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Needs of Gun Victims

T he roundtable participants were asked to consider how gun victims may be different from other crime victims and how the differences might affect the services they need or receive. The main themes that emerged were 1) the gun as the weapon of violence, 2) the young age of the victims, 3) the high cost of gun violence, and 4) the extraordinary media attention given to a small subset of gun crimes.

1. The Gun as the Weapon of Violence

Much has been written on why gun use increases the deadliness of attacks; for example, because guns inflict more damage than other instruments, they can be fired multiple times with little effort, firearms have a greater range, and assailants intending to kill choose the most efficient instrument.16 Whatever the impact of these different factors, it is clear that the fatality rate from gun assaults is much higher than that from other weapons. This is true regardless of the relationship between the victim and shooter, as the presence of a gun can turn a robbery, an argument, or an abusive relationship into a homicide.17

According to a 1996 BJS report, 29 percent of firearm homicide victims were killed because of an argument; 21 percent were killed during the commission of another crime, such as a robbery or drug crime; and 6 percent died as a result of a gang-related shooting.18 Offenders report firing a gun within 15 seconds of brandishing it, even when they had not intended to shoot the victim.19 Gun victims include those shot during traffic altercations, gambling disputes, and verbal disagreements.

The lethality effect is not lost on the victims. Participants repeatedly spoke of the nature of the weapon used. "An important difference is the gun itself. Guns are the only instrument developed to kill; victims facing a gun suffer the trauma of death or the fear of death," said family bereavement counselor Kevin O'Brien. Meanwhile, participant DeLano Foster, an OVC Program Specialist and survivor of multiple homicides, offered that "the difference between an armed robbery and a homicide could be the time it takes the victim to hand over his wallet." Eyewitness accounts frequently report victims putting their hands in front of them and "holding up articles of all kinds in their last moments in the magical belief that even a sheet of paper might save them."20

Bystander Victims

Durham, North Carolina: April 7, 1998. While walking with his mother, a 5-year-old boy was hit by a stray bullet from a gunfight. The bullet severed his spine, and Taquan Mikell may never walk again. The bullet struck him more than half a block away from the gunfight.

Nashville, Tennessee: July 2, 1999. Nashville teenager Eric Harvey Hazelitt was fatally shot in the chest when gunfire erupted at the John Henry Hale public housing complex in Nashville. Just 14 years old, he was caught in the cross-fire of two groups shooting at each other.

Referenced from In the Crossfire: The Impact of Gun Violence on Public Housing Communities, published by the U.S. Department of Housing and Urban Development, February 2000.

Washington, D.C.: June 21, 1999. Helen Foster-El, a 55-year-old grandmother, was outside her home in the 100 block of 56th Place SE. watching neighborhood children play when gunfire erupted between two groups. On hearing the gunfire, Ms. Foster-El began to shepherd the children into one of the neighborhood homes for their safety. As she was doing so, she was struck in the back by a stray bullet and died instantly.

Harrisburg, Pennsylvania: June 10, 1999. Raphael Rivera, 14, was in the immediate area of an altercation involving several individuals. When the altercation escalated into gunfire, Raphael, who was not involved in the argument, sustained a fatal wound to the chest.

Referenced from The Death Toll Since Columbine, a report of the U.S. Conference of Mayors, Washington, D.C., January 2000.

Gun violence also is frequently more random than other types of criminal victimization. One participant noted that "bullets don't always have a name on them. You can be shot from a great distance even with a bullet meant for someone else." Young men can be "casualties of a war they did not partake in" when gang members intent on retaliating shoot at random victims when they can't find the rivals they intended to kill.21 Other participants talked about small children sleeping in bathtubs to hide from stray bullets penetrating bedroom walls at night.

The bystander victim represents the most impersonal type of crime. But participants commented that, even when the shooter targets a particular victim, the gun crime is somewhat impersonal. The gun, as an instrument of both power and detachment, allows the shooter to remain physically and emotionally distanced from his or her victims. When the victims are shot in the back, as many are, they never even see the shooter's face. This may increase the "Why me?" response of so many gun victims, similar to the feelings of victims of drunk driving.

