Mass shootings: Assault Rifle and High-Capacity Magazine Restriction or Mental Health Investment? CLEARLY BOTH.

In the aftermath of the Annunciation Catholic Church shootings, both sides of our legislature have gone to their corners. Our Governor is weighing calling a special session. One side says we need to put more resources into mental health and to lock down schools.  The other side says we need to ban military assault rifles, AR 15’s, and high-capacity magazines. In my opinion, it must be both.

Poorly or unmanaged mental illness has major impacts on our urban quality of life and public safety. The impacts include homelessness, drug abuse, sex trafficking, and in the extreme, mass shootings. However, mental illness alone does not result in mass shootings. Most people with mental illness are not a threat to others.  Psychotic or just very angry people cannot commit mass shootings without serious weapons of war.

Just to be brief but clear, AR 15 rifles are not like any other hunting rifle. They were designed as a replacement for the World War Two standard issue M1 rifle and carbine.  The were designed to be light weight, almost recoilless, firing a small caliber, light weight, but high velocity round such that infantrymen could carry more ammunition. They were first deployed in combat in Vietnam. After initial design flaws in the M16A1, it was reengineered into the M16A2, which became the very effective primary weapon of the United States Military.

A bullet makes two types of holes, a permanent and a temporary cavity. The permanent cavity is the diameter of the bullet. The temporary cavity is caused by the energy the bullet releases out into surrounding tissue causing destruction. The AR 15 releases a lot of energy and destroys tissue far out from the permanent cavity.

To those who insist it is not the guns, it is mental health, I would ask why no other first world country has anything close to our problem with firearms violence?  We don’t have more mental illness than Britain, France, or Japan. Norwegians have a hunting culture and privately own hunting rifles, but they don’t have our gun violence problem. Yes, they had one horrific mass shooting perpetrated by Anders Breivik. And they all know his name because they had one mass shooting. We in the United States can’t call out the names of our mass shooters, there are too many.  Norway undertook many reforms including greater restrictions on semi-automatic firearms.

How did we get here today? On the weapons side, it was expedited by the sunset of the ten-year federal ban on assault rifles and high-capacity magazines in 2004. For the last 21 years a plethora of legacy and startup firearms manufacturers have entered the AR 15 manufacturing market. When we used to get printed sporting goods store supplements with the Sunday paper, there were usually ads for four to six, AR 15 variants. Firearms are basically durable goods. To continue to profit, they must gin up ongoing demand.

The mental health part of the equation developed for other reasons over a much longer period of time. I had a front row seat and sometimes direct involvement responding to the evolution of our public mental health crisis.

I had a 40-year police career, the first 11 as a uniformed patrol officer in the Phillips, Whittier, Central, Lyndale south Minneapolis neighborhoods, and later downtown. These neighborhoods hosted numerous residential, treatment, and group home facilities serving people struggling with mental illness. I did not know why that was or why the concentration.

Enter my wife Barb, who provided me many of those answers. Barb was a Hennepin County Social worker with a mental health case load for 34 years. She helped me understand. There were two major events that resulted in the deinstitutionalization of people with mental illnesses into the community. Prior, judicial commitments to state hospitals were very common. Whether patients would ever be released was uncertain. The first change came in the 1950’s and 1960’s, when the development of psychotropic medications entered the pharmaceutical market. They showed great promise to help with the management of chronic and persistent mental illnesses. The second event was a series of habeas corpus proceedings that challenged the indeterminate confinement of persons suffering mental illness without ongoing due process.

A solution is not as simple as restoring the old system of state hospitals in which people with a mental illness were involuntarily committed indefinitely. Although, our President has said we need to reopen the “asylums” for people who “belong there.” That is not to say we are not woefully short of clinical placement options and supportive services. Releasing them to the streets is neither humane nor in the community’s interest. Consider, if one of our own family members could have a better quality of life outside the institution, through medical and social support, understanding it will not be perfect, wouldn’t we want that for them?

Mental illness strikes in families of all racial, ethnic, and socio-economic levels, frequently in young adulthood, often to children of above average intelligence. The onset often begins with certain unusual behaviors that intensify.  At some point a diagnosis is identified. A promising family member decompensates, crises come and go. There may come a point where the family cannot physically manage a crisis and the police are called. To many families having to call the police to control a family member is a shameful decision.

The people who left the institutions, clearly needed help with the transition to the community and ongoing management of their mental illnesses. A proposed solution was an adequate number of skilled social workers with small and manageable caseloads in the community. This spoke to Barb’s empathy for this community of clients.  She was amongst the first Hennepin County social workers to volunteer for a Community Support Project, with office assignments close to clients. She was officed at the Circle F Club, serving people with mental illness, at 1905 3^rd Avenue South. This was walking distance from many residential programs serving her clients.

Barb worked with a cadre of empathetic and skilled social workers, nurses, and supervisors. They effectively helped their clients navigate life outside of the institution.

Where is the expected “unfortunately” part? Unfortunately, caseloads did not remain small. Community Support Project client caseloads were not to exceed 15.  Before Barb’s retirement, they had risen to 40 or more. In addition, the character of the client base changed considerably. A lot of Barb’s satisfaction came from helping folks with the small quality of life tasks that gave their lives purpose. For example, Barb helped a client bring her cat to a veterinary appointment. That cat meant a lot to the client and her stability.

