Will Mental Health Elements of Gun Law Prevent Mass Shootings?

On June 25, President Joe Biden signed into law the most extensive gun safety legislation in decades. Coming after a rash of mass shootings this year, the Bipartisan Safer Communities Act expands background checks for gun purchasers younger than 21 years and stiffens penalties against so-called straw purchasers, who buy a gun and sell it to someone who is not authorized to own it.

The measure includes $60 million in new funds over 5 years to provide mental health training for pediatricians who treat children and youth. While experts who spoke to Medscape Medical News said they welcomed the new resources, they cautioned that it is unlikely that the measures will end mass shootings.

What these funds and requirements will mean for the daily work of pediatricians is unclear; the American Academy of Pediatrics (AAP) has not yet commented about these provisions. The AAP and the American College of Physicians have expressed support for the legislation overall.

In a June 22 statement, AAP President Moira Szilagyi, MD, PhD, FAAP, said: “Pediatricians have long been advocating for federal policies that will keep children, families, and communities safe. This bill would help work toward that goal by encouraging state red flag laws, improving background checks, and limiting instantaneous sales of assault weapons to 18- to 20-year-olds.”

A congressional aid involved in crafting the legislation said the mental health provisions are broadly written, so pediatricians can implement them as they deem suitable to their communities.

“We see this as a vital and important resource for the care we are already providing,” said Katharine Hoops, MD, MPH, an assistant professor of pediatric critical care medicine and a core faculty member for the Center for Gun Policy and Research at Johns Hopkins University, Baltimore.

“Right now, a majority of pediatric mental health is being done by primary care providers,” added Hoops, who said she hoped that the new law would allow more pediatricians to become familiar with screening tools to identify youth at risk of injuring themselves or others with a gun.

“Providing more resources for clinicians, for pediatricians, for primary care providers to improve the provision of mental health counseling and risk-based counseling is potentially very beneficial,” she said.

But these efforts, whatever their eventual benefits, may not prevent mass shootings.

“There’s no evidence that strengthening pediatric mental health services will prevent mass shootings,” said Amy Barnhorst, MD, vice chair for community mental health at the University of California, Davis, Department of Psychiatry, who is an expert on the health consequences of guns .

Gun violence has become the leading cause of death among US children, government data show. In 2020, 4357 persons aged 1–19 years died from a gun-related injury, more than the number for auto accidents (3913), suffocation (1411), or drowning (966).

But Barnhorst said mass shootings represent no more than 1% of annual gun fatalities in the United States. And there’s no clear profile of what distinguishes young mass shooters from other young people, Barnhorst said. He noted that suicide is a greater risk for this group than being involved in a mass shooting.

“It’s like you have a few sick fish and you dump the antibiotics into the entire ocean,” Barnhorst said.

Barnhorst expressed more enthusiasm for so-called red flag laws ― or extreme risk protection orders ― which are court orders to remove guns from people in imminent danger of harming themselves or others for a limited period. Coupling these orders with mental health support could reduce the rate of youth suicide, Barnhost said. (The law includes $750 million to implement extreme risk protective orders.)

“Youth are more likely to die in a homicide or suicide or by unintentional injury than a fatal mass shooting,” Hoops said. She noted that one seemingly simple step to prevent tragedies, albeit one that is not always followed, is to store guns separately from ammunition.

“All of these are preventable deaths, and all are important to prevent,” Hoops said.

Hoops is a national spokesperson for the AAP but was not involved in drafting the legislation. Barnhorst reported no relevant financial relationships.

Marcus A. Banks, MA, is a journalist based in New York City who covers health news with a focus on new cancer research. His work appears in Medscape, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, TCTMD, and Spectrum.

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