Update on New York’s mandate on reporting of patients

Almost 1 year ago, New York lawmakers passed some of the most stringent gun control measures in the country. One of the provisions of the New York Secure Ammunition and Firearms Enforcement, or SAFE Act, requires mental health professionals to report individuals they believe are likely to be dangerous to their director of community services, who then decides if patients are to be reported to the criminal justice system. The initial report, called a "9.46," goes through a website set up by the state. These patients may be investigated to determine if they have a firearms permit and whether that permit should be revoked.

The law is controversial. The federal Veterans Affairs Department said it would not comply because the law violates federal HIPAA requirements, and the New York State Psychiatric Association also registered objections, as did I – soon after it was passed. Of note, nothing in the law allows for a mental health professional to directly notify law enforcement officials to confiscate weapons from dangerous patients.

Now that it’s been a while since implementation, it’s time to start asking how it’s going. How many patients have been reported to the directors of community services through the website? How many of those have been investigated? How many guns have been confiscated or surrendered? And how much safer are New Yorkers? Are suicide and violent crime rates dropping? Are the agencies involved pleased with the results to date?

In June, The New York World posted a piece headlined "SAFE Act registry of mentally ill nets few gun permit holders" that read, in part:

"Of the 6,000 reports that have been filed, 11 have been acted upon, testified Jed Wolkenbreit, counsel to the New York State Conference of Local Mental Hygiene Directors, citing figures from the state Office of Mental Health.

His organization’s members are county directors of community services, who under the law must approve or dispute assessments made by mental health providers of the potential of their patients to cause harm.

The flood of SAFE Act reports, Mr. Wolkenbreit asserted, is taking time away from commissioners’ other responsibilities in running their counties’ mental health systems: 'The biggest problem is the amount of time and resources that the SAFE Act is diverting from all of the other duties of the DCS [directors of community services] for what we believe to be a minimal return.'

The law says that reports must be made by the mental health professional. Yet some reports, testified Mr. Wolkenbreit, are being filed by someone other than the mental health provider seeing the patient, and many appear to be computer generated, based on existing patient files. In many cases, mental health providers listed on the documents, when contacted by community services directors for review, either said that they had not filed the reports or that the patients they had seen did not meet the SAFE Act reporting criteria, according to Mr. Wolkenbreit."

That was back in June. In late October, I spoke with Mr. Wolkenbreit, who did not have up-to-date statistics. He noted that the original reports that patients were being reported erroneously was inaccurate, and the issue instead was that there had been confusion with people who had the same name and birth dates as those being reported.

Wait, so first it was stated that patients were reported in error but, in fact, that was a mistake?

"At the very beginning, there were problems with identification, and now we’re getting more information," Mr. Wolkenbreit said.

In April, WGRZ-TV in Buffalo reported on David Lewis, a college librarian in treatment for anxiety, who lost his pistol permit. Once the situation was clarified, his firearms were returned. Mr. Lewis, however, was not happy with the situation and made his story public.

WGRZ went on to discuss difficulties enacting the legislation and how the agencies involved were unclear about who was verifying information – the state police or the counties. In Rochester, the station reported, a county clerk was told to call the patient to verify that he was the subject of a report.

Mr. Wolkenbreit now estimates that 15,000 people statewide have been reported to the justice system.

"A high percentage of those are people who have been hospitalized, the next greatest number come from clinics, and a smaller number come from private practitioners. Most of the reports come from New York City."

He noted that those reporting must supply identifying information to confirm that the reporter is a legitimate mental health professional, and there needs to be a clinical reason; simply stating that a patient has suicidal ideation is not enough to trigger a report to the justice system.

"The law was a reaction to the shootings in Connecticut and was not well thought out," Mr. Wolkenbreit said.

