Central to the American tradition of expanding protections for controversial speech is a robust distrust of potential censors to make reasonable judgments about what speech should be suppressed. But the arguments for a more restrictive approach to speech often implicitly or explicitly evince much greater trust in the likely decision-makers who will be entrusted with the authority to suppress speech. Whether restricting Communist speech, antiwar speech, “hate speech,” or “disinformation,” the case for empowering some authority figure—such as campus administrators, technology company employees, or government officials—builds on an assumption that those authority figures will be motivated by good intentions and be endowed with good judgment to make reasonable distinctions between the speech that should be tolerated and the speech that should not. Such confidence would often seem to be misplaced.

Intentional injuries claimed nearly two hundred lives every day in the United States in 2020, about two-thirds of them suicides, each a story of irretrievable human loss. This essay addresses the complex intersection of injurious behavior with mental illness and access to firearms. It explores what more can be done to stop gun violence while respecting the rights of lawful gun owners, preserving the dignity of persons with mental illnesses, and promoting racial equity. Strategies to prevent firearm injury in the United States are uniquely conditioned by a constitutional right to bear arms, the cultural entrenchment and prevalence of private gun ownership, and strident political disagreement on regulatory solutions to stem gun violence. Broad implementation of a range of complementary policies is needed, including community-based programs to address the social and developmental determinants of violence, improved access to a continuum of mental health services, firearm restrictions based on behavioral indicators of risk (not mental illness, per se), licensing for firearm purchase or ownership, comprehensive background checks for firearm purchase, and supply-side approaches to interrupt illegal firearm markets.