Once again, Americans are reeling from the shock and horror of a mass shooting at an elementary school. The tragedy in Uvalde, Texas, which left 19 children dead, is horrifying. But despite the statements of many politicians, it is not unimaginable. In fact, as of early June, there have been 33 additional mass shootings across the country since the Uvalde tragedy. Still, the scale of the violence and the youth of the victims in Uvalde has left many incredibly shaken, searching for both explanations and solutions.
In the aftermath of this school shooting, many have tried to tie the tragedy to the country's mental health care crisis. In the decades since Columbine, pundits and politicians have proposed many explanations for school shootings, from violent video games to rap music. But these days people are more likely to name mental illness as the cause of these heinous acts of violence.
Although there may be a correlation, there is no proven causality between mental illnesses and gun violence, much less school or mass shootings. According to the National Institutes of Health, a "large majority of people with serious mental illnesses are never violent." Further, researchers at Columbia University found that only 8 percent of mass shooters had a serious mental illness. The instinct to blame mass shootings on serious mental illness is understandable, but ultimately harmful. It does little but stigmatize and harm individuals with these diagnoses.
However, in that same Columbia University study, researchers found that mass shooters were more likely than the general public to have had past non-psychotic psychiatric or neurologic symptoms. The public tends to conflate serious mental illnesses, like schizophrenia or psychotic disorders, with violence and mass shootings. Yet, the evidence indicates that there is too much emphasis placed on serious mental illnesses and not enough attention paid to how less severe mental health issues contribute to gun violence when they go undetected and untreated.
Mental health is about more than just the serious disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5), the main diagnostic tool and authority published by the American Psychiatric Association. Individuals, even if they do not meet the DSM-5 criteria for mental illness, can be dealing with trauma, lack of closure, depression, anxiety, loneliness, and much more. These normal, human experiences and feelings can fester overtime if left unresolved. Without healthy, effective coping skills, people who are suffering can turn to maladaptive methods to manage their feelings. Some may even turn to maladaptive fantasies about violence. A small proportion may ultimately act on those violent fantasies in a distorted attempt to achieve closure or relief from their symptoms.
America does not need more DSM-5 diagnoses, hospitalizations, or intensive medicalized treatment modalities. We need better access to the simple, everyday mental health care that is critical to preventing suffering, interpersonal violence, and maybe even mass shootings. We must do more to help individuals who are struggling to manage intense feelings or cope with painful experiences.
Access to basic mental health care in this country is deplorable. Most people do not seek mental health treatment until they are at a crisis point—if they seek treatment at all. Yet, earlier mental health screenings and basic interventions would do much to reduce symptoms, stress, and suffering. Fortunately, these interventions are not complicated, controversial, or expensive. We need pediatricians and primary care doctors to ask patients about their mental health and screen for unmet mental health care needs. Talk therapy and skill building interventions should be cheaper and more accessible. Basic psychoeducation should be taught in public schools.
Much of the debate around preventing mass shootings is rancorous and highly politicized. Basic gun control regulations would likely help reduce gun violence, but given the political landscape, these policies are unlikely to pass. Instead, let's focus on a potential solution to gun violence that is simple, effective, and will have positive downstream effects on many aspects of American life. We can—and must—reduce violence and suffering across the United States by increasing access to basic mental health care for all Americans.
Dr. Tamir Aldad is a fellowship trained addiction psychiatrist and the founder and CEO of Mindful Care—the award winning first-ever psychiatric urgent care in the United States. Dr. Aldad graduated with an MBA from University of Chicago Booth School of Business, and completed residency and fellowship training at Northwell Health, after graduating medical school. He also conducted several years of behavioral health research as a physician scientist at Yale School of Medicine. He is passionate about acute mental health issues, public mental health and improving access to affordable care.
