However, President Trump is not alone in targeting people with mental illness in the aftermath of gun violence instead of focusing on access to guns. New York Gov. Andrew Cuomo and Texas Sen. Ted Cruz, among others, have done the same. If they’re successful, it will be another hard hit against marginalized communities during an administration when they are already under attack.

The American legal landscape is a complex web of laws that subject mentally ill people and those experiencing acute crisis or suicidality to surveillance and restrictions of their rights, which most notably includes the right of states to involuntarily commit a person with mental illness or to mandate outpatient treatment. Undergirding this legal framework is the presumption that people with mental illness are prone to violence (whether against themselves or others).

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This is sanism: The system of institutionalized oppression that systematically disadvantages people perceived or determined to be mentally ill, while granting privileges to those considered sane.

The legal link between violence and mental illness is so strong that the United States often uses institutionalization as part of the broader carceral system. Among the most glaring examples of this are the insanity defense, people who are deemed incompetent to stand trial, and sex offenders who are confined to mental institutions even after the completion of their criminal sentence.

Technically, people charged under these laws are not sent to prison. However, institutionalization functions as a form of medical incarceration; patients are not free to come and go, and are often confined in hospitals for a longer period than they would have been confined to jail or prison. In fact, the population of forensic patients in state psychiatric hospitals has grown so rapidly that many state institutions are at or beyond capacity, with some patients held for decades or even indefinitely.

The specific legal criteria for involuntary civil commitment vary across states, but most states rely on the dangerousness criterion. In theory, it assesses if a mentally ill person poses a threat of danger to themselves or others to determine whether to initiate civil commitment proceedings. However, states generally do not distinguish between the danger posed to oneself and the danger posed to others in determining the appropriate interventions. The law affirms that states, pursuant to their parens patriae power, or the authority to act as a guardian for those unable to act on their own behalf, have a substantial interest in subjecting people with mental illness to involuntary commitment to ensure their safety or their community’s safety.

So even when no crime has been committed, people can be medically incarcerated. In a country that guarantees a constitutional right to liberty and due process, that poses a serious problem.

Trump’s call for increased institutionalization, therefore, bears a striking similarity to the cruelty of his other policies: It capitalizes on widespread anxiety about community safety in order to justify expanding carceral control of “deviant” groups. People of color and other historically marginalized populations will bear the brunt of any such expansion. People of color are more likely to be found incompetent to stand trial, and Black people are three to four times more likely than white people to be diagnosed with psychotic disorders. Black and Native people are disproportionately impacted by institutionalization and are more likely to be mandated to receive involuntary outpatient treatment.

Much like the proposal the Trump administration is weighing today, previous policies meant to reduce gun violence ultimately increased surveillance and criminalization of people with psychiatric disabilities.  For example, 43 states currently require or authorize that people flagged by the state due to certain mental-health adjudications have their names reported to the FBI’s National Instant Criminal Background Check System (NICS). Four more states require such collection in an in-state database, each of which place people who have been involuntarily committed on lists alongside those convicted of violent crimes to bar them from purchasing firearms. Following the shootings at Virginia Tech, mental health related reporting to NICS spiked by 700 percent in just under seven years.

This becomes increasingly important as a focus on suicide becomes a larger target in gun violence prevention. While politicians have previously been met with skepticism for pinning mass shootings on mental illness, they have found support when focusing on the danger that people with mental illness are presumed to pose to themselves. This allows politicians to dodge the issues underpinning mass gun violence, instead targeting a population of people with much less political capital (people with mental illness) rather than the main perpetrators of mass shootings (straight white men). In that sense, they are leveraging sanism to protect white supremacist patriarchy.

As a result, the focus on suicidality is likely to increase the number of people who are institutionalized, without decreasing the number of mass shootings.

The American mental health system is violent. People with mental illness, particularly people of color with mental illness, are increasingly subject to punitive coercive treatment instead of community-based models for healing and care. The national fixation on mental illness which inevitably follows mass shootings is harmful not only because it does nothing to curb gun violence, but because it is a pretext for entrenching and expanding oppression.

Each time gun violence and mental illness are discussed together, we ultimately reinforce the discriminatory assumptions which animate our laws and justify dehumanizing treatment and oppression of psychiatrically disabled people.

