Could New Mental Health Tech Tackle Gun Violence?
Construing and ignoring the evidence-based link between gun violence and mental health is costing lives—although the connection may not be what you are thinking. New mobile mental health tech can meet the high demand for gun prevention research in the development of data-driven policies and gun violence prevention strategies, be a key instrument in driving down currently devastating gun violence statistics, and as a population-level solution, could save 1000s of US lives every year.
Mental Health and Gun Violence – What is the connection?
Media accounts of mass shootings galvanize public attention and reinforce the erroneous yet popular belief that mental illness often results in violence. However, research solidly and consistently posits that the overwhelming majority of people with serious mental illnesses are NEVER violent.
Taking accidental firearm deaths and robbery at gunpoint out of the equation, we cannot deny a relationship, although far from black and white, between mental health (and drug addiction) and gun violence, in terms of both suicide, intentional homicide, and other gun violence towards others.
1. Suicide: In many countries, death by suicide is the biggest non-medical killer of a number of age groups (overwhelmingly men). In the US, however, according to a report by the Brady Center to Prevent Gun Violence, suicide by gun is the method of choice, where nearly two-thirds of all gun deaths (~20,000) are suicides with guns. Meanwhile, multiple psychological autopsy studies (i.e., involving interviews with those that knew the deceased), agree that ~90% of people committing suicide have signs of mental illness.
Although multiple research studies, reviews, and meta-analysis highlight that the sheer number of guns in the US, topping the World charts for most guns per capita, inflates the number of suicides because of easy access to guns during suicidal episodes, the mental health care crisis and access to care is also a huge part of the problem.
2. Intentional homicide and gang violence: Intentional homicide accounts for nearly 1/3 of America’s annual gun-related deaths (estimated at 11,000 in 2016).
Recent criminology research has indeed found that while America hosts only 5% of the world population, it has 31 percent of the total shooters from 171 countries. Mass shootings (when defined as incidents where four or more people died), although disturbingly newsworthy and more common in the US, according to an FBI data analysis, they accounted for less than 1 percent of homicide victims in 2010. In other words, focusing on mass shootings is not a choice gun violence prevention strategy to vastly reduce the high number of people intentionally killed by guns in the US.
The driving force behind gun-related homicide is gang crime, a staggering ~80% of gun homicides are gang-related, where poor youth mental health is a key driver of gang membership, and untreated depression and other mental health problems tends to worsen after becoming a member, along with an increased appetite for violence and substance abuse.
Behavioral Medicine is Reviving Evidence-based Gun Violence Prevention
Despite gun violence being a leading cause of injury and death in America, and firearms injuries matching car accidents as the leading causes of non-medical deaths, analysis of the Federal RePORTER database revealed that gun violence and gun violence prevention is the least-researched cause of death and the second-least-funded cause of death.
To remedy these research restrictions the Society of Behavioral Medicine published an official statement in the February 2018 issue of the Translational Behavioral Medicine journal, urging the 1996 Dickey Amendment ban on the Centers for Disease Control and Prevention (CDC) funding for firearms and gun violence prevention research be lifted.
If mobile health (mHealth) and behavioral change researchers and innovators have their way, mental and behavioral health tech-based interventions that provide an ideal route to generational change will be leveraged to target the main sources of US gun violence rates—suicide and gang-related homicide.
Gun Violence Prevention with Augmented Mental Health
Improving Mental and Emotional Health Via Unrivaled Early Prediction, Detection, Intervention, and Instant Mental Health Care Access
Leading the charge for mental health change in the mHealth industry, augmented mental health tools employing cutting-edge developments in mental health monitoring with affordable smart tech, i.e., mobile phones, smartwatches, and other affordable wearables, are the optimal mHealth solution.
The key concept behind augmented mental health systems and practices centers around the Internet of Medical Things (IoMT). As the latest mental and behavioral health paradigmes, augmented mental health allows for the provision of real-time, responsive, and remote mental health care services using mhealth technology by i) utilizing previously unobtainable objective mental health data for ii) timely delivery of personalized mHealth interventions for mental and behavioral health management.
The Ideal Suicide Prevention Tools Need To Be Objective!In states that enacted mental health parity laws, suicide rates declining by 5% in the first 2 years indicates it was truly life-saving, yet Medicaid expansion can only do so much in the midst of a mental health care crisis.
Mental health specialist shortages mean increasing wait times to access in-network psychologists and psychiatrists and can even take months (e.g., 50 days median wait time for adolescent psychiatry in Ohio)—which does nothing for those who are at high risk of suicide.
Considering that most that commit suicide make initial attempts to access mental health care prior to their death, there is a truly priceless window of opportunity to save lives. Augmented mental health systems, can be used to remotely monitor the emotional state and mental health of those at-risk in real-time. Using advanced mHealth apps, real-time mental health status can be coordinated with 24/7, and immediate access to appropriately stepped care and support, including the real-time provision of personalized interventions, as and when needed.
Simply by asking users about their positive and negative mood using an automated mHealth questionnaire obtained 88% sensitivity and 95% specificity in predicting elevated suicidal ideation in those with bipolar disorder one week prior to in-person clinician assessment.
