In the wake of mass shootings in Buffalo, New York, and Uvalde, Texas, some officials have cited mental illness as a reason for the unprovoked attacks. But as we’ve explained before, having a mental illness isn’t predictive of who will perpetrate a mass shooting.
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Q: Do people with serious mental health disorders pose a greater risk of becoming mass shooters? A: People with mental illnesses are somewhat more likely to be violent than those without a diagnosis. But a majority are never violent, and very little is known specifically about mass murder. FULL...
www.factcheck.org
Q: Do people with serious mental health disorders pose a greater risk of becoming mass shooters?
A: People with mental illnesses are somewhat more likely to be violent than those without a diagnosis. But a majority are never violent, and very little is known specifically about mass murder.
FULL QUESTION
Subject: Mental illness and mass shootings
Is Trump correct that people with mental illness, such as schizophrenia and bipolar [disorder], [are] a greater threat to society?
FULL ANSWER
Following two mass shootings over a single weekend in August, President Donald Trump simplified a complex phenomenon when he deflected calls for increased gun control by laying the blame on mental health. In a
televised address the following Monday, he
stated, “Mental illness and hatred pulls the trigger, not the gun.”
The two deadly attacks that precipitated the president’s comments included the Aug. 3 shooting at a Walmart in El Paso, Texas, that killed
22 people, and the Aug. 4 shooting outside a bar in downtown Dayton, Ohio, that
killed nine.
Later, the president pointed to mental illness when discussing guns, saying on
Aug. 9 that “it’s a big mental illness problem” and “a sick mind pulls a trigger.” On
Aug. 15, before leaving for a rally in New Hampshire, Trump said, “These people are mentally ill and nobody talks about that,” suggesting that one solution might be to bring back broad institutionalization of those with mental health disorders. “I think we have to start building institutions again,” he said. And on
Aug. 18, when asked about gun control, he said, “I don’t want people to forget that this is a mental health problem.”
Trump returned to the subject on
Sept. 1 following yet another mass shooting in Odessa, Texas, that claimed
seven lives and injured 22. “It’s a mental problem,” he said.
Available evidence suggests that people with mental health disorders are more likely than those without such conditions to commit acts of mass violence. But many mass shooters do not have mental illnesses, and having a mental illness isn’t predictive of who will perpetrate a mass shooting. The factors that drive someone to commit an act of mass violence are complex, and while they sometimes may include mental illness, it has not been shown that mental illness is the primary cause of mass murder.
Furthermore, while serious mental illness is associated with a somewhat higher risk of being violent, most people with those illnesses are not violent, and most violence is committed by people who do not have psychiatric conditions.
Mental Illness and Mass Murder
Unfortunately, the type of detailed epidemiological information that the ECA study and others provide about mental health disorders and general violence isn’t available in cases of mass murder. “[G]iven how infrequent an occurrence it is,” said Columbia University forensic psychiatrist
Paul Appelbaum in an email, “I am not aware of any serious studies looking at the contribution of mental illness.”
Instead, most of the data about mental illness and mass shootings remain anecdotal or based on statistics assembled from various reports, some of which rely on secondhand information.
For instance, two Secret Service reports for
2017 and
2018 found that around two-thirds of the suspects in public mass attacks — events in which three or more people were harmed in a public space — experienced mental health symptoms prior to those events. An FBI
survey of 63 active shooter events in the U.S. between 2000-2013 found 25% of suspects had been diagnosed with a mental illness, and 62% had a mental health “stressor,” or what the agency identified as a sign that the shooter “appeared to be struggling with (most commonly) depression, anxiety, paranoia, etc. in their daily life in the year before the attack.”
Other researchers have attempted to document how frequently people with mental health disorders have been involved in attacks over a longer history.
Grant Duwe, a criminologist at Baylor University, calculated that of 185 public mass shootings in America between 1900 and 2017, at least
59% were carried out by people with symptoms of a serious mental illness or by those who had been previously diagnosed with a mental disorder. In contrast, using a stricter standard of psychosis, a database of U.S. mass murder events between 1913 and 2015 put together by Columbia University clinical psychiatrist
Michael Stone revealed that only about
20% of perpetrators had a mental illness.
Researchers say these types of studies, which are suggestive but also at times contradictory, should be treated with caution.
“These reports tell us less than they appear to tell us, although they are consistent with the possibility that perpetrators with mental illness may be overrepresented,” said Appelbaum. He said that in many cases, the mental illness classification was based on media reports or police records, making it hard to know if those determinations were accurate.
“Deducing the presence of paranoia or other delusional thinking from a newspaper report, particularly in a situation where there’s a presumption that ‘he must be crazy,’ seems pretty dicey to me,” he said.
McGinty, too, is skeptical. “I view them as invalid and very problematic in terms of the message they send,” she said of the descriptive studies. She also pointed out that accurate data on mental health symptoms in many cases is impossible to obtain because many perpetrators kill themselves. That means many of the assessments rely on talking to family members or coworkers after the fact, and there can be “huge amounts of measurement error,” she said. There can be after-the-fact rationalization at play as well.
Secondly, she explained that the studies can confuse correlation with causation. In other words, if someone is found to have had symptoms of mental illness, it’s often assumed that mental illness caused the mass shooting. Mental illness might have contributed, or it might not have had anything to do with it — in many cases, McGinty said, people with mental illnesses also have other factors that are more strongly associated with violence, such as anger issues, substance abuse or a history of traumatic events. It’s a “complicated epidemiological relationship,” McGinty said.
Some of these caveats are noted by the reports themselves. The
FBI report, for example, is careful to explain that a mental health “stressor” is not the same as having a diagnosis of a mental illness. The report notes that many Americans struggle with mental illness at some point in their lifetimes — 46% according to one study — and cautions against coming to the simplistic conclusion that mental illness was the motivating cause of a shooting. “[A]bsent specific evidence, careful consideration should be given to social and contextual factors that might interact with any mental health issue before concluding that an active shooting was ‘caused’ by mental illness,” the report says, before adding, “declarations that all active shooters must simply be mentally ill are misleading and unhelpful.”
It’s clear from the governmental reports, too, that even taking the data about mental health at face value still leaves many aspects of the mass attacks unexplained. The Secret Service
reported that around half of mass attacks in 2017 and 2018 appeared to be motivated by grievances, or perceived wrongs, related to home, work or another personal sphere. Grievances were more commonly cited than any other motive, including mental illness — which the agency said was a motivating factor in 14% of incidents in 2017 and 19% in 2018. Other motivating factors included ideology, such as white supremacy and anti-Semitism, and an attempt to achieve fame.
“There are countless factors that pull the trigger,” said Vanderbilt psychiatrist and gun violence researcher
Jonathan Metzl. Even if mental illness is involved, so too may be past history, racism and misogyny, among others. “To isolate it to just one thing is factually incorrect,” he said.
“Mass murders occur for many reasons and often multiple reasons: jealousy, extreme anger, political beliefs, revenge, and others, mediated by the effects of alcohol and drugs, poor impulse inhibition, social messaging, and other factors,” added Appelbaum. “Mental illness will sometimes be in that mix, but even when it is, experts will have difficulty assessing the role that it played.”