What about the people who need help? – Guns and Mental Illness Part 4

This post is part of a series.  Part 1 is here. Other links will be added to Part 1 as they’re published.

Another problem with an information pipeline from your therapist to the police is that people already withhold information from their mental health providers because they don’t want to be committed, or because they have other worries.  Even though the conditions under which a therapist is required to break confidentiality are pretty narrow, there are plenty of people who avoid therapy all together to maintain their privacy.

The first time I applied for a background check that included a consent form from my therapist, I was freaking terrified that some bit of information I disclosed would screw up my background check. And I have anxiety disorder—one of most common, least stigmatized, best understood mental health diagnoses out there. Granted, that level of worry is itself a symptom of the anxiety disorder, but expecting people with mental illnesses to act like they don’t have mental illnesses is kind of ridiculous, especially when you’re making it harder for them to get help.

If I were to start experiencing scarier, more significant symptoms, I would definitely be concerned about whether disclosing them to my therapist would impact my job. That doesn’t necessarily mean that I *wouldn’t* get them addressed, but it would give me pause. If we’re going to add *more of that,* we need to be really sure it’s worth it. Especially when, as I mentioned in the last post, mental health is only a tiny sliver of the problem.

This is magnified when you talk about taking people’s guns away, particularly with groups of people who are already clinging to their guns like they live in a warzone. I mean, the NRA is literally taking potshots at teenagers with PTSD because it might threaten their supporters’ ability to sell as many guns as humanly possible. “They’re coming for your guns!” is the best, most successful scare tactic the NRA has, and an awful lot of gun owners are *terrified* of this possibility. It’s one of the reasons mass shootings are such a big moneymaker for gun manufacturers, and therefore for the NRA by virtue of donations. Every time someone murders a bunch of people, people start stocking up on weapons just in case there’s a ban.  Not only do the gun manufacturers then have more money to pour into the NRA’s coffers, but at the same time, the people buying the guns are also donating to the NRA to make sure they get to keep those guns.

So, what happens when the card-carrying NRA member with an arsenal that the local police would envy experiences mental illness symptoms? There are already stigmas about mental illness and about seeking treatment, and they seem to be way more prevalent in conservative circles. So, he’s already got to overcome toxic masculinity telling him that a real man just deals with his problems. Maybe he’s got to overcome his pastor telling him that if you have a mental illness you’re not praying enough or your relationship with God isn’t right. If we add, oh, and you might lose the gun collection that makes you feel safe and that you’ve got a huge portion of your identity as an American and as a man tied up in, he’s even less likely to seek treatment.

That’s not to say that every NRA member views their guns as a core part of themselves or as an extension of their masculinity if they’re male.  But certainly many do.  Gun advertising reinforces this all the time.

And, yeah, I value the lives of the Parkland, and Great Mills, and Sandy Hook kids much more than I value anybody else’s gun collection.  But I also value the life of the guy who’s deeply depressed but doesn’t want to seek therapy because he fears they’ll take away his guns.

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What problem are we solving? – Guns and Mental Illness Part 3

This post is part of a series.  Part 1 is here. Other links will be added to Part 1 as they’re published.

Before we go too far down the road of targeting mental health as a means of solving gun violence, perhaps we should investigate whether it’s actually the root cause.  From everything I can tell, it’s not.  It’s a tautology to say that *something* has gone wrong in the head of someone who commits mass murder, but that doesn’t mean they have a mental illness.  It’s equally possible for them to simply be a selfish, or angry, or violent person who is perfectly sane.

While there are mental health issues that can mean a person should not have access to a gun, that doesn’t mean that everyone with a mental illness is a danger. In fact, people with mental illnesses are more likely to be victims of violence than to perpetrate it, and when they do, it’s mostly suicide. (I’m all for preventing suicide, but we have to acknowledge that the dangers are different.)

Mass shooters are pretty much uniformly white males, the demographic group with the best access to mental health services. The ones with the worst, black women, aren’t out there shooting up schools and concerts.

Following along with that, mental illness exists in Japan, Australia, Great Britain, and all these other countries who don’t have mass shootings.

We need better mental health care, and we should take steps to make sure that people who are actively homicidal or suicidal can’t access guns. *But* scapegoating mentally ill people not only harms an already marginalized group, but it also ignores large parts of the problem.

