, the current mental health treatment plans don’t know the answers to essential questions and continue to be off the mark when predicting outcomes. Clinicians will need to do more to assess and predict public safety outcomes.

Do professionals ever really know what other people can do? Clinicians assess for safety concerns and look at the complete clinical picture of a person before releasing their patients into the community. I think clinicians must begin to be more tuned into the degree of harm and predict the threat level. For example, clinicians may think someone is at risk of suicide but fail to indicate a more significant, severe threat to themselves or the public.

Then, clinicians will need to be more trained in de-escalation and crisis intervention. Without knowing how bad it can get, it is challenging to get a read on what could happen if there is a sudden loss or drop in impulse control and what that might mean for someone who is actively homicidal or suicidal. Indeed, lethality is scaled. Concerning HI, SI, and the potential risk of harm, clinicians sometimes forget that these considerations are less static and exist as an abstraction and continuum.

So, are all things considered? And is this enough? Everyone makes their own decisions moving forward.

About the Author

J. Peters

J. Peters is the Editor-in-Chief of Mental Health Affairs.

Award-winning book author and Bold 10 Under ten award recipient J. Peters, LCSW. Through his work as a Licensed Clinical Social Worker. Mental health therapist and disability rights advocate Mr. Peters fights for those without a voice in various care systems, such as the New York City Department of Social Services, the New York State Office of Mental Health, or the city's Department of Corrections.

Mr. Peter's battle with Schizophrenia began at New London University in his last semester of college. Discharged from Greater Liberty State Hospital Center in July 2008, Jacque's recovery was swift but not painless and indeed brutal after spending six months there.

He has published several journal articles on recovery and mental health and three books: University on Watch, Small Fingernails, and Wales High School. He is also a board member of the newspaper City Voices. Mr. Peters currently sits on the CAB committee (Consumer Advisory Board) for the Department of Mental Health and Hygiene in NYC and the Office of Mental Health (OMH) as a peer advocate.

Owner of Recovery Now in New York, a private psychotherapy practice, Mr. Peter's approach is rooted in a foundation of evidence-based practices (EBP). Jacques earned a master's degree in Social Work from Binghamton University and worked as a field instructor for master's and bachelor's level students in NYC.

He is blogging daily on his site mentalhealthaffairs.blog, Mr. Peters regularly writes articles relating to his lived experience with a mental health diagnosis.

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