In both the United States and globally, gun violence is strongly correlated with both poverty and inequality. A recent World Bank study found that inequality helped predict the difference in murder rates between states in the United States—as well as between countries. Suicides, which make up the majority of gun deaths in the country, skyrocket in times of economic distress. The Great Recession alone was linked to more than 10,000 suicides, according to one study.

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At a time when the Trump administration is undertaking an all-out assault on health care, food assistance, and the broader safety net, I reached out to Mark S. Kaplan, a professor of social welfare at the University of California, Los Angeles, to discuss the link between inequality and gun violence.

Jeremy Slevin: It sounds like from your research, the primary way we can quickly address the gun violence epidemic in this country is through gun policy—reducing the amount of guns that are available in circulation. Is that fair to say?

Mark Kaplan: Limiting access to guns is a form of harm reduction. What guns do to a society that is inherently violent—and we are a violent society—is that it lethalizes the violence. So if we are able to tamp down that violence by reducing people’s access to guns, that might be a first good step in the direction we’re talking about.

JS: Could you talk a little bit about your research on how inequality correlates with levels of gun violence?

MK: For one, we know that the numerous studies that have looked at the intersectionality of race and class and gun violence have clearly shown that there is some relationship between issues of racial segregation and issues of deprivation—social and material deprivation. The reduction of guns is not going to alleviate those problems. But there is a very troubling and very strong association, and gun deaths are only the tip of the iceberg. Often we don’t talk about the other 90 percent of that iceberg—people who have to be hospitalized, the financial cost, members of those families, the pain, the post-traumatic stress associated with it. So it’s a much bigger problem than gun death.

JS: Is it fair to say that to address the gun violence issue, you need to tackle both the issue of guns, but also tackle the issues of poverty and inequality?

MK: There isn’t one epidemic of gun violence—there are multiple epidemics of gun violence. Suicide doesn’t come up as often, but that represents two-thirds of gun deaths in this country. And that’s a problem that is different from the interpersonal violence. But both are particularly sensitive to the issue of gun availability.

Let me give you an example. California is rated as an A+ by the Brady scorecard, which rates states by the number of gun laws they have on the books. Nationally, 51 percent of all suicides are gun-related. In some states, it runs even higher, all the way to 80, 90 percent. In California, it’s 30 percent, on average. So it means that with fewer guns, there’s a window of opportunity to intervene and possibly rescue people who are suicidal. But with the presence of a gun, the opportunities to intervene diminish dramatically.

JS: Has there been any research, either by you or other scholars, on how suicides are linked to economic factors?

MK: I did recently complete a project, funded by the NIH, looking at the impact of the Great Recession on suicides. And indeed, there is a relationship! There’s some evidence that with the Great Recession we saw a rise in unemployment, we saw a rise in foreclosure rates, we also saw a rise in the rate of poverty—which may have contributed even more than the other two measures in economic distress. That rise in poverty contributed to an uptick in the suicide rate.

There are data that seem to suggest, both coming from the United States and more so from Europe, that many European countries such as Greece went through a very hard time. The EU imposed very restrictive, draconian measures that were attached to the loans they got, and that caused a cutback in welfare and health care and all sorts of other things. And in countries that traditionally had lower suicide rates such as Greece and Italy during the Great Recession, rates of suicide went up. But we know in this country too that the long-term research looking at periods of unemployment and following up five years or more show that for each percentage-point rise in unemployment, there’s also a rise in the suicide rate.

JS: And of course, in the United States, it’s very easy to get a gun, which seems to be the most fatal form of suicide. Of all suicide attempts, those attempted with a firearm are unfortunately more likely to be fatal.

MK: Yes, that’s referred to as the “case fatality rate.” With the use of guns, it’s nearly 95 percent.

JS: What would you recommend as policy solutions that get at both the firearm access and the social justice issues of gun violence?

MK: I think that we need to approach this in a more holistic way, a more comprehensive way. The gun issue is perhaps the first step. It’s how we tamp down the lethalization, which I brought up at the beginning. That’s something that researchers have looked at globally—the presence of guns. The first thing we need to do is lower the rate, the prevalence of gun availability, access to guns. California is a great example. Some of the most restrictive gun laws have produced very positive results, fewer gun deaths in the state. They say the winds blow from the west to the east, so hopefully that will happen.

