January 16, 2013

Annals of Risk Management: Guns and Mental Illness in New York

New York has just signed into law a new gun control measure [S. 2230] that comes as a direct response to the incomprehensible tragedy in Sandy Hook, CT. While the bill touts its "first in the nation" status, with respect to its approach to mental illness, it is by no means a model for other states to follow.

The bill addresses three distinct issues relating to mental illness: first, limiting access to gun licenses for those diagnosed as mentally ill and dangerous. Second, the bill requires gun owners who reside with a mentally ill and "dangerous" individual to keep guns under lock and key. Finally, and most disturbingly, the bill requires mental health professionals to report any patient who is "likely to engage in conduct that will cause serious harm to
him- or herself or others." In other words, the bill assumes that any individual with suicidal tendencies is a potential mass murderer. Such stereotyping is not what is needed in the mental health community.

Double Bind
S.2230 places a formidable burden on mental health professions - who not only must treat their patients, they are held accountable for predicting future behavior:

A new Section 9.46 of the Mental Hygiene Law will require
mental health professionals, in the exercise of reasonable
professional judgment, to report if an individual they are treating
is likely to engage in conduct that will cause serious harm to
him- or herself or others. A good faith decision about whether to report
will not be a basis for any criminal or civil liability.

If we have learned anything in the all-too-frequent incidences of random slaughter, the "likelihood" of homicidal acts is usually only revealed retroactively, long after the fact.

The bill goes on to read:

When a Section 9.46 report is made, the Division of Criminal Justice
Services will determine whether the person possesses a firearms
license and, if so, will notify the appropriate local licensing
official, who must suspend the license. The person's firearms will
then be removed.

After a therapist reports a potentially violent patient to the state - once again, this rather large population includes people who only threaten to hurt themselves - New York will run the names through the data base of licensed gun owners. All hits must result in license suspension. Of course, bureaucracies being what they are, it might take months for the suspension to take place. Hence, the individual who at one time exhibited psychotic symptoms or discussed violent feelings with a therapist might find him or herself months later confronted by cops on the doorstep. Such encounters will hardly be helpful for people trying to establish mental equilibrium.

Finally, the image of forcefully removing guns from the home surely presents enormous risk to gun owners and public safety officials alike. Who will do this and under what circumstances? My guess is that, given the profound implications of reporting patients to the state, most therapists will err on the side of non-reporting and rationalize their inaction, when necessary, under the heading of acting in "good faith."

The Wrong Cohort
It is important to note that only individuals receiving treatment for mental illness will be subject to this onerous standard. Given the fractured and fragmented nature of mental health treatment in this country, the vast majority of mentally ill individuals have never received and are not about to receive any treatment. And among the violent individuals who might well contemplate an attack of homicidal proportions, few would bother to discuss it with a therapist or go through the formality of securing a gun license before buying an assault weapon.

The relatively small subset of people impacted by the New York bill - people diagnosed with mental illness who are licensed gun owners - is likely to prove statistically insignificant, as is the probability that a single mass murder can be prevented by this radical undermining of the doctor-patient relationship. Surely, there is a better way to manage what has become a remote but appalling risk of life in the 21st century.

| 1 Comment

1 Comment

Thank you for the information, it is a shame that so many rush to solve a problem without considering all the consequences.

Red Hollingsworth
CompMinder

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This page contains a single entry by Jon Coppelman published on January 16, 2013 3:12 PM.

Annals of the Aging Workforce: An Old Man Takes His Lump(s) was the previous entry in this blog.

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