After Sandy Hook

Last week, as a mental health professional, I had the opportunity to offer my opinion on a local radio discussion about the Sandy Hook tragedy.  I had to collect my thoughts on this complicated problem for the radio, so I might as well post them online here as well.

I do not think it is just an issue of gun control vs. mental health policy reform.  I think this incident is indicative of a problem so big that it requires a comprehensive review of BOTH gun control AND mental health policy reform.

Politically, I’m an unabashed liberal.  Nothing good happens when guns with high capacity magazines get put in the hands of civilians.  The constitution needs to be interpreted and adapted to modern times because the founding fathers hundreds of years ago could never have predicted where modern technology would take us.  Read in a completely literal (concrete, dogmatic, unintelligent) fashion, the right to bear “arms” may even include nuclear weapons.  Plutonium, anyone?

Looking at recent mass shootings, you will find that most of the alleged perpetrators were identified as having some sort of history of mental health problems.  But the vast majority of people who suffer from mental illness are not violent.  It is not fair to label “crazy” people as likely mass shooters and further stigmatize this portion of our population.  In order to accurately identify and prevent high risk situations, you have to look further along the process of mental health evaluation and treatment.

In many of these situations there is mention of concern raised by a school or family member and a recommendation for evaluation and treatment.  But in the Arizona shooting, it is unclear if the alleged shooter ever sought out help.  There should definitely be improvements made in access to mental healthcare.

Once an individual is in treatment, it should fall upon the mental health professional to identify the people most at risk for gun violence and do something to prevent it.  But it is hard for us to do our job if our hands are bound by the law.  I think that the psychiatrist in the Colorado case may have come across some of these barriers despite the concerns she raised.  In my home state of Florida, the state legislature passed a ridiculous law “gagging” doctors from asking their patients if they even own guns, punishable by disciplinary action from the state health board and possible loss of license.  I am very glad that a federal court deemed this law unconstitutional late in 2011.  The Florida Baker Act law already makes it exceedingly difficult to have gun rights removed from a person suffering from dangerous mental illness.  It is only after a person has been sent to a mental health unit for 72 hour involuntary examination, after two psychiatrists complete a petition to the court for involuntary psychiatric treatment, and after a court hearing where the petition is granted and the patient is involuntarily committed to psychiatric treatment that a person’s name appears in the database barring them from purchasing firearms in Florida.  In a system where capacity is limited and managed care actively pressures psychiatrists to “get them in, get them out” as quickly as possible, there are multiple reasons why only a small minority of cases ever get to court.  Funding for mental health treatment should be increased, and managed care needs to stop being so stingy in this field.  Psychiatrists do not relish taking their patients to court. There is significant resentment generated from the patient, and the doctors very often end up being targets themselves.  Trust that if a doctor is going to the trouble of taking their patient to court, there is reason to be concerned.  In a mental health court case, there is a burden of proof that the individual in question is actually dangerous.  It is not against the law to have a mental illness, and “because I said so” is insufficient evidence to have a patient committed.  This is consistent with the philosophy that it should not be against the law to have mental illness, and I think this should actually stay the same.  Finally, once a person is committed in a mental health court, the way the database of people barred from purchasing firearms is maintained and updated needs to be improved.

That’s what I think.