Aug. 6, 2019 -- Although experts agree with President Donald Trump's condemnation of this weekend's two mass shootings in El Paso, TX, and Dayton, OH, many criticized his contention that mental illness is linked to gun violence and his characterization of psychiatric patients as "mentally ill monsters."
"Mental illness and hatred pulls the trigger, not the gun," Trump said during a Monday news conference.
In response, the American Psychiatric Association (APA) quickly issued a statement saying the "overwhelming majority" of people with mental illness are more likely to be victims of violent crime than to carry it out.
"Rhetoric that argues otherwise will further stigmatize and interfere with people accessing needed treatment,” the organization said, adding that Trump’s words can encourage others to act violently.
Discussing the need for new legislation for dealing with mass shootings, Trump said that coming up with solutions is "not up to mentally ill monsters, it is up to us."
Renee Binder, MD, a professor and director of the Psychiatry and Law Program at the University of California, San Francisco, says these types of shooters are "highly disturbed in some way or another," but there is not a strong connection between mental illness and violence.
"It's correlated with people who are angry and see violence as a solution. And that's not the same thing as saying 'mentally ill,' which has a very specific definition," Binder says.
In addition, using the term "monsters" to describe people who have mental illness "does a lot of harm," she says. "There's already so much stigma against people who have a diagnosis of mental illness."
Binder, a past APA president, was the senior author of an article published last year in JAMA Psychiatry titled, "A Reassessment of Blaming Mass Shootings on Mental Illness."
In the article, the authors say this type of attribution "distracts public attention from policy changes that are most likely to reduce the risk of gun violence."
They add that research shows that people who have psychiatric conditions commit only about 4% of criminal violence and that "violence perpetrated by individuals with serious mental illness is rarely lethal."
"Although the paper is a year old, I would still agree with everything in there," Binder says.
"Who does these types of crimes? I'd say they're very angry; they have a grievance against something; they may have some links with an extremist group; they may want to make a name for themselves," she says.
"The problem with labeling everything 'mental illness' is that it stigmatizes people who have a mental disorder ... and who would never be violent," she says.
"We vow to act with urgent resolve," Trump said of the two mass shootings, which occurred less than 24 hours apart.
The death toll from Saturday's shooting in El Paso now stands at 22; another 22 people were injured. The shooting in Dayton early Sunday killed nine and injured 27.
In addition, a shooting at the Gilroy Garlic Festival in California on July 28 resulted in four deaths and 13 injuries. Also, as reported by Medscape Medical News, at least seven people were killed and 48 were injured by guns in Chicago this past weekend, forcing Mount Sinai Hospital to temporarily stop accepting patients because it had no more room.
Trump said he will direct the Department of Justice to work with state and federal agencies and social media developers to create tools to identify mass shooters "before they strike." He also noted that many shooters, including the one who killed 17 students and staff members last year at Marjory Stoneman Douglas High School in Parkland, FL, displayed several "red flags."
"This is why I have called for red-flag laws, also known as extreme risk protection orders," he said.
But, he added, mental health laws need to be reformed "to better identify mentally disturbed individuals who may commit acts of violence and to make sure those people not only get treatment but, when necessary, involuntary confinement."
Binder says that these so-called red-flag laws sound like a good thing, in certain circumstances.
"It means guns should be taken away from people who are thought to be dangerous, at least temporarily; and that danger could be because they're involved with domestic violence, they're suicidal, they're intoxicated, or they've posted things on one of the social media sites. You don't want someone like that to have easy access to firearms," she says.
Asked whether she had concerns that a plan to identify "mentally disturbed individuals" could turn into identifying anyone with mental illness, and upping the associated stigma, Binder again stated that "what we typically call 'mental illness' is really not correlated" with doing something violent.
Binder says it would be difficult for people who have mental illness to do these types of crimes because of the need for organization and preplanning.
"This really has nothing to do with severe mental illness," she says.
In a statement, the American Psychological Association agrees with Binder.
"Blaming mental illness for the gun violence in our country is simplistic and inaccurate and goes against the scientific evidence currently available," said Arthur C. Evans Jr., PhD, who is CEO of the organization.
"There is no single personality profile that can reliably predict who will resort to gun violence. Based on the research, we know only that a history of violence is the single best predictor of who will commit further violence. And access to more guns, and deadlier guns, means more lives lost," he says.
Evans noted that the president's call for identifying and acting on red flags "requires research to ensure we are making decisions based on data, not prejudices and fear."