Falling through the cracks: the decline of mental health care and firearm violence

Abstract

Background: This paper argues that the decline in the availability of long-term, intensive mental health services, particularly through state mental health hospital systems, has had negative impacts on firearm-related deaths and possibly on the incidence of mass shooting events.

Aims: Establish the effect of reduced availability of long-term, intensive mental health treatment on firearm-related violence in the United States.

Method: Ordinary least squares regressions on cross-sectional data of US states.

Results: Mass shooting perpetrators had significantly higher rates of mental illness than the general population. In addition, using simple regressions, this paper’s results demonstrate that increasing the number of state psychiatric hospital beds is associated with lower rates of homicide.

Conclusions: The shrinking number of intensive, long-term mental health facilities in US states has had many negative consequences, including higher rates of firearm homicide.

Keywords:

• State psychiatric hospitals
• mental healthcare
• firearm violence

Acknowledgements

I would like to thank the Treatment Advocacy Center for making their data and reports easily and freely available. I would also like to thank Madeline Hintz, Ed Berisha, and two anonymous referees for helpful comments.

Declaration of interest

No potential conflict of interest was reported by the authors.

Notes

¹ See the NYT article: http://www.nytimes.com/2016/06/24/us/politics/senate-gun-control.html?_r=0.

² The data is available to the public at: https://library.stanford.edu/projects/mass-shootings-america.

³ The report is available at: http://www.treatmentadvocacycenter.org/storage/documents/no_room_at_the_inn-2012.pdf.

⁴ For 2005 beds per 100,000 citizens, population data from the 2000 U.S. Census is used instead of projected 2005 data as the census is only available on a decade basis.

⁵ All data and results are available upon request.

⁶ This is also consistent with cultural explanations of violence such as Markowitz and Felson (1998).