There was inadequate planning with the closing of state hospitals. On those occasions where the hospital or a placement was still needed, there are often no beds available in the hospital or group homes, and the remaining state facilities are at capacity.

As the years went on, that type of client that Barb could help keep on a stable path, was more often excluded, not exigent enough. They were often replaced by court ordered chemically addicted and criminally convicted clients, who also had a mental illness.  Barb became a de-facto probation officer for individuals who wanted no supportive services. The court would say, “Mrs. Hestness will monitor the client in the community, see that he keeps scheduled appointments, and takes medications as prescribed. Getting a client who is not interested and won’t open the door to comply, is completely unrealistic. That was not what pushed her to retirement. It was the inability to practice the empathetic, compassionate, and effective social work she was trained to do.

When Barb retired, she stayed in contact with some of her former clients, meeting for coffee etc. Some were amongst the more difficult, sometimes exhibiting behaviors that were frightening to the onlooking public. Barb could tell the difference.

Our city government is moving in at least two directions, hoping to more effectively serve citizens struggling with a mental illness. One of those directions is for the City to become more directly involved in responding to mental health crises, with Behavioral Crisis Teams (BCT). Social services of this nature are the primary responsibility of Hennepin County, their experienced, and licensed social workers. Nevertheless, an around the clock clinical crisis response team managed or contracted by the City would certainly fill a glaring gap.

It is important to remember though, that in recent weeks and months, the city and state have come face to face with a looming revenue shortfalls and widespread fraud amongst social safety net programs on the state level. In addition to the decline in local resources, it certainly appears federal funding for social programs is at risk and/or will be “reprioritized” to other purposes. Coordination with Hennepin County social services and our non-profit providers is essential, such that we are not duplicating efforts or working at cross purposes. We cannot afford to be wasteful of resources or our best intentions will be for naught.

A corollary discussion of some policy makers, is to keep police officers away from mental health response. That is unrealistic for a number of reasons. Nevertheless, the majority of crises have a lower probability of violence, trained clinical responders would of course be a better option.

The ability for a rapid response is a capability the police. Officers are on duty, in a car, with communications, and access to other emergency services. When the police are the first responders, it does not mean that BCT cannot be summoned. If the potential for violence is minimal, a handoff to BCT clinicians is appropriate and a superior response.  I am hearing very positive opinions on the program thus far.

In Barb’s years of social work, she developed a good sense for danger. Over the course of her career, Barb was assaulted three times by clients, once seriously. When she felt danger was present, she would ask for police officers to accompany her. She says she never had a bad experience with either a Minneapolis of suburban police officer.

There are also instances when the physical ability of police officers is critical. I observed this regularly, including my years with the University of Minnesota Police Department. Dating to at least January 2, of 1972, when poet John Berryman committed suicide by jumping from the Washington Avenue Bridge on campus, the bridge became a destination for suicide gestures. A good friend of mine from Minneapolis Central High School, who had become an attorney and seemed to be having a good life, jumped to his death from the bridge over a holiday break on campus.

UMPD officers on multiple occasions shed their gun belts and body armor, to dive into the Mississippi river, and rescue hopeless people trying to commit suicide. One such Officer is Mark McElroy, a former Gopher lineman. A young woman had drunk a caustic liquid, like a Drano, then jumped into the river.  Mark dove in the river, swam to her, and brought her to shore. Then, he swam back out into the river to recover the container of liquid so the paramedics would know what they were dealing with. Another UMPD Officer, Marianne Scheel, a solid swimmer, made several river water rescues.

Conclusion:

What to do about assault rifles and high-capacity magazines is clear: turn off the tap, ban new sales. So many of these weapons have fallen into private hands over the last 21 years that legal confiscation is entirely unrealistic.

Sure, let’s target harden schools.  How about churches? Shopping malls? Movie theaters? Something is better than nothing, let’s try to protect our kids wherever they are.

Improving mental health response is by no means the low hanging fruit it’s proponents imply. We need many more clinicians, social workers, facilities, and programs. How is that educational pipeline now? This will require upstream investment in our colleges and universities. We need enough of these professionals so that those small caseloads once proposed, can become a reality.

Let us also make sure our police officers who will not be getting out of mental health crisis response anytime soon, have the best training and resources we can provide them. I have been on the board of directors of the Minnesota Crisis Intervention team for eight years. The organization is twenty years old. We provide a 40-hour crisis intervention curriculum to the majority of Minnesota Police Officers. We have also branched out to train Fire, EMS, and 911, anyone who might be a first point of contact to a mental health crisis. We trained veteran MPD officers and continue to train new officers, providing them the knowledge and de-escalation skills they need. We also work with the State Department of Human Rights to assure our curriculum is satisfactory and in compliance with the Consent Decree.

Summary:

• Turn off the tap, stop new sales of assault style rifles and high-capacity magazines.
• Invest in the security in our schools and public gathering places.
• Invest for the long term in trained mental health professionals, first responders, and the resources required so that fewer high-risk people fall through the cracks.