Mental Health Matters . . . in Violence & Suicide

[Ed: This is the text of Dr. Young’s presentation to the Second Amendment Foundation’s 2022 Gun Rights Policy Conference October 2, 2022. The video is posted here, beginning at 1:46:45.]

We need to be concerned about ALL violence, not just with firearms because guns are NOT the issue.  Gun owners and those with mental illness are stigmatized by the ignorant. We must challenge the perception that either guns or mental illness are primary problems, while doing everything we can to prevent tragedies.

Only 4% of violent crime can be attributed to the perpetrator’s mental illness. People with MI are far more likely to become victims of violence than to commit it. 10% of Americans have some psychiatric illness at any point; 50% during our lifetimes.

Blaming psychiatric medications for violence is a red herring. Good treatment is almost always effective. The issue is that the mental illness worsens, or treatment is inadequate. Worry about people who are NOT in treatment at all, not those who are.

Criminal Violence

A large portion of criminal violence is due to drug culture– gangs, dealers, and addicts desperate to buy more. Addictions are also psychiatric problems – genetically based & very treatable now.

Career criminals have antisocial personalities (sociopathy) – others don’t matter, only their own desires. They are only influenced by consequences. Antisocial criminals end up incarcerated if not dead. Later in life, they may have learned that they can’t just get their way and acting out diminishes.

Serial killers are psychopaths. They also don’t care about others – and they enjoy others’ pain, distress and humiliation. In childhood, they were often kids who tortured animals and set fires. Nothing changes them, and their drive to harm others does not diminish. They can only be kept away from society.

Both sociopathy and psychopathy are genetically grounded, reinforced through developmental experiences.  Incarceration and protecting ourselves are the only practical interventions.

Community intervention can help reduce local violence. These programs are directed at those most likely to be attacked, who happen also to be those most likely to attack. For example, urban gang members and drug dealers.  

Means substitution occurs in aggressive violence —criminals use whatever tools they can, For example, “knife violence” in the UK has dramatically increased since self-defense with firearms has been essentially prohibited, even if one does have a gun.

Mass Killers (including School Shooters)

These are actually the least of these problems in frequency and casualties, less than 1% of criminal violence. But these attacks are the most publicized and scariest to us. The perpetrators ordinarily have poor social skills. They feel and are socially inadequate, they get bullied and so pull back from socialization and become reclusive. For example, the Newtown killer reportedly had significant autism. (Let’s remember that most people with autism are just shy introverts who would never hurt a fly.)

Half of mass shooters apparently had some psychiatric attention. Severe mental illness may be involved: The Colorado movie theater shooter had schizophrenia with delusions and hallucinations pressuring him. In the 1960’s, the University of Texas clock tower shooter had been a fine, upstanding young man, who developed irresistible compulsions to kill others, to his own distress. On autopsy, he was found to have a growing brain tumor.  

The young men who assault students, often their peers, are usually trying to avenge personal grievances. Almost all have been bullied (typically at that school), some define themselves as “incels” (rejected “involuntary celibates”), and there may be racism, homophobia or other disturbing beliefs.

Recent work proposes that underlying their hostility and desire to destroy others is likely unrecognized, untreated depression. With limited internal resilience and feeling nowhere to turn, they become suicidal. With nothing to look forward to in life, they feel that it isn’t worth living, for them or anyone. This nihilism decides them to take out others with them, because it is the only recognition they believe they will get in life. The relief this affords makes killing easier, culminating in their own suicide. But this also means that intervening in their initial depression can short-circuit the cascade of calamity.


This is by far the biggest issue in America’s violence. Like any violence, it is an outcomeof multiple factors. 2/3 of shooting deaths are suicides, and half of all suicides are committed by gunshot. Gunshot is a highly lethal, and this number of deaths comes from just the 5% of suicide attempts in which guns are used. But hanging, jumping, throwing oneself into traffic, crashing one’s car and drowning all are readily accessible and can be just as deadly.

People typically develop suicide plans with specific means; the final act may be impulsive.  Means substitution doesn’t typically happen as an individual shift of method. But different cultures have characteristic preferences. For example, in Japan hanging is the method of choice, in South & Southeast Asia it is household poisons.  It is no surprise that with the prevalence of guns in America they are used so much as tools for suicide. If all guns suddenly disappeared from the United States, many lives would subsequently be lengthened. But I expect that our overall suicide rates would not change over the long run just because of that, because people would move to using other means with that cultural change.

