A National Database of the Mentally Ill

Subtitled: Has Anyone Here Heard of Client/Patient Confidentiality? No? No.

Today, the National Rifle Association had a press conference.

Wayne LaPierre, the Executive Vice President spoke, and I, recently relocated back to Texas for the holidays, slept through it.

Then I saw the transcript, sat bolt upright in my bed, and got ranty on the internet.

The relevant bit (emphasis mine):

 The truth is, that our society is populated by an unknown number of genuine monsters. People that are so deranged, so evil, so possessed by voices and driven by demons, that no sane person can every possibly comprehend them. They walk among us every single day, and does anybody really believe that the next Adam Lanza isn’t planning his attack on a school, he’s already identified at this very moment?

How many more copycats are waiting in the wings for their moment of fame from a national media machine that rewards them with wall-to-wall attention and a 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? The fact is this: That wouldn’t even begin to address the much larger, more lethal criminal class — killers, robbers, rapists, gang members who have spread like cancer in every community across our nation.

So, since the NRA seems long on rhetoric and short on facts, I thought I’d clear some stuff up for them.

Patient confidentiality exists even if you have mental illness.

Funny how that works, where you have rights still, when you have mental illness. Psychiatrists still have to follow HIPPA rules. In fact, notes on psychotherapy that are kept separate from medical charts are given even more protection. Was the NRA suggesting that we trounce all over patient confidentiality and require all diagnoses to be reported? Just the “dangerous” ones? Would someone like to clarify for me which ones those are?

Therapists are already required to report anyone who makes a credible threat, and warn any possible targets.

This is largely based on the Tarasoff Rule, which came out of Tarasoff v. Regents of the University of California. In essence, when a psychologist or therapist hears a client threaten harm, they are obligated to warn those people who may be in danger. “Protected privilege ends where the public peril begins.” This is one of several exceptions to confidentiality, which can be summed up as confidentiality except in instances of harm to self or others. (Which includes reports of child abuse while another child is in the home, risk of suicide, elder abuse, and any threats or injury or death to another.)

So, say there was a high correlation between being mentally ill and being violent. (There’s not.) And then say the Connecticut shooter was mentally ill and in treatment (As far as we know, he wasn’t.) And then, say he’d confessed his plan… oh wait, there’s already methods in place to deal with that. So your database does what now, NRA?

Not everyone with mental illness is diagnosed. 

So would you be requiring everyone to be tested for mental illness then? I mean, I’d be all over that if you didn’t then require that  the mentally ill be registered in a database à la sex offenders. 

Mental illness isn’t exactly uncommon. 

Twenty six percent of American adults meet criteria for a diagnosable disorder in a given year. That, for those of you inclined towards fractions, is one quarter of the population. Since I’ve noticed that it’s somewhat less than a quarter of the population that’s having trouble committing violent crimes with guns, I’m going to posit the radical notion that having mental illness and being near weaponry does not a killer make. Of course, there are some mentally ill people who shouldn’t be near guns. I’ll agree to that easily. There’s also some mentally sound people that we’d rather not have near guns.

Discrimination against the mentally ill is actually a problem. 

Nifty research here. (Abstract only if you’re not at a university, sorry.) Basically, the neurodiverse are more likely to be discriminated against by their employers and coworkers, as well as facing disadvantages in competing for jobs. So maybe we could try to avoid making that worse? Like say, by avoiding the creation of a searchable database of those with mental illness?

Note: I’m fully aware that some people with mental illness are violent. So are some neurotypical people. I’d be all over a psychometrically sound test of impulse control/aggression/etc, that tested abilities related to using a gun responsibly. Using science to determine safe gun owners–great! Using a highly stigmatized population to avoid discussing gun control–jerk move.

NRA Press Conference — More Guns in Schools!

The NRA has finally spoken on the tragedy last week in Connecticut and how I wish they hadn’t.  Not because it isn’t telling to hear how crazy they are, but because it is depressing to know how much they hold sway over the people in the government.  The amount of money they have to push their agenda is obscene.  As is the agenda itself.  As is their unwillingness to take questions after their press conference.  But I digress.

