Public Health, safety

22. A Pediatrician’s Recommendations for Decreasing Gun Violence in America

Part One: How to Decrease Gun Violence in America

Several weeks ago, my niece in Guilford, CT called me sobbing after her high school friend was killed by a bullet; two boys had been messing around with a father’s gun, and one teen accidentally shot himself in the head. Following this tragedy, the Parkland, Florida massacre occurred on Valentine’s Day, 2018.  In this country gun violence is everywhere, and it occurs continuously.  Our nation has lived through the horror of Aurora, Newtown, San Bernardino, Orlando, Los Vegas, etc. The list goes on and on. Every day, about seven children are killed by guns in the US. Though we don’t always hear about them, small-scale tragedies (like the one in Guilford) should elicit the same outrage as bigger ones. Every human life is precious, and too many have been lost to gun violence. Enough. No more useless thoughts and prayers. No more young lives cut short. The time has come for action. Significant regulatory change must occur on a national level. What can our government do to improve the situation? Plenty, and here are some suggestions:

  1. Follow Australia’s example. Ban the sale of AR-15s and other semiautomatic weapons for civilian use. There is no reason the public needs weapons designed to produce a high body count. Newsflash, the zombie apocalypse isn’t happening anytime soon. Hold gun dealers responsible if they break the law.
  1. Prioritize national values. The Declaration of Independence describes our inalienable rights, “Life, Liberty and the Pursuit of Happiness.” Organizations like the NRA have become so blinded by the idea of protecting one liberty—gun ownership—that they have lost sight of the more important concept, life. Without life, there can be no liberty or happiness.
  1. Organize a buy-back program to collect assault rifles and other weapons that have already been sold. This may sound farfetched, but colleges could offer free courses to young men and women who voluntarily return weapons, no questions asked. Federal subsidies could be provided to support these types of creative buy-back programs.
  1. Establish a nationally recognized, strict application and licensing process to own a weapon. Like Australia, enforce a 28-day waiting period for firearm sales.
  1. Streamline the background check system with one national database. Require background checks wherever guns are sold, including gun shows. Update gun licenses yearly for a fee. Integrate mental health histories into the database.

The latter is much trickier than it sounds, and I welcome suggestions on this issue. Millions of Americans struggle with psychiatric problems. How do we decide which people are too unstable to receive weapons? Should mental healthcare providers be required to anonymously report the names of patients at high risk for committing suicide or murder? What if someone wants to buy a gun, but his name has been unfairly flagged in the database; what recourse would he have? While there are no easy answers to these questions, they must be addressed on a national level if we are going to rise above gun violence.

  1. Require gun applicants to pass tests on the following subjects before receiving a weapon:

-proper gun storage

-proper gun usage

-infant through adult CPR

-personal mental health, in the form of a screening questionnaire

  1. Disqualify gun applicants with a history of domestic violence, psychiatric problems, and criminal prosecution. Close loopholes through which high-risk buyers can slip—such as those who have been prosecuted but not yet convicted.
  1. Encourage the development of “smart guns” that recognize the fingerprint/retina/DNA of the original buyer. Smart gun technology would have prevented the Sandy Hook massacre and countless other tragedies.

Gun owners frequently complain that smart guns might fail in high-risk situations. Given current technology, this may be true, but statistics show that guns are rarely used in self-defense. Furthermore, guns don’t make American homes safer; rather, multiple studies indicate that guns dramatically increase the risk of homicide, suicide, and unintentional injury for family members. Incidentally, in Australia gun applicants are required to offer a “genuine reason” for needing a gun, and self-defense is not considered a justifiable reason.

  1. Develop reliable, non-fatal, bullet-free weapons for use by law enforcement.
  1. Ban guns from public facilities, including stores, schools, offices, hotels, churches, restaurants, car washes, movie theaters, etc. Improve security in vulnerable public locations, such as grade schools. For the record, arming teachers is NOT a feasible way to improve security; as far as I can tell, shooting people has never been part of a teacher’s job description, nor should it be. The last thing I’d want in any child’s classroom is a gun.
  1. Allow federal agencies to study gun violence and develop creative solutions for effecting positive change. Since 1996, the Dickey Amendment has prevented the CDC from studying gun violence. For the past 20+ years, strides have been made in all other areas of American public health, but not in the arena of gun violence. Why not? Because the NRA has remained enmeshed in highest levels of our government. If progress is to be made, this needs to change.
  1. Set age 30 as the minimum for purchasing a gun. Most people with schizophrenia present with the disease between age 16 and 25. Those with bipolar disorder generally develop symptoms between 20 and 30. By age 30, therefore, most organic psychiatric conditions will have surfaced.
  1. Invest in public school systems. Subsidize programs to hire more child psychologists, especially those trained in neuropsychological testing. Identify children with learning disabilities and social problems at the earliest possible age. Improve support services for the children and families who need them.

Part Two: The Complex Relationship Between Gun Violence and Mental Health

Although the NRA and our current administration have emphasized poor mental health as a primary cause of gun violence, many people who commit homicide have no psychiatric history. Although these individuals may completely lack empathy, they aren’t necessarily insane. A boy who feels culturally marginalized (from school failure, bullying, poverty, gang violence, divorce, abuse, racial/ethnic discrimination, inability to obtain higher education, lack of a decent job, etc.) might grow up to become an angry young man. Unfortunately, there is no way to predict which disgruntled people are going to carefully plan a school attack and purchase an AR-15, which is why unfettered access to deadly weapons is so problematic.

On a national level, addressing the causes of cultural marginalization will help to avoid retaliatory violence. At home, one strategy parents can employ to protect the emotional welfare of children is limiting digital exposure. Studies have shown that teens exposed to more than two hours of screen time daily (including cellphones, computers, iPads, etc.) have higher rates of depression, social isolation, and suicidal ideation.

In Congress and across the country, voices are clamoring for better access to mental healthcare; indeed, this is a critical issue in America, where psychiatric problems are ubiquitous. Nearly 20% of adults and 10% of children—a whopping 43 million people—suffer from mental health issues, the most common of which are anxiety and depression. Here lies the crux of the problem as it relates to gun violence. Anyone suffering from depression (which is a lot of people) can have a bad day, grab the gun they’ve been keeping at home, and act impulsively. If a gun is easily available, such acts are more likely to be fatal—either for the gun owner or family members. Intentional gun-related deaths, therefore, stem from a combination of human emotional problems and access to weapons—not one or the other. Acknowledging this relationship is essential to decreasing gun violence.

How can our nation improve access to mental healthcare? We need to establish a single payor, national healthcare system with universal coverage for all Americans. In addition, we must restructure insurance reimbursements to medical providers. Procedure-oriented doctors often receive inflated payments for services, whereas mental healthcare providers tend to be under reimbursed. Not surprisingly, inequitable reimbursement has led to a critical shortage of mental healthcare providers. Those who enter the field won’t necessarily accept insurance, and most patients can’t afford to pay exorbitant out-of-pocket fees. Regardless of access to care, it is important to recognize that psychiatric problems are intrinsic to the human condition and won’t be eradicated anytime soon. Nor will every person with a psychiatric condition seek or be compliant with treatment.

In summary, the relationship between gun violence and mental health in this country distills down to three root causes: cultural marginalization, organic psychiatric problems, and easy access to weapons. On a national level, legislative changes can, and should, be made to address these issues. But let’s be clear about one thing: unbridled access to weapons, especially AR-15s and other semi-automatic weapons, is the easiest point to address within the triad.

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