Because any of us can kill ourselves at any time, intervention can be urgent & prevention vital.  Suicide is nearly always preventable because the belief that one must die almost always comes from perfectly treatable depressive illness or delusional thinking. Chronic or recurrent illness increases lifetime risk of suicide, so continuing treatment can be necessary.  

Suicidal people, like mass killers, almost always give clues to their frame of mind & intent. There are far more suicide attempts than deaths; the 95% of attempts that don’t kill typically involve less lethal means and are done in circumstances that confer a better chance of rescue.

Red Flag Laws (or Emergency Protection Restraining Orders)

These are billed as a way to keep people in crisis safe from suicide or doing violence to others. None of those in force are fair or effective:

  • There is no due process ensuring that the accused can face the accuser or present his side.
  • The initial period of confiscation can last up to a year without appeal.
  • The subject must pay for representation to contest the confiscation.
  • Penalties for false accusations don’t match the impact of a wrongful action.
  • Storage of confiscated firearms is usually haphazard, with damage often done.

Two problems are the most serious in relation to the risk of suicide:

  • Only firearms are subject to confiscation, not any other weapons or dangerous tools.
  • There are no requirements for psychiatric evaluation if the subject is not considered criminal.

Data so far shows no significant benefit to these laws. We can’t tell how many lives may have been saved, but we know that a few lives have been lost in their execution (just as with no-knock warrants). In all states, with reasonable cause, law enforcement can either criminally arrest someone or transport him to a hospital for psychiatric attention. Weapons can be separated from a subject when required. The only reason for these gun confiscation laws is to confiscate guns. Fear of that keeps many gun owners from seeking help when they could.

How can we help as a gun rights community?

We can speak to firearms enthusiasts credibly, confronting the stigma of mental illness and promote treatment. Showing our caring & compassion also counters the bloodthirsty image the anti-s tar us with.

There are a number of helpful programs coming out of the Second Amendment/firearms world:

  • WalkTheTalkAmerica, founded by Michael Soldini, works to raise awareness of depression, suicide & violence risk in the firearm community.
  • SaferHomes is SAF’s collaboration with Washington State experts. They show how gun owners can keep their homes safe, and train advocates & gun owners to help each other.
  •  Voluntary Do-Not-Sell lists are bills that legislatures in Washington, Virginia and Utah have passed laws that enable gun owners to temporarily register to not be allowed to buy a firearm for whatever period of time they choose.
  • HoldMyGuns, founded by Sarah Joy Albrecht and Genevieve Jones promotes temporary, voluntary storage of existing firearms at FFLs, and educates them in recognizing suicide risk. Similar work done by NSSF, and in New Hampshire and a few other states.  
  • FasterSavesLives, led by Jim Irvine, arranges training of school personnel to carry concealed, and be prepared to fight off attackers and give emergency trauma care. This is prevention, not just intervention, because once a school is known to have such staff ready, attackers choose less well defended places.

What can individuals do?

We can use our situational awareness to intervene compassionately. Because people give clues about being depressed or angry & their potential to commit violence or suicide, those close to them are likely to recognize a problem. Families, friends, co-workers, teachers, pastors – any may be confided in, notice worrisome behaviors, or sense a risk.

Ask about their frame of mind – asking does not promote acting out. It opens a path toward hope. The person wants help or wouldn’t show clues; otherwise, they’d already be dead. They just don’t know what to do. Be empathic, supportive, encouraging. Be gently persistent in persuading the person to get help & help them find it.

Where, one might wonder? Ask about evaluation & treatment options from any health care provider, mental health agency or the Mental Health Association. There usually local hotlines. Learn about these options in case you need to use them. The National Suicide Prevention Hotline is now 988. If danger seems imminent, call 911. Your loved one will thank you later.



Robert B Young, MD

— DRGO Editor Robert B. Young, MD is a psychiatrist practicing in Pittsford, NY, an associate clinical professor at the University of Rochester School of Medicine, and a Distinguished Life Fellow of the American Psychiatric Association.

All DRGO articles by Robert B. Young, MD