We have tried sensible gun control in the United States, and there is evidence that it can work. In 1975, the District of Columbia enacted the Firearms Control Regulations Act, which effectively banned handguns in the district. Colin Loftin, Ph.D., and his colleagues published a study in 1991 showing that the law resulted in a dramatic decline in gun homicides and suicides; it saved an estimated 47 lives each year in the District of Columbia during the period it remained in effect (N. Engl. J. Med. 1991;325:1615-20).
The irony in Dr. Loftin’s study is that it validated the public safety benefit of the very law that the U.S. Supreme Court struck down as unconstitutional in District of Columbia v. Heller. The court’s decision in Heller, expanded to the states in McDonald v. Chicago, affirmed that the Second Amendment confers an individual right to possess firearms for personal protection. Never mind the scientific evidence for how dangerous this might be.
After Heller, we can’t broadly limit legal access to guns here, as other countries have done. We have to do something more difficult, which is to try to keep guns out of the hands of certain "dangerous people." But we often don’t know who the dangerous people are (until it’s too late), and the people that we might assume to be dangerous (say, because they have a mental illness) mostly are not. Our existing federal prohibitions, inherited from the Gun Control Act of 1968, are both overinclusive and underinclusive. As a result, people who are dangerous can slip through the cracks, while people who are not dangerous can be unfairly subjected to stigma, public fear, social rejection, and discrimination.
Given that psychiatrists’ predictions of violence aren’t much better than a coin toss, and we live in a country awash in firearms, reducing gun violence in the tiny proportion of mentally ill individuals at risk is a vexing challenge. A policy to seize guns, at least temporarily, from people during and immediately following a dangerous mental health crisis – a law like the ones Indiana, Connecticut, and California already have in some form – might be a place to start.
By itself, such a law may have only a marginal effect. But it could make a difference in combination with other sensible measures that would be permissible under the Second Amendment – policies such as universal background checks, beefing up enforcement and lowering evidentiary standards for prosecuting illegal gun transfers, banning assault weapons and high capacity ammunition magazines, and maybe requiring personalized gun technology to ensure that a gun could only be operated by its licensed owner.
There are sensible things that Congress and states could do to reduce gun violence. Meanwhile, some legislators seem intent on moving in the opposite direction – making guns easier to obtain and carry, and in more public places, than ever before. On Sept. 10, voters in Colorado went to the trouble of booting out of office two lawmakers who dared to support gun control. Less than a week later: another mass shooting.
That firearms have become a symbolic issue in a paralyzed political debate over individual rights and government intrusion is enough to make a public-health–minded researcher or clinician, on a bad day, lose hope for evidence-based policy. A good day will be one with more reasonable conversation about firearms, fewer people with untreated mental illness, and nobody dead from a gunshot in America.
We do need to improve mental health care in this country; we need more effective treatments and better access to services for people with serious mental illnesses. That said, people with mental illness are really not the source of our social problem of gun violence. Mass shooters with mental health problems get a huge amount of media attention, but they do not represent most people treated by psychiatrists. They’re also atypical of most people who commit violent crimes. We also need to think more broadly about mental illness and violence in society as two separate public health problems that overlap at the moment of such tragedies.
Dr. Swanson is professor of psychiatry and behavioral sciences at Duke University Medical Center, Durham, N.C. He is principal investigator of a multisite study on firearms laws, mental illness, and prevention of violence, cosponsored by the National Science Foundation and the Robert Wood Johnson Foundation’s Program on Public Health Law Research. Dr. Swartz is professor of psychiatry and behavioral sciences and head of the division of social and community psychiatry at Duke University Medical Center. He examines the effectiveness of services for people with severe mental illness. His current research focuses on the effectiveness of firearms laws, involuntary outpatient commitment, psychiatric advance directives, and antipsychotic medications.