Gun violence: More complicated than a 'mental health problem'

Emanuella Grinberg and Jacqueline Howard, CNN | 11/6/2017, 2:33 p.m.
According to President Donald Trump, the tragic Texas church shooting that left 26 people dead was "a mental health problem ...
Devin Patrick Kelley, 26, of New Braunfels, Texas, is accused of killing 26 people, and injuring more after opening fire at First Baptist Church in Sutherland Springs, Texas. Source: Texas DPS

(CNN) -- According to President Donald Trump, the tragic Texas church shooting that left 26 people dead was "a mental health problem at the highest level."

If you ask mental health researchers, such mass shootings are much more complicated than that.

On Sunday, 26-year-old Devin Kelley sprayed bullets across the sanctuary of First Baptist Church in Sutherland Springs, Texas, about 30 miles east of San Antonio. The youngest killed at the church was 18 months old; the oldest was 77 years old.

"We have a lot of mental health problems in our country, as do other countries, but this isn't a guns situation," Trump said during a joint news conference Monday in Tokyo.

"This is a mental health problem at the highest level," he said. "It's a very, very sad event."

Trump's response to the Texas church shooting echoed previous comments he has made on gun violence. In 2015, Trump said that he was opposed to tightening gun laws in the United States but was in favor of addressing mental health to prevent shootings.

Yet various epidemiologic studies over the past two decades show that the vast majority of people with severe mental illnesses, such as schizophrenia, bipolar disorder or severe depression, are no more likely to be violent than anyone else.

Rather, people with severe mental illnesses are more than 10 times more likely to be victims of violent crime than the general population, and only about 3% to 5% of violent acts can be attributed to individuals living with a serious mental illness, according to the US Department of Health and Human Services.

So exactly how are mental health and gun violence intertwined, and what is needed to end the violence?

Gun violence and mental illness are public health problems "that intersect at the edges" but have very little overlap, Jeffrey Swanson, a professor in psychiatry and behavioral sciences at Duke University who specializes in gun violence and mental illness, told CNN last year.

"Mental health stakeholders are loath to have this conversation about improving mental health care in a context driven by violence prevention, because that's not why we need mental health reform per se," Swanson said. "We need it because people are struggling with illnesses, and they don't have access to care."

Instead of policies that restrict gun access based solely on mental illness diagnoses or because a person has made contact with the judicial system or health care agencies due to mental illness, the American Psychological Association, the National Alliance on Mental Illness and other advocacy groups have called for gun access criteria based on more subtle indicators of potentially dangerous behavior.

Those indicators -- such as having past or pending violent misdemeanor convictions or charges, domestic violence restraining orders or multiple DUI convictions -- have been largely informed by the work of Swanson and others.

Swanson supports intervention at the point of purchase through comprehensive background checks -- but to make background checks work, criteria for inclusion on the database should be based on other indicators of risk besides mental health history, such as those indicators of aggressive, impulsive or risky behavior.