The ability of mentally disturbed individuals to kill at a distance, together with the enormous firepower of semiautomatic weapons, may have facilitated the gun rampages that have taken so many lives in recent years. Participant Michelle Scully Hobus was shot and her husband killed when a crazed gunman armed with two semiautomatic TEC-9 pistols roamed a San Francisco, California, law firm, shooting 15 people, killing 9 before taking his own life. It was a long time before she could shake the feeling of danger. "Even though I knew that the gun massacre at the law firm was an extremely rare event, I kept having the feeling that it would happen again. I couldn't sit with my back to the door; I thought someone would come in and blow everyone away."

  • Just as Larry Gene Ashbrook did on September 15, 1999, when he shot 14 people (7 dead) in the Wedgwood Baptist Church in Fort Worth, Texas.

  • Just as Mark Barton did on July 29, 1999, when he shot 22 people (9 dead) at two brokerage firms in Atlanta, Georgia.

  • Just as Kip Kinkel did on May 21, 1998, when he shot 24 people (2 dead) at Thurston High School in Springfield, Oregon.

  • Just as George Hennard did on October 16, 1991, when he drove his truck into Luby's Cafeteria in Killeen, Texas, and opened fire on the lunchtime crowd, killing 23 people before shooting himself.22

Moreover, gun victims face constant reminders of their trauma from the everpresent gun seen on television programs and commercials and in films and videos. Even American slang, for example, "one shot," "take aim," and "set your sights," takes its toll on some victims. Some participants reported that any loud noise, like balloons popping and cars backfiring, could "trigger" a response. The exorbitant media attention paid to each new multiple-victim shooting also is retraumatizing for gun victims of similar tragedies. Security changes, such as metal detectors in schools, hidden cameras, dress codes, and guards in the halls, are constant visual reminders of school shootings.

Like other crime victims, gun victims seek redress against their shooters through the criminal justice and civil justice systems. Many victims, like participants Scully Hobus and Jaquie Algee, have become activists.

RECOMMENDATION: Clinical evidence supports the therapeutic value of victims working as change agents, in grassroots or church activities, informal support groups, and anticrime organizations.23

2. The Young Age of the Victims

As previously noted, gun crime disproportionately affects young people. Their injuries and grief must be understood in this context. The participants who work with adolescents spoke of the pessimism and despair, particularly in the inner cities, where communities are losing children to gun violence daily. Youngsters whose relatives and friends have been shot automatically think that sooner or later it will happen to them. They plan their funerals, write their obituaries, and specify the clothing in which they want to be buried. A psychological counselor for teenagers in Baltimore, Maryland, Dr. Rosetta Graham, spoke of the need to do much more for this age group: “Around age 14 or 15 they become more private and hold in their grief. They are caught between adults who know how to make their needs known and young children whose caregivers speak for them.” Studies of urban youth show a high correlation between exposure to violence and depression and PTSD.24

The hopelessness of this population was a recurring theme. The participants agreed that one major shooting, or the daily loss of friends and classmates, can have a profound effect on young people just beginning to explore their independence and develop plans for their future. While some hold in their grief, others become suicidal or act out their feelings on the street. Even in suburban settings where violence is rare, a highly publicized school gun massacre can have a significant impact. Counselors working with students at Columbine High School in Littleton, Colorado, worried about kids who were somewhat depressed and doing drugs before the shooting. In the months since the shooting, they have seen an increase in drunk driving, suicide attempts, and fighting. Disaffected students—or those who feel alienated or rejected—don’t trust anyone, don’t feel safe, and don’t do well in school. Similarly, after the 1998 shooting of 22 students at Thurston High School in Springfield, Oregon, there was a 600-percent increase in referrals to the school nurse and a 400-percent increase in arguments and fights reported to the principal. Many students, even some who were not present at the school but who watched the news coverage, experienced a loss of control, a feeling of being violated, and a sense of guilt that they survived.

For many students, the fear of gun violence is strong enough to interfere with the quality of their lives and their performance in school; they also may suffer from increased absentee, truancy, and dropout rates. Participants who work with children explained the importance of getting them to talk about their fears. They are hungry for information and may distort facts and think they could have prevented the shooting. They need to understand that the school shootings on the evening news are rare events and that schools are safe places.

