Services Effectiveness Research Program (SERP)

Duke University School of Medicine
Department of Psychiatry and Behavorial Sciences

Current and Recent Projects

Principal Investigator(s): Jeffrey Swanson, PhD

SERP Investigators & Collaborators: Marvin Swartz, MD; Allison R. Gilbert, PhD; Phillip J. Cook

Project Description: This project is a scientific inquiry into the societal problem of firearm violence; the link between mental disorder and risk of firearm violence; and the function of laws, such as the federal Brady Act, designed to reduce that risk in part by limiting access to guns for persons with mental illness.

Over 30,000 people were killed with firearms in the U.S. in 2006, accounting for two-thirds of violent fatalities. Acts of gun violence by mentally disordered individuals—such as the 2007 shootings at Virginia Tech—have been the focus of intense media coverage and public concern. However, scientific evidence is lacking to support the assumption of increased risk of gun violence among persons with mental illness in general, and little is known about whether existing gun laws are effective in protecting the public. Some legal scholars and mental health professionals allege that the laws are stigmatizing and discriminatory.

This study will empirically test three theories of the relationship between mental illness and risk of gun violence: psychopathological motivation, which attributes violent behavior to features and manifestations of the mental illness; criminogenic risk exposure over the life course, which attributes violent behavior to exposure to social and environmental influences, and social labeling processes , which accounts for the influence of socially-imposed labels about mental illness and dangerousness. Several research questions will be addressed: Are persons with a history of involuntary psychiatric hospitalization at higher risk of firearm violence than the general population or than other persons with mental illness? Do laws and policies that base gun restrictions on mental health history confer additional public safety benefit beyond the effect of restrictions based on criminal history? Does the social and legal presumption of increased risk of gun violence in people with mental illness bear unintended consequences—perhaps unnecessarily infringing on the civil liberties of people with mental illness, increasing reliance on involuntary commitment, and reinforcing the stigma of mental illness? The investigators will analyze administrative data from the public mental health and law enforcement systems in Connecticut , Massachusetts , and New York . Trends in arrests for gun-related crimes and fatalities for three large cohorts of individuals diagnosed with serious mental illness, along with trends in the general population will be examined. The effects of gun laws will be estimated by comparing trends in gun violence for persons disqualified vs. not disqualified from gun purchase due to mental health history, and during the period before vs. after states' implementation of reporting to the National Instant Criminal Background Check System.

The broader impact of this study will be the contribution of new evidence toward reducing gun violence in society—a leading cause of death and injury in the U.S. , and a critical problem in the public health and criminal justice arenas. Evidence from this study will enable a comparison of the explanatory power and relevance of the three theoretical perspectives on gun violence among persons with serious mental illness, and will test the effectiveness of laws that are intended to reduce gun violence. The study will also shed light on the potential unintended consequences of gun laws for persons with mental illness, thereby informing the development of policies to reduce risk while mitigating stigma and social marginalization that may result from conferring the label of “dangerous” on the basis of disorder and disability, rather than on demonstrable individual risk.