And then we can begin to tackle some of these social inequities and inequalities, and some of the structures that promote inequality. Violence is a more difficult social problem to tackle. It represents more than just the loss of lives: The economic toll on society is huge. How do we redress the various measures of inequality? The distribution of wealth and income, the issue of racially segregated communities, the under-resourced and underfunded social welfare infrastructure that seems to be taking a hit in the current administration—those are issues that also need to be addressed. We are lowering the safety net right now. In other words, under the current government … we’re requiring work for health care, so we’re dropping the safety net, meaning that people are going to get hurt.

This interview has been lightly edited for length and clarity.

My mind still flashes back to my hometown every time news of a shooting breaks, even though Tomasz was killed almost five years ago. It was early on Christmas Eve in 2012 when a man set his family home on fire and shot the firefighters who responded to the blaze from a berm across the street. He used the same model of assault rifle that was used in the Sandy Hook massacre two weeks earlier.

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I found out Tomasz was dead on Twitter. I had been watching footage of my town burning for hours, hoping that I didn’t know the people who had been killed. Then a local reporter tweeted a picture of a piece of notebook paper where she had scrawled the names of the victims. She spelled Tomasz’s first and last name wrong, with “ch”s where there should have been “z”s and “k”s, but that felt almost appropriate. His Polish name had confused people for his entire life—at least 25 percent of people responded “bless you” when he introduced himself, and when teachers struggled with the pronunciation during roll call his entire class used to shout his name in unison.

Our town was never particularly pro-gun, but after Tomasz was murdered we became fierce advocates for gun control. And about three weeks after his death, New York State had a new gun-control law to show for it—with a special provision that makes the penalty for murdering a first responder life in prison without parole. It was lauded in New York City, and Albany, and even my hometown, but once you step over the county line, “Repeal the SAFE Act” signs dot the front lawns. There, the law is viewed with a mix of indignation and hostility—an encroachment on a centuries-old way of life of people who genuinely don’t believe their guns are part of the problem.

I’m a product of that side of the county line, too. My grandfather taught me and my brothers how to shoot tin cans and milk jugs before Thanksgiving dinner when I was ten years old. He thought of guns as a tool, and grumbled instructions with the same matter-of-fact directness he used when he taught me how to change an alternator. I’m still not a great shot—I hit low, because I drop my arm—but I’m competent. That was important to my grandpa—he respected that my brothers and I were nervous nerds, but he needed us to be able to fend for ourselves.

Grandpa made the only joke I ever remember him telling during that shooting lesson. One of my little brothers was telling a story, and—forgetting that there was a pistol in his left hand—he flailed his little eight-year-old arms towards Grandpa’s torso while his index finger was still on the trigger. My grandfather pushed the barrel of the gun back toward the ground and flipped the safety on before chuckling, “Be careful where you point that thing—my flesh is very tender, and doesn’t much like being shot.”

That’s the thing about guns—no one much likes being shot. But last year, 33,594 Americans were killed by guns—5,000 more than the number of people who died from prostate cancer. We’ve changed the way we practice medicine to make sure those cancer patients get the treatment they need—but guns, not so much.

The trouble with guns is that they were designed to kill, and they do it more readily than anything else we’ve created for the job. Even people who grew up with them—who think of them as tools, and respect their inherent danger—know that. That’s why they were written into our constitution, and that’s why we cling to them. It’s because that power—the power to kill—is a thing white Americans feel entitled to.

And it is, to be clear, white (mostly male) Americans who are worried about our guns. We are 80 percent more likely than black Americans, and 157 percent more likely than Hispanic Americans, to prize gun access over gun safety. That level of concern spiked right after Obama was elected, and in the years following the top reason gun owners cited for having a weapon switched from “hunting” to “safety.” That’s also when, as Bill O’Reilly put it, white folks started to realize that it might not be “a traditional America anymore.”

Over the centuries, white Americans have felt entitled to a lot. We’ve felt entitled to usurp land, and to lay waste to human bodies, and to enrich ourselves by exploiting others. We have been forced, very slowly, to recognize that those things aren’t our right. None of it has been graceful—we fought wars for land and slavery, rioted for segregation, and elected a white supremacist in response to our first black president—but eventually we can shake this part of our history loose, too. Just because guns are a part of our legacy, that doesn’t mean they have to be a part of our future.

I have to believe that we can realize that. Because the alternative—that we keep bleeding American lives just to prove that we can—is too gruesome to bear.