Health Care

Finger-pointing: Who owns gun violence?

February 28, 2018
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Gun violence in the U.S. has many pointing fingers in many directions. Considered by many as a public health issue, gun violence has captured our attention and motivated legions of our youth to demand action.

But where should our fingers be pointing?

Most people are pointing to mental health. Obviously, they say, people who wantonly kill others must have severe mental health issues. Most of us seem to believe that adequate mental health programs are needed.

Several years ago, I chaired a statewide committee to determine the extent of need for psychiatric beds. Normally this is a simple task of simply projecting the anticipated number of people affected, the expected length of stay at a psychiatric facility and the expected occupancy rate. The computations generally are relatively simple. However, simplicity was far from what we encountered. It seems that our mental health system only directly involves a few of the potential people who might benefit from care, and we ended up not knowing the true extent of the need.

Gathering information on the extent of need is very difficult. There is much variability in deciding who might need mental health care. Much depends on who first encounters a person exhibiting behaviors or attitudes.

Often a person first encounters our criminal justice system. Police are called to respond to situations that might erupt in violence. If warranted, they can detain or incarcerate an individual. If uncontrolled behavior is clearly an issue, they may call on the probate court to render a decision as to whether an individual should be closely supervised or involuntarily admitted to a custodial or psychiatric facility. If there is personal or property damage, our courts can order imprisonment. How many of these require mental health care? We are told that many do, but how many?

In the case of youth under the age of 26, our education system is the responsible body. Unacceptable behaviors often are relegated to our mandatory special education programs. Schools are expected to accommodate troubled students in a manner as to let them progress without necessarily disrupting others in the schools. How many might be true mental health patients is not routinely reported, especially since educators are loath to provide self-fulfilling prophesies regarding students.

Our social welfare system encounters many who might benefit from mental health care. Family assistance programs often address broken family units and identify individuals who do not comply with societal norms. Employment training programs identify individuals unable to function well in a structured workplace. How many might be candidates for mental health treatment is unknown.

Many point to our health system in the belief that having a person seen by mental health professionals is a key answer to our gun violence problems. However, there are many aspects to health and their limitations must be weighed. We have several psychiatric facilities, but they are limited. If more patients were presenting for care, they could expand, and there are many indications that more inpatient beds and facilities are needed, but we don’t know how many. 

Acute mental health care personnel are in short supply. Many areas do not have ready access to psychiatrists. Psychiatric nurses and psychiatric social workers similarly are limited.

Financial support for mental health care is in disarray. Many individuals have arranged private financial coverage for direct care services, but the nature of mental health is that a variety of support services are required, since inpatient care is often limited, and more assertive community-based support services are needed, but often not privately covered. Viability of our public mental health programs that typically can arrange a variety of support services is jeopardized by the diversion of funds to the private insurers.

Some areas are blessed with many services to serve the mentally ill — others are not. The range of needed services to sustain people in their own communities is large, but actual services often are lacking. Without community services to allow people to remain in their communities, the alternative is institutionalization, something the enlightened mental health professionals try to avoid.

Our public health personnel like to consider social determinants of health. They believe in going “upstream” to discover why health issues arise. In the case of gun violence sparked by mental health, causes are varied. Factors that often get cited include biochemistry, heredity, environment, income, lack of family cohesion, bullying, violent video games, brutality on television, rap lyrics, poor religious upbringing, etc.

Our societal leadership bears some ownership of gun violence. Lax state and federal laws make gun ownership easy. Efforts to institute means to curb guns are stymied as there is no agreement on effective and acceptable measures. Manufacturers have efficiently produced relatively low-cost weapons. Retailers provide ready access for those who can pay. Criminals can steal or otherwise obtain weapons in almost any area of the country. 

The list of things we can point to is huge. Who gets to own the gun violence problem? We all do. We may not directly cause it, but we certainly inherit the consequences.

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