Defining the specific conditions that can impair judgment or significantly increase risk of harm to self or others is an important step in this process, which needs serious involvement of mental health professionals, stakeholders, law enforcement and policymakers.

The majority of mental illnesses do not pose a risk to others. When there is a risk, in the majority of cases when someone is involuntarily admitted to a psychiatric inpatient unit, it is not because the person poses a risk to others. Rather, it is more often the case that the person is at risk of self-harm, as in the case of a depressed, suicidal patient. Sadly, people with severe mental illness are often the victims of violence and abuse.

In psychiatric disorders, concerns typically arise in acutely psychotic patients with paranoid delusions that convince them to harm others. This may happen in – but is not limited to – schizophrenia, dementia, severe psychotic depression or psychotic bipolar illness.

These conditions are rather strongly associated with increased risk of suicide, not homicide. Therefore, more realistic gun laws in regards to mental illness could also save many lives from suicide.

Substance use is a major contributor to violence in mental illness, and it needs to be included in the calculations when it comes to gun restriction. Other situations with increased risk of harm to others are personality disorders with a high level of impulsivity or lack of remorse, such as antisocial personality disorder.

But the reality is that most people with personality disorders do not seek treatment and are not known to mental health providers.

It is also worth noting that most countries have a similar prevalence of severe mental illness compared with the U.S., yet they have much lower rates of mass murder than the U.S.

Every time mental illness is linked by the media or politicians to acts of violence, the highly charged emotions of the moment can affect those with mental illness and their families, and that can perpetuate stigma.

When “mental illness” is vaguely addressed in gun debates, those with a psychiatric condition such as anxiety or phobia but without an increased risk of violence or impairment in judgment may avoid seeking treatment.

In my view, to turn the focus on the role of mental illness in gun violence into meaningful actions, the following steps are needed:

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