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Mental Illness and Guns

As controversial as “gun control” is the debate over gun violence also brings up the idea of controlling the people who own or want to own guns. This is hardly a new topic.  More than 100 years ago, the debate over mentally ill and guns arose when a disturbed gunman killed President McKinley.

Dr Jeffery Swanson wrote in JAMA:

“The 1968 Gun Control Act prohibitions on the adjudicated mentally ill have remained in place long after civil commitment reforms and deinstitutionalization have run their course, radically reducing and reshaping the ranks of the involuntarily committed. The definitions are rendered blunt and indiscriminate; they leave too many at-risk people unidentified, while including others with largely nondangerous disorders of thought, mood, and behavior.New criteria and rules, designed to identify the small number of seriously mentally ill people who are demonstrably dangerous and to prevent them from accessing firearms, now occupy center stage in the gun policy reforms emerging at the national and state levels. But the laws are both sensible and overreaching; lawmakers need to find the right balance between public safety and civil rights as they try to sort out one from the other.

Dr. Swanson points out that shortly after the Sandy Hook School shooting, New York passed a new law that seeks to force mental health professionals and doctors to report when one of their patients seem dangerous:

The law also requires mental health professionals—psychiatrists, psychologists, social workers, and nurses—to report to local mental health authorities the names of all patients deemed likely to seriously harm themselves or others. A reported person’s name will then be checked against a database of state gun licensees; if a match is found, the gun license may be suspended and police authorized to find the person and remove the person’s firearm.

So what’s the problem? Dr. Swanson finds three main issues:

Three problems beset New York’s new reporting law for mental health professionals.

-“The first is overidentification; the law could include too many people who are not at significant risk.”

-“The second is the chilling effect on help seeking; the law could drive people away from the treatment they need or inhibit their disclosures in therapy.”

-“The third is invasion of patient privacy; the law amounts to a breach of the confidential patient-physician relationship.”

“Mental health professionals already have an established duty to take reasonable steps to protect identifiable persons when a patient threatens harm. However, clinicians can discharge that duty in several ways, as the situation demands, often without compromising a therapeutic relationship that depends on confidentiality. For example, the clinician could decide to see the patient more frequently or prescribe a different medication. Voluntary hospitalization is also an option for many at-risk patients.”

(Source: Jeffrey Swanson, PhD, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3071 Med Ctr, Durham, NC 27701 (jeffrey.swanson@duke.edu).


Why Mental Illness may NOT be the Biggest Issue in Gun Crimes

Despite what politicians say, the mentally ill are not the gun-firing criminals you would expect. The National Journal reports:

Perhaps most important, although people with serious mental illness have committed a large percentage of high-profile crimes, the mentally ill represent a very small percentage of the perpetrators of violent crime overall. Researchers estimate that if mental illness could be eliminated as a factor in violent crime, the overall rate would be reduced by only 4 percent. That means 96 percent of violent crimes—defined by the FBI as murders, robberies, rapes, and aggravated assaults—are committed by people without any mental-health problems at all.     (also see this blog for more citations)

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