Guns Are Only Part of the Issue

I can’t help but write about this.  First, let me get this out there that I am a gun owner.  That’s not to say that I don’t think there could be more strict gun laws.  According to this article the U.S. obviously has the highest gun ownership with roughly 89 guns per 100 people.  The next two countries closest in gun ownership are Switzerland and Finland each with about 45 guns per 100 people.  The U.S. also has the highest gun related deaths, which makes sense.  More guns = more gun related deaths.  So I do think it’s worthwhile to look at modifying our gun policies.  In looking at Switzerland and Finland policies surrounding guns here is what I found interesting and wouldn’t be horrible to adopt or modify to adopt here:

• Switzerland:  Must have a copy of your criminal record not older than 3 months before buying guns AND ammunition.  You can’t get a gun if you  have a criminal record, or suffer from addiction or psychiatric problems.
• Finland – Must be an active member of a gun club for 1 year prior to purchase.  Must be vetted by a doctor and the police before purchase.

We have background checks here before buying a gun in most cases.  I think it could be an interesting proposition to have to go through one before you buy ammunition, as well.  Your situation could have changed between the time of buying the gun and buying ammo.  I also kind of like the idea of having to have been an active member of a gun club for 1 year prior to purchase.  I would even go so far as to require with that gun membership gun safety classes.  This would ensure that you are knowledgeable about and familiar with how to handle a firearm.  It would also show that your purchase isn’t an emotional one.  I also like the idea of having to have a doctor sign off and not allowing those with untreated or poorly managed addiction or other psychiatric problems to purchase.   I don’t think having an addiction problem or psychiatric problem should exclude you from buying a gun EVER, but I think that you should be in current treatment with the doctor in belief that your treatment is stable.  I will come back around to this issue in a bit, because I think this is where the biggest issue with these mass killings lies.

But first, just because a country has more gun related deaths, does that mean that their crime rate and murder rate overall is higher?  In other words, is it the guns that kill people or is it the people that kill people?  Is too much focus being put on guns?  If you look at this report of the murder rates of 193 countries with reporting dates ranging from 2005 to 2011 (so not a year to year comparison, but still an overall picture), the U.S. ranks 99th out of 193 countries for murder rates.  Switzerland ranks 182nd and Finland ranks 126th.  In the previous report, the countries with the lowest gun ownership and lowest gun-related deaths were: Portugal, Israel, United Kingdom, Netherlands, and Japan.  Their murder rates are 158th, 131st, 157th, 162nd, and 188th.  While the U.S still tops all these countries, just because Switzerland and Finland have more guns didn’t necessarily mean their murder rate was higher.  And out of 193 countries, the U.S. is 99th NOT 1st.  Some of the countries with murder rates higher than the U.S. are Cuba, Ukraine, Phillipines, Lithuania, Indonesia, Russia, Caymen Islands, Barbados, Greenland, Mexico, St. Kitts.  The highest murder rates seem to be on Islands, South America and Africa as can be seen by this map:

via chartsbin.com

Out of curiosity, I looked up the gun laws in Russia and Greenland for comparison. Russia doesn’t allow typical guns, however you can obtain an air gun with rubber bullets or a gun that shoots tear gas (?), so basically gun ownership is pointless and the most common weapon is a kitchen knife.  However, some of their rules in obtaining these guns I think could be useful here:  You must pass an exam – we have to pass an exam to get our drivers license, I think it would be fair to do the same to get a gun.  The license must be renewed every five years.  I think this seems logical too, but to enforce you would have to have some sort of registry and I’m not entirely sure how I feel about that.  You must have a steel gun safe.  I think that’s fair too, especially in homes with children. As far as Greenland, you have to pass a background check and such, but it doesn’t seem like it’s a thing people really do there so I couldn’t find much info.

To re-cap the gun issue, looking at what other countries do I think the United States could stand to add a few regulations to guns:

• Get a doctor’s clearance
• Pass a background check before purchasing a gun AND ammo.
• Pass an exam
• Be a member of a gun club prior to purchase (and hopefully after as well)
• Have a gun safe (how to enforce this one though??)

I’m sure there will be disagreements to those ideas, but it could be a start.  The larger problem I see though is that of mental healthcare.  We, along with every other country, has struggled with how to properly care for mental health concerns.  Long ago, exorcisms used to be performed as it wasn’t thought to be a medical problem but that of religion.  In the early 1800’s institutionalization began, but the problem was that even up to the 1930’s people didn’t really know how to qualify who should be put in the institutions.  Psychiatry either didn’t exist or was just in its early beginnings.  There was no formal way of diagnosing.  It is reported that people were involuntarily committed for reasons having more to do with social control than psychiatric treatment. In 1847 a law was passed making a more formal process of commitment, but even in the 1930s there were still enough husbands ridding of wives to institutions for things such as not doing their housework.(¹) These institutions held everyone from the schizophrenic to those with alzheimer’s, down syndrome, autism, epileptics and so many more.  The institutions were overpopulated and under funded. Treatment suffered. In 1930 the lobotomy became a popular “treatment” option.  Electroconvulsive shock therapy was also widely used at this time.(²)  Until the 1960’s the voice of paternalism asserted the need for involuntary commitment.  But in 1954 the anti-psychotic drug called Thorazine was introduced, along with a few others, and the populations in asylums began to decrease.  At the same time African-Americans and women were struggling for civil rights and this flowed over into the civil rights of the mentally ill as well.(^1,2)  The process of deinstitutionalization began.  Changes in health care law and insurance coverage led to a reduction in the use of existing mental hospitals.  It was thought that the mentally ill would be better and more humanely treated in community organizations rather than state run institutions.  It was a nice thought.  But we seemingly got so concerned with the rights of the mentally ill, that we forgot to look hard and long enough at the effect it might have on the safety of the rest of the population.  It wasn’t well thought out at all and funding hasn’t been there to help either.  So what has happened?

