The recent shooting in Nashville, Tennessee, where a gunman opened fire on students and school administrators,1 has raised concerns about the effectiveness of firearms background checks in identifying potentially dangerous individuals. It is alarming to note that the shooter, who reportedly had a history of mental illness, was able to legally purchase firearms. What is more concerning is that this is not an isolated incident. The weapons used in all 10 of the deadliest mass shootings in the United States in the past decade were also obtained legally.2 This highlights a significant flaw in our current system and emphasizes the need for stricter regulations on firearms to prevent their use by individuals who pose a danger to society.

President Biden's recent executive order3 aimed at combating gun violence is a crucial step toward ensuring public safety. The order includes measures to improve background checks prior to gun sales, which is essential for preventing individuals with a history of violence or mental illness from obtaining firearms.4 However, it is crucial to recognize that addressing the issue of gun violence goes beyond just implementing stricter gun control measures.

While background checks are a crucial tool, they are not foolproof. A study examining public mass murderers over 24 years found that half of the offenders had a history of mental illness, but less than 5% had gun-disqualifying mental health records.5 This suggests that many individuals who pose a danger to society may not have records entered into the system and may still be able to purchase firearms legally. Moreover, individuals who purchase firearms illegally clearly evade any background check.

Research has shown that the risk of interpersonal gun violence for individuals with well-managed mental illness is extremely low.6 However, this risk significantly increases in cases where people lack access to treatment or engage in drug and alcohol abuse. Consequently, to prevent gun violence, it is imperative to increase accessibility to mental health care services and diminish the stigma associated with mental illness and substance use disorders.7 Nevertheless, we must also recognize that many individuals who struggle with mental illness may hesitate to seek help due to fear of being labeled as dangerous or having their firearms taken away. Therefore, we must address the societal stigma surrounding mental illness and firearms ownership. By promoting a culture of mental health awareness8 and reducing the stigma surrounding mental illness, individuals may feel more comfortable seeking help and addressing any potential risks associated with firearms ownership.

Another at-risk group for gun violence comprises transgender individuals. The Nashville school shooter was identified as transgender. Unfortunately, transgender individuals face significant barriers to mental health care access and are often stigmatized by society, making them particularly vulnerable to mental illness. Nearly half of all transgender individuals have attempted suicide,9 and anti-transgender legislation10 in some states seeks to restrict their access to health care and other resources, which exacerbates their vulnerability. Such laws can make it even harder for transgender individuals to seek help and support, potentially leading to further mental health issues and an increased risk of gun violence.

Increasing anti-transgender sentiment could escalate gun violence against transgender individuals, given the historical marginalization, discrimination, and violence faced by the transgender community. A report by the National Center for Transgender Equality indicates that nearly one in 4 transgender people in the United States has experienced some form of violence.9 In some instances, transgender individuals may feel compelled to acquire firearms for self-defense due to concerns about being targeted,11 which is particularly worrisome, given the high rates of mental illness and suicide in this community. This cycle of violence not only puts transgender individuals at risk but also endangers society as a whole. Therefore, it is crucial to address the root causes of anti-transgender sentiment and promote a culture of inclusivity and acceptance. This will help reduce the likelihood of violence and ensure that all individuals feel safe and valued in society.

It is essential that society does not restrict transgender individuals' access to health care and therapy that could help alleviate the mental distress caused by societal discrimination and marginalization. Instead, we must address the systemic barriers that prevent transgender individuals from accessing mental health care, resulting in poorer health outcomes than their cisgender counterparts,12 such as a lack of insurance coverage13 or discrimination by health care providers.14

In conclusion, mental illness, transgender issues, access to health care, and firearms ownership are complex issues that require multifaceted solutions. We must prioritize public safety and take action to prevent gun violence while promoting mental health awareness and reducing the stigma surrounding mental illness and firearms ownership. This includes ensuring that firearms background checks are more effective in identifying potentially dangerous individuals, improving access to mental health care, and addressing the root causes of anti-transgender sentiment. It is our responsibility as a society to take action and prevent tragedies such as the recent shooting in Nashville from happening again. We owe it to ourselves and future generations to create a safer, more inclusive society where everyone can live without fear of gun violence.

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