This is the key question so many of us involved in the gun debate face. On a personal level, answering it has big implications for our families’ safety. As Amy discussed in a recent post, having a gun in the household increases the chances that someone in the household will die by gunshot, though even in households with guns there are many things you can do to keep your kids safer.

US and Japanese Flags With GunBut what about across the country? At the national level, the question has big implications for our country’s laws. Many people carry concealed or unconcealed weapons in public places out of fear of crime. Some people argue (see, for instance, here) that laws that allow easy access to guns and that allow guns to be carried in public places in the United States help to keep crime rates down. A recent study in The American Journal of Medicine – one of our country’s most prestigious sources of cutting-edge research in medicine and public health – concludes that that the answer is decidedly “No.”

The authors of this study examine rates of firearm ownership in 27 developed countries: from culturally relatively similar ones like Australia and New Zealand, to culturally quite different ones such as Japan. They also consider rates of major depressive disorder in those countries. Then they ask how firearm ownership and mental health problems in each country are related to the crime rate and the number of firearm deaths per person.

What they find is striking: the more guns in a country, the higher its rate of firearm deaths. The relationship is very strong, and holds up even when you don’t consider the countries at the extremes, such as the United States (high gun ownership, high firearm death rate) and Japan (low gun ownership, low firearm death rate). No matter how you slice the data, the more guns a country has, the more likely the average citizen is to die by gunshot. By contrast, there is a small, statistically significant relationship between mental illness and rates of gun deaths, but the association is very weak.

But some people might say that even if more guns means more gun deaths, criminals will be less likely to strike in countries where they fear that their potential victims could have a concealed weapon. In other words, maybe crime rates go down at the same time that would-be criminals are more likely to get killed. Unfortunately, once again the authors find that the answer is “No.” They find that there is no relationship between the number of guns per person in a country and the country’s crime rate. The U.S. happens to have a lot of guns and, in recent years, pretty low crime rates. But Japan has very few guns and even lower crime rates. And the UK and Israel have fewer guns than the U.S., but more crime.

Surely there must be some cases in which the presence of guns helps to prevent a crime, or in which potential victims kill would-be attackers. Still, this study has a very clear conclusion: on average and across the developed world, having more guns does NOT make countries safer.

The policy proposals that President Obama announced on Wednesday (organized by category here) outlined a wide-ranging agenda, including twenty-three items that could be implemented through executive action and twelve recommendations for action from Congress.* The items are a mixed bag, ranging from immediately actionable ideas to proposals that may never make it through Congress. Some are vague (launching a national dialogue about mental illness) while others are very specific (confirming a director for the ATF).  In the coming weeks, PAGV will explore, seek input on, and respond in detail to the specific items. Here we outline a few of our immediate reactions as parents and concerned citizens.

  1. This is an important first step. It is gratifying to see the President both take direct action on a number of important gun-related matters, and publicly initiate the conversation about what needs to change to address the ongoing epidemic of gun violence in the United States.
  2. We strongly agree with the need for a comprehensive legislative and executive agenda, one that attempts to solve gun violence by addressing gun access, gun safety, school safety, societal factors, and mental illness.  Reducing the threat of violence to our children will clearly require such a broad-based, comprehensive effort. Any flaws in individual proposals do not invalidate the entire effort.
  3. There will be something for everyone to like, and for everyone to hate, in the proposals.  Given the current political climate, this may be inevitable.  Due to the absence of thorough research into the causes and effects of gun violence, there is little agreement about its remedies, beyond a desire to see it end.  To some, allocating $10,000,000 to research the connection between video games and violence seems like the worst kind of pandering to the NRA’s “it’s-everything-but-the-guns” narrative. To others, requiring background checks on all gun sales seems like the first step in a government takeover.
  4. Some of the proposals concur in fundamental ways with recent policy proposals from Parents Against Gun Violence. One of the executive orders, for example, directed the Centers for Disease Control to initiate research into the health effects of gun access (PAGV Policy Plank #2, Empower Researchers), while a proposal to Congress urges legislators to allocate $30,000,000 for schools to develop emergency-response plans (Policy Plank #5, Protect Schools).
  5. While President Obama implemented a number of executive actions, the biggest proposed changes will all require legislative action. All of the major funding allocations (with the exception of $20 million to encourage states to share background data) also have to go through Congress. In the coming weeks, concerned parents and citizens need to make sure that our voices and perspectives are heard in the legislative debates.

