COLORADO SPRINGS, COLORADO – NOVEMBER 20: People hold a vigil at a makeshift memorial near the Club Q nightclub on November 20, 2022 in Colorado Springs, Colorado. Yesterday, a 22-year-old gunman entered the LGBTQ nightclub and opened fire, killing at least five people and injuring 25 others before being stopped by club patrons. (Photo by Scott Olson/Getty Images)
This article was originally published in Stateline, an initiative of The Pew Charitable Trusts.
A grim and familiar pattern has followed the parade of mass shootings across America. In their aftermath, the nation’s attention focuses on the direct victims of the attacks, the dead and injured, their families and friends, and the witnesses.
But a growing body of research reveals that the negative effects of mass shootings spread much farther than previously understood, harming the health of local residents who were not touched directly by the violence. Mental health experts say the recognition should prompt authorities to direct more attention and resources toward preventing such events — and helping a broader group of people after they occur.
“It changes the entire picture on how much public resources we should use to attack gun violence,” said Erdal Tekin, co-author of a September brief on the expanding research in the journal Health Affairs. “It would be informative for the public and policymakers to know that the impact of gun violence extends to people who think they are safe.”
Research shows that mass shootings lead to higher rates of depression and anxiety and higher risks for suicide among young people. They also lead to an overall decline in a community’s sense of well-being. One study found a higher incidence of infants born prematurely or with low birth weight in counties where a mass shooting had occurred.
Some studies suggest that mass shootings damage economic prospects in a community, diminishing productivity and earnings.
There isn’t a consensus about what constitutes a mass shooting. The Health Affairs brief describes mass shootings as: those with multiple victims, that are unexpected and random, typically occurring in a public place and unrelated to another crime such as gang activity or armed robbery. The FBI’s definition is one in which at least four people are killed with a gun.
Often, researchers say, the mass shootings occur in areas not prone to routine gun violence, shattering the sense of safety and well-being that residents previously took for granted for themselves and their families.
“We’ve known for years, decades in fact, thanks to the work of neuroscientists and others, about the traumatic effects on actual witnesses to mass shootings,” said Aparna Soni, a health economist at American University who co-authored the piece in Health Affairs. “Anxiety, depression, PTSD. What we didn’t have a good handle on are the effects on the community, on those who live nearby who have been emotionally affected by something happening in their own community.”
Daniel W. Webster, co-director of Johns Hopkins University’s Center for Gun Violence Solutions, likewise said the new health research should change the calculus about societal costs of gun violence.
“When we’re thinking about policies to lower gun violence, whether in communities or schools or whatever, there is always this cost-benefit analysis that goes on for policymakers,” he said.
The community-wide impact of gun violence is rarely considered in that analysis, Webster said, whether in Baltimore, Chicago and other cities where shootings are common or in areas with mass events that draw national media attention.
“People really grossly underestimate the social cost of gun violence in all forms in the United States,” he said.
Informing Public Debate
Even though the political parties differ on what to do about guns, the new research should prompt greater spending on mental health services, said Heather Harris, a research fellow in criminal justice at the nonprofit research organization Public Policy Institute of California.
“Building up community mental health isn’t just a way to prevent mass shootings, but a way to help people who are affected when it happens,” she said. “All that should be much more robust, but it takes resources and people capable of doing that work.”
The Affordable Care Act increased access to mental health services for millions who previously didn’t have health insurance. And after years of relatively flat federal funding for community mental health, the federal government recently made mammoth new investments in that area. Since 2020, federal spending on community mental health has climbed by about 75%, to nearly $3 billion in 2022, according to the federal Substance Abuse and Mental Health Services Administration.
Most of that additional spending came via one-time infusions included in various COVID-19 relief packages, which mental health advocates have celebrated, even as they worry about what happens when those investments run out.
“We have these huge, huge investments in cash in these COVID packages, but as they run out, it’s a question of what happens then,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness. “Are states going to step up to fill that gap, or are they going to look to the federal government to keep funding those services?”
Some states have increased mental health spending, spurred in part by mass shootings in schools. After the 2019 mass shooting at the Marjory Stoneman Douglas High School, for example, Florida increased spending on school mental health by $100 million a year. In addition, the state increased spending this year for community mental health by $126 million.
The boosts came after years of essentially flat state spending on mental health, said Melanie Brown-Woofter, president of the Florida Behavioral Health Association. “Our legislature has made great strides in recognizing the need for mental health and substance use treatment,” she said. “They’ve shown more willingness not only to discuss it but fund it.”
Many jurisdictions have crisis psychological services that intervene after mass shootings, particularly when schools are involved. But experts on gun violence say those services generally don’t last long and aren’t extended to the wider community.
Cost also remains a barrier for many residents who need mental health services. Even those with health insurance still often face substantial out-of-pocket expenses. But an equally nettlesome problem is a severe lack of mental health providers, particularly in rural America.
“Even if you have enough funding and the best evidence-based practices, if we don’t have the workforce to provide that care, we aren’t going to be able to help people and it takes time to build up that resource,” said Wesolowski.
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