Friday, December 06, 2013

Guest Blogger Dr. Erik Roskes with an Update on Gun Legislation and the Mentally Ill

In case you haven't heard enough from the Shrink Rappers on mental illness and gun legislation, I'm stealing a synopsis of the recent legislative changes from The Crime Report, a blog by forensic psychiatrist Dr. Erik Roskes.  Taken verbatim, with permission of course:
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On October 1, 2013, Maryland’s modified firearms safety law took effect.  Passed in the aftermath of the Newtown massacre, this law expanded the group restricted from owning certain firearms.  This blog will focus only on the mental health aspects of the law, as I have no claim to expertise outside the mental health arena. 
 Editor's Note: See an official report from Connecticut State's Attorney on The Crime Report here.
Until September 30, 2013, two classes of people were restricted from possessing regulated firearms:
(1) a person who “suffers from a mental disorder… and has a history of violent behavior against the person or another,” and
(2) a person who “has been confined for more than 30 consecutive days to a [psychiatric] facility.” 
Effective October 1, 2013, a new law took effect, expanding and modifying the classes of people restricted from possessing weapons for reasons related to mental illness.  Now, the groups include:
(1) a person who “suffers from a mental disorder… and has a history of violent behavior against the person or another;”
(2) a person who “has been found incompetent to stand trial” (IST);
(3) a person who “has been found not criminally responsible” (NCR – this is Maryland’s version of the insanity defense);
(4) a person who “has been voluntarily admitted for more than 30 consecutive days to a [psychiatric] facility;”
(5) a person who “has been involuntarily committed to a facility” for any period of time; and
(6) a person who “is under the protection of a guardian appointed by a court…, except for cases in which the appointment of a guardian is solely a result of a physical disability.”
It is important to note the following:
Importantly, criminals without mental illness are only restricted if they have been convicted of specific “disqualifying crimes” or if they have received a 2 or more year term of imprisonment for a common law crime.  This disparity regarding removal of weapons from offenders with mental illness whose weapons would not be removed based on the crime alone raises potential disability rights questions.  
Thus, for example, category 1 requires no causal nexus between the individual’s mental illness and his or her history of violent behavior.  Thus, a person with, say, an eating disorder and a history of fighting during his or her adolescence would be subject to the restriction on firearm possession.  Conversely, the person with a history of multiple fights, no mental illness, and no other disqualifying events (such as a conviction for a violent crime) would be permitted to retain his (or, less commonly, her) weapons.  Where exactly is the logic here?
Categories 2 and 3 involve numerous defendants whose crimes themselves might not be dangerous.  In the hospital in which I work, the modal crime for which people are committed as IST is trespassing. 
While few people are found NCR for crimes that are not violent in some way, there are some whose underlying offenses are non-violent. 
Category 4 is especially concerning to those of us treating people with mental illness, in that it targets patients who seek treatment willingly, and who do not meet any of the other criteria for removal.  Thus, this restriction is imposed on people without any history of violence or criminal behavior, and who have sought treatment of their own accord.  Essentially the restriction punishes the very behavior we would wish to reinforce. 
Category 6 is interesting in its leading to bizarre rules, such as the recent report in Iowa regarding the ownership of guns by blind people.  From where I sit, this is simply a head-scratcher, making me wonder who is making decisions on our behalf. 
But most concerning for me is category 5, which was modified in the section of the code regulating involuntary commitment to require the hearing officer to determine if “the individual cannot safely possess a firearm based on credible evidence of dangerousness to others;” if the hearing officer so finds, he or she is to order the individual to surrender any firearms to law enforcement.  Note that no such finding is to be made for individuals civilly committed only due to self-directed dangerousness or suicidality.
According to the US Centers for Disease Control and Prevention, indicate there are over 19.000 firearm suicides per year in the US.  By comparison, there are about 11,000 firearm homicides each year. 
Based on research from the NIMH, at least 90% of those who commit suicide (approx. 17,000) have the sorts of mental illness that could lead to civil commitment.  Research varies with regard to homicide, but for discussion purposes, assume that as many as 10% (approx. 1100) of people who commit homicide by firearm have mental illness.  Simply put, for every gun-related homicide committed by a person with mental illness, there are approximately 17 gun-related suicides. 
If the new Maryland law were to be applied nationally, we would be potentially preventing a small number of people with mental illness from committing homicide by firearm, while doing nothing to protect the vastly larger number of people who might kill themselves with that same weapon. 
As I have already written, reactive gun laws do little more than assuage the public’s anxiety about mental illness, without doing much of anything to actually protect the public.  It makes us believe that our elected officials and appointed policy makers are doing something – anything – to make our communities safer, without regard for whether the things that they do actually will lead to positive results.  From where I sit, the changes in Maryland will do little to make our communities safer.  With apologies to a recent New York mayoral candidate, there are just too damn many guns. 

--Erik Roskes, M.D.

8 comments:

Anonymous said...

Is a suicidal "thought" considered as a violent behavior?

P-K

Dinah said...

P-K: No.

Anonymous said...

Good. I just wanted to be sure they weren't planning to include everyone hospitalized for suicidal thoughts on the list.

The lawmakers sure don't have much faith in psychiatric treatment. There are many people who get better, and some who recover completely. I don't think they should have to pay for the rest of their lives for being ill at one time.

P-K

In the Pink said...