* Note that Obama actually signed only three executive orders (technically “presidential memorandums“) on Wednesday.  The 23 “executive actions” named in the Obama proposal describe general policy priorities that would not require Congressional approval for implementation. However, many of the proposed “executive actions” come far from implemented (or implementable) public policy at this point.

In the wake of the Newtown shooting, several medical organizations have spoken up about either gun violence itself, firearm safety or about the response of other organizations, such as the NRA.

Since much of the nationwide dialogue after this tragedy has involved discussions on mental health, it makes sense that the American Psychiatric Association issued their remarks. Dilip Jeste, MD, president of the APA, sent a letter December 20 on behalf of the organization to Senate Majority Leader Harry Reid, Senate Minority Leader Mitch McConnell, Speaker of the House John Boehner and House Minority Leader Nancy Pelosi.

The letter, which you can download here, focused on two main points. First, as part of their responsibility to their profession, Dr. Jeste said “psychiatrists stand ready to do whatever we can to help alleviate the suffering caused by the tragedy and to help the survivors cope with life after a trauma of this unimaginable magnitude.”

But more importantly, Dr. Jeste followed that with a reminder that focusing too much on the mental condition of the shooter risks inappropriately increasing the stigma already associated with mental illness. “Stigma remains one of the greatest barriers to early identification, intervention, and treatment for Americans seeking help for mental illness, and we hope that Congress will avoid making generalized assumptions about persons now in or seeking treatment for mental illness,” Dr. Jeste wrote.

After noting that the “vast majority of violence” does not occur at the hands of individuals with mental disorders, Dr. Jeste said that those who do commit the crimes generally are not receiving adequate or appropriate mental health treatment. The statistics he notes are sobering: Public mental health spending has been reduced by $4.35 billion from 2009 to 2012, and 29 states have gotten rid of over 3,200 psychiatric inpatient beds since 2008.

He also brought up an issue which had been in the medical news recently related to doctors’ ability to discuss firearm possession and safety with their patients: “We are also profoundly disturbed by recent efforts in some states to curb or bar the ability of physicians, including psychiatrists, to prudently and confidentially inquire about the presence of firearms in the home when the behavior of their patients warrants such an inquiry,” Dr. Jeste wrote.

An article published in JAMA Pediatrics (formerly Archives of Pediatrics and Adolescent Medicine) provided the history of the Florida law that attempted to prevent doctors from speaking to their patients about firearms, concluding “Dialogue stemming from these questions will help families protect children from multiple forms of harm.”

A few days after sending that letter, the APA spoke up again to express their “disappointment” to the statement by the NRA and specifically the mental health stigmatization that NRA CEO Wayne LaPierre promoted with his comments. The APA wrote in their news release (pdf):

“The association objected to LaPierre’s assumption that horrendous crimes such as the one committed by shooter Adam Lanza are commonly perpetrated by persons with mental illness. In addition, he conflated mental illness with evil at several points in his talk and suggested that those who commit heinous gun crimes are ‘so possessed by voices and driven by demons that no sane person can ever possibly comprehend them,’ a description that leads to the further stigmatization of people with mental illnesses.”

Noting that “only four to five percent of violent crimes are committed by people with mental illness,” Dr. Jeste reminded the press that those with mental illnesses are rarely violent and are much more likely to be crime victims than crime perpetrators. Calling the use of the word “lunatic” by LaPierre “offensive,” Dr. Jeste said, “About one quarter of all Americans have a mental disorder in any given year, and only a very small percentage of them will ever commit violent crimes.”

The letter concludes with a statement from APA CEO James Scully, MD: “The idea that mental illness and evil are one and the same thing is simply a relic of the past and has no place in our public dialogue. People who are clearly not mentally ill commit violent crimes and perform terrible acts every day. Unfortunately, Mr. LaPierre’s statements serve only to increase the stigma around mental illness and further the misconception that those with mental disorders are likely to be dangerous.”