Friday, May 3, 2013

Guns and Mental Health Care: Finding the Right Solutions

By Ron Honberg, NAMI National Director of Policy and Legal Affairs

"The President reacts as John Brennan briefs him on the details of the
shootings at Sandy Hook Elementary School in Newtown, Conn. The
President later said during a TV interview that this was the worst day of
his Presidency."  (Official White House Photo by Pete Souza)
As you’ve probably been hearing, Congress is at an impasse in the debate over guns. They have retreated, for the moment, from the issues that divide them, including whether limits should be imposed on assault weapons, if the loophole should be closed that exempts individuals who purchase firearms at gun shows from background checks, and other divisive issues.

There is one area though in which the gun control and the pro-gun lobbies appear to have reached an agreement: that mental health background checks should be expanded. Some of the rhetoric has been inflammatory and highly offensive.

For example, in the days following the tragedy at Sandy Hook Elementary school, Wayne LaPierre, the executive vice president of the NRA, attempted to deflect attention away from calls to ban assault rifles and automatic weapons by focusing on what he regards as the “real problem”: the large numbers of dangerous people with mental illness walking our streets.

LaPierre said, “How many more copycats are waiting in the wings for their moment of fame—from a national media machine that rewards them with the wall-to-wall attention and sense of identity that they crave—while provoking others to try to make their mark? A dozen more killers? A hundred more? How can we possibly even guess how many, given our nation's refusal to create an active national database of the mentally ill?”

But these offensive quotes are not limited to the NRA and their allies. Consider this statement by Mark Glaze, Director of Mayors Against Illegal Guns, a leading organization advocating for gun control, that appeared this January in an article in The Washington Post.

“The system looks like Swiss cheese. It stops a lot of bad guys from getting guns, but it lets a lot of bad guys through. Every mental health record that isn’t in the system is a ticking time bomb waiting to go off in another community.”

There is certainly little disagreement that guns should be kept out of the hands of people who are violent. But focusing the debate solely on expanding mental health background checks misses the point. After years of neglect, coupled with huge budget cuts since the recession began in 2008, mental health services are frequently not available to those who need them most. On any given day, six out of 10 people living with serious mental illness do not have access to any mental health treatment.

Moreover, most people living with severe mental illness are not violent. Thomas Insel, M.D., director of the National Institute on Mental Health (NIMH), recently testified on this point at a Congressional hearing:

“Research has suggested that persons with schizophrenia whose psychotic symptoms are controlled are no more violent than those without serious mental illness (SMI). Nonetheless, when untreated psychosis is also accompanied by symptoms of paranoia and when it is associated with substance abuse, the risk of violence is increased. Importantly, the risk of violence is reduced with appropriate treatment. Moreover, people with serious mental illness are 11 times more likely than the general population to be victims themselves of violence.”

Despite these research findings, existing laws take a broad, categorical approach to mental health background checks rather than focusing on predictors of violence. The Federal Gun Control Act states that “persons adjudicated to be mentally defective or who have been committed to a mental institution” are prohibited from possessing firearms and ammunition. And, states are directed to report the names of individuals who fall into these categories for inclusion in the National Instant Background Check (NICS) system. A recent report by Mayors Against Illegal Guns shows that some states have reported thousands of records and others none at all.

NAMI has testified that federal legislation should eliminate highly offensive terminology such as persons “adjudicated as mentally defective” and provide clearer guidance on who should and should not be included, based on current scientific understanding. 

The real solutions however lie in improving America’s broken mental health system. A system that does not enable people to get mental health care until their symptoms deteriorate to the point of constituting acute emergencies is no system at all.

NAMI has recommended a number of steps in the aftermath of Newtown, including:

  • Early identification and intervention in mental health care.
  • Training of school personnel, law enforcement and other first responders on crisis intervention.
  • Implementing school based mental health services and supports.
  • Increasing the qualified mental health workforce.
  • Fully implementing Medicaid expansion and other key components of the Affordable Care Act, including mental health parity.
  • Providing support for families who function as primary caregivers.
  • Achieving proper balance in federal and state privacy laws.

There are several bills in Congress that would take steps towards achieving some of these objectives, including the Mental Health Awareness and Improvement Act, which would put resources into school based mental health services, suicide prevention and other areas, and The Excellence in Mental Health Act, which would establish a funding stream for Community Mental Health Centers (CMHCs) that achieve certain core competencies in treating people with mental illness.

However, at the same time that these new programs are being considered, vital areas of federal funding such as housing and research on mental illness are slated for cuts.

Taking one step forward and two steps backwards is not going to get the job done. And, limiting the debate solely to how mental health reporting requirements can be expanded in gun background check systems will not solve the problem either.


Anonymous said...

I am high functioning with bipolar. As long as I take my medications, I'm fine. If I don't take them, I'm a danger to MYSELF only. I want to own a gun for my own personal protection but if there was a national database, I'd be denied even though I'm not a danger to anyone. Until they can identify everyone with mental illness and then rank their illness to determine "threat" level - leave my personal freedoms alone!

K Johnson said...

As I have spoken out, multiple times before, to just about anyone who would listen to me... What would our national debate be about education reform, the drug war, gun violence... so many things if we first looked at the structure of our mental healthcare system. I speak because I have been through, being diagnosed with bi-polar at age 15 and having a son with diagnosed with Autism at age 3.

