Guns, Public Health & Mental Illness Joshua Horwitz Executive - - PowerPoint PPT Presentation

Joshua Horwitz

Executive Director Jhorwitz@efsgv.org 202-408-7560 x1001

Guns, Public Health & Mental Illness

June 10, 2016

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Suicide 63% Homicide 33% Other/Undetermined 4%

US Firearm Deaths in 2014

More than 33,000 gun deaths and 81,000 non-fatal gunshot injuries per year

Source: CDC’s WISQARS™ (Web-based Injury Statistics Query and Reporting System). Fatal Injury Reports, 1999- 2014, for National, Regional, and States; Nonfatal Injury Reports, 2001 - 2014

Source: CDC’s WISQARS™ (Web-based Injury Statistics Query and Reporting System). Fatal Injury Reports, 1999-2014, for National, Regional, and States

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0. 3.5 7. 10.5 14.

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Age-adjusted Firearm Death Rate per 100,000 Year US Suicide US Homicide US All Intents

Age-adjusted Firearm Death Rate: United States

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Legal Context: Supreme Court recognizes legal right to a gun in the home for self defense But that right is not unlimited.

Who can exercise the right safely?

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Federal Prohibitors:

• Felons; fugitives
• Persons who have been involuntarily committed to

a mental institution

• Those convicted of a misdemeanor crime of

domestic violence

• Those subject to permanent domestic violence

restraining orders

• Unlawful users or those addicted to a controlled

substance

Who should be prohibited from purchasing and possessing firearms? Can evidence help us do a better job identifying risk?

I Turned to the Experts…

March 2013: Convened at Johns Hopkins Bloomberg School of Public Health, Baltimore MD

• Public Health Researchers
• Mental Health Providers
• Medical Professionals
• Gun Violence Prevention Advocates
• Policy Experts
• Law Enforcement

Evidence Consensus Recommendat ions

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Jeff Swanson Duke University, School of Medicine Shannon Frattaroli Johns Hopkins Bloomberg School of Public Health Richard Bonnie University of Virginia School of Law Beth McGinty Johns Hopkins Bloomberg School of Public Health Daniel Webster Johns Hopkins Bloomberg School of Public Health Paul Appelbaum Columbia University School of Medicine Renee Binder University of California, San Francisco, School

• f Medicine

Consortium for Risk-Based Firearm Policy

9 Amy Barnhorst UC Davis Psychiatry and Behavioral Sciences Garen Wintemute UC Davis Emergency Medicine, Violence Prevention Research Program

96% 4%

Attributable Risk of Minor or Serious Violent Behavior Towards Others:

Other Risk Factors Serious Mental Illness

96% of violence occurs due to reasons other than serious mental illness alone

Serious mental illness, on its own, contributes very little to

• verall violence towards others (a bigger risk factor for suicide)

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There are certain times, in certain settings, when those with a serious mental illness are at increased risk of violence

2% 8% 23% 36% 37%

0% 10% 20% 30% 40%

General population without mental illness Outpatients in treatment Emergency departments Involuntarily committed inpatients First-episode psychosis patients

Percent Violent Within 6 – 12 Months

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• Age (Young)
• Male
• Low socioeconomic

status

• Alcohol abuse
• Drug abuse
• History of violence
• Serious mental illness

Significant Risk Factors for Dangerousness

Note, some of these risk factors cannot constitutionally be used for gun prohibitions

• Older
• Female
• Middle to upper SES
• No serious mental illness
• No substance abuse
• No psychiatric hospitalization
• No arrest history
• Younger
• Male
• Lower SES
• Serious mental illness
• Substance abuse
• History of psychiatric

hospitalization

• History of arrest

CUMULATIVE VIOLENCE RISK

<1 % violent 65 % violent

Predicted Probability of Violence in a One-year Period: Data From a Three City Study (Swanson, 1990) Violence risk is multi- factorial and cumulative: Risk linked to mental illness is embedded in other factors

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Population Attributable Risk of Suicide

Serious mental illness, on its own, contributes significantly to suicide

Mental Illness

47% - 74%

Other factors 26%

47-74% of violence toward self attributable to mental illness alone

Gun Ownership & Suicide

• Access to firearms is correlated with the risk of

suicide.

• Case-control studies in the US have found that

the presence of a firearm is a strong risk factor for suicide.

Restricting firearm access on the basis

• f certain dangerous behaviors is

supported by the evidence; restricting access on the basis of mental illness diagnoses is not.

A new tool to help individuals in crisis

• Gun Violence Restraining Order (GVRO)

– Temporarily removes firearms from individuals who pose an immediate threat

• f harm to self or others

– Based on Domestic Violence Restraining Order – Enables law enforcement and families to intervene when individuals are exhibiting dangerous behavior

Governor Brown Signing the Bill

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CA GVRO – Factors Courts Must Consider

• A recent threat of violence or act of violence by the subject
• f the petition directed toward another, or himself or herself
• A recent violation of a protective order of any kind
• A conviction of a violent offense
• Mental health diagnosis is NOT a factor

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A gun-safety group announced Thursday it is going back to voters after Washington state lawmakers failed to pass a bill creating extreme-risk protection

• rders that take guns from

people who pose a serious risk of hurting themselves or

• thers.

Discussion

Joshua Horwitz

Executive Director Jhorwitz@efsgv.org 202-408-7560 x1001

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