The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.

After nearly every mass shooting, like a merry-go-round, arguments emerge that pin the violence on an individual’s mental illness or the prevalence of extremely lethal guns. Ultimately, boiling it down to one, the other, or even both of those things doesn’t get us anywhere close to the nuance required to understand why gun violence happens.

Linking violent gun attacks and mental illness can stigmatize people with mental health conditions, despite the fact that those with mental illnesses are extremely unlikely to be perpetrators of violence. There are several important myths to bust about this relationship and facts to make clear. 

The Seattle Times reviewed scientific studies, spoke with experts and probed state and federal gun laws to answer basic questions about mental health, gun violence and what we know about the factors that contribute to gun deaths.

What do we know about the relationship between mental illness and violence?

Multiple research studies have found that the vast majority of people with mental health conditions are not violent toward others. It is far more likely that a person with a psychiatric disorder, like depression, will use a gun to hurt themselves than someone else. According to the Centers for Disease Control and Prevention, in 2010, suicide accounted for 61% of gun-related deaths — and most people who died by suicide used a firearm.

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How to find help

If you are experiencing suicidal thoughts or have concerns about someone else who may be, call the National Suicide Prevention Lifeline at 800-273-TALK (8255); you will be routed to a local crisis center where professionals can talk you through a risk assessment and provide resources in your community. More info: suicidepreventionlifeline.org. Or reach out to Crisis Text Line by texting HOME to 741741 for free, 24/7 crisis counseling. More info: crisistextline.org.

Some research suggests that people with serious mental illnesses, such as schizophrenia, are more likely than people without a mental health diagnosis to commit a violent crime, with one study finding a 2.9% risk among those with diagnosed mental illness compared to 0.8% for people with no mental illness. 

But the overall number of crimes committed by people with a mental health diagnosis makes up a tiny fraction of total violent crimes. According to a widely cited 1990 report from the National Institute of Mental Health, people with mental illness committed only 4% of violent crimes. 

The likelihood someone commits a violent crime rises to about 10% when an individual also has a substance use disorder. However, when people with mental illness engage in violent behavior, it’s often for the same reasons as people without a mental health diagnosis: People may feel hopeless and harbor grievances related to work, school, finances or interpersonal relationships.

What risk factors raise a person’s propensity for mass violence?

A couple of key patterns appear in the history of mass shootings in the U.S. First and foremost, perpetrators tend to be men. 

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According to The Violence Project, a nonpartisan research nonprofit, out of 172 mass shooters studied, 95% of them were male. Among school or university-based shootings, male shooters tend to be younger but typically have a history of trauma, bullying, or feelings of rejection. When it comes to race and ethnicity, 52.3% of mass shooters are white, followed by 20.9% who are Black, and 8.1% who are Latino. 

In addition to substance use, some scholars have suggested that people with mental illness may be more likely to be violent when they also grew up in poverty, have been the victim of a crime, experienced early-life trauma, or live in a neighborhood with lots of crime.

What policies are in place to keep people at risk of hurting themselves or others from getting or keeping a gun?

Washington has a handful of gun control laws intended to address concerns about gun violence and the risks individuals might pose to themselves or others. 

One so-called “red flag” law allows officials to remove guns from an individual’s possession — or keep people from purchasing new guns — for one year. When police or loved ones know someone is at risk of killing or injuring themselves or others, they can “red flag” the person by petitioning a Superior Court judge for an extreme risk protection order, or ERPO. Someone under this type of civil protection order is added to the national no-sell list, their guns can be confiscated, and they’re required to give up concealed pistol licenses.

Washington voters led much of the nation in saying guns must sometimes be seized to prevent violence. How’s the law working?
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A second law allows people to voluntarily surrender their gun rights without involvement from the courts. This option allows people who know they might be a risk to themselves or others, such as those with suicidal thoughts, plans or a history of attempted suicide, to waive their right to buy or possess firearms.

Washington restricts gun ownership and access in other ways. The following groups are barred from owning a gun: Children and adolescents under 18, people convicted of felonies, anyone arrested or convicted of a crime of domestic violence, subjects of domestic-violence protection orders and anyone ordered by the court into involuntary mental health treatment for 14 days. Federal law also limits gun ownership and possession, including among people who have been adjudicated by a court as mentally ill or committed to a mental health institution. 

Is it common for people with mental health conditions to go without proper care?

About 22% of adults in Washington experience a mental illness, according to the national nonprofit Mental Health America’s 2021 report, making the state the sixth highest for prevalence of mental illness. Still, nearly 1 in 4 adults in Washington with mental illness report they have not been able to get treatment, often due to lack of insurance or adequate coverage, too few providers and stigma.

Public support is high for increasing access to mental health services, but funding lags at both the federal and state level — and other barriers, such as a workforce shortage, keep people from receiving critical care. 

Mental health resources from The Seattle Times

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In Washington, several bills that sought to reduce shortages in the mental health workforce failed to pass in the 2022 session. Gov. Jay Inslee, who declared a youth mental health crisis in 2021, did approve a budget that gives a marginal increase to the amount of money community behavioral health agencies can get back when they serve clients on Medicaid. He also signed off on $10 million in funding to construct a 16-bed crisis stabilization facility. This summer, a 988 hotline will go live statewide to provide support for people in a mental health crisis.

How does the U.S. compare to other developed nations when it comes to prevalence of mental illness?

According to a 2017 study by the Institute for Health Metrics and Evaluation, when it comes to mental illness or substance use, the U.S. is on par with nations like Spain, Greenland and Australia. The study found that Canada and the United Kingdom had lower rates of mental illness among their populations. 

A 2020 brief from The Commonwealth Fund, a private research foundation, however, found U.S. residents had higher rates of mental illness, could not afford to get help, and were less likely to have a mental health professional on their primary care team than other high-income countries. 

The countries do differ on gun policy, with others imposing stricter gun laws: In the weeks after the 2019 Christchurch mosque shooting in New Zealand, for example, the Parliament banned semi-automatic weapons. Over the next six months, law enforcement bought back over 56,000 weapons. 

Likewise, Australia and Canada have tightened gun regulations. This week Canadian Prime Minister Justin Trudeau introduced legislation to freeze the number of handguns in the country, as well as limit magazine capacity. In countries with mandatory background checks, safe storage laws and other gun regulations, research shows there are fewer mass shootings and lower levels of gun violence. 

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What do we know about the psychological toll of gun violence? 

A recent study from the American Psychological Association found that mass shootings topped a list of possible stressors, with 62% of adults overall — and three-quarters of those in Generation Z — reporting that they’re significantly stressed when mass shootings are in the news. 

This collective sense of stress and insecurity around gun violence is borne out by decades of research. Gun violence can have wide-ranging and serious effects on the mental health of victims and their families, those who live in neighborhoods where they’re often exposed to such violence, and those who consume news or other media when shootings happen. 

Children who witness such violence, for instance, can experience anger or post-traumatic stress disorder, become withdrawn, and become desensitized. Mass shootings also have spillover effects on community members who didn’t experience it, and can damage the well-being of entire communities. A study from 2020 found that mass shootings significantly reduced the probability of a community having “excellent wellbeing,” and that the effects on community health were longer and more severe when the number of victims was high.