(NBC) – If there’s one thing Republicans and Democrats can agree on, it’s that mentally ill people should not have access to firearms.
But as lawmakers rush to restrict that access in the wake of recent mass shootings, mental health experts warn of unintended consequences: from gun owners avoiding mental health treatment to therapists feeling compelled to report every patient who expresses a violent thought.
“Many patients express some idea of harm to other people, everything from, ‘I wish I could rip my boss limb from limb,’ to, ‘I have a gun and want to blow that guy away,’” said Paul Applebaum, director of the Division of Law, Ethics, and Psychiatry at Columbia University.
Therapists usually interpret this sort of talk as part of the treatment process, experts say. But under a new law in New York, one of the strongest to be passed to date, therapists may feel compelled to report every instance of violent talk, lest they face legal consequences if something happens. And some say ordinary patients may wind up suffering the most.
“There’s one group of people who are gun owners who may reasonably or unreasonably think, ‘I’m not going anywhere near a mental health person, because if they misinterpret something I say as an indication I’m going to hurt myself or someone else, they’re going to report me and take away my guns,’” Applebaum said.
Several polls conducted since the shooting in Newtown, Conn., have found widespread support for new legislation that would restrict the possession of firearms by the mentally ill, as well as for increased government spending on mental health.
Federal law already bars the sale or transfer of firearms to a person who is known or thought to have been “adjudicated as a mental defective.” In addition, at least 44 states currently have their own laws regulating possession of firearm by mentally ill individuals, according to the National Conference of State Legislatures. But not enough states report their mental health data to the federal government, rendering the federal law largely toothless.
‘Not taking any chances’
New York’s expanded gun law signed by Cuomo on January 15 goes further than most state laws in that it requires mental health professionals to report any person considered “likely to engage in conduct that would result in serious harm to self or others” to local health officials. Those officials would be authorized to report that person to law enforcement, which could seize the person’s firearms.
Previously, New York judges could compel seriously mentally ill people thought to be dangerous to receive involuntary outpatient treatment.
“I see it very frequently,” Steven Dubovsky, a professor of psychiatry at the University of Buffalo, said of patients expressing violent fantasies. “You see people who struggle with anger or have violent thoughts, and if I thought they were going to act on it right away, I would stop them.”
“Now if you’re mistaken, you’re wrong about this, and you don’t report it, you could face criminal sanctions. I’m not taking any chances at that point,” Dubovsky said. That could encourage therapists to over-report, he said.
Rep. Rob Barber, who was critically wounded alongside Rep. Gabby Giffords, talks about his task force to provide advice on mental health issues to prevent gun-related violence.
There have been cases where better enforcement of laws already on the books might have helped avoid bloodshed, said Richard J. Bonnie, a professor at University of Virginia’s law school. Bonnie headed a state commission on mental health law in the wake of the mass shooting at Virginia Tech.
Shooter Seung-Hui Cho, who killed 32 people and then himself at the university in 2007, should have been adjudicated as mentally defective following a special justice’s order issued two years before the shooting, Bonnie said. Such a designation, properly reported, would have disqualified him from owning a gun under existing federal law.
But that message never got passed on to the feds or Virginia Tech, Bonnie said.
Shoring up the flaws in mental health reporting to the National Instant Criminal Background Check System – something Obama addressed in his proposals – would help prevent future mistakes, Bonnie said. Obama also called for background checks to be required on all firearm purchases – currently only 7 states account for 98 percent of the names prohibited for reasons of mental illness in the NICS database, according to Mayors Against Illegal Guns.
According to DJ Jaffe, executive director of the Mental Illness Policy Org, which advocates on behalf of the seriously mentally ill, all the talk of mental health and gun violence obscures a bigger issue – a nationwide struggle with how to care for the mentally ill.
“Most of the things they’re discussing are totally irrelevant to helping people with serious mental illness,” Jaffe said. “No one wants responsibility for the seriously mentally ill.”