Dr. Forman: Many leaders who oppose increased gun regulation point to improving access to mental health care as the solution to reducing gun violence in America. How much do you think improved access to mental health care can drive down gun violence?
Dr. Gold: Improved access to mental health care would likely have a substantial effect in decreasing suicide rates. Suicide is the 10th leading cause of death in the US, and the 2nd leading cause of death among adolescents and young adults. About 40,000 people commit suicide each year. More than half commit suicide with a firearm. Only 2 interventions have evidence indicating effectiveness in regard to decreasing suicide: mental health treatment is one of them, the other is restriction of lethal means. So yes, mental health treatment is likely to decrease suicide rates overall, including probably some percentage of firearm suicides.
However, if you are talking about firearm homicides—of which there are about 11,000 a year—even with adequate mental health resources and access for everyone in the US, you would not significantly affect rates of gun violence. Most of these by far are variations of interpersonal violence—domestic violence, even “gang” violence, which is often interpersonal. Since mass shootings committed by individuals with or without mental illness typically account for less than 0.5% of all gun deaths per year, improved access to mental health treatment is not an effective intervention.
Dr. Forman: Do you believe it could be an effective way to drive down deaths without any changes in gun regulation?
Dr. Gold: For reasons I’ve cited here, no. Since most gun violence toward others is not committed by individuals with mental illness, improved access to treatment would be ineffective for this type of gun violence. Suicide is a different story—as many as 90% of people who commit suicide have a history of or an active psychiatric diagnosis at the time of death.
Dr. Forman: What policy prescriptions, if any, would you make on a federal level for reducing gun violence in America?
Dr. Gold: Many interventions are possible and supported by evidence already available. We need to look at evidence of dangerousness, ie, risk of violent behavior, with or without mental illness. Mental illness should be taken out of the equation as it is not a productive line of discussion.