Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing and Health Care Policy

The newspaper headlines daily bombard us with tragedies of unspeakable scope. Firearms and guns are most often at the center of the incidents. The ongoing debate in Congress about gun ownership as a right and gun control policy as a public health intervention seems to ebb and flow with the latest random acts of violence. Whether or not gun violence is a public health matter, it is most certainly of concern to Nursing.

The American Academy of Nursing has recently applauded the legislation introduced by Senator Feinstein (see link to AAN statement) that has made an attempt to curb the epidemic of gun related tragedies. With the guidance of the Expert Panels on Violence and Psychiatric/Mental Health/Substance Abuse, the American Academy of Nursing sent a letter to Senator Dianne Feinstein endorsing her legislation to re-establish an assault weapons ban. In the May-June 2013 issue of Nursing Outlook, members of the Academy (Amar, Beeber, Laughon, & Rice, p. 184) ask policymakers to act on behalf of us all. These thought leaders provide us with recommendations and commentary about how we can make substantive policy changes that prevent the estimated 30,000 firearm-related deaths each year. The following are current bills introduced in Congress that address gun violence:

Assault Weapons Ban of 2013 Senate – http://www.govtrack.us/congress/bills/113/s150/text

Assault Weapons Ban of 2013 House – http://www.govtrack.us/congress/bills/113/hr437

Safe Communities Safe Schools Act Senate –http://www.govtrack.us/congress/bills/113/s649/text

In this interview, one author, Dr. Michael Rice adds commentary to the discussion about the escalating violence today. Dr. Rice describes the failure of our current policies and the ridiculous arguments that assault weapons are in the purview of responsible gun ownership. Read more about the legislation that has stalled in the House and Senate that we should all strive to move forward.

Michael J. Rice, PhD, APRN-NP, FAAN is a Professor at the University and Associate Director of the Behavioral Health Education College, College of Nursing, University of Nebraska Medical Center, Omaha, NE.

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN


PhotoMichaelRiceMichael J. Rice, PhD, APRN-NP, FAAN

Associate Director, Behavioral Health Education College

College of Nursing, University of Nebraska Medical Center




Question 1. What are the forces that promote or hamper changes in Federal Gun Legislation and how is healthcare affected by those forces?  Are the issues restricted to legally owned weapons? 

To listen, click here.

The forces that are affecting the current federal gun legislation really have more to do with a frame of reference. Responsible legal gun ownership is different than the right to buy high capacity weapons that really amount to weapons of mass destruction. Self defense does not involve weapons of mass destruction, and military weapons with high-capacity magazines are just that. They are weapons of mass destruction or guns of mass destruction, particularly when owned in civilian populations and environments. We are no more okay carrying pressure cooker bombs because they’re high-capacity, but ironically we seem to allow high capacity magazines.

The second part of the issue is: Really, where do legal and illegal guns come in? One of the statistics that gun control advocates often throw out is that 30,000 people a year are killed by guns. That is true. However, if we break that down we find out that less than 6,000 people a year are killed by legally owned weapons. But 30,000 people a year – the remaining group, are killed by illegally owned guns – in drive by shootings, in urban areas of our cities etc. These are illegal activities that we cannot stop through gun legislation of legal owners. However, at the same time, legal and responsible ownership would naturally dictate that we not have high capacity kind of instruments that would allow people to harm large numbers of people at a time. What we need to realize is that we will not stop the activity, but we can minimize the consequences by eliminating the potential for stolen guns of mass destruction.

This recently raises the question about what is being defined here. With 4 million members of the NRA and 300 million citizens of the country, then we really need to reexamine how we look at weapons and what they’re for, and what’s an appropriate venue for those weapons. The real issue is people want a simple solution to assure themselves of safety that they don’t have to invest in or think about. The reality is there are complex solutions for complex problems, and they involve effort.

Now one of the things that always comes up in this is about mental health. If we look at the statistics, less than 3% of those people that are in prisons for murders are seriously mentally ill – less than 13% have a diagnosable mental illness of any kind. And yet, here we are looking at the 12 deadliest shootings in U.S. history, 6 of which have taken place since 2007, and/or at least 62 mass shootings in the past three decades (according to recent Mother Jones survey). Of the 62 that occurred within the last three decades, 24 have been within the last 7 years alone. If we look at the issues that this really presents to us, there is some association in the last 7 or 8 deadly shootings of people having a serious mental illness. But it’s not the presence or absence of a mental illness that’s the problem; it’s the presence or absence of them being in treatment. One would really have to logically argue that if we hadn’t cut 1.4 billion dollars out of the mental health budget since 2008 in all 50 states, that these things could have been prevented and that we certainly could have gotten services to people and saved innumerable number of services in the future.

