Turning over mental-health patients’ records to the state government is unlikely to prevent gun violence, say many mental health professionals.
“There is not enough science and evidence out there indicating that people with mental illness are involved in more violence than the general population,” said Glenn Liebman, CEO of New York State Mental Health Association. He is among the mental health professionals who object to New York’s recently enacted gun-control law.
The law — called the Secure Ammunition and Firearms Enforcement Act, or SAFE Act, — was signed on Jan. 15 by Gov. Andrew Cuomo. That made New York the first state to pass tougher gun control legislation after mass shootings in Newtown, Conn. and Aurora, Colo.
The law requires background checks on gun-buyers, limits the number of bullets in a gun’s magazine and adds tougher penalties for gun violence. It also requires mental health professionals to disclose patients’ personal information to the government when the professionals detect violent tendencies. The provision took effect on March 15.
But many mental health professionals say the provision enhances discrimination against the mentally-ill, overlooks the inaccuracy of behavior assessment science and raises serious privacy issues. They also object to the provision because of too little public scrutiny before the law was enacted.
Here is a closer look of how this provision works, compiled from information provided by New York State Psychiatric Association:
- Who must report? Physicians, psychologists, registered nurses and licensed clinical social workers.
- When to report? When mental health professionals believe, based on their “reasonable medical judgments,” the patient is “likely to engage in conduct that will cause serious harm to self or others.” Psychologists don’t need to act if they believe such report will jeopardize the safety of themselves or potential victims.
- Report to whom? To the local Director of Community Services. If the community service director agrees there is indeed a threat of violence, then the agency discloses information to the New York state Department of Criminal Justice Services.
- What kinds of information will be disclosed? Psychologists can report any information that’s relevant to assessing the likelihood of violent conduct to local community service. Local community service agency can only provide the person’s name and other non-clinical information to the state department. The information will be destroyed after five years if the patient does not commit violence.
- What is the result? The information will be used to determine whether the patient’s license for a firearm should be suspended or revoked.
In one of the major objections to the law, some mental health experts say it implies a direct connection between mental illness and violence in the society — a connection, they say, is still unclear.
The link between mental illness and violence is questioned in some studies. A 1994 University of Chicago study, for example, found that the mentally ill contributes to 4.3 percent of violence in the community, compared to 34 percent from those who abuse drug and alcohol. A 2002 study published in The American Journal of Public Health found that mental health is seldom the sole trigger of violence. There are other factors involved, such as history being a victim, homelessness and poor medical care.
By re-enforcing stereotypes about mental illness, say some mental health experts, the law will erode the essential trust between a physician and a patient. It is also likely to deter some people from seeking help, the critics argue.
Linda Carter Galbato, director of student services for the undergraduate program in psychology at Syracuse University, summed up that concern this way: “If you know that what you share might be or will be reported, why bother going to therapy? Why would you take that risk when you are already fragile and vulnerable?” said Galbato. “I would be afraid that it might create more mental health issues.”
Patients don’t always act on their violent fantasies they described in a comfortable clinical setting, Galbato cautioned. Patients may also begin to lie, Galbato argues, if they don’t trust their psychologists.
The mental health provision also doesn’t specify what “serious harm to self or others” and “professional reasonable judgment” exactly stand for, say the critics.
“It’s kind of fuzzy here,” said Dominic A. Carone, professor of rehabilitation psychology at Upstate University Hospital. “That criterion can be disputed between individuals in terms of what constitute reasonable, professional judgment.”
The clinical way of predicting violence is simply to ask patients about their feelings, according to Carone. Psychologists make judgments based on how vivid and specific patients’ descriptions of the violent plans are. There are also systematic violence assessment tools, such as a checklist to rate a person’s psychopathic tendencies.
But predicting violence is still far from perfect, say mental health critics of the law.
“I don’t think that’s very accurate science at this point,” said Tanya Gesek, a children’s psychologist in Syracuse who specializes in anger management and anxiety. “The best predictor of future behavior is past behavior. Without previous act of violence, it’s still pretty difficult to predict the first act of violence.”
Gesek also expressed concerns that the law was passed too fast. Gov. Cuomo waived the three-day waiting period when the act was passed. No public hearing was held.
“The law was put into place very quickly without really seeking the advice of mental health professionals about what implications this will have for their practice,” said Gesek.
(Maya Gao Qian is a graduate student in magazine, newspaper and online journalism.)
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