Who with mental illness should not be allowed to have a gun?
That was the question debated by mental health experts, members of law enforcement, gun control advocates and gun violence researchers in a conference at Johns Hopkins University in Baltimore last month. "There are mental illness diagnoses that do increase your risk of violence," says Josh Horwitz, who organized the event and is executive director of the gun control group Coalition to Stop Gun Violence. "But identifying which [diagnoses] those are and who those people are is going to be difficult."
The consequences for trying to link a diagnosis to violent behavior became clear after it was revealed that Newtown shooter Adam Lanza was possibly autistic. The autism community came out in full force to debunk any report that tried to draw such a link. And recent research shows the risk of violent acts committed by those with mental health diagnoses as part of the total population was just 3-5 percent.
And yet the same question of gun access for those with mental illness will be posed to members of the Senate when they come back from recess Monday and consider legislation that asks for tougher gun background checks for those deemed mentally incompetent.
Few in the gun control debate agree on the answer to the question, but most say the current system isn't working.
Current federal law says any person who has been formally committed to a mental institution, such as by court order, or who has been adjudicated as a so-called "mental defective," cannot get access to a gun.
Those standards aren't condoned by mental health professionals, who say the term "mental defective" is deeply offensive, as well as not clearly defined. Gun control groups, meanwhile, say the law doesn't do nearly enough to keep guns away from people who shouldn't have them. And even gun rights groups have problems with the current system, with the NRA saying recently that states needed to do a better job at submitting names of mentally ill people to the National Instant Criminal Background System (NICS). The NRA is right that states haven't been great at compliance – almost 20 states submitted fewer than 100 mental health records to the database as of October 2012, according to research from the gun control group Mayors Against Illegal Guns.
So while there are problems with the current system, most groups involved in the debate disagree about how to fix them. And nowhere is that fight playing out more vigorously than at the state level.
The same concerns are playing out in New York, where legislation with a similar bent recently went into effect. The New York Safe Act of 2013 requires mental health professionals to report a patient to county governments if they believe he or she is "likely to engage in conduct that would result in serious harm to self or others."
When the bill was passed in January, New York Gov. Andrew Cuomo said that "people who have mental health issues should not have guns... they could hurt themselves. They could hurt other people."
The mental health community wasn't happy with Cuomo's broad-brush statement, nor with his legislation.
"The treatment providers themselves are saying [to this legislation]: 'Look, we are supposed to help people, enter therapeutic relationships," says Ron Honberg of the National Alliance on Mental Illness. "If we're responsible for making judgments about people who may be violent and reporting them to state police, then that's going to compromise the relationship."
Honberg says he also believes the legislation is "one more factor that could make people reluctant to seek help."
This story has been updated to add context to Josh Horwitz’s quote.