I voluntarily committed myself in a dual diagnosis drug rehab facility for 28 days then sent to the psychiatric side for two months. That was 10 years ago. But does that mean I can never own a gun? I don't want one but am very curious on this issue as my fiance owns guns so how does that law help? It is just isolating me for needing medical help. SO can someone with heart disease not own a gun because they were hospitalized for heart surgery over 30 days? I guess not because this law is only for mentally ill persons. This gets my goat.

Dinah said...

In the Pink: Laws vary by state, and then there is the issue of whether the hospital reports it to the database. So the law has been that admissions over 30 days need to be reported, but I don't think (help me here, Dr. R) that private facilities were doing this, only state hospitals. In California, if you've been brought in on a 5150, you can't own a gun (again, I think), even if you were released at a hearing.

New laws are not retroactive.

There is nothing to stop your fiance or spouse from owning a gun. Plenty of people commit crimes and suicide with the legally owned guns of family members. You want the world to make sense?

Je Suis said...

"In California, if you've been brought in on a 5150, you can't own a gun"

I seriously hope that you are wrong on this, since the logical conclusion would be to bring every citizen in on a 5150 and then release them, thereby ending the gun control debate - everyone can be easily given a psychiatric history, and thus cannot own a gun, dangerous or not. This amounts to an insidious encroachment of Orwellian paternalism, with psychiatry deeply enmeshed in the process. For ones own good, of course.

So, legislation that prevents gun ownership for a mental health issue? The answer is simple: avoid mental health treatment and professionals. This legislation makes any encounter with these professionals dangerous to ones lifestyle and liberty, not to mention personal rights. Like the right to own a gun; now, based on a professionals opinion - yes, opinion - you stand to lose a great deal. And if they are wrong?
Well, you lose, and they don't. It's that simple. For your own good, deal with your issues in silence, do not involve these professionals, and if worse comes to worse, make sure you get it right the first time. Because psychiatry is not your friend, it is a tool being used by the lawmakers to subjugate a subgroup, one whose members are deemed dangerous with only cursory evidence. A group that is unpopular, and preferably invisible. One that is different, and therefore, by default, perilous. Those with a mental illness. No matter the form of the illness. because such individuals are uncomfortable for 'normal' people, and therefore make an easy target.

Interestingly, there was an uproar over a federal judge making similar comments about another group earlier this year: Judge Edith H. Jones of the 5th Circuit Court of Appeals is alleged to have made comments concerning minorities, and how these minorities become involved in more violent crimes than non-minorities.
This is born out via FBI statistics; the prisons are primarily filled with minorities - and yes, it can be argued that this is because of an imbalance in the way that minorities are treated, but that is another issue and not the purpose of my point here. Simply put, the claims are that minorities are involved in a greater proportion of violent crimes - yet I see no legislation that is aimed at prohibiting minorities from owning guns. Where is the legislation that says that if you are a minority, and arrested, you can no longer own a gun, guilty or not? It does not exist. Why is that? Because it would be unfair to single out a group for the actions of some of that group? Because it would be discriminatory? Yes, to both, of course. But, then, how is it acceptable to do the same for the mentally ill?

The answer is simple: in America, the mentally ill are the modern equivalent of the Jews in Nazi Germany - an undesirable group of people that make an easy target for a political agenda. Our brave new world is neither particularly
new nor necessarily brave after all. But then, what can we expect when the profession used to target these unwilling victims has it's roots in Nazi Germany in the first place?

Anonymous said...

There is no end to all the laws the government can pass to stigmatize people with mental illness.

In my state you have to answer on your drivers license application if you are "currently receiving psychiatric treatment." So that means in 2016 when mine is up for renewal I will have to go off my medication so that I can answer honestly that I am not "currently receiving psychiatric treatment." It's so stupid. I haven't had a speeding ticket in almost twenty years, no DUIs ever, etc. But, for some reason people with mental illness can't even be trusted to drive.

Instead of the government making it worse for people with mental illness, wouldn't it be nice if they actually did something that made things better.

Pseudo-Kristen

eroskes said...

In the Pink: In Maryland, the law applies to admissions to psychiatric facilities only, so a stay of 30+ days in a medical or rehab setting would not apply. Not sure about substance abuse treatment, but since substance abuse raises the risk of violence far more than mental illness in the absence of substance use, it would not surprise me if a stay of 30+ days would not qualify in somebody's mind.

Dinah: not sure what the mechanism is for private hospitals - or, for that matter, state hospitals - to report patients who stay beyond the 30 day cutoff. Frankly, I am not sure that our legislators, in their wisdom, gave this any thought.

Je Suis: I cannot disagree with much of what you have said. Clearly, this is yet another effort of policymakers to use mental health as a bogeyman for the complexities of a world that is difficult to understand. This is the point I was trying to make. Being from MD, I am not aware of the rules in California, so I have no response to this, other than to agree that if there is to be a mental health restriction on gun ownership, surely it should come long after the initial emergency evaluation - there ought to be proper diagnosis at the very least, something that can take some time.

All: recently the Hopkins School of Public Health released what seems to be a rather thoughtful report, recommending that the people who should not be permitted to own firearms should be those with a demonstrable risk of violence to self or others. The report can be found at http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-gun-policy-and-research/publications/GPHMI-State.pdf.

Personally I have no confidence that legislators will respond to thoughtful arguments, but one can always hope.