There has been a big push in response to the shootings to tighten gun laws, but the NRA, unsurprisingly, doesn’t think guns are the problem.  In fact, they think guns are the solution.

I have spent much of the last week trying to find good, solid information on gun policy in the US, but I’ve had a lot of difficulty.  Everything has been done by a special interest group or just written in political blogs and forums.  There appear to be no studies of the efficacy of things like the Gun Free School Zones, just arguments that mass shootings happen in Gun Free Zones.

To use a cliché here, the plural of anecdote is not data.  Yes, a lot of public shootings have happened in Gun Free Zones, but that’s partially because so many public places are Gun Free Zones.  Statistically, it’s not surprising.  But if we’re using anecdotes to make points, let’s look at a couple of things that don’t survive the bad things don’t happen if someone armed is in the audience, people don’t shoot there — just from the last few years.

2009 Fort Hood Shooting

If there’s any argument against the idea that trained people with weapons have the ability to stop this sort of thing, it’s the Fort Hood Shooting.  One gunman killed 13 people and wounded another 29 on a military base. Almost everyone he shot was a trained member of the military or police force.  He had a shoot out with police, which he won, and continued to shoot more people.

2011 Tuscon Shooting

Gabby Giffords was shot at a public event in a gun-friendly state and one of the men who helped subdue Loughner was carrying a gun.  You know how they stopped the shooter?  He had to reload, at which point there was an opening for people to tackle him.  He was not shot, he was tackled and held down by several people in the crowd.  If that’s not an argument for smaller clips, I don’t know what is.  And it certainly doesn’t support the evil people hear “gun free zone” as a smorgasbord opportunity.

2012 Empire State Building Shooting

11 people were shot — one by the gunman, one was the gunman himself, and 9 people who were shot by the police trying to get the gunman.  Yes, more guns are clearly the answer to keeping people from being hurt.

And, of course, the mother in the most recent shooting was well-armed and well-trained and she didn’t managed to stop her son from killing her and the kindergarteners.  This is not victim blaming, it’s the reality of the power-differences between someone who is crazy and wants to shoot people and even the most well-trained person who finds themselves suddenly faced with insanity in the middle of their routine day.

And then there are all the other incredibly wrong-headed things that the NRA said, I’ll just put them here for you, but feel free to read the whole thing yourself.

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?

Yes, I think every person who ever took a Xanax should be in a registry to stigmatize them and make them seem like killers despite the fact that this would be such a huge registry that it would be useless and it would only serve to make sure people who needed mental health care would avoid seeking it out to avoid being on the registry.  GREAT IDEA.

 And the fact is, that wouldn’t even begin to address the much larger and more lethal criminal class: Killers, robbers, rapists and drug gang members who have spread like cancer in every community in this country. Meanwhile, federal gun prosecutions have decreased by 40% — to the lowest levels in a decade.

You know what else is at the lowest levels?  Crime.

With all the foreign aid, with all the money in the federal budget, we can’t afford to put a police officer in every school?

The average police officer makes $50,406, there are 138,925 schools in the US, which makes the budget of doing this just over $7 billion, without including the extra budget of training and oversight or the fact that most schools would probably need more than one officer.  I’m not saying it’s not worth the money to send to education, but is it the best use of the money and is there any way, in this fiscal cliff landscape, that it’s possible to approve an increase in spending of that magnitude?  It’s certainly not such a small number that you can ignore the cost as thought it’s negligible.

There’ll be time for talk and debate later. This is the time, this is the day for decisive action.We can’t wait for the next unspeakable crime to happen before we act. We can’t lose precious time debating legislation that won’t work.

But what is the point of acting before we have any reasonable expectation that it will work?  I don’t understand why they expect us to understand why their legislation will work?  Or why they think questioning that is a bad thing?  Can we lose precious time implementing a program that is expensive and completely ineffective?.

And then there’s the question that the NRA didn’t address, one that is an important one — why are people who aren’t well-trained public servants allowed to get their hands on these weapons when we know even the well-trained people don’t always do a good job with them?