[NYAPRS Enews] WSJ, NYT, TU Looks at NY Gun Law's Mental Health Impact

[Harvey Rosenthal]

NYAPRS Note: Today's papers take an analytical view of NY's new gun
control law's impact on people with mental health needs and the services
they may seek. It looks at several concerns about unintended
consequences of the law that may deter people from seeking or disclosing
fully in a therapeutic relationship. 

The Times piece underscores a critical paradox: while it leads off with
concluding that mass shooters have to be 'deeply disturbed,' a term most
will read as having a mental illness, it quotes experts who conclude
"most mass murders are done by working-class men who've been jilted,
fired, or otherwise humiliated - and who then undergo a crisis of rage
and get out one of the 300 million guns in our country....the sort of
young, troubled males who..often do not qualify for any diagnosis."

It concludes with Dr. Paul Appelbaum's hopeful frame: "Some experts,
like Dr. Appelbaum, say the Connecticut school shooting offers the kind
of opportunity that only comes once every generation or two: to rethink
the entire mental health system. It might include appointing a
presidential commission; re-envisioning community mental health care;
focusing more on vigilance for problems in young people, and reducing
stigma."It seems to me an opportunity to step back and rethink what the
entire system should look like," Dr. Appelbaum said."

 

Law's Mental-Health Provision Draws Ire

By Tamer El-Ghobashy  Wall Street Journal  January 16, 2013

 

A provision in New York state's new gun-control laws that requires
mental-health professionals to report potentially dangerous patients is
drawing concern from experts who fear it could discourage people from
seeking treatment and treads on client confidentiality.

The measure requires physicians, psychologists, nurses or clinical
social workers to alert local health officials if a patient "is likely
to engage in conduct that would result in serious harm to self or
others." After an evaluation, the health officials would pass on the
person's information to law-enforcement agencies that would be
authorized to seize any firearm owned by the patient.

If a person is found not to own any firearms, the patient would be added
to a statewide criminal background check database, marking a significant
expansion of who would be made ineligible to legally buy a firearm.

"I understand the intent, but I fear these kinds of practices may well
deter people from seeking care or fully disclosing" their condition to
psychologists, said Harvey Rosenthal, executive director of the New York
Association of Psychiatric Rehabilitation Services.

He said the legislation seems designed to allay public fears of guns in
the hands of the mentally ill with little thought given to "the chilling
effects" it may have on treatment. Studies have shown that mentally ill
people are far more likely to be the victims of violence rather than
perpetrators.

The prospect of being put on such a list could be enough to prevent
someone from seeking care and creates the impression that "you're
turning psychologists into police officers," said Eric Neblung, a
psychologist and the president of the New York State Psychological
Association.

Patients might worry about being honest: Even the most fantastical
violent expressions could be subject to a legal mandate, Dr. Neblung
said.

But DJ Jaffe, executive director of Mental Illness Policy Org, an
advocacy group, said concerns over the legislation are
"hyper-theoretical" and that the greater, and more practical, risk is
that very seriously mentally ill people "have a plan to kill people, and
it doesn't go reported."

Mr. Jaffe said the legislation should go further by using the names
compiled under the law to help those people get "priority treatment."

Mental-health professionals already have an ethical obligation to
respond to threats of violence, such as warning potential victims of
possible threats. Dr. Neblung said the new law compels caregivers to
break confidentiality before clinical remedies are exhausted.

Of particular concern, he said, is that the law could prevent
professionals such as police and corrections officers from seeking
treatment for fear they could lose their firearms-and their jobs.

Already, officers often pay for treatment with cash rather than going
through insurance to avoid anyone knowing about their psychological
issues, Dr. Neblung said.

Under the law, therapists and others must use their professional
judgment to determine if a patient poses a real threat. A decision to
not disclose a patient's violent statements wouldn't lead to punishment
if it was made "reasonably and in good faith."

Dr. Neblung said the language is vague and the potential for sanctions
must be studied.

-Laura Nahmias contributed to this article.

http://online.wsj.com/article/SB1000142412788732423510457824422405690812
6.html?mod=googlenews_wsj 

----------------

 

Warning Signs of Violent Acts Often Unclear

By Benedict Carey And Anemona Hartocollis New York Times January 16,
2013

 

No one but a deeply disturbed individual marches into an elementary
school or a movie theater and guns down random, innocent people.

That hard fact drives the public longing for a mental health system that
produces clear warning signals and can somehow stop the violence. And it
is now fueling a surge in legislative activity, in Washington and New
York.

But these proposed changes and others like them may backfire and only
reveal how broken the system is, experts said.

"Anytime you have one of these tragic cases like Newtown, it's going to
expose deficiencies in the mental health system, and provide some
opportunity for reform," said Richard J. Bonnie, a professor of public
policy at the University of Virginia's law school who led a state
commission that overhauled policies after the 2007 Virginia Tech
shootings that left 33 people dead. "But you have to be very careful not
to overreact."

New York State legislators on Tuesday passed a gun bill that would
require therapists to report to the authorities any client thought to be
"likely to engage in" violent behavior; under the law, the police would
confiscate any weapons the person had.

