When horrific shootings occur by apparently unbalanced people and gun control is brought up, we hear cries of “But wait. Mental health.” Not only does addressing one not preclude addressing the other, but it’s really not an argument. Let me break down the issues with the amorphous call for addressing mental health as I see it. And next week I’ll make the case for specific actionable steps that can be taken towards gun control. One by one. I want those who ignore them and focus on mental health to read each one and tell me why they don’t want each specific suggestion implemented. Again, this is not an either/or problem. A multi-pronged approach is warranted; there are no simple answers. Ever.

Oftentimes, the media doesn’t provide the public with actual diagnoses…because they don’t have that information. It is supposition that feeds the desire to call for help, but isn’t always applicable. If a patient poses an imminent threat to himself and others, he can be involuntarily committed. But what if the danger isn’t imminent? HIPAA laws come into play; a patient’s privacy is given legal protection. And what if the person is not under the care of a psychiatrist or psychologist? How can calls to focus the conversation on mental health and not gun control help? Okay let’s say a third party observes that someone poses a major threat to himself or to others? Then, the police can be called in and asked that they take the person for evaluation. But police aren’t likely to take someone in without strong evidence. There is a liability inherent with forcibly taking someone in.

For any of these scenarios to be addressed, I imagine that HIPAA laws have to be relaxed or police given a waiver from liability. But both of these scenarios open the door to abuses that hurt an individual’s liberty. Okay, so what about if we were to find a way to legally define someone as a danger without jailing or hospitalizing him and without compromising his liberty? Then what? Deny them access to purchasing a gun? Makes sense to me. But ummm….wouldn’t that be gun control? How could the gun-loving public reconcile itself to that?

So, let’s approach from the other direction. How do you implement mental health background checks? How do you determine that someone is under care? Or should be under care?  Or that someone is balanced and well and would pose no danger if given a gun? Would the family doctor come into play? A store front doctor? Would they be criminally or civilly liable if the person injured or killed someone within a certain time frame…as if you could guarantee stability in anyone…

Bottom line, determining one’s mental status as a precursor to allowing someone to purchase a gun is problematic. I struggle to understand how those who cry “Mental health!” actually envision concretely driving down shooting incidents without employing gun control. But wait, let’s take slide this a bit more.

We’ve all read the news. We know that many shooters are not necessarily diagnosable let alone commit-able; they are just angry. Angry people can buy guns; we know that. If having committed domestic violence and/or having a restraining order isn’t sufficient to preclude someone from purchasing a gun, then why would the condition of being a loner or an angry young man?

Okay, so in micro, dealing with mental health issues in terms of individuals won’t help.

What about the calls for overall improving mental health help? Well, it’s out there. For those with insurance, it is covered And the existence of HIPAA laws means no one has to know you’re going. Not your employer, not your parents, not your child. And if you don’t have insurance, there are a myriad of low and no-cost services out there. This post from earlier this year is a great place to start looking. Or, start Googling “low cost mental health” and nearby resource will come up. Nothing to change here. Help exists. And what if it isn’t a question of insurance, but awareness? Well then, the media can run more PSAs. This is the first non-gun-control concrete step we’ve been able to determine so far. We are on a roll.

Okay, next argument. What about stigma? People who need help aren’t getting it because they are ashamed. And that may be true, But can we quantify? How do we even know to what extent that is taking place, let alone how many of those are the people using guns and shooting? I don’t know that we can determine either. And regardless, trying to come up with a plan for society to encourage those who need help to recognize they do and to seek that help is nothing that requires delaying or avoiding to take steps in parallel to better control access to guns.

Yes, as a society we need to do more to enable those who need help to get it. But if we are to actually do something concrete to ensure that those who need help do not kill others, then we have to address the kinds of scenarios noted here – and patient and HIPAA advocates would not like that – while also simultaneously finding other ways to make it a safer world.

Making our world safer need not be an either/or proposition. Next week I offer concrete steps and welcome specific objections to why each should not be considered.