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Most people with mental illness are not violent, and most firearm violence is not a result of mental illness. While these conversations are typically triggered by a shooting at a school or another public venue, less than 1 percent of firearm deaths in US are attributed to mass shootings.
By focusing the dialogue on mental health, we lose the op- portunity to develop targeted interventions that are far more likely to make a difference. In June, one month after the mass shooting at an elementary school in Uvalde, Texas, and 23 years after the Columbine High School shooting, Congress compro- mised to pass gun safety legislation. The bipartisan bill includes increases in mental health program and school security fund- ing, but also includes funding to implement red flag programs and crisis interventions, strategies to limit gun access for those convicted of domestic violence, requiring firearm dealers to register federally, and expanded background checks for young adults who wish to purchase firearms. A Pew Research Cen-
ter survey shows that while the majority (64%) of Americans support the legislation, 78% believe it will do little to nothing to reduce gun violence. While the legislation is historic in its bi- partisan support, we must remember how long it took and how many lives have been lost in the interim. The American Medical Association and numerous other specialty organizations have released statements supporting gun control and recommended numerous policy changes to reduce firearm death, only a few of which are included in the recent legislation.
In reality, America’s broken mental health system and the rising incidence of gun violence are two very separate national crises that require specific, targeted interventions. Addressing one crisis may lead to a small improvement in the other. While a small number of mentally ill individuals may be prone to violence, witnessing or learning about gun violence has a dis- tinct negative mental health impact on our children. But we are unlikely to see significant change in one crisis by addressing the other. After all, while mental illness exists in other high-income countries, the US remains an outlier when it comes to gun violence. Only by taking decisive action such as universal back- ground checks, requiring safe storage of all personal firearms, and restricting access to assault weapons will we see significant reductions in gun violence.
What can we as physicians do to address this important pub- lic health issue? On an individual level, we must recognize that the presence of firearms in a household increases the risk of homicide, suicide, or accidental firearm death for those living in the home. Talking to our patients about firearm storage and safety is a basic intervention applicable to almost any special- ty, and should be a required part of primary care and mental health assessments. When conversations about gun-safety are respectful and nonjudgmental, patients are more likely to store firearms safely or remove them altogether. Understanding the laws regarding gun safety in your community allows physi- cians to have informed discussions with patients. Laws vary by state, and even within states there may be differences in local ordinances. Extreme risk protection order (ERPO) laws or “red
flag” laws, allow family members or law enforcement in some states to seek a court order to temporarily remove an individu- al’s firearm and prohibit them from purchasing a new firearm if there is evidence that the individual is a danger to themselves or others. Health care professionals may disclose information to support an ERPO when required by law or in the case of an imminent threat. While 19 states and the District of Columbia have thus far passed ERPO laws, a “red flag” bill introduced to the Michigan Senate in February has yet to be scheduled for
a hearing. Michigan law does include child access prevention and safe storage language, which requires that trigger locks
or locking gun storage is sold along with the purchase of new firearms (unless an individual establishes that they already have a qualifying trigger lock or gun case), but does not require that owners keep their weapons locked.
While research into preventing injury from firearms has been limited for much of the past due to federal funding restrictions, more organizations have contributed support towards research- ing firearm safety in the past decade. To learn more about how you can promote gun safety in your role as a physician, the American Medical Association launched a free online module on The Physician’s Role in Promoting Firearm Safety (https:// edhub.ama-assn.org/interactive/17579432). Likewise, UC David has developed the BulletPoints Project (https://www. bulletpointsproject.org/) as a resource for both clinicians and medical educators. It includes components on social determi- nants of health, clinical scenarios, and suggestions for specific interventions. Johns Hopkins University also developed a
free online course titled Reducing Gun Violence in America: Evidence for Change (https://www.coursera.org/learn/gun-vio- lence). There are also numerous gun safety advocacy organiza- tions, some of which focus specifically on physician advocacy, for those who hold an interest in using our voices as physicians to promote gun safety on a larger scale. •
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References
1. https://jamanetwork.com/journals/jamapediatrics/fulla rticle/2789946?guestAccessKey=41fde697-e79f-411c- bed3-743faeb63055&utm_source=For_The_Media&utm_ medium=referral&utm_campaign=ftm_links&utm_ content=tfl&utm_term=031422
2. Statement form the APA on Firearm Violence
3. https://rollcall.com/2022/06/15/15gunsmental/
4. https://www.pewresearch.org/politics/2022/07/11/broad- public-approval-of-new-gun-law-but-few-say-it-will-do-a- lot-to-stem-gun-violence/
5. https://www.ama-assn.org/press-center/press-releases/ ama-statement-texas-school-shooting
6. Tolat ND, Naik-Mathuria BJ, McGuire AL. Physician Involvement in Promoting Gun Safety. Ann Fam Med. 2020;18(3):262-264. doi:10.1370/afm.2516