Public policy: Where are the psychiatrists?

If you’ve been following our columns for the past few weeks, you’ll note that we’ve been interested in the ongoing gun control legislation in Maryland as it pertains to those with psychiatric disorders.

My co-columnist, Dr. Anne Hanson, likes the metaphor that this legislation, as it pertains to intersection of gun ownership rights and mental illness, is like the Wicked Witch of the West and notes, “Things must be done carefully.” I’ve come to think of these laws as being similar to the boardwalk game, Whack-A-Mole. In Maryland, the Firearms Act of 2013 is being debated as I type – our legislative session ends on Monday. The legislation, as put forth by Gov. O’Malley and his administration, does not include a requirement to report dangerous patients to the state, but individual legislators have supported first a bill, then an amendment, to mandate legislation with wording similar to what has passed as part of the New York SAFE Act. Each time we believe the issue is dead, it pops up again, only to get whacked down and then resurface from another unexpected hole. I’m hopeful that it has died a final death and that mandatory reporting will not make its way into Maryland.

Why are legislators proposing laws where there is no clear benefit to the community? There are no data to support either the idea that reporting “likely to be dangerous people” to a federal database for the purpose of revoking firearms permits or preventing such permits from being issued will make us safer, and the fear is that such legislation will deter dangerous individuals from seeking treatment. Our legislators have deemed this “the chilling effect” and with such a label, they’ve acknowledged the possibility and can then minimize it. On the other hand, we don’t know for sure that such legislation won’t make us all safer; there simply are no data. What we do know is that the New York Veterans Administration has publicly stated that it will not comply with the reporting requirement, and that a New York firearms site has announced that doctor-patient confidentiality is gone and people should be careful about what they say to their therapists.

Why would any Maryland legislator support such measures, given that they may deter people from seeking treatment? Since my own delegate was a co-sponsor of the bill to require mandatory reporting of patients who are likely to be dangerous, I went to speak with him about it. His response was that this was the recommendation of the Task Force to Study Access of Individuals With Mental Illness to Regulated Firearms. What’s really interesting about this recommendation is that of the 17 members on the task force, there was only one psychiatrist – an administrator for the Department of Health and Mental Hygiene whose role was to represent the state. Many organizations were represented, but mental health clinicians of all flavors were notably missing. While the Maryland Psychiatric Society did not have a seat at the table, the Associated Gun Clubs of Baltimore and Maryland Shall Issue (a citizens’ defense league) were both represented. That’s right, our state had a mental health task force where the gun activists had a larger voice then the psychiatrists. I’ll leave it to you to decide if that makes any sense.

As much as I believe that mandatory reporting of those “likely to be dangerous” to an FBI database by mental health professionals is a bad idea, I don’t know that it is. There is simply no research on this. It’s interesting that our state task force also suggested that firearms be seized from dangerous people – a measure that might be welcome by clinicians worried about a patient’s safety – but this recommendation did not influence any proposed legislation.

Toward the purpose of understanding what data are out there to inform our laws, I want to put in a quick plug for Reducing Gun Violence in America: Informing Policy with Evidence and Analysis, edited by Daniel W. Webster and Jon S. Vernick of the Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public Health. In the aftermath of the Sandy Hook Tragedy, Webster and Vernick put together a volume that includes extensive reviews of the available literature on firearms research. One chapter is devoted to mental health research, and two of the seven co-authors of that chapter are psychiatrists. The book is the result of the Summit on Reducing Gun Violence in America, held Jan. 14-15 at Johns Hopkins.

The book became available with surprising speed. Kathy Alexander, a publicity manager for JHUP told me, “While most of our manuscripts (as a whole) are reviewed by scholars in the field, this time we had multiple scholars reviewing chapters at the same time to speed up the process and to have those sections reviewed by those scholars that follow that particular angle. It was really amazing. In the scramble to get the summit and the accompanying book out, our employees gave up vacations, angered family members during the holidays, and obviously lost some sleep.” The result, however, is a wonderful, state-of-the art review of what we do and don’t know about gun violence, and while a single chapter is devoted to mental disorders, the topics of suicide and dangerousness are prominent throughout the manuscript.

When it comes to legislation regarding those with psychiatric disorders, we need a few improvements. We need to be guided by the available research, not by emotions, and we need psychiatry – as represented by those who actually treat patients – to have a voice in discussing the clinical implications.

<[QM]>--Dinah Miller, M.D.

