But Josh Horwitz, executive director of the Coalition to Stop Gun Violence, said he doesn’t think people with mental illness will be stigmatized if they can’t get a gun. “You go to a gun dealer and you fail a background check,” he said. “Unless you broadcast this, how will it stigmatize you?”
Horwitz explains how the federal background check works. In 40 states, people who try to buy a gun from a gun store will have to fill out a federal form asking 10 questions, including age, address, whether the person has ever been committed or “adjudicated a mental defective” – language dating from 1964. In some states, called “point of contact” states, instead of calling the FBI with the information, the gun dealer calls the state police, who route it through the system and do their own background check.
“You need to look at the hardware and the people,” said Horwitz. “You need a varied approach – there’s no one way to fix this. You need to eliminate the most dangerous hardware. And you need to tailor the response so you get people who are more likely to be dangerous than others. This is never going to be perfect.”
In a point-of-contact state, if the prospective gun buyer lies on the form, and the state finds out, that person will be prosecuted, said Horwitz, adding that Virginia prosecutes about 900 people a year for lying on the form. “My suspicion is that the people who get prosecuted are the people who lie about felonies, not about mental illness,” said Horwitz.
But Horwitz said that the background checks don’t always work, and has been a longtime critic of the gun-show loophole, in which private sales do not require background checks. “One of the things the NRA is right about is that these laws don’t get enforced,” said Horwitz.
“We are in the process” of building a consensus on screening and gun violence, said Ron Manderscheid, Ph.D., who with Eric Goplerud launched a field initiative to address guns and violence in the wake of the December 14 Newtown, Connecticut school shooting. They are working on two areas: one is screening for sale or ownership of a rifle, shotgun, or pistol, and the other is examining the issue of duty to report.
“We support that there be screening, but the screening should focus on expressed or intended violence, including the factors that lead to these, which may include mental health or substance use issues,” said Manderscheid, who is executive director of the National Association of County Behavioral Health and Developmental Disability Directors. He stressed that there is gun violence that has nothing to do with mental illness or substance use disorders.
“We will share with the field, and will get input,” said Manderscheid. In general, he thinks that the duty to report should be set up the same way it is for “established surveillance and reporting mandates for child maltreatment, intimate partner violence, and elder abuse.” Instead of developing a completely new process – one aimed only at mental health providers -- he recommends that other entities also have a duty to report. “We believe that the onus should not be on one person, the provider, we still believe that the onus should not be on one person, but there should be a second independent person that does the screening that is required.” For example, in reporting child abuse, teachers are among the mandated reporters, he noted.
Meanwhile, Appelbaum continues to stress this one point: threats of violence, not mental illness, should be the screening focus. In Indiana, for example, the law states that if someone has ever made a threat – regardless of whether they have a mental illness – they are more likely to be dangerous. This is the approach Appelbaum favors. “You need to have an overt act, to show there’s a threat.”