Gun Violence, Public Health, and Education

Image by Mimi Shang

Image by Mimi Shang

The shooting at Umpqua Community College in Roseburg, Oregon on October 1, 2015, which killed 9 people and wounded 9 more, brought the frightening reality of mass shootings back into focus. Not that such shootings were out of the public eye for long: on June 18, 2015, nine people were killed at the Emanuel African Methodist Episcopal Church in Charleston, South Carolina.

In their lifetimes, Washington University in St.Louis students have borne witness to several other high-profile mass shootings, including the 1999 Columbine shooting and the tragic events in Aurora, CO and Newtown, Connecticut in 2012.

The effects of gun violence are deleterious enough to warrant special attention from the Washington University Institute for Public Health. Dr. Sean Joe of the Brown School, a professor who has studied homicide and firearm violence, is part of the Institute’s year-long initiative focusing on gun violence.

Though Pew Research Center reports that the rate of homicides in the United States has declined significantly since its peak in 1993, a study in the Journal of Trauma found that it remains significantly higher than in other high-income countries, with 19.5 times as many firearm murders. Joe said, “Our gun violence rate is much higher [than other wealthy nations]. We have greater gun access, which [also] relates to greater illegal acquisition of firearms.”

Despite the decline in homicides, the number of active shooter incidents have increased in recent years. The FBI defines “active shooter incidents” as situations where individuals use firearms to attempt to kill people in a public space, such as a place of business or a school, and excludes shootings that stem from gang or drug violence.

Between 2000 and 2007, an average of 6.4 active shooter incidents occurred annually. Between 2007 and 2013, that number rose to 16.4. 40 percent of these active shooter incidents can be classified as “mass killings,” incidents where the shooter killed three or more people.

Observers tend to agree that something must be done about mass shootings and other forms of gun violence, but there is less agreement about what that should be. Some people advocate gun control; others believe in arming law-abiding citizens to protect against active shooters. Some hold that the abundance of firearms results in more gun violence, while others blame mental illness.

The links between mental illness and mass shooting are complex. It is virtually impossible for psychology and psychiatry to predict if a person with mental illness is likely to commit mass murder. The vast majority of people with serious mental illness never commit a homicide. However, it is clear that intervention has a positive impact. In a study on schizophrenia, it is shown that the rate of homicide committed by those with a psychotic illness is 15 times higher before treatment than after.

Joe, who also studies suicide in Black Americans, agrees that there are links between mental health and gun violence, but it usually manifests as self-harm. “Two-thirds of the gun deaths in the US are suicides, not homicides,” he said. “When you’re talking about mass shooting, clearly there are some psychiatric issues … some [shooters] are not clinically mentally ill, but there’s clearly something psychologically causing them distress, something about their values.”

However, Joe does not endorse the common narrative that mass shooting is a symptom or expression of mental illness. “It’s much more an expression of being socially disconnected …These individuals … found pain in the way they lived their lives. That’s much more salient to me [than mental illness],” said Joe.

Joe is also quick to point out that people with mental illness suffer much more violence than they commit, notably at the hands of law enforcement.

Linking mental illness to mass shootings, especially when done as a “surface political response,” said Joe, can generate additional stigma against people who have mental illness. It can also be used to argue against restricting gun access. “I think at times … people [discussing the role of mental illness] are trying to rule out any role firearms play in the process,” said Joe. “I think when we start to … [understand] that those who are mentally ill can live good lives, that they need support, [this discussion] would not be stigmatizing.”

Though gun availability and mental illness as causes of mass shootings are often presented in opposition, Joe argues that a potential solution should draw on aspects of both viewpoints. “If an individual can’t get the weapon, they can’t use the weapon, but it’s not the major determinant that made them want to engage in mass shootings.” Similarly, he said, mental health is not the “smoking gun to understand gun violence in the US. It’s just one part of the process, and doesn’t fully explain what’s going on.”

Joe advocates a community-based model of violence prevention. “What we really want to work on is how to increase safety planning and counseling,” he said. “There are individuals who might be at risk of harming themselves or others, and it is known that they have firearms in the home. We need their family members to help: when that person is in crisis, keep that individual away from firearms, and maybe at some point return that access.”

Such a model, Joe said, will require training and education in communities. “We have to educate families, hunters, gun clubs, and gun owners, and help them understand when their loved ones are in crisis.” Regular gun safety training should include education on how to remove an individual’s gun access, said Joe.

However, as many mass shooters are socially isolated – is such a model useful? Joe said yes. “These individuals are not fully disconnected from family. There are points of contact, people they’re engaged with; maybe people at the shooting range. We want to make sure that those people are educated and could look for warning signs.”

Joe said one thing is clear: solving the issues of gun violence and mass shootings will take cooperation from academia, government and communities. “We are firm in our understanding [that] we have too many gun deaths and injuries,” he said. “[The initiative is] trying to…create as many common tables as possible to see what innovations we can come up with.”

Urvi is a sophomore from Pineville, NC. She can be reached at

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