Although exposure to violence will affect all adolescents to some extent, different services are needed when the shooting is an isolated tragedy versus when there is a daily threat of violence in the community.25 In the high-profile school and workplace shootings, crisis response teams “debrief” the victims and witnesses, often in a group setting. The interventions for schools and communities that witness violence are based on the assumption that the incidents they witnessed are one-time horrific events. Participants who had the benefit of this type of crisis response service felt a sense of security while the teams were there and a great void when they left. In the absence of organized training, teachers, school administrators, and guidance counselors are scrambling to get up to speed on crisis response. Many professionals who helped care for the students who were shot or witnessed a massacre of their classmates also became depressed and suicidal. According to School Superintendent Jamon Kent, the shooting at Thurston High took place May 21, 1998, and the aftershocks still occupy one-third of his time in the office.

RECOMMENDATION: Participants recommended that communities victimized by gun massacres be offered long-term assistance and training so they can more effectively be involved in the healing process.

Different problems arise and different types of interventions are needed to address chronic gun violence. For the past 10 years at least, young African-American males have experienced violent crime at a rate significantly higher than the rate for other age groups.26 Sandra DeLeon, Director of the Rise Above It violence prevention program in West Orange, New Jersey, reported that 60 percent of the students they serve know someone who has been shot. In their neighborhoods, gun violence is more predictable than random. They come to school worrying about the gunshots they heard the night before. The students need to hear, preferably from peer counselors, that there is a future to look forward to and they are not destined to be either buried or behind bars in jail. But the participants also agreed that this is an uphill battle. The strong correlation between poverty and violent crime means that those with the fewest resources are the most vulnerable. In some cases, the parents of homicide victims are very young. An enormous amount of preventive counseling is needed to keep them from exacting retribution while they struggle to get daycare, buy food, and arrange for the burial of a loved one.

The literature on children and adolescent victims reinforces the group’s findings about the vulnerabilities of young gun victims. A Task Force on Adolescent Assault Victim Needs, convened by the American Academy of Pediatrics, recommends addressing the psychosocial needs of young victims along with their physical injuries.27 To do this effectively, the task force noted that health care providers must acknowledge and address three myths: 1) that all adolescent victims are “bad” kids who probably deserve what they got, 2) that it is dangerous to care for adolescent victims who may be members of a gang, and 3) that it is hopeless to help them because of the high risk of reinjury and subsequent acts of violence by the victim.

The myth that all adolescent victims are “bad” kids is particularly harmful for young African-American men growing up in neighborhoods rife with drugs and gun violence. Generalizations about “predator youth” cause added grief for gun victims and stigmatize them and their families unfairly. Future employers may refuse to hire a young man with a bullet in his arm, assuming that he was a gang member or a bad person because he’d been shot.28 On the other hand, the tendency to use violence is considered a serious potential consequence of being a young victim of gun violence. In fact, “a new study by the National Center on Crime and Delinquency finds that one of the best predictors of whether a teenager will commit a crime is whether he or she has been a victim.”29 Siblings of gunshot victims are frequently preoccupied with revenge fantasies and may be encouraged and assisted by their peers in exacting vigilante justice. Once having resorted to violence, young men engage in more risk-taking behavior. Thus, a cycle of violence continues, and being shot once becomes the greatest predictor for being targeted again.30 However, the risk factors for this group are often overcome by the resourcefulness and determination of families surviving in the inner city.

RECOMMENDATION: Participants agreed that assistance for gun victims, particularly young African-American men, must include programs designed to teach victims to regain their self-respect and status in the community without resorting to more violence. Quick outreach and support to newly bereaved families can help redirect their grief toward positive efforts to honor the memory of their loved ones.

Although much of the roundtable discussion centered on teenage youth, elementary school-age children also are frequent witnesses to gun violence and often display symptoms of PTSD and other trauma-related disorders.31 Some children are afraid of school, and many become fatalistic. Some engage in aggressive play and perform poorly in school,32 while others become desensitized to violence and lose the ability to recognize and avoid dangerous situations. The few research studies that were available to participants suggested that witnessing gun violence affects children in many different ways, depending on the type of wound, the proximity to the shooter, the relationship of the shooter and victim, and whether the shooting took place in a context generally considered safe, among other things. Different reactions can be expected from boys and girls. Child witnesses who have been raised in a subculture of violence in the home may have additional risk factors for long-term psychosocial consequences.33 Effects also can be seen in somatic disturbances. According to participant Marianne Z. Wamboldt, M.D., a child psychiatrist in Denver, Colorado, clinicians have noted a relationship between the general stress in the community after the shooting at Columbine High and an increase in asthma cases and deaths among preschoolers.

