States Consider Mental Health Issues In Relation To Gun Control

One and a half months after the Newtown tragedy, the nation is finally engaged in a debate on gun control and mental health services.  The President has proposed comprehensive reform in both areas.  While proponents and opponents argue those issues in the national arena, states are considering their own legislation.  According to USA Today, about ten states are considering gun-control measures while seven other states are considering new mental health measures.  Interestingly, Kansas and Texas are both considering implementing mental health measures and loosening gun restrictions.  This article will touch on specific measures and proposals in New York and California.

New York Gun Control Law

New York has enacted the nation’s first post-Newtown gun control law.  In addition to limiting clip sizes and standardizing licensing statewide, the law contains provisions that focus on the mentally ill. The law requires mental health professionals engaged in treatment, defined as physicians, psychologists, registered nurses, and licensed clinical social workers, to notify the director of community services or a designee when they determine that a “person is likely to engage in conduct that would result in serious harm to self or others,” a determination that some opponents believe is hazy and likely to lead to over- or under-reporting.  If the director agrees with the mental health professional’s determination, he or she must report the patient’s name and other identifying information, not including the patient’s diagnosis, to the division of criminal justice services.  That information is to be used solely for the purpose of determining whether the patient’s gun license should be suspended or revoked, whether the patient should be prevented from receiving a license, or whether the patient should not be permitted to possess a firearm.  The law exempts mental health professionals from liability for disclosure or failure to disclose, assuming the mental health professional exercised reasonable, good faith judgment.

The law also extends Kendra’s Law, named after a commuter who was pushed in front of a subway train by a mentally ill person who was not receiving treatment, through 2017.  Kendra’s law permits judges to order “assisted outpatient treatment” to certain mentally ill individuals who, among other criteria, cannot live safely on their own, have a history of hospitalization, incarceration, or violence, and are unlikely to seek treatment.  The gun control law extends the period of treatment from six months to one year and requires patients to undergo reviews before being released.

The law, naturally, is not universally favored.  Second amendment issues aside, some  advocates for patients with mental illness feel that the reporting requirement may cause some among the mentally ill to avoid treatment or may cause overreporting of people who are not truly likely to become violent.  Others simply feel that including mental health provisions in a law about gun control is tantamount to accusing all mentally ill persons of being violent.  Others, however, particularly proponents of Kendra’s Law, feel that the law will allow the seriously ill to get the treatment they require.

California Mental Health Law

According to California Health Line, state officials believe that its mental health law should be a model for the nation.  In 2004, it enacted Proposition 63, now known as the Mental Health Services Act (MHSA). State Senator Darrell Steinberg (D-Sacramento) says that 20% of revenue generated by the MSHA is devoted to prevention and early intervention programs.  Steinberg has proposed to Vice President Biden that the nation base its mental health reform on the MHSA.  Representative Doris Matsui (D-Sacramento) agrees, and further proposes that the nation bolster Medicaid funding for mental health organizations, particularly community mental health centers. Rusty Selix, Executive Director for the Mental Health Association in California, notes that the MHSA has created programs to help homeless people with disabling mental illnesses.

Steven Segal, Director of the Mental Health and Social Welfare Research Group at the University of California, Berkeley,  praised the law, but was candid about its ineffectiveness in funding involuntary care to commit patients to hospitals.  Segal notes that 46% of states have civil commitment policies that allow states to commit dangerous or disabled patients to confine and treat people in hospitals or in the community; 54% of states have programs that allow commitment for general health and safety.  According to Segal, the more expansive guideline are associated with 1.42 fewer murders per 100,000 people.  Segal also notes that lower access to beds in psychiatric facilities is associated with 1.08 more homicides per 100,000 people.

Most mental health advocates caution that the mentally ill are not generally violent, but welcome the opportunity for a thoughtful discussion on mental health reform.  Segal noted that firearms restrictions are associated with decreased homicides.  In short, in his view, “The gun is a tool used to express aggression, and access should be restricted.”  In the weeks and months ahead, we’ll see whether the nation agrees.