Friday, March 29, 2013

The Wicked Witch of the West, Behind the Scene

One week from now our legislative session will be over and we'll be left to sort through the wreckage of the new laws that hit us. Every year I do this I wish we had some way to limit the number of bills that could be introduced, to give the public a fighting chance to figure out what their representatives are trying to do to them.

The Shrink Rappers have been pretty busy with this particular session and I've written a short column about it over on Clinical Psychiatry News. Feel free to hop over there and read my piece "A Glimpse Under the Hood." The site doesn't require you to register anymore although there is one small annoying popup ad you have to click past first.

This afternoon is the big day. The House version of our governor's gun bill is going to a vote in a joint committee. If it passes, which everyone expects it will, that will be the final step before it joins the other version already passed by the Senate to become law. We've managed to keep psychiatry out of the decision to take guns away from people and to at least provide some education to the legislators about the limitations and dangers of policies based on categorical mental illness.

It looks like insanity acquittees, criminal defendants who are incompetent to stand trial and people under guardianship will be barred from purchasing weapons, as will be anyone under an active protective order. This addition is required by the Federal government to be compliant with their gun laws. People can petition to have their gun rights restored although the administrative logistics for this have yet to be hammered out, and legislators (in spite of their professed intent to get guns out of the hands of dangerous people) have shown a striking reluctance to enforce seizure of weapons from anyone who falls into one of these categories. And yes, they carved out certain assault weapons out of the list of proposed banned weapons.

The final piece is the Maryland version of the New York SAFE Act. The original bill has been dropped, but it bounced back in the form of an amendment to today's bill which will be voted on this afternoon. The last three days have been pretty intense with discussions about how to protect our patients from getting reported to police. Dinah has already written extensively about this in USA Today and in Clinical Psychiatry News, and I outlined the New York requirements here. We're hopeful Maryland is not going to skip down that yellow brick road. That yellow isn't gold.

Which brings me back to the Wicked Witch of the West. When crafting law, her advice "These things must be done carefully" is a good thing to remember. I thought of this often when looking at bills proposed to modify all of our involuntary treatment laws. Regardless of which way you fall on the issue, the worst outcome is to create confusion. I don't know if any of the changes will actually make it out of committee next week so I won't speculate here, but like most states following all these high profile shootings there was a rush to cobble together a lot of changes while the time was ripe. And it showed in the legislation.

And now for something completely different:

Well, not completely. I listened to a presentation yesterday by Dr. Jeff Swanson, a sociologist and epidemiologist who studies the impact of certain public policy decisions and programs. He was part of a summit meeting on gun policy recently at Johns Hopkins. I listened to 90 minutes of impressive outcome data on gun violence and mental illness. His research provides strong support for the futility of reducing gun-related violence by singling out people by diagnosis. Unfortunately, as we've already seen with the sex offender registries, futility and costly ineffective public policies are not mutually exclusive.

So that's where I've been disappeared to lately. I hope to come up for air soon.