However, when an estimated 80% hide their suicidal thoughts from doctors and therapists during their last visits, objective remote monitoring of suicidal patients is clearly critical. Far less advanced than today’s emotion recognition capabilities, the real-time objective monitoring of emotions from physiological signals that is used in the latest augmented mental health systems will undoubtedly be able to predict suicidal ideation in the immediate future.
Augmented Mental Health: A Population-Level Solution to Gun Violence
Augmented mental health holds great potential in generating sweeping population-level changes in gun violence—targeting intentional homicide and suicide—and also in collecting big data for data-driven development of policies and gun violence prevention strategies, outside of CDC restrictions.
Through promoting mental health tracking in schools and youth projects (particularly in areas where gang crime is high), and as part of the health insurance plans provided by employers (who insure 55.4 percent of the population) or the government (who insure 35.5 percent of the population through Medicare and Medicaid), the top contributors to gun violence—gang crime and suicide—can be strategically targeted without entering the political and legislative battlefield that is US gun control.
Ahonen, L., Loeber, R., & Brent, D. (2017). The Association Between Serious Mental Health Problems and Violence: Some Common Assumptions and Misconceptions. Trauma, Violence, & Abuse, 152483801772642. http://dx.doi.org/10.1177/1524838017726423
Anglemyer, A., Horvath, T., & Rutherford, G. (2014). The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis. Annals Of Internet Medicine, 160(2), 101-10.
Behrman, P., Redding, C., Raja, S., Newton, T., Beharie, N., & Printz, D. (2018). Society of Behavioral Medicine (SBM) position statement: restore CDC funding for firearms and gun violence prevention research. Translational Behavioral Medicine. http://dx.doi.org/10.1093/tbm/ibx040
Brady Center to Prevent Gun Violence. (2016). The Truth About Suicide & Guns (p. 2).
Hepburn, L., & Hemenway, D. (2004). Firearm availability and homicide: A review of the literature. Aggression And Violent Behavior, 9(4), 417-440. http://dx.doi.org/10.1016/s1359-1789(03)00044-2
Lang, M. (2011). THE IMPACT OF MENTAL HEALTH INSURANCE LAWS ON STATE SUICIDE RATES. Health Economics, 22(1), 73-88. http://dx.doi.org/10.1002/hec.1816
Lankford, A. (2016). Public Mass Shooters and Firearms: A Cross-National Study of 171 Countries. Violence And Victims, 31(2), 187-199. http://dx.doi.org/10.1891/0886-6708.vv-d-15-00093
Mayors Against Illegal Guns. (2013). Analysis of Recent Mass Shootings.
Melia, R., Francis, K., Duggan, J., Bogue, J., O'Sullivan, M., Chambers, D., & Young, K. (2018). Mobile Health Technology Interventions for Suicide Prevention: Protocol for a Systematic Review and Meta-Analysis. JMIR Research Protocols, 7(1), e28. http://dx.doi.org/10.2196/resprot.8635
Nielssen, O., Bourget, D., Laajasalo, T., Liem, M., Labelle, A., & Hakkanen-Nyholm, H. et al. (2009). Homicide of Strangers by People with a Psychotic Illness. Schizophrenia Bulletin, 37(3), 572-579. http://dx.doi.org/10.1093/schbul/sbp112
Nestadt, P., Triplett, P., Fowler, D., & Mojtabai, R. (2017). Urban–Rural Differences in Suicide in the State of Maryland: The Role of Firearms. American Journal Of Public Health, 107(10), 1548-1553. http://dx.doi.org/10.2105/ajph.2017.303865
Salvatore, T. (2015). Do 90% of Suicide Victims Really have Serious Mental Illness? Psychological Autopsy Studies, Psychopathology, and Suicide. Exploring The Impact Of Key Axioms On Direction Of Suicide Prevention. http://dx.doi.org/10.13140/RG.2.1.1089.7444
Swanson, J., McGinty, E., Fazel, S., & Mays, V. (2015). Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Annals Of Epidemiology, 25(5), 366-376. http://dx.doi.org/10.1016/j.annepidem.2014.03.004
Thompson, W., Gershon, A., O'Hara, R., Bernert, R., & Depp, C. (2014). The prediction of study-emergent suicidal ideation in bipolar disorder: a pilot study using ecological momentary assessment data. Bipolar Disorders, 16(7), 669-677. http://dx.doi.org/10.1111/bdi.12218
Watkins, A., & Melde, C. (2016). Bad Medicine. Criminal Justice And Behavior, 43(8), 1107-1126. http://dx.doi.org/10.1177/0093854816631797
Zuberi, A. (2016). Feeling Safe in a Dangerous Place: Exploring the Neighborhood Safety Perceptions of Low-Income African American Youth. Journal Of Adolescent Research, 33(1), 90-116. http://dx.doi.org/10.1177/0743558416684948
An Interview With Stop, Breathe & Think
Zero Suicide? New Scientific Tools to Turn Fantasy into Reality
Smart Mental Health Insurance—The Key to Insurtech Industry Dominations?
Can New Mental Health Tech Enhance the Therapeutic Relationship?
Data Privacy & Security in the Era of Augmented Mental Health
The Death of Psychotherapy As We Know It
Mental Health Insurance Crisis: Can mHealth Help?
Plug the Employee Productivity Drain with Augmented Mental Health
A Global Access Solution to the Trillion Dollar Mental Health Crisis