Mental Illness and Gun Violence
Nearly 200,000 Americans are injured every year from firearms. One of the most common topics of discussion and research in this area is mental health and suicidal behavior, since most of the fatalities are due to firearm suicides. Suicide screening and pr
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Mental Illness and Gun Violence Michael Jellinek
The Toll In 2017, an estimated 173,668 people, including 21,671 children, in America sustained gunshot wound trauma from the discharge of a firearm used in criminal activity, murders, assaults, suicides, suicide attempts, unintentional shootings, and/or by police intervention. Approximately 39,773 (23%) people died from gun injuries including 3443 (9%) are kids. The greatest number of deaths—23,854 (63%) are deaths by suicide including 1296 (38%) of child dying by suicide. Approximately 4015 (17%) are deaths by suicide by veterans. Gun violence related to suicide is almost twice the number of deaths from homicide.
Suicide Risk While there have been specific and unfortunate limitations on researching interpersonal gun violence, there is a larger literature on suicide. There are descriptive studies looking at risk factors such as age, gender, geography, circumstances, previous history of attempts and methods. Further, we know from psychological postmortems that mental illness, specifically depression, impulsivity, substance use, sense of isolation, and a history of previous attempts all add to the level of risk. However, this relatively well studied and too frequent cause of death has been stunningly resistant to population level mental health approaches as reflected by both the efforts with veterans and the rising suicide rate. Although most people killing themselves M. Jellinek (*) Newton Wellesley Hospital, Newton, MA, USA Massachusetts General Hospital in Boston, Boston, MA, USA e-mail: [email protected] © Springer Nature Switzerland AG 2021 M. Crandall et al. (eds.), Why We Are Losing the War on Gun Violence in the United States, https://doi.org/10.1007/978-3-030-55513-9_7
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are depressed, many are not. Some are dealing with overwhelming anxiety, childhood or adult trauma, or repeating a pattern of suicide in the family. Others have suffered a sudden loss such as the death of a parent, rejection by someone they love, or failure to achieve what they saw as a critical goal. Some have practiced suicide with increasing risk often in complete privacy, unbeknownst to anyone. Most attempt suicide impulsively, are grateful for being rescued, and do not attempt again. Many may have additional risk factors and be more vulnerable to a variety of circumstances for historical, social, and genetic reasons. For example, underlying habits such as substance use, especially alcohol, or a neurological trait such as impulsivity increase the risk [1].
Suicide Screening Suicide would seem to be the easier challenge to impact from a gun violence/prevention perspective. However, mental health approaches to suicide prevention are crude. Screening questionnaires list risk factors, but are not adequately predictive. There are too many factors—personal, situational, historical, genetic—that are difficult qualify or quantify. If the police or a psychiatrist knows of a person who acknowledges suicidal thoughts, has a specific plan and means to carry out that pla
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