And in Washington, lawmakers said that President Obama was considering a
range of actions as part of a plan to reduce gun violence, including
more sharing of records between mental health and law enforcement
agencies.

The White House plan to make use of mental health data was still taking
shape late Tuesday. But several ideas being discussed - including the
reporting provision in the New York gun law - are deeply contentious and
transcend political differences.

Some advocates favored the reporting provision as having the potential
to prevent a massacre. Among them was D. J. Jaffe, founder of the Mental
Illness Policy Org., which pushes for more aggressive treatment
policies. Some mass killers "were seen by mental health professionals
who did not have to report their illness or that they were becoming
dangerous and they went on to kill," he said.

Yet many patient advocates and therapists strongly disagreed, saying it
would intrude into the doctor-patient relationship in a way that could
dissuade troubled people from speaking their minds, and complicate the
many judgment calls therapists already have to make.

The New York statute requires doctors and other mental health
professionals to report any person who "is likely to engage in conduct
that would result in serious harm to self or others."

Under current ethical guidelines, only involuntary hospitalizations (and
direct threats made by patients) are reported to the authorities. These
reports then appear on a federal background-check database. The new laws
would go further.

"The way I read the new law, it means I have to report voluntary as well
as involuntary hospitalizations, as well as many people being treated
for suicidal thinking, for instance, as outpatients," said Dr. Paul S.
Appelbaum, director of the Division of Law, Ethics, and Psychiatry at
Columbia University's medical school. "That is a much larger group of
people than before, and most of whom will never be a serious threat to
anyone."

One fundamental problem with looking for "warning signs" is that it is
more art than science. People with serious mental disorders, while more
likely to commit aggressive acts than the average person, account for
only about 4 percent of violent crimes over all.

The rate is higher when it comes to rampage or serial killings, closer
to 20 percent, according to Dr. Michael Stone, a New York forensic
psychiatrist who has a database of about 200 mass and serial killers. He
has concluded from the records that about 40 were likely to have had
paranoid schizophrenia or severe depression or were psychopathic,
meaning they were impulsive and remorseless.

"But most mass murders are done by working-class men who've been jilted,
fired, or otherwise humiliated - and who then undergo a crisis of rage
and get out one of the 300 million guns in our country and do their
thing," Dr. Stone said.

The sort of young, troubled males who seem to psychiatrists most likely
to commit school shootings - identified because they have made credible
threats - often do not qualify for any diagnosis, experts said. They
might have elements of paranoia, of deep resentment, or of narcissism, a
grandiose self-regard, that are noticeable but do not add up to any
specific "disorder" according to strict criteria.

"The really scary ones, you have a gut feeling right away when you talk
to them," said Dr. Deborah Weisbrot, director of the outpatient clinic
of child and adolescent psychiatry at Stony Brook University, who has
interviewed about 200 young people, mostly teenage boys, who have made
threats. "What they have in common is a kind of magical thinking, odd
beliefs like they can read other people's minds, or see the future, or
that things happening in their dreams come true."

Even if such instincts could be relied on, the mental health system is
so fragmented in the country that it is hard to know whether the
information would get to the right person in time. According to Dr.
Bonnie, the Virginia law professor, the Virginia Tech gunman was ordered
to outpatient treatment by a judge more than a year before his rampage
but was never hospitalized, which would have shown up on a background
check.

The state database now includes such cases, after the reforms. "But
we're a state that has a centralized database like that; in many states
there's no one place to get it all; it's all kept locally, community by
community," Dr. Bonnie said.

The federal background check database, which is supposed to have updated
information from states, has only a patchwork, because of the wide
variety of state laws on reporting, experts said. Even if it were
entirely up to date, it would not catch the many millions who never see
a mental health professional despite deep distress.

Some experts, like Dr. Appelbaum, say the Connecticut school shooting
offers the kind of opportunity that only comes once every generation or
two: to rethink the entire mental health system. It might include
appointing a presidential commission; re-envisioning community mental
health care; focusing more on vigilance for problems in young people,
and reducing stigma.

"It seems to me an opportunity to step back and rethink what the entire
system should look like," Dr. Appelbaum said.

http://www.nytimes.com/2013/01/16/health/breaking-link-of-violence-and-m
ental-illness.html?_r=0 

--------------

 

New Gun Law Offers Reply to Mass Killings

State Becomes the First in the Nation to Act After Horror of Newtown,
Conn.

By Casey Seiler  Albany Times Union  January 16, 2013

 

ALBANY - "We are fighting back," Gov. Andrew Cuomo
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Andrew+Cuomo%22>  said before
signing a sweeping gun control bill at the Capitol just an hour after
the Secure Ammunition and Firearms Enforcement Act was approved by the
state Assembly.

The measure expands the definition of banned assault weapons, creates a
state database for pistol permits, reduces the maximum number of rounds
in a magazine and requires background checks on all gun sales, including
those between individuals.

