Why Psychiatrists Must Confront Gun-related Violence

During my recent stay in Scotland, I had a most peculiar experience while walking through the streets of Edinburgh, Glasgow, and Stirling, late at night: I felt safe. This is a sensation I almost never have while walking in American cities of comparable size. As my wife and I learned during our stay there, Scotland has a violent and bloody history, going back many centuries. And, to be sure, modern-day Scots-a remarkably friendly and civil people-must deal with crime, drugs, and violence, just as Americans do. But they do not worry much about gun-related violence. According to the London-based Gun Control Network, there were a grand total of four gun-related homicides in Scotland, between 2009 and 2011.¹ That’s right: four. Leaving aside per capita comparisons for the moment, keep in mind that there were over 20,000 gun homicides in the US during 2009-2010 alone.²

And lest you suppose that the Scots are stabbing or bludgeoning each other in droves-(ie, committing thousands of non-gun-related homicides)-Scotland’s average total homicide rate between 2006 and 2008 was less than half the average for the US homicide rate during this same period.^3,4

I don’t want to draw any sweeping conclusions from this one comparison-I simply want to introduce an international perspective to the issue of firearms regulation. I also want to argue that this contentious issue is of urgent relevance to psychiatry, as several articles in Psychiatric Times have demonstrated.^5-7

Why should psychiatrists care about firearms regulation? The reason that might first come to mind-the putative role of mental illness in several recent mass shootings-is actually the least important. (As I write, reports of a new mass shooting in Wisconsin are trickling in). Aurora, Colorado-type mass shootings-horrific though they are-actually amount to a minuscule percentage of gun-related deaths in the US. There are more compelling reasons why psychiatrists should be involved in the gun control debate. 

First, psychiatrists are experts in assessing risk factors for suicide, and gun possession is a major risk factor for completed suicide. The US has a firearm- suicide rate almost 6 times higher than comparison countries.⁸ One study of handgun possession in California found that,  in the first week after the purchase of a handgun, the rate of firearms suicide among purchasers is about 57 times as high as the adjusted rate in the general population.⁹

Similarly, a recent review concluded that:
 

       “There are at least a dozen US case–control studies in the peer-reviewed literature, all of which have found that a gun in the home is associated with an increased risk of suicide. The increase in risk is large, typically 2 to 10 times that in homes without guns, depending on the sample population.”¹⁰
 

Second, psychiatrists are frequently called upon to assess “dangerousness” to others. Such requests may originate in emergency settings; on inpatient units, or in the context of a forensic evaluation. While persons with psychiatric illness comprise only a small fraction of those involved in gun violence, gun possession per se is an important factor in any determination of dangerousness to others-particularly in this country. Compared with other high-income countries, firearm homicide rates in the US are nearly 20 times higher; and in the population aged 15 to 24, firearm homicide rates are almost 43 times higher here than in other high-income countries.⁸

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