Tuesday, February 12, 2013

Bang Bang: I'm thinking about Gun Legislation and the Mentally Ill

The figure I've heard is 40.  Forty pieces of new legislation brought before the Maryland General Assembly this year pertaining to firearms.  Some of them specifically address issues of gun ownership and those with mental illness.  Others don't, but simply conflict with one another.  There's a bill that would make it a crime (yes, a crime) to ask someone who purchases ammunition for identification.  Another bill requires that those purchasing ammunition must present identification.  Nothing like having our legislators on the same page.  Please don't quote me on that 40 number, I could be wrong.

Personally, I wouldn't flinch if they repealed the second amendment and did away with guns for everyone.  I've got my curare darts ready to shoot at the bad guys, who needs a gun?  And really, who needs a high velocity assault rifle? People who buy guns may have the best of intentions: shoot Bambi for dinner, protect their families, be ready for that government-overthrowing militia.  No one buys a gun thinking the bad guy will wrestle it from them, they'll shoot themselves while cleaning it, they'll use it when they get into a drunken brawl, their kid will play with it and shoot a friend, their kid will take it to school and shoot someone, they'll fly off the deep end and go postal when their wife has an affair or a boss fires them.  And those mentally ill folks, they aren't "us," the gun owners would never get depressed and kill himself, that stuff happens to "other people," those mentally imbalanced folks who shouldn't own guns.  And of course, the onset of mental illness is predictable, to one can know at the time of purchasing a gun that they or someone in their family won't be affected.  I do hope you'll forgive my sarcasm.

I'm not sure why the Newtown killings spurred this.  Nothing we've heard indicates that these laws would have prevented that (I could be wrong, maybe the shooter was telling a psychiatrist about his plans and the psychiatrist did nothing).  The college student in Colorado had seen a school psychiatrist once (?) and then dropped out.  Do we want every kid who goes to a mental health center to be reported to the FBI?  If you wanted a poster child for gun control and mental illness, then the college student in Arizona who shot the Congresswoman and innocent bystanders may have been the right one-- his behavior was reported to be flagrantly unusual and he was banned from campus.  Perhaps if there were easily accessible databases of people who purchased ammunition, then when these people came to the attention of mental health professionals, they could have run a check to see if they owned guns and were stockpiling ammunition, and maybe that would have spurred preventive action.  But for the most part (and there are exceptions), our spree killers have not been people who would be captured by the current proposals: people who've been hospitalized for more than 30 days, who've informed a mental health professional of plans to kill, people who've been involuntarily hospitalized for being dangerous.  So why now?

Take away everyone's gun, it's okay by me, so why do I feel so strongly that we shouldn't pass laws that use mental health professionals as agents of the state to fill databases?  Because it stigmatizes those with mental illness. Because it may deter people who are dangerous from getting much needed help.  Because we're bad at predicting who is dangerous in the absence of a specific threat.  Because we have measure to deal with specific threats (we can warn the victim, notify the police, hospitalize the patient).  Those requirements don't bother me because they leave me as the agent of the patient -- as far as I'm concerned, it's never in my patient's best interest to do nothing if they tell me they are going to kill someone.  Bad for the victim, and bad for my patient to rot in prison for years.  But mandatory reporting of people I think might be dangerous for the sake of putting them in a database, well, I've told you, I'm not good at guessing. 

 If you wanted to pass a law that says that if a psychiatrist calls the police with concerns that a patient has a gun and might be dangerous and the police are obligated to follow up on this, that would be okay.  As is, we can request involuntary evaluation (we can't demand hospitalization here in Maryland), but sometimes there is little else the police can do.  But mandatory reporting of our suspicions for act that have not occurred?  And even though this year's mandatory reporting law includes an immunity clause, we've seen mandatory reporting laws in other states turn into criminal acts: if you don't report, you can go to jail.  Specifically, there are states where it's a crime for a doctor to not report suspected child abuse. It's a law that get proposed nearly every year in Maryland.

Okay, so I rant at Shrink Rap readers.  Today I also ranted in the Baltimore Sun in the hopes that our legislators might read it and think about the implications of these proposed laws.  Do visit the Sun website and read my article.  You'll note that I titled it "Reporting the Mentally Ill: Will this Really Halt Gun Violence?"  Somehow, the op ed editor was inspired to change the title to one that looks like I'm against any legislation that would keep guns from the mentally ill, and that's not true.  I just don't think the treating clinicians can be agents of both the patient and the state, and I believe that doctor-patient confidentiality is necessary for medical treatment. People may be safer if they're not afraid to get help, and the less barriers the better.

You'll tell me what you think, here, or better yet, on the Baltimore Sun's website where our legislators might see your thoughts.