Authors: Jessica McCann & Tonantzin Juarez
The intersection between gun violence and mental health in the U.S. is well-documented. Witnessing gun violence, being physically harmed by gun violence, or losing a loved one to gun violence can lead to a lifetime of trauma and poor physical health. Moreover, most gun related deaths in the U.S. are suicides, showing that guns are readily available to those with pre-existing mental health issues. Gun violence disproportionately affects people of color and those with low incomes who are more likely to experience gun violence and least likely to access follow-up care. Financially, gun violence costs the U.S. at least $1 billion annually in hospital care alone, including inpatient stays and emergency room visits. In observance of National Mental Health Awareness Month, we revisit the intersection of mental health and gun violence, examine contributing factors and explore promising policies and programs.
Toll of Firearms in the U.S.
In 2021 there were 48,830 firearm-related deaths, more than motor vehicle/traffic-related deaths and the most ever recorded in the U.S. Though the toll of firearm violence varies widely by state, the overall U.S. firearm-related death rate is the highest among high-income countries, seven times higher than Canada and 340 times higher than the United Kingdom. Firearms are the leading killer of children and youth in the U.S., with children aged 5-14 being 21 times more likely to die by gunfire than their counterparts in other high-income countries. Moreover, active shooter incidents in the U.S. have increased by nearly 2000% between 2000 and 2021, from 3 to 61.
In the U.S., gun violence intersects with mental health in many ways. First, more than half of gun-related deaths are by suicide, though this is often overlooked in ongoing debates on gun control issues. Secondly, gun violence affects children in several ways, all of which limit a child’s potential and cost society a great deal. A gun injury, witnessing firearm violence, or the loss or injury of a loved one increases a child’s likelihood to experience anxiety, depression, PTSD, substance use disorder, and more, potentially leading to a lifetime of poor mental (and physical) health outcomes. Third, gun-related trauma can and often does ripple throughout communities experiencing violence. While this ripple effect can occur within neighborhood boundaries, it can also intersect with other shared identities, such as LGBTQ+ communities fearing violence after the Pulse mass shooting. Those experiencing the gun-violence ripple effect can suffer from multiple mental health issues including hypervigilance, fear, hopelessness and other trauma responses.
Gun violence does not affect populations equally. Black and Latino children are disproportionately exposed to gun violence, leading to higher burdens of mental health issues than their white peers. Research shows Black women are far more likely to die by firearm homicide than white women, gun violence exposure is associated with increased suicidality in Black Americans, and police killings are associated with insufficient sleep in Black Americans. Additionally, in communities already experiencing trauma from poverty, racism and segregation, underfunded schools and housing, and predatory lending, which are disproportionately Black and Brown communities, gun violence magnifies these existing traumas.
Firearm Policies
Gun safety policies save lives. States with gun safety laws have fewer gun-related deaths than other states and research shows that states with permit requirement laws have lower overall suicide rates, lower suicide-by-firearm rates, and smaller proportions of suicides attributable to firearms. This supports the notion that beyond the effects of poverty and population density, specific laws regulating the ownership of handguns are associated with a range of improved outcomes. Yet, despite overwhelming evidence in their favor, enacting policies that restrict firearm access has been an uphill battle. Gun rights groups, firearm manufacturers, lobbyists, and pro-gun politicians are unrelenting in their pursuit of Second Amendment freedoms. For example, we know common-sense laws help keep guns away from abusive partners. In fact, research shows a 12% reduction in intimate partner homicide in states prohibiting firearm sales to those under restraining orders. Yet loopholes in federal and some state laws allow abusive partners and stalkers to circumvent these laws.
This is clearly illustrated by recent court proceedings. Before June 23, 2022, courts agreed that it was constitutional under the Second Amendment to disarm those under domestic violence restraining orders. However, in New York State Rifle & Pistol Association v. Bruen, the U.S. Supreme Court declared that pre-Bruen gun-related rulings were contradictory. The ruling deems any gun law unconstitutional if it is not analogous to laws existing at the time of the nation’s founding – in the late 1700s. In November of this year, the Supreme Court will hear arguments on United States v. Rahimi, which seeks to strike down a law aiming to keep guns out of domestic abusers’ hands. It remains to be seen whether the Court will protect domestic abuse survivors or side with those lobbying to protect the gun rights of abusers.
Conversely, 29 states prohibit people with serious mental illness, defined as those who have been involuntarily committed to a psychiatric hospital or found to be a danger to themselves, from having firearms. Even though an individual under these categories is banned from owning a gun by federal law, these separate state prohibitions are important to ensure fidelity as well as increase public safety and health. In March of this year, the Biden-Harris administration created the White House Office of Gun Violence Prevention with the goal of identifying new executive actions, partnering with state and local officials, and coordinating the first-ever federal interagency response to mass shootings and concentrations of community violence. These actions will reduce community violence and lead to improved mental health and wellness.
Looking Ahead
Not all gun policies are as regressive as some mentioned above. In April, the Biden Administration closed the so-called “gun show loophole,” ruling that anyone selling a gun must undergo a background check and become a licensed dealer. Additionally, we now know that simple state-level policies like background checks, limiting access for high-risk groups (e.g., previous domestic violence perpetrators), and carry permit requirements work: states lacking these common sense policies have a gun violence rate on average 2.5 times higher than more progressive states.
Groundbreaking public health programs are also stepping in. In Philadelphia, the University of Pennsylvania Trauma Violence Recovery Program helps survivors immediately after an incident, providing the health care they need while linking them with mental health, legal and other resources. In Baltimore, Safe Streets provides dispute resolution, anti-violence community messengers and other services, and has been shown to reduce violence in most communities served. Outside the program and policy realm, communities are fighting back. Community-led survivor services, including immediate response after a firearm incident or long-term services, help bridge gaps between marginalized populations and law enforcement to provide trusted supports, resource navigation, and financial help. Proactive community action, combined with progressive policies, will reduce gun violence, improve the mental health of communities, and ensure brighter futures for our youth.