To the editor:

If we are going to discuss gun violence and mental illness, we must start with the fact that mass shootings are rare: They accounted for less than one-fifth of one percent of the homicides in this country between 2000 and 2016. Gun deaths on the other hand happen every day, most of them suicides. In 2017, we had the highest number of gun deaths since 1968 at 39,773 deaths. Two-thirds of them were suicides.

Every time there is a mass shooting, too many people blame it on mental illness. No one who is sane would do such a thing, they say, so the perpetrator must be mentally ill. Mental illness is not a vague term, but rather a whole group of brain-related health conditions that can be diagnosed and treated. People with a mental illness are far more likely to be victims of crime than they are to commit crimes; they account for about 4 percent of violent crime in the United States.

In a study of 63 active shooters and how they behaved before the shooting, the FBI concluded that 16 had a confirmed diagnosis of mental illness. Those doing the study noted that statements that all active shooters have a mental illness “are misleading and unhelpful.”

So, who are these mass shooters? Data tells us they have varied backgrounds, are mostly male and often have a strong sense of injustice. They feel they have been treated unfairly by society and that no one cares. They may have problems with authority and openly admire mass shooters. They may be seeking revenge and are stressed by a variety of factors including finances, jobs, relationships, the abuse of drugs and alcohol, sexual distress or the stress of caregiving.

They probably believe that violent action is an answer to their problems, have a target in mind, access to the weapons they need and no moral or ethical constraints. They may spend time on the internet talking about their grievances, searching out groups of like-minded individuals or they may be a lone wolf going his own way.

Despite the descriptions of potential shooters, there are no accurate predictors of future violence. So what do those of us who care about mental health do both to protect the vulnerable and lessen the violence? Become advocates for rational solutions to the problem of violence and respond to this national moment of fear and unease to make changes.

One obvious way to lower the number of gun deaths is to take weapons away from those who are at risk of committing suicide or doing violence. Several states have already passed what are known as red flag laws, or, more accurately, extreme risk protection orders. What the order does is temporarily take away any guns from someone who is deemed to be at risk to themselves or others. The law needs to be fairly written to protect a person’s rights, but when properly done can save lives without harming an individual’s liberty.

Another way to save lives is to have universal background checks that eliminate all loopholes. Databases need to be improved with every state cooperating by providing information that can not only keep guns out of the hands of felons but those with a severe mental illness who may be dangerous to themselves or others.

We must insist on better funding for mental health programs, particularly community-based programs.

A MacArthur Violence Risk Assessment showed increased potential for violence when mental illness is accompanied by substance use disorder. The answer is comprehensive treatment both inpatient and outpatient, the use of medication-assisted treatment and drug courts to send people to treatment instead of jail. In some cases, the drug use is known but not the underlying mental illness. Both need to be treated.