It is estimated that most of the reports filed with the directors of community services go on to be filed with the justice system. In only a small number of cases have the reports resulted in the removal of guns from owners – Mr. Wolkenbreit was quick to say that he did not have access to these statistics. He was able to say that mental health professionals have not been happy with the reporting requirements. He did not know whether SAFE Act legislation has made a difference in firearms violence.

I spoke with Benjamin Rosen, director of public information for the New York State Office of Mental Health. Mr. Rosen directed me to some informational websites and spoke with me twice, kindly calling me back to follow up. Unfortunately, he did not have any statistics and said those numbers would have to be collected from each of the 57 counties and New York City. He noted that such information is not generally released, and if he does provide more details down the line, there will be another follow-up column here on Shrink Rap News.

As much as the idea of mandatory reporting of patients "likely to be dangerous" is distasteful to mental health professionals, New York state has passed this law, and the experiment has begun. The fear is that it will deter people from seeking care, a concern that some are quick to dismiss. Since we don’t have the answers as to how difficult such laws are to implement and what impact they have, this is extremely important work that New York is doing. It is crucial that other states have access to their experience and results to guide policy.

In Maryland, a similar reporting law was proposed last year, and it was not passed. If patient reporting and keeping guns from the dangerous mentally ill, however, result in changes in suicide and/or gun violence rates, in either direction, this needs to be made public. Either way, it’s important for New York to be the leader on this issue and help to guide policy across the country.

Dr. Miller is a coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: The Johns Hopkins University Press, 2011).

Almost 1 year ago, New York lawmakers passed some of the most stringent gun control measures in the country. One of the provisions of the New York Secure Ammunition and Firearms Enforcement, or SAFE Act, requires mental health professionals to report individuals they believe are likely to be dangerous to their director of community services, who then decides if patients are to be reported to the criminal justice system. The initial report, called a "9.46," goes through a website set up by the state. These patients may be investigated to determine if they have a firearms permit and whether that permit should be revoked.

The law is controversial. The federal Veterans Affairs Department said it would not comply because the law violates federal HIPAA requirements, and the New York State Psychiatric Association also registered objections, as did I – soon after it was passed. Of note, nothing in the law allows for a mental health professional to directly notify law enforcement officials to confiscate weapons from dangerous patients.

Now that it’s been a while since implementation, it’s time to start asking how it’s going. How many patients have been reported to the directors of community services through the website? How many of those have been investigated? How many guns have been confiscated or surrendered? And how much safer are New Yorkers? Are suicide and violent crime rates dropping? Are the agencies involved pleased with the results to date?

In June, The New York World posted a piece headlined "SAFE Act registry of mentally ill nets few gun permit holders" that read, in part:

"Of the 6,000 reports that have been filed, 11 have been acted upon, testified Jed Wolkenbreit, counsel to the New York State Conference of Local Mental Hygiene Directors, citing figures from the state Office of Mental Health.

His organization’s members are county directors of community services, who under the law must approve or dispute assessments made by mental health providers of the potential of their patients to cause harm.

The flood of SAFE Act reports, Mr. Wolkenbreit asserted, is taking time away from commissioners’ other responsibilities in running their counties’ mental health systems: 'The biggest problem is the amount of time and resources that the SAFE Act is diverting from all of the other duties of the DCS [directors of community services] for what we believe to be a minimal return.'

The law says that reports must be made by the mental health professional. Yet some reports, testified Mr. Wolkenbreit, are being filed by someone other than the mental health provider seeing the patient, and many appear to be computer generated, based on existing patient files. In many cases, mental health providers listed on the documents, when contacted by community services directors for review, either said that they had not filed the reports or that the patients they had seen did not meet the SAFE Act reporting criteria, according to Mr. Wolkenbreit."

That was back in June. In late October, I spoke with Mr. Wolkenbreit, who did not have up-to-date statistics. He noted that the original reports that patients were being reported erroneously was inaccurate, and the issue instead was that there had been confusion with people who had the same name and birth dates as those being reported.

Wait, so first it was stated that patients were reported in error but, in fact, that was a mistake?

