Several years ago it was bullying, this year it is gun control; all precipitated by horrific incidences that ruined the lives of many and will continue to do so until we identify the underlying problems. Both intimidation  and gun violence are intimately related. There is a huge elephant sitting in the room yet we continue to ignore him by  applying  knee-jerk remedies to adaptive problems.   The tragedy in Newtown is not an isolated incident of senseless violence nor did this man develop these thoughts overnight. Sadly, this type of violence is preventable, preventable if detected early.   Violence is symptomatic of much deeper issues, which we have not begun to discuss.

As usual we have the right answer to the wrong question. The question and the elephant in the room are: how  do we increase  access to quality mental  health care?   How do we  become better at screening, especially, those at increased risk of mental illness (and that is everyone)?  How do we reduce stress?  Education and  data are good places to start.   Improving health literacy would also be helpful.

People who commit these mass shootings are deranged.     I agree deranged, insane people should not have guns.  But how do you identify a deranged person?    And I haven’t heard many make a distinction   between the two:  insanity  versus mental illness?  They are two different animals and both are not as easy to diagnosis in our  crazy society.

Mental illness is a huge category that is often a waste basket diagnosis for many medical providers .  Who  will make the decision that someone with a history of “mental illness” should have her rights restricted?    I am a physician and I would not trust physicians  alone including mental health specialists to make that decision. Why?  Because women and people of color are disproportionately given that diagnosis compared to white men, data confirms it (please see links below).  The potential for abuse is too powerful.

 In essence,  this law would  take away the rights of those least likely to commit the crimes for which the laws were instituted.  Does that make sense?  We are so focused on solving the problem,  we have forgotten this is an adaptive problem where technical fixes by themselves do not work.   There may be a temporary decrease in fatality but it will not be long-lasting.

See links for more info:   .http://www.who.int/mental_health/prevention/genderwomen/en/, http://www.cdc.gov/omhd/amh/factsheets/mental.htm.

{Tips or Paranoia:  Our mental health delivery system stinks!  A diagnosis of mental illness frees physicians and other providers who come in contact with those patients from taking their symptoms seriously!

***Warning: You will be mentally ill  once you enter that system unless you are health literate. I  treated enough women who I naïvely referred for help because of depression only to have them  return  zombies.    In the ER, it was not unusual for patients with intentional drug overdoses evaluated by mental health  to return for the same problem the following week with their recently filled empty pill bottles each having multiple refills and the potential to kill…that is the revolving door our mental health care system.

We need increased  access to quality mental health for everyone where recovery instead of control of symptoms is the goal.}

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Guns do not start violence! Guns facilitate, making violence more lethal.  Gun control legislation requiring universal background checks is a no brainer.  Why are we even debating it?    I was excited at the   public’s recognition of the role of mental illness in violence.  But disappointed  politicians choose to  scapegoat those with  mental illness.   Violence is not only about guns and mental illness it is also reflective of our culture.     Violence is an adaptive problem where all eyes should be on mental health care, law enforcement, and educational systems.

In the case of Newtown, there must have been missed RED FLAGS!    These red flags are  clues used to detect early signs/symptoms of mental illness or  severe symptomatic stress.  Once we (society)  suspect someone is at risk we need some system to manage or help these people.  Currently, we have no such system except law enforcement!  The mental health system is a  broken revolving door.

My take/questions on Newtown:

Was this man under the care of a mental health provider or any medical provider? If not why? If so, what kind of treatment was he receiving? How closely was he monitored? And most importantly, was he  on medications?

{ Tip or Paranoia:  Just a word about Medications. They are double-edged swords, they help people but they also harm people. Unlike guns, MEDICATIONS can initiate crazy thoughts and VIOLENCE, irrespective of mental illness.}

This man was deranged, not just  “mentally  ill.”   Red Flags were missed.    By increasing access to quality mental health care and improving health literacy among physicians and patients,   in addition to other  remedies that impact safety and improve mental health, we can prevent these tragedies by improving our  detection and treatment of  red flags.  Of course, there are other approaches, all of which involve multi-disciplinary collaboration of some of the various stakeholders already mentioned.

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Let’s listen and use common sense,  making sure we don’t create  even  larger problems for a group already stigmatized.   More information in the above areas would shed light  and prevent many of  these types of tragedies.   It is  not only  the failure of our Mental Health Delivery System and other systems such as Law Enforcement , Education  but also our insatiable appetite for all forms of violence in the media.   Violence is intertwined with our culture; making it an adaptive problem requiring behavioral and cultural changes. 

Taking away access to guns from people with Mental Illness is unfair,  is Failure to Listen and unconstitutional! 

It will increase mental illness by stigmatizing it further.

Restricting access to guns for those who are “mentally ill” will disproportionately affect women and people of color leaving white men the only owners of guns. Aren’t they the most common perpetrators of tragedies like Newtown?

Such a law will not target the perpetrators but it will harm innocent people by limiting their rights and stigmatizing them.

Increase ACCESS TO QUALITY MENTAL HEALTH BEFORE mental illness takes root.   That is smart policy!

Increase ACCESS TO QUALITY MENTAL HEALTH; not Decrease the RIGHTS of the mentally ILL!

Technical fixes will not solve adaptive problems.

For more information on mental health  and getting involved:

http://www.nami.org/