The Role of Mental Illness Identification and Screening in Firearm Background Checks

Kevin Barklage


Americans are emotionally sensitive to the issue of gun violence due to highly publicized mass shootings, which lead to substantial debate over what measures should be taken to keep people safe and prevent such violence. Arguments between gun-rights advocates and gun-control proponents rarely lead to agreement. The influence of mental illness on gun violence, however, superficially seems to invite a consensus. Many call for the seemingly simple task of implementing better mental-health screenings to keep weapons out of the hands of these individuals. Nevertheless, implementing these measures is challenging, in part because the relationship between mental illness and violence is not so simple. Furthermore, identifying individuals with the appropriate mental-illness factors and restricting their access to firearms is a challenging endeavor.

Mental Illness and Violence

According to the National Institute of Mental Health, nearly 20 percent of Americans have some diagnosable form of mental illness. A smaller percentage, approximately 4 percent, have what is known as a serious mental illness (SMI). Mental illness, when framed broadly, does not necessarily indicate an increased risk of violence. The risk increases, however, when the scope of mental illness is narrowed to include specific diagnoses of SMIs and further increases when amplifying factors are considered such as anti-social behavior and substance abuse. Until these individuals act out in violence or enter the criminal justice system, they are likely not identified during a firearm background check.



Current federal statutes prohibit access to firearms by individuals who have a mental illness and have been certified as a risk by a court or other authority. Furthermore, the law prohibits access to firearms by individuals who have been involuntarily committed to a mental institution. While these prohibitions must continue, certain individuals with mental illness may be at an increased risk to commit violence prior to their official entry into court system. Even individuals who are receiving treatment may demonstrate a potential risk for violence and may act out unexpectedly. Legislation, therefore, needs to require timely reporting individuals who may be at risk, even before they demonstrate a history of violence or enter into the criminal justice system, to ensure their identification during a firearm background check before it is too late.

Federal laws need to ensure that the focus of firearm prohibitions is on a totality of the circumstances and does not exclusively focus on the mental health aspects. Furthermore, they should focus on amplifying risk factors such as substance abuse, history of violence, or behavior that would indicate an increased risk of violence and not just a history of violence. Federal laws also need to place less emphasis on individuals who are involuntarily committed to a mental institution. Given the shifting treatment strategy for individuals with mental illness away from hospitalization due to resource and procedural issues, the laws need to prohibit firearm access by individuals who meet these risk criteria and may be receiving voluntary treatment or are otherwise never committed.

Reporting and Procedural Implications

Clear mental-health criteria that prohibit individuals from purchasing or possessing firearms must be standard across the country. Even with standard criteria, however, prohibitive records must be submitted to a national database to ensure effective background checks. Though there has been some progress with states’ reporting, significant variations still exist. Laws should require, rather than simply authorize, the reporting of limited mental health information that would prohibit an individual from purchasing a firearm based on clear criteria in a comprehensive national database.

Privacy issues associated with reporting mental health records are largely mitigated through specific legislation and regulations that only require enough information to identify that an individual is prohibited. Legal issues, however, arise when restricting rights of individuals who are seeking voluntary treatment and have not entered the criminal justice system, as they are guaranteed Constitutional due process. These individuals should not be burdened with court proceedings if they have not violated any laws, yet they would nevertheless have to be afforded the opportunity to challenge the prohibition. Individuals receiving treatment could acknowledge that their right to purchase or possess a firearm is temporarily restricted until they have been found to no longer present a threat or risk of violence. Legal issues may arise with having someone with a mental illness, regardless of the severity, effectively waive their Constitutional rights, but it could allow treatment without imposing court procedures. Another option to provide due process is through the increasing presence of Mental Health Courts (MHCs), which could allow clinicians to report certain individuals without waiting for the individual to enter into a criminal court. The expertise of staff at MHCs may ensure the focus is providing proper care while determining whether firearm rights should be restricted and ensuring the individual receives appropriate due process.


Clinical Implications

Many mental-health professionals assert that imposing firearm restrictions will deter individuals with mental illness from seeking help. Others mental-health professionals are concerned that firearm legislation focusing on mental health stigmatize individuals with mental illness. Concerns over a perceived stigma, however, are outranked by cost and ability to access mental-health treatment, among others, as reasons people with mental illness avoid treatment. While some may argue that firearm restrictions are a legal burden, the narrative needs to change so that the restrictions are framed as not as not being punitive in nature, but as part of a treatment plan to ensure their safety. While this thesis focuses on background checks, they alone cannot prevent at-risk individuals with mental illness from accessing guns owned by others, including those owned by family members. Deliberate actions are therefore needed to prevent these individuals from accessing firearms.


Firearm legislation must identify appropriate mental illness diagnoses and other behavioral factors that would designate a person as prohibited from purchasing a firearm. This legislation must also establish clear and standard requirements for reporting appropriate mental health information while accounting for legal due process and judicial involvement. Finally, it must consider the potential ramifications on medical professionals’ efforts to effectively treat those with mental illness. Legislators who implement laws that prevent certain individuals from purchasing or otherwise obtaining a firearm need to have a thorough understanding of these issues. Furthermore, the discourse must be based on research to ensure that productive debate leads to effective actions that will help keep people safe.

Numerous studies and scholarly journal articles assert that most people with mental illness do not commit acts of violence. While this is true, it does not account for certain individuals with severe mental illness, those not receiving treatment, or those with substance abuse or co-occurring disorders. When accounting for these additional factors, individuals with mental illness are indeed at a higher risk for violence. Restricting access to firearms should not be the ultimate goal. Rather, it needs to be an element of a broader strategy to improve access to mental health treatment for these individuals while mitigating risk.


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