"At the very beginning, there were problems with identification, and now we’re getting more information," Mr. Wolkenbreit said.

In April, WGRZ-TV in Buffalo reported on David Lewis, a college librarian in treatment for anxiety, who lost his pistol permit. Once the situation was clarified, his firearms were returned. Mr. Lewis, however, was not happy with the situation and made his story public.

WGRZ went on to discuss difficulties enacting the legislation and how the agencies involved were unclear about who was verifying information – the state police or the counties. In Rochester, the station reported, a county clerk was told to call the patient to verify that he was the subject of a report.

Mr. Wolkenbreit now estimates that 15,000 people statewide have been reported to the justice system.

"A high percentage of those are people who have been hospitalized, the next greatest number come from clinics, and a smaller number come from private practitioners. Most of the reports come from New York City."

He noted that those reporting must supply identifying information to confirm that the reporter is a legitimate mental health professional, and there needs to be a clinical reason; simply stating that a patient has suicidal ideation is not enough to trigger a report to the justice system.

"The law was a reaction to the shootings in Connecticut and was not well thought out," Mr. Wolkenbreit said.

It is estimated that most of the reports filed with the directors of community services go on to be filed with the justice system. In only a small number of cases have the reports resulted in the removal of guns from owners – Mr. Wolkenbreit was quick to say that he did not have access to these statistics. He was able to say that mental health professionals have not been happy with the reporting requirements. He did not know whether SAFE Act legislation has made a difference in firearms violence.

I spoke with Benjamin Rosen, director of public information for the New York State Office of Mental Health. Mr. Rosen directed me to some informational websites and spoke with me twice, kindly calling me back to follow up. Unfortunately, he did not have any statistics and said those numbers would have to be collected from each of the 57 counties and New York City. He noted that such information is not generally released, and if he does provide more details down the line, there will be another follow-up column here on Shrink Rap News.

As much as the idea of mandatory reporting of patients "likely to be dangerous" is distasteful to mental health professionals, New York state has passed this law, and the experiment has begun. The fear is that it will deter people from seeking care, a concern that some are quick to dismiss. Since we don’t have the answers as to how difficult such laws are to implement and what impact they have, this is extremely important work that New York is doing. It is crucial that other states have access to their experience and results to guide policy.

In Maryland, a similar reporting law was proposed last year, and it was not passed. If patient reporting and keeping guns from the dangerous mentally ill, however, result in changes in suicide and/or gun violence rates, in either direction, this needs to be made public. Either way, it’s important for New York to be the leader on this issue and help to guide policy across the country.

Dr. Miller is a coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: The Johns Hopkins University Press, 2011).

Almost 1 year ago, New York lawmakers passed some of the most stringent gun control measures in the country. One of the provisions of the New York Secure Ammunition and Firearms Enforcement, or SAFE Act, requires mental health professionals to report individuals they believe are likely to be dangerous to their director of community services, who then decides if patients are to be reported to the criminal justice system. The initial report, called a "9.46," goes through a website set up by the state. These patients may be investigated to determine if they have a firearms permit and whether that permit should be revoked.

The law is controversial. The federal Veterans Affairs Department said it would not comply because the law violates federal HIPAA requirements, and the New York State Psychiatric Association also registered objections, as did I – soon after it was passed. Of note, nothing in the law allows for a mental health professional to directly notify law enforcement officials to confiscate weapons from dangerous patients.

Now that it’s been a while since implementation, it’s time to start asking how it’s going. How many patients have been reported to the directors of community services through the website? How many of those have been investigated? How many guns have been confiscated or surrendered? And how much safer are New Yorkers? Are suicide and violent crime rates dropping? Are the agencies involved pleased with the results to date?

In June, The New York World posted a piece headlined "SAFE Act registry of mentally ill nets few gun permit holders" that read, in part:

"Of the 6,000 reports that have been filed, 11 have been acted upon, testified Jed Wolkenbreit, counsel to the New York State Conference of Local Mental Hygiene Directors, citing figures from the state Office of Mental Health.