Question 2. There are some who wish to distance healthcare from gun legislation.   Could you speak to why healthcare should or should not be involved?  

To listen, click here.

Generally I agree that they are two separate distinct issues. First as I noted earlier, responsible gun ownership is different from a responsible health policy. Eight of the last nine public tragedies involving shootings have been associated with people with mental illnesses who have not been followed up, not seen, not have access, not received services. So, from a public health issue, we are paying really for the reduction in services across really all 50 states. Not even since the downturn, but really for decades – decades that have eroded the services, eroded the number of providers. We’re probably at the highest time period of need yet the lowest supply of trained psychiatric mental health providers ever in the history of this country.

The promise in those cases when we focus on health is always to close the institutions – which is a good idea – and to turn the money over and use it for community-based services. What we’ve done however is that we’ve consistently slashed the budgets and found those dollars spent someplace else. Since 2008, the National Alliance for the Mentally Ill reports that the budgets have been slashed $1.8 billion out of the total state mental health budgets. But the real issue is that it was never replaced after the institutional closings in the 1960s. So, when we have a group of people who are increasingly vulnerable, with mental health needs and services, we see that the health issues begin to escalate. Are gun shootings much more lethal in forms of suicide and suicide attempts? Absolutely. There is no question about it. Are domestic partner assaults more lethal if there’s a gun involved? Absolutely. There is no question about it. Are hate crimes more lethal when guns are involved? Absolutely.

It is not really a public debate as so simply become tools – and so the argument really is do we separate the tools and somehow then continue to allow ourselves to avoid dealing with the base issue which is our national attitude in health policy. I find it amazing when we look at the backlash of people – Senators who talked about voting “no” for gun legislation – that they immediately throw up mental health care. To be honest it is somewhat disingenuous – to throw up healthcare having never done anything about it and not intending to do anything about it.

While we have the national health care policy, we certainly don’t have the infrastructure in place anymore particularly in terms of personnel or staff to deal with the existing health care needs let alone the additional mental health needs of the additional 30 million people who will be put on the Affordable Care Act rolls. So the bottom line is, there’s a price, and what that price is. That’s something we’re going to pay for, for a very very very long time. Why? Because people wanted to save a few dollars.

Question 3. How would you characterize the beliefs about how this legislation affects mental healthcare\substance abuse,  veterans healthcare, intimate partner violence and the societal impact on gun violence?

To listen, click here.

It really becomes disingenuous to argue about supporting gun ownership while at the same time saying that you’re going to support mental health care and then quite literally doing nothing about either one. As I said when we started, these [issues] are about weapons and guns of mass destruction – magazines that have the capacity to eliminate 1- 200 people to create tragedies such as we saw in Connecticut.

The legislation really has very little to do with controlling that, although at best for those individuals who have histories of violence or histories of intimate partner violence, histories of assaulting people with weapons, it might help to do the screenings and it would be at the very least a minimum kind of first step. But the belief system to categorize them and everyone with mental illness as having a problem is preposterous. One of the statistics we need to be very clear about, and I get very strong on, is that if we look at the number of veterans from Iraq and Afghanistan because of the improved body armor, 53% have PTSD. That’s a mental illness. That means with the implication of passing [proposed legislation] that we restrict guns from all who have mental illnesses that we restrict 53% of the veterans who have fought for that very right. That could be problematic.

It would seem that much more common sense approach would really be to deal with the support and infrastructure of the health care system that deals with mental health care substance use, veterans mental health, intimate partner violence, and the societal impact on – for lack of better term – civility. We’re an incredibly fractured country in our tolerance for variations – it’s almost beyond my comprehension anymore. And that’s where we get back to the Justice Department’s 30,000 individuals killed with guns each year. Again, about 6,000 of those are with legally owned guns and we don’t know what percent of the background checks, if they had histories of violence or checks, would have stopped that.

What we do know is the remaining 24,000 to 30,000 people who are killed with illegal guns in this country is not something that we can do something about and it is not a mental health care issue. It is something outside of either one that quite honestly spending time and effort enforcing our existing laws would probably be far better. The bottom line of all of this is that we can fix the gun legislation all we want and continue to do silly things like support guns of mass destruction. But until we deal with some of the basic thread issues in our society such as mental health care substance abuse, veterans mental health care, intimate partner violence, and the use of guns being okay, we’re not going to find a resolution.