Dr. Miller is co-author of Shrink Rap: Three Psychiatrists Explain Their Work (Johns Hopkins University Press, 2011)

If you’ve been following our columns for the past few weeks, you’ll note that we’ve been interested in the ongoing gun control legislation in Maryland as it pertains to those with psychiatric disorders.

My co-columnist, Dr. Anne Hanson, likes the metaphor that this legislation, as it pertains to intersection of gun ownership rights and mental illness, is like the Wicked Witch of the West and notes, “Things must be done carefully.” I’ve come to think of these laws as being similar to the boardwalk game, Whack-A-Mole. In Maryland, the Firearms Act of 2013 is being debated as I type – our legislative session ends on Monday. The legislation, as put forth by Gov. O’Malley and his administration, does not include a requirement to report dangerous patients to the state, but individual legislators have supported first a bill, then an amendment, to mandate legislation with wording similar to what has passed as part of the New York SAFE Act. Each time we believe the issue is dead, it pops up again, only to get whacked down and then resurface from another unexpected hole. I’m hopeful that it has died a final death and that mandatory reporting will not make its way into Maryland.

Why are legislators proposing laws where there is no clear benefit to the community? There are no data to support either the idea that reporting “likely to be dangerous people” to a federal database for the purpose of revoking firearms permits or preventing such permits from being issued will make us safer, and the fear is that such legislation will deter dangerous individuals from seeking treatment. Our legislators have deemed this “the chilling effect” and with such a label, they’ve acknowledged the possibility and can then minimize it. On the other hand, we don’t know for sure that such legislation won’t make us all safer; there simply are no data. What we do know is that the New York Veterans Administration has publicly stated that it will not comply with the reporting requirement, and that a New York firearms site has announced that doctor-patient confidentiality is gone and people should be careful about what they say to their therapists.

Why would any Maryland legislator support such measures, given that they may deter people from seeking treatment? Since my own delegate was a co-sponsor of the bill to require mandatory reporting of patients who are likely to be dangerous, I went to speak with him about it. His response was that this was the recommendation of the Task Force to Study Access of Individuals With Mental Illness to Regulated Firearms. What’s really interesting about this recommendation is that of the 17 members on the task force, there was only one psychiatrist – an administrator for the Department of Health and Mental Hygiene whose role was to represent the state. Many organizations were represented, but mental health clinicians of all flavors were notably missing. While the Maryland Psychiatric Society did not have a seat at the table, the Associated Gun Clubs of Baltimore and Maryland Shall Issue (a citizens’ defense league) were both represented. That’s right, our state had a mental health task force where the gun activists had a larger voice then the psychiatrists. I’ll leave it to you to decide if that makes any sense.

As much as I believe that mandatory reporting of those “likely to be dangerous” to an FBI database by mental health professionals is a bad idea, I don’t know that it is. There is simply no research on this. It’s interesting that our state task force also suggested that firearms be seized from dangerous people – a measure that might be welcome by clinicians worried about a patient’s safety – but this recommendation did not influence any proposed legislation.

Toward the purpose of understanding what data are out there to inform our laws, I want to put in a quick plug for Reducing Gun Violence in America: Informing Policy with Evidence and Analysis, edited by Daniel W. Webster and Jon S. Vernick of the Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public Health. In the aftermath of the Sandy Hook Tragedy, Webster and Vernick put together a volume that includes extensive reviews of the available literature on firearms research. One chapter is devoted to mental health research, and two of the seven co-authors of that chapter are psychiatrists. The book is the result of the Summit on Reducing Gun Violence in America, held Jan. 14-15 at Johns Hopkins.

The book became available with surprising speed. Kathy Alexander, a publicity manager for JHUP told me, “While most of our manuscripts (as a whole) are reviewed by scholars in the field, this time we had multiple scholars reviewing chapters at the same time to speed up the process and to have those sections reviewed by those scholars that follow that particular angle. It was really amazing. In the scramble to get the summit and the accompanying book out, our employees gave up vacations, angered family members during the holidays, and obviously lost some sleep.” The result, however, is a wonderful, state-of-the art review of what we do and don’t know about gun violence, and while a single chapter is devoted to mental disorders, the topics of suicide and dangerousness are prominent throughout the manuscript.

When it comes to legislation regarding those with psychiatric disorders, we need a few improvements. We need to be guided by the available research, not by emotions, and we need psychiatry – as represented by those who actually treat patients – to have a voice in discussing the clinical implications.

<[QM]>--Dinah Miller, M.D.

