Morning Zen Guest Blog Post ~ Kevin Dwyer

Firearms & mental illness comparison to comparable nations
Trained as a social scientist in examining cause and effect one looks for similarities and differences among variables that have a logical relationship to the variation in outcomes. When looking at death by firearms one can examine accidents, homicides and suicides. For example it might be hypothesized that the numbers of accessible firearms might increase the number of human deaths by firearms beyond those directly related to legal self-defense or policing. You might make comparisons between our country and comparable countries such as England, Canada or Australia whose language and social-ethnic strata are similar & who have stable, democratic governments. These countries have identifiable differences in firearm access laws. They also keep statistics on important variables of access to firearms and lethal outcomes. 

The findings are clear (as reported by advocacy groups and government agencies). Among these comparable countries:

Firearms and fatalities

• The number of privately owned firearms is highest in the USA
• The number of all deaths by firearms is highest in the USA
• The number of suicides by firearms is highest in the USA
• The number of homicides by firearms is highest in the USA
• The number of firearm tragedies involving 4 or more victims is highest in the USA
• The number of children killed by firearms is highest in the USA
• Most firearms deaths occur among persons who have legal access to the firearms, most frequently firearms from their home

According to the Washington Post’s Mark Fisher (December 14, 2012) U.N. data shows an American is 20 times more likely to be murdered by a firearm than a person living in any other developed country. 

Mental illness

• All 4 countries have similar incidence levels of persons with mental illness.
• Only 3 of the 4 have full parity health care coverage for treatment of mental illness. Even with the Affordable Care Act, the USA does not have universal parity for mental health treatment.
• All 4 countries agree that persons with mental illness should not have access to or be able to purchase firearms. However, in the USA, persons with serious mental illness can purchase firearms thru private sales where no “background check” is required. 

Conclusion:
Easy access to abundant firearms in the USA by persons with and without mental illness can be associated the higher death, tragedy and firearm violence in our country making our schools, malls, streets, houses of worship and our homes more lethal than comparable settings in the other 3 similar countries. The data speaks for itself, more accessible firearms, more tragic deaths, more murders, and suicides with firearms. One may conclude:

• Lower the number of privately owned firearms you will lower the number of deaths by firearms.  Seems logical. It is very clear that if you lower the availability of firearms to persons with mental illness you will reduce the number of violent acts, particularly suicides.

Recommendations
Given the conclusion, there are other interventions that can be made. If we are not going to support reducing privately owned firearms we must block access to those firearms by angry, depressed, or other family members with mental illness.

Another thing we can do is help people better address anger, stress and, yes, mental illness. An untreated schizophrenic with paranoid inner voices can have those voices shut off or toned down with medication. The voices are neurochemical and can be treated neurochemically with psychotropic drugs, psychotherapy and supports. If a teen is despondent, anxious and bullied, that teen can be helped and supported by counseling and caring peers/family. All children and youth can be taught social skills to improve problem solving and coping skills.              

What we have learned about addressing early warning signs preventing firearms tragedies in schools
Since the school shooting at Jonesboro, Arkansas, and more critically after Columbine, schools have been improving prevention and intervention initiatives to reduce peer violence and tragedy. One very effective prevention mechanism has been to provide easier access to school mental health staff to respond to student’s reports of concerns about their friends, about shared sadness, about stress and anger. We have successively taught students to share worries. Some of these efforts have focused on suicide threats, others on bullying some on scary facebook chatter. The results have been many thousands of supportive interventions for school children and their families. Few keep records of these interventions so no one can tell if these interventions prevented killings but the general data shows reductions in both completed youth suicides and in school violence since the 1990’s. School security officers and metal detectors and other hardware may be helping but “humanware,” caring connections and mental health services are more vital in developing this improved safe school climate.  

Importantly, students themselves are critical in preventing violence. Students now feel that “warning signs” they see or hear from a friend can be shared with trusting adults and that help will be the result rather than punishment or adults discounting their shared concerns.

Furthermore, when teachers and school staff are supported in raising concerns about a student’s stress and observed functional changes in behavior, children are saved from acting on suicidal or violent thoughts and plans. 

Teaching & supporting mental health promotion, early and intensive intervention is successful in schools
There are numerous effective mentally healthy things that schools are doing with success that can be applied to all ages. If children can be taught positive coping skills and self control strategies so can adults. Employers, community organizations can communicate and teach these constructs. Warning signs can be publicly broadcast to improve awareness. And we need to do more to help the adult and youth who may be burdened by mental illnesses. Improvements in treatment and interventions are not sufficiently publicly understood. Access to help is not sufficiently supported. 

