1. Comments: Guns, Mental Illness, and Violence Philip J. Cook Duke University San Francisco APHA meeting 10-29-12

2. Presenter Disclosures “no relationships to disclose”

3. A. Is mental illness associated with crime and violence? 1.New Connecticut data (Jeff Swanson) Of those who received services in public MI system 20% had felony conviction 21% convicted of violent crime (One comparison: 4% of Illinois adults have felony) 2. International data (18 HICs; Large et al 2009) ~7% of homicides committed by schizophrenics Similar proportion regardless of overall rate!

4. B. Is gun disqualification predictive of violence and crime? Logic says yes: 1.Involuntary commitment usually based on (imminent) danger to self or others 2.“Adjudication” often tied to court proceedings for commission of crime 3.California law (Renee Binder) Dangerous to self or others  72 hour hold  ban on guns for 5 years

5. Regression Results for CT data Sample: Hospitalized for MI Result: no difference in gun crime for involuntary vs voluntary hospitalization But: criminal record and substance abuse are both strong predictors of gun involvement

6. C. Does MI disqualification save lives? Logic for ban: SMI 1  Disqualification 2  NICS 3  no gun Link 1. Haphazard at best Link 2. MI records now a majority of NICS records (excluding aliens) but incomplete Link 3. Only stops acquisition if from licensed dealer. (Rare but increasing – Josh H)

7. CT results Jeff’s preliminary findings on gun crime: For disqualified mental patients, post-NICS likelihood < pre-NICS The point estimate is quite large but n.s. What about other evidence?

8. Evaluation of Brady Act (Ludwig-Cook JAMA 2000) First set of provisions (2/94 to 12/98) Only affects handgun sales by federally licensed dealers. 32 states are affected. The others already meet the minimum requirements. Dealers must initiate a background check and observe a waiting period of 5 working days.

9. Brady Handgun Prevention Act Second set of provisions (12/98) All types of guns are included. Dealers must conduct an “instant” check directly, using state and/or FBI systems. If there is any question, the default is to transfer the gun after 3 days.

10. Adults (25+), Gun Homicide, Brady Treatment vs. Controls

11. Adults (25+), Gun Suicide Brady Treatment vs. Controls

12. Conclusions from Brady Act Discouraging results – no discernible effect on gun violence Plausible explanations 1. incomplete records 2. informal market is not regulated & provides a huge loophole Have improved MI records since 1990s made it more effective?

13. What now? The logic for ban is sound: Speaks for itself: “dangerous to self or other” or “not guilty by reason of insanity” But no direct empirical evidence that ban is effective. (That may change) What do we require of the evidence in this case? Ban unless evidence  “safe” No ban unless evidence  “dangerous”