What role does serious mental illness play in mass shootings, and how should we address it?

• Published date: 01 February 2020
• Author: Edward Mulvey,Jennifer Skeem
• Date: 01 February 2020
• DOI: http://doi.org/10.1111/1745-9133.12473

DOI: 10.1111/1745-9133.12473

SPECIAL ISSUE ARTICLE

COUNTERING MASS VIOLENCE IN THE UNITED STATES

What role does serious mental illness play in mass

shootings, and how should we address it?

Jennifer Skeem1Edward Mulvey2

1University of California—Berkeley

2University of Pittsburgh

Correspondence

JenniferSkeem, University of California—

Berkeley,120 Havilland Hall, Berkeley,

CA94720.

Email:jenskeem@berkeley.edu

Fundinginformation

MackCenter for Mental Health and Social

Conflict,UC Berkeley

Research Summary: A popular explanation for mass

shootings is that the assailant “must have been mentallyill.”

A popular policy solution is exceptionalist—enter more

gun-disqualifying psychiatric records into the background

check system to keep guns away from identified people

with mental illness. We synthesized research on the con-

nection between mental illness and common violence, gun

violence, homicide, and mass violence. We focusedon seri-

ous mental illnesses like schizophrenia, bipolar disorder,

and major depression, which are not the same as emotional

distress from life circumstances and problematic personal-

ity traits. We found an association between serious mental

illness and violence, but it is weaker than the public imag-

ines or the media portrays, and rarely causal. Serious mental

illness plays a limited role—it is neither a necessary nor a

sufficient condition for mass violence.

Policy Implications: Exceptionalist policies in which seri-

ous mental illness is assumed to cause mass shootings will

do little to prevent them—and will subject millions of non-

violent people with mental illness to stigma and unwar-

ranted social control. Mass violence is a multidetermined

problem. Because major risk factors forviolence are shared,

improvements in policies designed to keep guns out of

the hands of dangerous people without mental illness will

also go far in preventing incidents involving those with

mental illness. Chiefly, these steps include sharpening the

criteria for gun disqualification and temporarily removing

Criminology & Public Policy. 2020;19:85–108. wileyonlinelibrary.com/journal/capp © 2019 American Society of Criminology 85

86 SKEEM AND MULVEY

guns from individuals at imminent risk for violence. The

implementation of threat assessment teams and funding for

crisis services for people with and without mental illness

may also be helpful.

KEYWORDS

mass violence, mental illness, policy, prevention, psychosis, public mass

shooting, violence

In the wake of almost every highly publicized mass shooting in the United States, an impassioned

and familiar debate plays out in popular and political discourse over a central concern: What causes

this terrible, recurring problem, and how do we fix it? The positions are predictable. Those on one side

frame mass shootings as part of the larger complex problem of gun violence in the United States, where

more than 350 people are injured by gunfire every day and approximately100 of t hem die (Centers for

Disease Control and Prevention,2018). Those on t his side also arguethat t he principal policy solution is

better gun regulation, including universal background checksfor buyers, a ban on military-style assault

weapons and high-capacity ammunition magazines, and crackdowns on gun trafficking (Webster &

Vernick,2013). Those on the other side, including the National Rifle Association, primar ilyblame mass

shootings on deranged people. The problem is not guns, they argue, but “mentally ill” people who turn

guns on innocents. The chief policy solutions then are to “fix America’s broken mental health system”

(National Rifle Association—Institute for LegislativeAction, 2013, para. 2) and to prevent people with

mental illness from buying guns by systematically entering gun-disqualifying mental health records

into the National Instant Criminal Background Check System (NICS; see Silver, Fisher, & Horgan,

2018).

When one confronts the graphic news of a mass shooting—including horrific images, terrifying

witness narratives about how multiple people were murdered in a public space, and heart-rending grief

of those who lost loved ones, there is a natural pull to leap to mental illness as an explanation. After

all, why would any person of sound mind indiscriminately massacre people, especially strangers or

children? When trying to understand terrible acts of violence, one easy explanation is that the killer

“must’ve been mentally ill” (Corrigan, as cited in Chen, 2018, para. 6). Of course, such an explanation

has a circular quality (i.e., “Why did this man do this terrible thing?” Because he is mentally ill. “An d

how do you know he is mentally ill?” Because he did this terrible thing.).

Despite its tautological quality, the explanation is popular. In a Washington Post–ABC News spon-

sored survey of ∼1,000 randomly selected Americans, 63% of respondents believed that public mass

shootings in the United States are primarily a result of mental health problems (compared with 23%

who believed they are primarily a result of inadequate gun control; Craighill & Clement, 2015). In a

more rigorous survey of more than 4,000 Americans, Barry, McGinty, Vernick, and Webster (2013)

found that most respondents (85%) supported gun policies and laws designed to specifically targetand

restrict people with mental illness. This finding is consistent with a much larger body of evidence that

negative attitudes toward people with serious mental illnesses like schizophrenia and bipolar disor-

der are prevalent and persistent in the United States and include the assumption that these people are

particularly dangerous (see Link & Phelan, 2013; Pescosolido, 2013).

This assumption is fueled by the news media (McGinty,Webster, & Barry, 2014), which dispropor-

tionately emphasizes a link between mental illness and violence. Although only an estimated 3% to