"You can overpower the extremists with intelligence and with reason and
with common sense," Cuomo said Tuesday afternoon in the Red Room, which
was filled with reporters as well as law enforcement officials,
including Albany County Sheriff Craig Apple
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Craig+Apple%22>  and city of Albany
Police Chief Steven Krokoff
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Steven+Krokoff%22> .

The governor expressed regret that it "required tragedies and loss of
life to actually spur the political process to action," a reference to
the Dec. 14 school shootings in Newtown, Conn., and the killings of two
firefighters in the Rochester suburb of Webster 10 days later.

After passing the state Senate 43-18 late Monday night, the bill cleared
the Democrat-dominated Assembly 104-43 at the end of an almost-five-hour
debate Tuesday.

"Let us be perfectly clear: This bill is about protecting people -
protecting our children, protecting our families, protecting first
responders, police officers and firefighters," Assembly Speaker Sheldon
Silver
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Sheldon+Silver%22>  said at the
signing ceremony, which was also attended by two of the state Senate's
three conference leaders: Jeff Klein
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Jeff+Klein%22>  of the five-member
Independent Democratic Conference and Andrea Stewart-Cousins of the main
Democratic body.

Senate Republican Leader Dean Skelos
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Dean+Skelos%22> , who controls the
chamber jointly with Klein, did not attend. A dozen members of the GOP
conference voted in favor of the measure.

Also not celebrating was the National Rifle Association
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22National+Rifle+Association%22> ,
which released a statement saying it was "outraged at the draconian gun
control bill that was rushed through the process late Monday evening."
The powerful gun lobbying organization called it "a secretive end run
around the legislative and democratic process ... with no committee
hearings and no public input."

While the Senate moved directly to the roll call of votes on the
measure, Tuesday's Assembly debate saw Republicans peppering Democrats
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Democrats%22>  for details of the
bill's provisions.

Assemblyman Jim Tedisco
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Jim+Tedisco%22> , R-Schenectady,
held up a copy of the U.S. Constitution that the lawmaker said he never
leaves home without. "Amendment Two - you're going to turn that into
Amendment 1.5 today," Tedisco said of what he described as the
diminishment of gun rights.

Others called out Cuomo for what they accused was an overweening desire
to pass the nation's first legislative response to the recent spate of
shootings. Assemblyman Steve Katz
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Steve+Katz%22> , R-Westchester
County, knocked what he called Cuomo's "misguided, egotistical" attempt
to boost his presidential prospects in 2016.

Others expressed concern over the bill's expansion of mental health
providers' ability to commit those found to be a danger to the public
under what's known as Kendra's Law. The SAFE Act also requires mental
health professionals to report to local officials if they think a
patient could prove to be a danger to himself or the general public, and
empowers local law enforcement to collect the patient's guns and suspend
firearms permits.

"I think many of us object to the connection between violence and mental
illness ... that seems to inform these new policies," said Harvey
Rosenthal
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Harvey+Rosenthal%22> , executive
director of the state Association of Psychiatric Rehabilitation Services
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Association+of+Psychiatric+Rehabili
tation+Services%22> , which represents mental health care consumers and
providers. " ... You get this kind of round-'em-up mentality that I
think will only deter care."

Newtown shooter Adam Lanza
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Adam+Lanza%22> , Rosenthal pointed
out, was apparently never diagnosed with the sort of mental illness that
would have triggered the provisions of the new law.

"Whether it's Adam Lanza or any number of people who are at risk, I
think the system in New York for too long has been unresponsive," said
Rosenthal, who served as a member of Cuomo's Medicaid Redesign Team. "
... I don't think Kendra's Law, which depends on cops and courts, does
that."

Glenmont's Michael Carey
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Michael+Carey%22> , whose
13-year-old autistic son Jonathan died in 2007 at the hands of a health
care worker who was trying to restrain him, said he was less bothered by
the chance the bill would stigmatize the mentally ill than with what he
described as the state's inadequate resources to serve them.

"If there are families in trouble but no crisis care to take them to,
what do you do?" said Carey, a vocal critic of Cuomo's mental hygiene
reforms.

In another sign of guns' diminished status in state government, New York
Comptroller Tom DiNapoli
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Tom+DiNapoli%22>  on Tuesday
announced that the state's vast Common Retirement Fund
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Common+Retirement+Fund%22>  will
freeze its investments in publicly traded commercial firearm
manufacturers.

The freeze affects the pension fund's holdings in an index fund of
45,325 shares of Sturm, Ruger and Company valued at approximately $2.2
million - pin money compared with the fund's full value of $153 billion.

The pension fund's holdings in Smith and Wesson Holding
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Smith+and+Wesson+Holding%22>
Corporation were sold in December, just four days after the shootings in
Connecticut.

In a statement, DiNapoli - like Cuomo a Democrat - insisted that the
decision was not political, but strictly business.

"After the terrible events in Newtown," he said, "it is clear that the
national movement toward greater regulation of firearms manufacturers
will impose significant reputational, regulatory and statutory hurdles
that may affect shareholder value."

http://www.timesunion.com/local/article/New-gun-law-offers-reply-to-mass
-killings-4195504.php#ixzz2I8oqI328

 

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