So, once we’ve kept guns out of the hands of mentally ill people, many of whom have never and would never hurt a fly, what are we doing about the next mass shooting by an angry white guy? I mean, you could make a compelling argument that toxic masculinity and white entitlement are mentally unhealthy, but those sicknesses exist at the cultural level rather than the individual level. Are we addressing any of that? Are we addressing the fact that domestic violence is a much better predictor of someone becoming a mass shooter than a mental health diagnosis is? Or are we scapegoating people with mental illnesses and calling it a day?

And let’s pay attention to the fact that we are scapegoating people with mental illnesses.  That stigma already exists.  People already face rejection, fear, and stereotypes when anyone finds out that they’ve got a mental health diagnosis.  When we paint mentally ill people as a shooting spree ready to happen, we only add to that.  And that stereotype isn’t even true.

The police are part of the problem – Guns and Mental Health Part 2

This post is part of a series.  Part 1 is here.

In my previous post, I talked about the privacy concerns raised by the proposal to modify HIPAA to allow therapists to either submit mental health information to the background check database or provide it directly to law enforcement.

My next big concern is with providing this information to law enforcement, and what the police will do with this information. The police already have a tendency to shoot people who they view as behaving erratically or who they see as a threat. Telling them in advance that someone they’re going to interact with has a mental illness can prejudice them toward a belief, maybe unfounded, that the person is dangerous. And, like everything else, those prejudices get amplified when dealing with any minorities, particularly black people. So, my big question is, what information from someone’s private mental health records do you want the police to have? When police have this information, how do you ensure that they’ll behave reasonably and proportionally? How do you ensure that putting Bob’s depression or bipolar diagnosis in the hands of law enforcement doesn’t get him shot?

As a related question, if you’re changing HIPAA, are police officers now bound by HIPAA (with the related training that entails)? Or, once they know that John Q. Smith of 471 Maple Drive in Anytown, NY is diagnosed with depression and bipolar disorder, do they get to disseminate this information? And, again, what if it’s wrong? If it was actually John H. Smith who had those diagnoses, what recourse does John Q. Smith have about the false information that’s out there? Is he entitled to know the police are keeping those records? What safeguards are they using?

Before we mess with HIPAA, I have some questions (Guns and Mental Health – Part 1)

This is a multipart post.  Subsequent posts will go up on a schedule. (Hey, I wrote four posts today, I’m getting at least a week’s worth of mileage out of them.) They’ll also link back to the previous posts.

Part 1:  Before we mess with HIPAA, I have some questions

I have seen a lot of people arguing that HIPAA laws need to be changed so that if your therapist decides you’re dangerous, they can tell law enforcement. This was also one of the policy points from March for Our Lives yesterday.  (To be clear, I give the Parkland kids *so much credit* for taking the horrible thing that happened to them and working to make sure it doesn’t happen to the next group of kids.  This is criticism and questions of specific policy proposals, not of their motives or them as people.  We also shouldn’t expect teenagers to put out perfect policy proposals, because of course they lack the experience that adults bring to these issues.)

I have questions. And concerns. This will be long, so I’m breaking it into multiple posts.

First of all, therapists are already *required* to report if they think you’re going to harm yourself or others. This is covered under existing laws.

So what, specifically do you want to change? You want a lower standard for mandatory reporting?  Okay, what specifically needs to be reported and to whom? The therapist reports directly to the background database? Okay, who’s in charge of reviewing the therapist’s assessment? That is, what prevents a therapist who thinks *nobody* should have guns from reporting on people who aren’t actually a danger? What prevents a therapist from using this process selectively, whether deliberately or because of subconscious biases? Is the patient entitled to know that this information has been submitted? If it’s incorrect, what rights do they have to appeal it? What data on a patient’s diagnosis stays in that database, and how is it protected? (If you are found guilty of a crime, that’s a matter of public record. Your health information is not, and it requires a whole different level of security than the existing background check database currently does.)

What do you do in case of a breach? If someone steals the list and plasters it all over the web, who’s responsible, and what kind of damages are those patients entitled to? For that matter, who decides what mental illnesses get you on this list? Is there a list of illnesses? Specific symptoms? Is there a specific screening tool, or is it completely up to the therapist’s discretion? What are the diagnostic criteria? Who’s in charge of updating them as knowledge and understanding of mental illness changes?

Basically, can you ensure that whatever you’re proposing is an accurate reflection of someone’s likelihood of becoming violent, doesn’t inappropriately expose their private medical information, and doesn’t inappropriately take away their right to own a gun.