Mental health workers ask about firearms in the home
One positive intervention by mental health professionals working with children and youth has been to routinely inquire about the availability of firearms in the home of persons receiving mental health services, particularly for those who are suicidal, depressed, paranoid or angry and impulsive. We all do this now. Most therapists will drill down to insure that if firearms are in the home families are made aware of the danger and are urged to remove those firearms or at a minimum secure them. Complacency or discounting the danger is generally not tolerated. Even securing firearms in the home is not fool-proof. Children and youths have broken locks, found combinations, even bought bullets to use in unloaded family firearms to kill themselves and sometimes others. 

Mental health treatment works to reduce tragedies
Proven mental health treatments have been supported through training and professional best-practice guidelines. The best-practice constructs we have used with children can be generalized for the public across the life-span. Adults, family and friends can be supported in sharing their concerns about their stressed loved ones with mental health professionals, clergy or others who are or can be trained to listen and support in confidence the shared “warning signs” that may require interventions. Connection to crisis centers is now common. People can be given ways to approach a friend or family member who is in distress to seek mental health help. To make this more universal will require a responsive and effective mental health system. We know that professionally supported family interventions that are used effectively for substance abuse and can also be used to get a person into treatment and prevent tragedy. It takes planning, communication, training and changes in our view of friends helping friends to get mental health treatment. It requires a general understanding that firearms are a serious danger when available to persons with early and imminent warning signs of mental illness.     

Gun security measures in homes are important
Even without new controls gun owners should routinely be given information about the dangers of having weapons in the home when a family member is in distress, has a mental illness or a history of impulsivity or rage. Gun clubs and others could support firearm storage for persons who know that removing the firearms is a preventive measure during a time of family stress.

Policy recommendations

Address Early Warning Signs to prevent firearm tragedies

• Establish a national Presidential public health initiative to assist the public in recognizing and helping family members and friends to seek mental health treatment services for functional mental illnesses, particularly depression and thought disorders. Using the Center for Disease Control & Prevention along with the Substance Abuse and Mental Health Services Administration, NIMH & the Justice Department in conjunction with professional, mental health consumer and advocacy groups, establish an Presidentially tasked advisory council to quickly produce an array of technologically current materials for public information to make it easy for worried family and friends to know what to look for and what to do to contact and receive best-practice mental health advice on helping effectively reach those with signs of mental illness, particularly those talking about their thoughts or plans for suicide or violent acts. Ensure a service system is in place to provide the necessary diagnosis and treatment for those found to need immediate mental health interventions. This initiative should be at the Presidential level and not be given to a specific agency!
• Using the same advisory group (possibly expanded to include other agencies – FBI) establish an information system to address the clear understanding that firearms access is extremely lethal for persons with mental illness, including persons expressing thoughts of suicide, persons with rage behaviors, impulsivity and anyone who shares disturbing thoughts concerning the use of firearms. These public messages should focus on both actions and words of friends and family members. Ideas and direction should be focused upon gun owners to increase their awareness of the extreme danger access to firearms present for persons with diagnosed and undiagnosed mental illness. Gun clubs should be supported and encouraged to provide free storage of firearms for families requesting that service. Clear do’s and don’ts about firearm security in the home should be provided to gun owners on a regular basis.  Legislation might also be needed to affirm liability for lax firearm security in homes. Trigger locks (or other technology) could be mandated for all firearm sales.   
• Provide statistical data to all news media regarding the daily numbers of persons who die by firearms and the connection of that to firearm access of the diseased. 
• Provide public information and reminders to the general public about techniques for interpersonal problem solving, conflict resolution and symptoms listeners/viewers may have warranting self-referral for help.  Resources for such wellness services should be funded and encouraged. Mental wellness tips could be part of advertising for various industries to encourage positives.  

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Kevin P. Dwyer, M.A., a Nationally Certified School Psychologist, is an education and child mental health consultant.  He recently served as a principal research associate for the American Institutes for Research. For over 30 years he practiced school psychology in public schools and held several local, state and national leadership positions in the fields of mental health and education, being responsible for the design, development, implementation and evaluation of programs and practices, for improving school climate, safety, and wellbeing for the education, and mental health of children.  He has helped school staff in many districts use data to inform decisions on improving caring and connectedness with students and professional peers.  His work, publications, presentations, and practices have influenced public policy and the development of efficient, family-focused collaborative child service systems.  During his 30 years as a public school psychologist, he worked directly with over 10,000 children and their families as well as trained over 6000 educators. He provided psychological services to children, including those with disabilities and those whose anxiety and mental health problems blocked learning and adjustment.  He assisted teachers and staff in supporting a caring, inclusive school climate for all children.  In 2007, the Maryland Coalition of Families awarded Mr. Dwyer and his wife for their work in making schools more family friendly.  He served as president of the National Association of School Psychologist and was given its highest honor, the Life-time Achievement Award.  In 2000, he received the Tipper Gore “Advocacy award for improving the lives and mental health of America’s children” from the National Mental Health Association.