Anonymous said...

It is too bad that successfully treated mental illness makes neither good press nor good entertainment and so ignorance and stigma remain. A national database of "the mentally ill" will deny the next generation the quality of life that this generation has enjoyed by eventually becoming a resource for employers during background checks. Parents will have to choose between treatment which will tag their children unemployable or leaving their children untreated which will actually make them unemployable. This will be a 60-year step backwards to a time when treatments did not exist.

Anonymous said...

I don't think that there should be a national database which lists everyone with mental illness. By doing this it not only discriminates against people who have mental illness but it also solidifys society's perception that people with mental illness are dangerous and violent. I have worked with many people who are suffering from mental illness and none of them have a violent bone in their body.

If a person is determined to get a gun they will do it. I agree that there must be background checks when a person wants to purchase a gun. But if that person has a mental illness they shouldn't be automatically disqualified from purchasing one. As mentioned in this blog people with serious mental illness are 11 times more likely to be victims of violence themselves. Instead of determining that all people with mental illness are dangerous, I think we as a society should be educating ourselves and others on what mental illness is so everyone stops thinking that all people with mental illness are dangerous.

Anonymous said...

If physicians must report seizure disorders in order to prevent their patient from obtaining a driver's license, then the same should hold true for mental illness and the ability to obtain firearm. Lets not sensationalize assault weapons because they are not the problem. Here are the facts. More than 6000 murders are committed every year with handguns while less than 30 are committed with assault weapons. Within the US, 10% of all murders are committed by the mentally ill. If we expand the number of suicides committed by the mentally ill, the number is even greater. It is my opinion that anyone who has received psychiatric treatment should be banned from owning a firearm based on a mandatory federal database. Also, it should be a felony to have a firearm in the residence of a mentally ill person who is in this registry.

Live in care work UK said...

If the government will not involve and stop this, it will become a dangerous trend...

David Sadler said...

The debate on mental illness needs to expand to include a discussion on the differences if any between terrorist acts and other violent acts attributed to mental illness. More and more they all seem to be shades of the same color - different forms of mental illness.

What is the difference between someone using an assault rifle to kill a bunch of people vs a bomb made from a pressure cooker? The best that can be said is a difference in cultural background, but not much more. Am I wrong?

Anonymous said...

It seems like a national database wil do more to stigmatize,and stop people who need help from getting it.What are we supposed to do with a police officer struggling with deppression?People who have been convicted of violent act's should not be allowed to own a gun,Whether they are mentally ill or not.

JadedHula said...

Please cite your credible sources. I want to know where your numbers come from. Credible sources are not popular news sites, blogs from other people, or articles in non medical journals. Your sources must be credible or your whole comment will not be taken seriously. Thank you.

Anonymous said...

"It is my opinion that anyone who has received psychiatric treatment should be banned from owning a firearm". This quote is the best example of ignorance I have seen in a long time. They assume that anyone receiving psychiatric treatment is violent, when reality is that only a small percentage is violent. The only effect a law like this would have would be to discourage those that need help from getting help. Those that enjoy hunting and/or the shooting sports would rather go untreated than give up something they enjoy. Airline pilots used to lose their jobs if they were taking anti-depressants, so those that needed them didn't take them because they did not want to lose their job. As a passenger, I would rather have a pilot whose depression was being treated than a depressed pilot who wasn't being treated.

Lucas Riedler said...

I have severe Bipolar, I also have 8 years of military service, where I carried and was trained with knives and firearms. I like shooting, I like going to the range. I don't think a gross overreaction to recent tragedies is an acceptable answer. I think a national database will only be used to make life harder on a group of people for whom life is more difficult than average. Citing suicide as a reason to keep guns from people with MH Dx is ludicrous. When you consider approximately 40% of the population will experience depression at some point in their life, that is a huge chunk of the population that would have their constitutional rights taken.

R. Quayle said...

If someone put me in a database basd on my colour it would be called racism and I think we could all agree that it's wrong and immoral. But if I am going to be put on a list for having bipolar disorder and anorexia nervosa it's no problem in the natioal conscience. I feel a lot safer America, thanks.

Anonymous said...

Within the US, 10% of all murders are committed by the mentally ill. . . . It is my opinion that anyone who has received psychiatric treatment should be banned from owning a firearm based on a mandatory federal database."

Could you please explain why the other 90% of murders in the United States are done by people WITHOUT mental illness and how a database would prevent those murders from occurring? Thank you.

Mental Health Is A Full Time Job said...

I am the proud parent of a beautiful woman who happens to have an illness; she is not her illness. Much the same as other illnesses she takes medication daily. She is one of the lucky ones who has access to appropriate medical care and accepts that this makes her life better. If you look at or speak with her you will not know that she has an illness that has required her to be hospitalized for treatment. Enough about my pride and joy.
As a human resources practitioner and the discussions I have read bring memories of past over reactions against those with illnesses or even those who are different.
Please keep your phobias in check. Instead of acting from fear invest your energy in improving access to mental health treatment.
Choose to be and act like the beautiful human being you can be - like my daughter.