After my 19-year-old son was shot in Chicago, I went to many support groups, community organizations, and church-affiliated meetings, but I really wasn’t getting what I needed. I needed to be more active in the movement to reduce gun trauma. I found comfort in joining The Bell Campaign, a grassroots victim-based organization, modeled after Mothers Against Drunk Driving.

—Jaquie Algee,
Southeast Regional
Director for The Bell Campaign

RECOMMENDATION: The roundtable consensus was that much more research is needed to develop services that take into account the full range of effects that gun violence has on children. OVC should work with other offices in the Office of Justice Programs (OJP), such as the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention (OJJDP), the Violence Against Women Office (VAWO), and BJS, to develop a research agenda concerning the needs of gun violence victims. The evaluation of promising direct service programs for child victims of gun violence should be encouraged and funded by OJP.

3. The High Cost of Gun Violence

Gunshot injury and death place a burden on the health care system in the United States that far exceeds the toll of other types of criminal victimization. Because of the traumatic nature and extent of their injuries, gunshot victims are more likely than other crime victims to require overnight hospitalization and followup care. BJS reports that gunshot victims represented only 5 percent of the estimated 1.4 million hospital emergency department patients treated in 1994 for violence-related nonfatal injuries. But while the majority of crime victims are treated and released, gunshot victims represent a third of those requiring hospitalization.34 The average cost of acute care treatment ranges from $14,85035 to $32,00036 per hospital admission. Because of the young average age of the victims and the frequent need for rehospitalization, the lifetime medical costs are very high, around $35,500 per victim. For all victims of firearm injuries (assaults) and deaths (homicides) in 1994, the lifetime medical costs totaled $1.7 billion. Government programs, primarily Medicaid, are the primary payers for 50 percent of hospitalized gunshot injury cases due to violence.37

The growing cost of gun violence can affect the trauma care available for all community members. At King/Drew Medical Center in Los Angeles, California, hospital expenses, not including professional fees, were more than $270.7 million for the 34,893 patients hospitalized for gunshot injuries from 1978 to 1992.38 Some 96 percent of these costs were paid with public funds.39 Between 1983 and 1990, the financial strain of treating uninsured patients contributed to the closure of 10 out of 23 trauma centers in Los Angeles County.40

In addition to direct health care and related expenditures, gun violence exacts a substantial economic toll on its victims and society in general in terms of lost productivity, use of the criminal justice system, pain and suffering, and diminished quality of life. Economists and public health statisticians estimate an annual bill of more than $100 billion for all of these gun violence costs. An examination of more than 1,000 jury awards in cases involving shooting victims yields an average loss of more than $3 million for a single family of a homicide victim.41

The economic loss is even more staggering for victims who sustain spinal cord injuries (SCIs) from gunshot wounds. These relatively rare catastrophic cases account for the lion’s share of the medical costs for gun injuries. Each year, approximately 10,000 persons suffer an SCI and require hospitalization. Nearly a quarter of these injuries are caused by acts of violence, primarily gunshot wounds. Violence-related SCIs have increased dramatically since the early 1970s, over-taking falls as the second leading cause of SCIs (after motor vehicle accidents) in the past 4 years.42 The average first-year expenses have been estimated at $217,868 (in 1995 dollars) for violence-related SCIs, although the amount varies considerably depending on the extent of neurological damage. With recurring annual charges for violence-related SCIs calculated at $17,275, the lifetime charges are estimated to be more than $600,000 for each victim. This includes charges incurred as a direct result of the injury, such as emergency medical services, hospitalizations, attendant care, equipment, supplies, medications, environmental modifications, physician and outpatient services, nursing homes, household assistance, vocational rehabilitation, and similar miscellaneous items. It does not include indirect costs, such as lost wages, fringe benefits, productivity, pain and suffering, and diminished quality of life, which could be twice as much as the direct costs.43

