The mass shooting at the Inland Regional Center in San Bernardino, CA on December 1 was the 355th mass shooting of the year, and was preceded by a mass shooting in Savanah, GA earlier in the day. The usual responses from both gun rights supporters and gun ban supporters have been rolled out, but not much will likely change. What does make the regular occurrence of such events so alarming is the fact that overall, all types of violent crime have been regularly decreasing over the past 20 years.
In spite of a very steep decline in the overall violent crime rate, we have seen during the same time period an increase in the frequency of mass shootings and active shooter events. Unwrapping the issue is difficult because different data sources have different definitions of “mass shooting.” The 355 number cited above comes from a definition of mass shooting as 4 or more people, including the shooter, killed or injured in a single event or related string of events without a cooling off period. Mother Jones, another source of compiled mass shooting data, defines mass shootings as events in which 4 or more are killed in a shooting event. Incidents with fewer than 4 deaths are not counted as mass shootings.
While the definitions of mass shooting vary, both sources show a clear upward long term trend in the number of shooting events. Politicized debate around gun control aside, given the high correlation of mass shootings with shooters who have had prior history of mental illness, it is not immediately clear that an outright ban on guns would actually address the deeper factors behind mass casualty events.
Attacks like the Oklahoma City bombing, 9/11, or Pan Am Flight 103 have all demonstrated that those with a true desire for mass casualty have tools at their disposal that can cause far more carnage than automatic weapons. There is a distinct possibility that an outright ban on guns – ignoring potential armed resistance by the more hard core gun activists – may unleash upon us an age of suicide bombings in the US, similar to what we see on a regular basis in many parts of the Middle East.
The real issue behind the gun control debate in the United States is that we lack a framework for truly understanding why such events occur with such regularity, and how to prevent them in the future. One likely culprit is the nearly 20 year ban on the Centers for Disease Control conducting gun violence research. Ban is perhaps a strong term – Congress has failed to approve CDC funding for any research related to gun violence since 1996, in spite of a 2012 executive order to resume such research in the wake of the Newtown mass shooting. Given the political climate, it is unlikely that government funded research will resume anytime soon.
The tragedy is that, from a public health perspective, continued research would likely provide a deeper picture of the mental health issues that are manifested in mass shooting events. Much like preventive care for chronic conditions, mental health services are currently more reactive than proactive. This allows a large number of citizens fall through the cracks into homelessness, substance abuse, and violence which all are significant contributors to high cost utilization of emergency health services. We currently have no effective behavioral models that we can use to predict whether a citizen is psychologically ready to commit a mass casualty act. As a result, each Planned Parenthood clinic attack, each school shooting, or each Oklahoma City bombing comes as a surprise and each year a growing number of citizens are needlessly killed, maimed, or psychologically scarred.
There is an increasing cost associated with our unwillingness to have a non-politicized discussion of how we have gotten to a point where a mass shooting – however defined – has become a normal news event. That cost goes beyond the immediate casualties, but can be mitigated with the development of new models for mental healthcare that can keep pace with the shifting dynamics of technology and the economy.