Tuesday, November 19, 2019 | ePaper

Mass Shootings, Guns and Suicide

Suicide is in decline all around the globe, except in the US. Why?

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Brendan Kelly :
Last August, at least 31 people died in the US following mass shootings in Dayton, Ohio, and El Paso, Texas. In response, President Donald Trump announced that "mental illness and hatred pulls the trigger, not the gun".
No. Grammar aside, this statement is factually incorrect and problematic on many levels.
First, the facts. One person in four will have a mental illness at some point in life, but people with mental illness perpetrate fewer than 5 per cent of gun-related killings in the US. They account for just 3 per cent of violent crimes overall.
The mentally ill have far more to fear from the mentally well rather than the other way around. People with major mental illnesses are over twice as likely to be victims of violent outbursts compared to people without mental illness.
Second, automatically associating violence with mental illness is not only wrong but also stigmatizing. Following an horrific crime, many people fail to find a simple explanation and so conclude that the perpetrator "must have been mentally ill".
It is easier to say this than face the fact that "sane" people sometimes do very, very bad things. But they do.
Third, as it happens, there is an important issue relating to guns and mental illness, but it's not the issue that President Trump seems to think it is. It is the issue of suicide.
Around the world, suicide is in decline. The global rate has fallen by more than a third since 1990. Of course, even one suicide is one too many, but this trend demonstrates that suicide rates can fall and therefore public health measures should be ramped up.
One major country is bucking the global trend. In the US, the rate of suicide rose by 24 per cent between 1999 and 2014. Why? These issues are multi-faceted, but a key part of the answer lies in the methods of suicide used. Each year, the US has approximately 45,000 suicides, of which around half are gun-suicides.
As a result, suicides account for almost two thirds of gun-related deaths in the US, far outstripping gun-related homicides. Put another way, the US has 4 per cent of the world's population but 35 per cent of the world's gun suicides. It is difficult to see how the message could be clearer: guns are a key part of the escalating suicide problem in the US.
Would reducing access to guns reduce suicide? There is every reason to believe it would.
Many people who attempt suicide have both a steadily depressed mood and a more fluctuating, impulsive desire to self-harm. Reducing access to means of self-harm, such as pills used in overdoses, is a very effective way to address the impulsive element of this equation.
While some people will still be determined to die by suicide, a great many will re-consider their decision if delayed. Their depressed mood also needs to be addressed, but reducing access to means is vital in the short-term. And it works in the long-term too.
Acetaminophen (paracetamol) regulations are a good example. Putting acetaminophen pills in blister packs and preventing people buying large quantities in a single transaction give distressed people pause for thought.
In the UK, the introduction of acetaminophen regulations was followed by a 21 per cent reduction in deaths from paracetamol poisoning. There is similar evidence to support placing barriers at bridges and train platforms.
The only problem with this approach is that it is not possible to predict who will or will not die by suicide. As a result, these preventive measures must be applied to everyone.
Here in Ireland, I am more than happy to put up with the inconvenience of not being able to buy more than 12 acetaminophen pills in a single transaction when there is clear evidence that these regulations save lives.
As a result, psychological assessments or background checks for mental illness prior to buying guns in the US simply will not work. Measures to diminish or delay access to guns need to be applied to everyone if they are to be effective, just like acetaminophen regulations.
Finally, even if President Trump had been correct (and he wasn't) when he said that "mental illness and hatred pulls the trigger, not the gun", his words still contained the solution that is obvious to so many people, especially the growing number of US families bereaved by gun-suicide: if there is no gun to begin with, nobody can pull the trigger.

(Brendan Kelly, M.D. Ph.D., is Professor of Psychiatry at Trinity College Dublin, Ireland, Consultant Psychiatrist at Tallaght University Hospital, Dublin, and author of The Doctor Who Sat For A Year).

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