A handful of gunshot SCI victims have fared better than most. For example, the SCI students from the Columbine shootings have had the benefit of a community-wide effort to raise funds for remodeling living areas, paying for medical and living expenses, specially equipped vans, and even college scholarships. But these are atypical cases. The majority of people with violence-related SCIs are young African-Americans with low socioeconomic status. Many in this group have been targets of gun violence and have sustained most of their injuries because of drug- or gang-related activity. Those who return to their communities after surviving months with tubes in their bodies face a daunting challenge in school. Paralyzed for life, they never will be the same active teenagers again. The practical and social problems like calling ahead and waiting hours for transportation, wheelchair access to classrooms, and dealing with colostomy bags are difficult enough without the added fears of testifying in court and being targeted again by the shooter. Those with violence-related SCIs are more likely than other SCI patients to have intractable pain and commit suicide. For others, the cost of acute care and rehabilitation, among other things, can lead to the dim prospect of constant dependence on the Government or family.44

4. The Extraordinary Media Attention to a Small Subset of Gun Crimes

On April 20, 1999, the world watched as two high school students, armed with automatic weapons and shotguns, killed 12 students and a teacher and wounded 23 others before turning the guns on themselves. The tragedy at Columbine High School is considered a defining moment in the public’s consciousness about gun violence. The nonstop real-time media coverage of this horrendous massacre, both on the air and in print, was traumatizing to the victims’ families and friends, the community, the state of Colorado, the United States, and the world. The roundtable participants discussed this media coverage, focusing on its impact on children and its message for those haunted by the unpublicized loss of a loved one to gun violence.

RECOMMENDATION: Participants agreed that the media should be more sensitive to how their coverage of gun violence affects victims and children. OVC should develop training materials and guidelines for media coverage of gun massacres.

School shootings in particular are traumatizing for children because they all go to school.45 After Columbine, preschoolers in Colorado began talking about where they would be going to school as the place where they would die. School systems around the country saw the phenomenon of school-phobic kids, as both the news media and talk shows exaggerated a child’s risk of being shot at school. Although participants thought that such news coverage should carry a warning caption for parents about the possible adverse effects on young children, they also felt that older children are hungry to know what has happened and have a great need for information. In all cases, parents and teachers need to help children process the information they see on television, so they can realistically assess their own safety in school.

Unfortunately, the misconceptions about the risk of school shootings are pervasive in all age groups. A recent analysis of opinion polls taken after the shootings in Jonesboro, Arkansas, and Littleton found a 49-percent increase in parents’ anxiety about children’s safety in the classroom, even though statistical studies by the U.S. Department of Justice (DOJ) and the National School Safety Center showed a 40-percent decrease in school-associated violent deaths in 1998–1999, the school year including the Columbine shooting. These tragic events are truly rare—with 52 million students enrolled in public school, the chance that a school-aged child would die in school in 1998–1999 was 1 in 2 million.46

The gap between public fear and reality is not surprising, as media coverage is focused on less than 1 percent of homicides—those with multiple victims. Even within a group of multiple-victim gun homicides, the rarest events get the most media attention. For example,

  • December 4, 1999: Sacramento, California. A 31-year-old Asian man shot and killed his daughter and four sons, reportedly after having an argument with his wife. A shotgun and a high-powered rifle were found in the apartment.

  • December 5, 1999: Baltimore, Maryland. Five women were found shot to death in their Northeast Baltimore row house. Police said the women, who were not involved in drug activity, were shot to send a message to a relative who was involved in the drug trade.

  • December 6, 1999: Fort Gibson, Oklahoma. Five students were injured when a 13-year-old opened fire at a middle school with a 9 mm handgun he took from his home.

The family homicide, an all-too-common occurrence, was reported only by the California press. The Baltimore shooting was prime-time news for a day and then was eclipsed by the middle school shooting in a rural community in Oklahoma.

Even among victims of the same shooting, the media may focus on one or two to represent the face on the story. Perhaps because of their pronounced activism on the gun issue or because of some other special attribute, these chosen victims become the story of the massacre. In Homicide: The Hidden Victims, A Guide for Professionals, Deborah Spungen describes how individual victims of multiple-victim shootings “tend to get lost in the scale of the horror,” while “covictims who have had a loved one selected for the [poster victim] may experience feelings of reluctance, exploitation, loss of control, and anger.”47

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Working With Victims of Gun Violence
July 2001
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