We have a mental health crisis in this country; not just in terms of the growing number of Americans who are experiencing mental health stressors, but in the availability of care. Rather than laying out a plan to address the underlying issues that are preventing tens of millions of Americans from seeking help, however, psychiatrist Kelly Posner Gerstenhaber and Stand With Parkland's Anthony Montalto argue in a new column at the New York Daily News that we should be expanding the use a mental health screening and couple it with "red flag" laws. 

The Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS), is a system used in every state in the country and around the world to screen for suicide risk through a series of six simple questions that anyone can ask. The answers determine if the respondent is a risk to themselves or others.

According to Stand With Parkland, this is one of the things to interrupt the pathway to violence. 80% of mass shooters are suicidal. Sometimes those folks acquire a gun with the intention of harming others, looking to share their pain or hoping they themselves will be killed in a shoot-out. C-SSRS would help detect those who are suicidal earlier — and prevent harm.

Major health care systems in two states that began using this method in 2019 reported a 50% reduction in suicide. The U.S. Department of Homeland Security found the protocol so useful that they developed a customized app allowing employees to access the Columbia Protocol at all times. Yet very few states and local governments actually pair this protocol with gun prevention initiatives.

There's nothing wrong with assessing your own mental health. In fact, I'd say that's a good thing. And if that was what Gerstenhaber and Montalto are suggesting, I'd be fully on board. The problem is that the pair want to couple this mental health assessment with gun control.  

Imagine if we applied this to the risk protection orders (known as red flag laws) that are already used in states to ensure dangerous people do not have access to guns. About a third of the time, the shooter exhibits warning signs beforehand. Gun violence would drop significantly. Not only would suicides decrease, but deaths and injuries related to suicides — when suicidal people do harm to others as well — would also plummet.

If, for instance, Florida had had such a program in place in 2017, when the Parkland shooter — who had documented signs of suicidal behavior — easily bought a gun, he may have been stopped. People concerned about his behavior and mental health could’ve used the Columbia Protocol and got him the mental health care he clearly needed.

In Trump’s shooter’s case, his employer or any officials at his schools who noted concerning behavior could have voiced their concerns. And that action could have then led to his parents’ removing the AR-15 he used to shoot the president from their home or not purchasing it years earlier. In fact, it was a Secret Service report of 67 averted mass shootings that found threat assessments and tools like the Columbia Protocol are the best practice for preventing targeted violence.

There are already a lot of "ifs" there, but let me add one more. If these individuals had demonstrated behavior concerning enough to warrant a "red flag" petition, then the civil commitment laws that are in place in both Florida and Pennsylvania could have been used to get them in front of a mental health professional for an evaluation, and inpatient treatment if it was deemed necessary. But if authorities depended solely on a "red flag" law, it's likely those individuals would never have undergone any sort of formal mental health evaluation at all, and they would have been free and clear to harm themselves or others, even if their ability to lawfully purchase and possess a gun had been taken from them.  

There are about twenty states that have "red flag" laws in place, and none of them have been able to point to significant declines in "gun violence" as a result. There have been just a few studies that have examined suicide rates pre-and-post "red flag" implementation, and the results have been decidedly mixed. One study looked at suicide rates in in Indiana and Connecticut, which were two of the first states to implement an ERPO law. In Indiana, overall suicides dropped by 7.5% in the ten years following enactment, but in Connecticut, the suicide rate actually increased. 

Throughout their column, Gerstenhaber and Montalto repeatedly conflate "red flag" laws with mental health treatment, even though the vast majority of ERPO statutes have no mental health component to them whatsoever. It's a judge, not a mental health professional, who decides whether someone is a danger to themselves or others, and when someone is subject to a "red flag" order the courts consider the dangerousness to be dealt with once their legally-owned firearms have been taken away. No mental health treatment is mandated, and it's certainly not provided. 

All too often "red flag" laws are used as an end-around our crumbling mental health care systems. It costs a lot of money to build new facilities and fully staff them. It's much cheaper to use an ERPO statute to disarm supposedly dangerous people than it is to treat the mental conditions that make them a danger to themselves or others.  

We need to destigmatize mental health treatment, and groups like Walk the Talk America are doing incredible work promoting mental health care without injecting the politics of gun control into the equation. I would argue that "red flag" laws inhibit gun owners from reaching out when they're struggling. In fact, my colleague John Petrolino has highighted research from New York that found gun owners are significantly less likely to seek out mental health treatment thanks to the reporting requirements mandated by the NY SAFE Act Mental Hygiene Law.

I'm sure that Gerstenhaber and Montalto sincerely want to reduce suicides in the United States, just like you and I do. I don't take issue with their motivation, only their means. "Red flag" laws simply aren't the answer to our mental health crisis, and all too often are an impediment and a distraction that allows politicians to avoid the hard work of fixing our broken mental health system.