His organization’s members are county directors of community services, who under the law must approve or dispute assessments made by mental health providers of the potential of their patients to cause harm.

The flood of SAFE Act reports, Mr. Wolkenbreit asserted, is taking time away from commissioners’ other responsibilities in running their counties’ mental health systems: 'The biggest problem is the amount of time and resources that the SAFE Act is diverting from all of the other duties of the DCS [directors of community services] for what we believe to be a minimal return.'

The law says that reports must be made by the mental health professional. Yet some reports, testified Mr. Wolkenbreit, are being filed by someone other than the mental health provider seeing the patient, and many appear to be computer generated, based on existing patient files. In many cases, mental health providers listed on the documents, when contacted by community services directors for review, either said that they had not filed the reports or that the patients they had seen did not meet the SAFE Act reporting criteria, according to Mr. Wolkenbreit."

That was back in June. In late October, I spoke with Mr. Wolkenbreit, who did not have up-to-date statistics. He noted that the original reports that patients were being reported erroneously was inaccurate, and the issue instead was that there had been confusion with people who had the same name and birth dates as those being reported.

Wait, so first it was stated that patients were reported in error but, in fact, that was a mistake?

"At the very beginning, there were problems with identification, and now we’re getting more information," Mr. Wolkenbreit said.

In April, WGRZ-TV in Buffalo reported on David Lewis, a college librarian in treatment for anxiety, who lost his pistol permit. Once the situation was clarified, his firearms were returned. Mr. Lewis, however, was not happy with the situation and made his story public.

WGRZ went on to discuss difficulties enacting the legislation and how the agencies involved were unclear about who was verifying information – the state police or the counties. In Rochester, the station reported, a county clerk was told to call the patient to verify that he was the subject of a report.

Mr. Wolkenbreit now estimates that 15,000 people statewide have been reported to the justice system.

"A high percentage of those are people who have been hospitalized, the next greatest number come from clinics, and a smaller number come from private practitioners. Most of the reports come from New York City."

He noted that those reporting must supply identifying information to confirm that the reporter is a legitimate mental health professional, and there needs to be a clinical reason; simply stating that a patient has suicidal ideation is not enough to trigger a report to the justice system.

"The law was a reaction to the shootings in Connecticut and was not well thought out," Mr. Wolkenbreit said.

It is estimated that most of the reports filed with the directors of community services go on to be filed with the justice system. In only a small number of cases have the reports resulted in the removal of guns from owners – Mr. Wolkenbreit was quick to say that he did not have access to these statistics. He was able to say that mental health professionals have not been happy with the reporting requirements. He did not know whether SAFE Act legislation has made a difference in firearms violence.

I spoke with Benjamin Rosen, director of public information for the New York State Office of Mental Health. Mr. Rosen directed me to some informational websites and spoke with me twice, kindly calling me back to follow up. Unfortunately, he did not have any statistics and said those numbers would have to be collected from each of the 57 counties and New York City. He noted that such information is not generally released, and if he does provide more details down the line, there will be another follow-up column here on Shrink Rap News.

As much as the idea of mandatory reporting of patients "likely to be dangerous" is distasteful to mental health professionals, New York state has passed this law, and the experiment has begun. The fear is that it will deter people from seeking care, a concern that some are quick to dismiss. Since we don’t have the answers as to how difficult such laws are to implement and what impact they have, this is extremely important work that New York is doing. It is crucial that other states have access to their experience and results to guide policy.

In Maryland, a similar reporting law was proposed last year, and it was not passed. If patient reporting and keeping guns from the dangerous mentally ill, however, result in changes in suicide and/or gun violence rates, in either direction, this needs to be made public. Either way, it’s important for New York to be the leader on this issue and help to guide policy across the country.

Dr. Miller is a coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: The Johns Hopkins University Press, 2011).