Dr. Miller is co-author of Shrink Rap: Three Psychiatrists Explain Their Work (Johns Hopkins University Press, 2011)

If you’ve been following our columns for the past few weeks, you’ll note that we’ve been interested in the ongoing gun control legislation in Maryland as it pertains to those with psychiatric disorders.

My co-columnist, Dr. Anne Hanson, likes the metaphor that this legislation, as it pertains to intersection of gun ownership rights and mental illness, is like the Wicked Witch of the West and notes, “Things must be done carefully.” I’ve come to think of these laws as being similar to the boardwalk game, Whack-A-Mole. In Maryland, the Firearms Act of 2013 is being debated as I type – our legislative session ends on Monday. The legislation, as put forth by Gov. O’Malley and his administration, does not include a requirement to report dangerous patients to the state, but individual legislators have supported first a bill, then an amendment, to mandate legislation with wording similar to what has passed as part of the New York SAFE Act. Each time we believe the issue is dead, it pops up again, only to get whacked down and then resurface from another unexpected hole. I’m hopeful that it has died a final death and that mandatory reporting will not make its way into Maryland.

Why are legislators proposing laws where there is no clear benefit to the community? There are no data to support either the idea that reporting “likely to be dangerous people” to a federal database for the purpose of revoking firearms permits or preventing such permits from being issued will make us safer, and the fear is that such legislation will deter dangerous individuals from seeking treatment. Our legislators have deemed this “the chilling effect” and with such a label, they’ve acknowledged the possibility and can then minimize it. On the other hand, we don’t know for sure that such legislation won’t make us all safer; there simply are no data. What we do know is that the New York Veterans Administration has publicly stated that it will not comply with the reporting requirement, and that a New York firearms site has announced that doctor-patient confidentiality is gone and people should be careful about what they say to their therapists.

Why would any Maryland legislator support such measures, given that they may deter people from seeking treatment? Since my own delegate was a co-sponsor of the bill to require mandatory reporting of patients who are likely to be dangerous, I went to speak with him about it. His response was that this was the recommendation of the Task Force to Study Access of Individuals With Mental Illness to Regulated Firearms. What’s really interesting about this recommendation is that of the 17 members on the task force, there was only one psychiatrist – an administrator for the Department of Health and Mental Hygiene whose role was to represent the state. Many organizations were represented, but mental health clinicians of all flavors were notably missing. While the Maryland Psychiatric Society did not have a seat at the table, the Associated Gun Clubs of Baltimore and Maryland Shall Issue (a citizens’ defense league) were both represented. That’s right, our state had a mental health task force where the gun activists had a larger voice then the psychiatrists. I’ll leave it to you to decide if that makes any sense.

As much as I believe that mandatory reporting of those “likely to be dangerous” to an FBI database by mental health professionals is a bad idea, I don’t know that it is. There is simply no research on this. It’s interesting that our state task force also suggested that firearms be seized from dangerous people – a measure that might be welcome by clinicians worried about a patient’s safety – but this recommendation did not influence any proposed legislation.

Toward the purpose of understanding what data are out there to inform our laws, I want to put in a quick plug for Reducing Gun Violence in America: Informing Policy with Evidence and Analysis, edited by Daniel W. Webster and Jon S. Vernick of the Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public Health. In the aftermath of the Sandy Hook Tragedy, Webster and Vernick put together a volume that includes extensive reviews of the available literature on firearms research. One chapter is devoted to mental health research, and two of the seven co-authors of that chapter are psychiatrists. The book is the result of the Summit on Reducing Gun Violence in America, held Jan. 14-15 at Johns Hopkins.

The book became available with surprising speed. Kathy Alexander, a publicity manager for JHUP told me, “While most of our manuscripts (as a whole) are reviewed by scholars in the field, this time we had multiple scholars reviewing chapters at the same time to speed up the process and to have those sections reviewed by those scholars that follow that particular angle. It was really amazing. In the scramble to get the summit and the accompanying book out, our employees gave up vacations, angered family members during the holidays, and obviously lost some sleep.” The result, however, is a wonderful, state-of-the art review of what we do and don’t know about gun violence, and while a single chapter is devoted to mental disorders, the topics of suicide and dangerousness are prominent throughout the manuscript.

When it comes to legislation regarding those with psychiatric disorders, we need a few improvements. We need to be guided by the available research, not by emotions, and we need psychiatry – as represented by those who actually treat patients – to have a voice in discussing the clinical implications.

<[QM]>--Dinah Miller, M.D.

Dr. Miller is co-author of Shrink Rap: Three Psychiatrists Explain Their Work (Johns Hopkins University Press, 2011)