If the current debate about gun violence and gun safety leads to increasing access to mental health services, I’m all for it. However, in the process we have to be very careful not to unfairly malign “the mentally ill”—or to overgeneralize about any designated group of people—regarding their propensity for violence. Just what is the true relationship between guns and mental illness?

In his post “Guns and Mental Health” psychiatrist Gordon Livingston reported the relevant statistics: “Of the total number of gun deaths in this country, around 30,000 a year, the majority are not the result of mental illness, but of ordinary human emotions like anger, hate, greed, and despair. In fact, about half of all shootings are suicides.”

Violence in general is more likely to occur when substance abuse is involved. Addictions expert Adi Jaffe states, for example: “(A)lcohol is involved in more than 50% of violent crimes and about 75% of partner violence” (Psychology Today).

Illegal drugs are implicated as well, of course. And then there are the legal ones—including sleep aids, amphetamines used for ADD, and antidepressants—that have been too often linked to violence.

Still, why do some turn to violence while others don’t? Neuroscientist Marco Iacoboni points out in a Scientific American article that the mechanism that turns anger into violence is lack of cognitive control, or what we usually call self-control. Some people, for various reasons, don’t develop this adequately. Others may lose it under certain circumstances.

What, then, is the actual deal with guns and mental illness? How do we go about identifying those most at risk for violent behavior, particularly the gun kind? It’s not easy, Dr. Livingston said:

The only real predictor of future violence in anyone turns out to be a past history of violent behavior. Absent this, professionals are little better than the average citizen at identifying those likely to harm others. Many people report violent fantasies (remember your reaction to the last person to cut you off in traffic); few act on them.

The American Psychological Association outlines three strategies, though, that can work to prevent gun violence:

1. On the individual level. “Although it is important to recognize that most people suffering from a mental illness are not dangerous, for those persons at risk for violence due to mental illness, suicidal thoughts, or feelings of desperation, mental health treatment can often prevent gun violence.”
2. On the community level. “Prevention of violence occurs along a continuum that begins in early childhood with programs to help parents raise emotionally healthy children and ends with efforts to identify and intervene with troubled individuals who are threatening violence.”
3. Effective policies. “Firearm prohibitions for high-risk groups — domestic violence offenders, persons convicted of violent misdemeanor crimes, and individuals with mental illness who have been adjudicated as being a threat to themselves or to others — have been shown to reduce violence.”