As of 2009 an estimated 4.5 million people suffer from the worst forms of mental illness – schizophrenia and manic-depression.  Of those 4.5 million 40% are not receiving treatment on any given day.  A study done in 1986 show that at least one third of the homeless population is mentally ill.  A study done in 1992 showed that seriously ill individuals living in the community were three times more likely to use weapons or to hurt someone badly than the general population.  There are more people with mental illness in jail and prisons than there are in state hospitals.  There is a direct relationship between the closing of mental hospitals and opening new prisons.(³).  The other places people go, such as those with alzheimer’s, down syndrome, etc. requiring constant care are into nursing homes.  There no longer seems to be the inhumane treatment of shackling them or performing lobotomies, but in many ways the care, or lack there of is equally as bad.

With regards to the statistic on violence, you can do a quick internet search and find numerous sites noting that pretty much all of the mass shooters in at least the last 20 years were either currently taking or had recently been taking drugs for mental illness (anti-psychotic, anti-depressive, anti-anxiety).  A couple of which had been taking drugs or seeing psychiatrists for schizophrenia.  With or without guns, I believe these people would have done the same amount of damage.  Maybe they would have made a bomb.  Maybe they would have used knives.  Who knows?  Either way, even though they were on medication for their problems the level of care was still not good enough.

I think part of the problem is simply that we still don’t have a solid grasp on what constitutes mental illness and what causes it.  We have drugs that can “fix” these mental disturbances in some cases, but in other cases the drugs themselves increase homicidal and suicidal thoughts.  This goes for the schizophrenic as well as those with mild anxiety or depression.  I myself have taken anti-depressants before and have seen a counselor.  They helped tremendously, but probably like so many others I stopped going to counseling because insurance stopped covering it.

We need to figure this out.  The mass institutionalization was terrible and so is the current system of pretty much doing nothing.  We need to find a happy medium.  This article(³), from the International Journal of Psychosocial Rehabilitation goes into some ideas about how we can make it better:

• Give them jobs that turn their limitations into strengths.  If they are autistic and don’t mind monotony, give them a job that someone else might find no satisfaction out of.
• Give tax incentives to employ those with mental illness.
• To provide more daycare centers and housing facilities.  For those that shouldn’t be working out in the public, still rehabilitate them within the house and give them jobs to do within the home.
• Establish Mental Health Courts.  There are a few of these but not enough.
• Open up more localized mental health hospitals for those that cannot adequately and safely be rehabilitated.  A family member should be allowed to stay with them, thus decreasing the chances of neglect
• Assertive Community Treatment – This includes a treatment team of a psychologist, psychiatrist, social worker, case manager and nurse that establishes close and consistent relationships with the individuals.

I think the above is the best solution for the worst of cases, but I also think that even those that have very mild cases of anxiety or depression should have access to Assertive Community Treatment.  I would even go so far as to say it would be great if everyone could have a check in with a psychologist or counselor once a quarter or twice a year.  Even the healthiest of individuals will go through some depressive state at some point.  This would decrease the stigma with mental illness and treatment rates would skyrocket (I would think).  It would also enable problems to be noticed sooner hopefully.  And maybe if someone is diagnosed with a mental disorder and doesn’t follow one of a few different  suggested treatment plans, they would face the consequences of being involuntarily sent to a mental hospital, for their benefit and for that of society as a whole.  At some point we should be able to recognize that yes, they are humans and they deserve rights and to be treated humanely, but they also are not in their right mind to make qualified medical decisions on their behalf.  We need to recognize that I think.  Instead of automatically shipping people off to institutions, or doing nothing, I think we need to take a more proactive approach.  Let’s have the best of both worlds – help them live as normal life as possible in society as long as they are cooperating in their treatment and if not, let’s keep them and everyone else safe by providing a place for them to go that feels as much like a home as possible.  And the quarterly or bi-annual check ups for those that are healthy I think would only increase their quality of life as well.  It could keep people on the right track of positive thinking.  It could be awesome.  And if more people saw those roles as awesome, then we would have the staff to be able to make it happen.

How to fund all this is the biggest problem.  I am not one that thinks that healthcare should be government run for a variety of reasons, but possibly a program such as this could or should be – whether it is state or national.  There are so many medical problems out there, but this has the biggest impact on society.  This is the only medical problem I can think of where there is potential for violence if left untreated.  Mental Health Care Reform has to be a priority!

References:

1.  http://www.toddlertime.com/advocacy/hospitals/Asylum/history-asylum.htm
2. http://psychrights.org/states/Maine/InvoluntaryCommitmentbyAliciaCurtis.htm
3. http://www.psychosocial.com/IJPR_13/Deinstitutionalization_Sheth.html