Pointing to madness is an understandable reaction in the face of unspeakable evil- after all, anyone who could shoot up a school has to be insane, right? Unfortunately, it’s not that simple, and when we approach the issue of mass shootings and gun violence as primarily a matter of mental illness we are ignoring many more significant pieces of the puzzle. In addition to factual misconceptions being perpetuated, a lot of conversations about violence and mental illness are stigmatizing to people who suffer, causing real harm. Setting the record straight about the interplay between mental illness and gun violence is necessary and important.

Nationwide, only about 3% of all violent crime is committed by people with serious mental illnesses¹. NAMI estimates that 4.3% of the general population in the United States suffer from serious mental illness,² suggesting that there is not a strong correlation between having a serious mental illness and committing a violent crime.³ The correlation is even weaker when you consider people diagnosed with any mental illness. It is an oft-quoted fact that people who suffer from any kind of mental illness are far more likely to be the victims of violence than the perpetrators.⁴ There is no mental health diagnosis that is an accurate predictor of future violent behavior, not even schizophrenia. So, while we can look at an individual person with a mental illness and say “the warning signs were there” and be totally correct, statistically the mental health diagnosis (or potential diagnosis) is not one of those warning signs.

When people talk about keeping guns out of the hands of the dangerously insane, there are three main ways that are proposed to identify those people: a pre-purchase psychological evaluation, scanning a person’s existing medical records for psychiatric diagnosis, and creating a mandatory registry of people with certain mental illnesses.

Pre-purchase psychological evaluation is the most reasonable option out of the three, but such evaluations are rarely used even in countries with strict gun control laws. The sort of psych eval that might predict a person’s propensity for violence (even when they are trying to hide it) would involve extensive interviews with psychologists with special training. If we had a system where very few people owned guns these interviews might be practical as part of the process, but it just wouldn’t scale as an addition to our current model. Only two developed countries (Germany and Japan) currently use any kind of psych eval in evaluating candidates for gun ownership. In Germany, this restriction only applies to applicants under 25. Japan has effectively banned gun ownership almost entirely, and requires a “mental check” to be performed at a hospital. The cost and logistical challenge of implementing effective evaluations would be extreme, even if potential gun owners paid providers directly for evaluations. A national database of potential gun owners would be necessary to track who had been evaluated and their results, to prevent people from “doctor shopping” until they got a favorable evaluation.

The second idea, using existing medical records, is actually partially in use in the United States already. People who receive Social Security Disability Insurance (meaning they are too disabled to work) for mental illness and who have been found incompetent to manage their own benefits for reason of mental incapacity are legally prevented from owning guns. When you see a news story about “legislation to keep guns out of the hands of the mentally ill” this is generally what they are talking about. Legislation was finalized in 2016 to make it mandatory for states to report this information to the National Instant Criminal Background Check System (NICS.) In 2017, this legislation was rescinded. The number of people who are affected by this law is very small, roughly 75,000, and it hinges on them being found to be severely incapacitated, not on any specific diagnosis. Also, the legislation in question never addressed whether this population should have gun rights or not, only how enforceable the existing law is. It makes for a good headline, but it’s not very substantive. As far as scanning everyone’s medical records go, even if there was information that could predict violence (there isn’t) and we ignored all privacy concerns (we shouldn’t,) it would require a central database of all medical records, which does not exist anywhere and would be prohibitively expensive to set up.

The last commonly suggested measure is a national database of people with severe mental illness. By now we know that no diagnosis is a strong predictor of future violent behavior, so such a database would not be very effective in reducing gun violence. What about a database of people whose doctors think they might be violent in the future? Now we are expecting doctors to have super-human powers of perception. Beyond that, doctors and therapists should be in the business of helping people, not enforcing laws. Those professions have strong ethical codes that would not be compatible with that sort of reporting. Where mandatory reporting laws do exist, they address situations where there is an immediate danger to self or others.

Restrictions on medical professionals would have a chilling effect on people who are considering seeking treatment for mental illness. Adding to the already significant stigma that surrounds mental illness would be a disaster. The risks faced by people with an untreated mental illness are well-documented and can be devastating.

So what do we do?

While mental illness is not predictive of violence, other things are. Not surprisingly, people who have been convicted of violent crimes are far more likely to commit violent crimes again in the future than the general population. Not only is a conviction for violence predictive of future violence, the opportunity exists to legally curtail a person’s gun rights while preserving due process and right of appeal. The purpose of this article isn’t to editorialize on the best solutions to our problems with gun violence, but it would be an oversight to discuss something like mental illness being a poor predictor of violence without mentioning that much better predictors exist.

The state of mental health care in our country is a real issue. People are suffering and it’s something we should be talking about. Access to care needs to be improved and stigma needs to be conquered. But mental illness is not “the issue” when it comes to gun violence in general or mass shootings in particular. When we get bogged down on the topic of mental illness and guns, we are not addressing “the issue” at all, we are being effectively distracted from the issue. Gun control is not impossible. Most other countries have figured out ways not to have mass shootings on a weekly basis. Let’s look to them for solutions instead of scapegoating people with mental illness.

Don’t get distracted.