Sorry, but mental health pros are not clairvoyant
In a news conference last week after the shooting at Robb Elementary School in Uvalde, Texas, Gov. Greg Abbott, R, proclaimed that “anybody who shoots somebody else has a mental health challenge, period. We as a government need to find a way to target that mental health challenge and to do something about it.” Uvalde Mayor Don Mclaughlin, R, echoed Abbott’s sentiment: “Maybe we could have caught it. Maybe if we had the counselors, maybe if we had the mental health people, we could do it.”
As psychiatrists, we have a message for Gov. Abbott and Mayor Mclaughlin: We wish more than anything that mental health professionals could solve this problem. But sadly, we’re just not that powerful. We’re clinicians, not clairvoyants. We’re trained to listen, to diagnose complex disorders and even to assess risk of imminent harm to self or others. But despite our training, we cannot predict a person’s future actions.
A diagnosis is not a prophecy. Risk assessment is about probabilities, but probabilities cannot tell us what a person will do on any given day. We know that a history of violence increases one’s risk of future violence, but we cannot know what form that violence could take, or whether it will happen tomorrow, five years from now or never.
Most troubled teenagers and young adults do not become violent. In the spirit of protecting individual freedom, we cannot detain young men simply because they have troubling thoughts and abstractly fit a profile of a potentially violent offender. And who would decide which young people should be identified as future perpetrators of school violence? Teachers? Social workers? Fellow students? Mental health counselors or psychiatrists? What would we do with those who are selected? What forms of individual monitoring or restraint are compatible with a free society? Do we have the means and available professionals to work with all of the teens selected as potential threats in schools?
Since psychiatrists cannot reliably predict on an individual basis who will commit violent acts, what do neuroscience and epidemiology teach us about teens and young adults that can help us develop workable policies to make our schools more secure? MRI and other scientific studies have shown that the male brain (in particular the prefrontal cortex, which is responsible for reasoning, good judgment and impulse control) does not fully develop until the mid-20s. From epidemiological data, we know that young people are at greatest risk for psychosis (often with symptoms of paranoia, delusions, mania, hallucinations and impulse dysregulation) between 18 and 25. We also know most school shooters are under 21.
So there is a more effective solution than asking mental health providers to predict the future: establishing a higher minimum age to purchase firearms.
Public health policies have reduced risk in other contexts by setting age-based rules for certain groups to protect the general population. States that established a minimum legal drinking age of 21 in the United States saw a 16 percent median decline in motor vehicle crashes. And recognizing that poor judgment increases the rate of accidents, many car rental agencies limit their liability by forbidding those under 25 to rent their vehicles. In California, drivers under 18 may not drive alone between 11 p.m. and 5 a.m. for their first year of licensure because of their elevated crash risk.
These regulations benefit the community at large, even though they limit young people’s freedoms. Doesn’t it seem reasonable to limit the possession of guns for those under 25, given the data for brain development and impulse control? The safety benefit of restricting firearm purchases by young adults would be a significant step toward reducing the alarming rate of mass school shootings.
As psychiatrists, we agree there is value in having more mental health practitioners available to treat troubled teens and young adults, and more resources need to be allocated toward this end. But it’s a fallacy to believe this will solve the gun violence epidemic. The sad irony is that living through school lockdowns, hearing about mass shootings and experiencing regular shooter drills at schools are contributing to the epidemic of depression and anxiety in school-age children.
Our children are begging us to save them -- and not only during 911 calls when a deranged gunman storms their classrooms. Children all over this country need us to protect them, not with armed guards that remind them that they are at constant risk of being attacked, but with laws that are based on science and epidemiology. Limiting access to guns for those whose brains are still developing would save lives.