Monday, December 24, 2012

Senator Feinstein: Protect Us From The Mentally Ill

Dear Senator Feinstein,

I am writing to you as a Californian, a father, a physician and a law-abiding responsible firearms owner. In light of recent tragic events and your response of proposing new federal firearms legislation, I felt strongly compelled to tell you two things . . .

While I do not support your efforts to ban certain firearms, as a member of a mental health team, I wish to bring your attention to some painfully glaring shortcomings in our country’s legislation pertaining to the liberties afforded to persons suffering from mental illness. The liberties I refer to, of course, are access to firearms and not any other . . .

Small changes to our laws relevant to the reporting of specific high-risk psychiatric symptoms would have avoided at least some of the tragic mass shootings which we have seen in the last few years (Cho, Loughner, Holmes, Roberts and Lanza). I propose we develop a system which would require reporting of patients with certain very specific high-risk psychiatric symptoms to NiICS, effectively barring them from acquiring firearms.

We cannot overlook the fact that close review of the assailants’ histories will reveal clear clinical findings and symptoms which would help identify high-risk individuals in the future.

As you may know, California has implemented the Mental Health Firearm’s Prohibition Reporting System (WIC section 8103, subs: (f)(2)(B)and (f)(2)(G) as well as section 8105 sub (b) as amended by AB 203 (Beall)) whereby “mental health facilities are to immediately report specified information to the CA DOJ regarding persons admitted to a mental health facility when they’re determined to be a danger to themselves or others, or who are certified for intensive treatment” to the DOJ.

This is a good and well-focused law. The intent of this law, no doubt, is to then include that reported data in the National Instant Criminal Background Check (NICS) System.

Nevertheless, as you may also be aware, many individuals suffering from disturbing symptoms aren’t admitted to in-patient treatment if they haven’t demonstrated that they are a threat to themselves or others. And there’s a high threshold for declaring someone a threat. This was most likely the case with Cho, Loughner, Holmes, Roberts and Lanza.

This is due, in part, to the fact that even people suffering so terribly can still refuse hospitalization and/or medication. Some who may be taking their medications may find them only partially effective. They may become angry over their side effects, may feel that the medications, while alleviating the disturbing symptoms, also strip them of what they perceive to be their real self. Others may become despondent, having the insight that theirs is a lifelong, debilitating disorder.

Their families, health professionals and sometimes law enforcement personnel who encounter these people are powerless to do anything to help them, protecting both them and the general public.

That’s a dilemma we need to resolve. Because hindsight will show that all of the five recent mass killers were troubled, but not didn’t quite meet the threshold I mentioned above. While many want to vilify these individuals calling them monsters, they are still people and their suffering, in one way or another, lead them to commit their monstrous crimes.

In addition, while finding more and better ways to help these people is a necessary long-term goal, we have a responsibility to protect the innocents in our society from the violent acts they commit.

To wit: people with high-risk psychiatric symptoms may not be obligated to undergo treatment but they should not be allowed to possess firearms.

I propose we develop a system which would not just require reporting of patients in institutions but create a system whereby patients with very specific high-risk psychiatric symptoms (i.e. hallucinations, ideations of reference, persecution or other paranoid delusions as well as those with profound thought disturbances) are flagged to NiICS. Certainly, a system of checks such as an appeals process and a formal process of adjudication would be appropriate, too.

I specify symptoms rather than diagnoses because general diagnoses aren’t focused enough. Neither is being prescribed a specific medication, as many psych meds are used off-label with much success: case in point: SSRIs for anxiety or OCD.

Until funds are allocated and an infrastructure created to help people suffering from serious mental illnesses (and this must be done) we need to enact legislation that targets high-risk individuals.

Punishing millions of responsible citizens for the shortcomings of our mental health care system or the laws regulating it is neither a measured, equitable or effective response to tragedies like Newtown. We can’t abridge the liberties of millions when the problem lies with a relative few.

Found at: The Truth About Guns

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