NY Misses the Target on Mental Health: DC Gets It Right

Quite frankly, the biggest issue with New York’s new gun law is not what’s in it, it’s what’s missing.

New York took bold steps last week and with lightening-speed passed what has been called the “nation’s toughest gun law.” The stuff that makes NRA-types go nuts got all the media attention – bigger restrictions on assault weapons, a new limit on ammunition magazines, a ban on Internet sales, and real-time background checks to name a few.  But also within the Secure Ammunition and Firearms Enforcement Act (SAFE) is a new provision that requires licensed mental health professionals – psychiatrists, psychologists and social workers – to alert local mental health officials if a patient “is likely to engage in conduct that would result in serious harm to self or others.” The local mental health folks will then conduct their own evaluation and if they concur with the potential risk, that patient will be added to a statewide database of folks who can’t get a gun. If they already own a gun, local cops are going to bang on that person’s door, demand to see the gun and take it.

Mental health professionals have always carried an ethical duty to warn, but the state has generally left it to practitioners to decide when and how to report. Practitioners usually listen for an explicit threat, conduct a more thorough assessment, and then weigh a series of options that might include notifying those at risk, arranging hospitalization, and/or calling the police. That flexibility has given clinicians the ability to deal with a potential risk of violence without breaching confidentiality and perhaps keeping that person engaged in a course of treatment that in and of itself, may diminish risk.

The mandate in the new law is broad and in this environment, will likely be applied much more often than the current standard. Several prominent mental health experts have already expressed their concerns.  Dr. Paul Appelbaum, director of law, ethics and psychiatry at Columbia University told the New York Times, “It undercuts the clinical approach to treating these impulses, and instead turns it into a public safety issue.” Dr. Eric Neblung, a psychologist and the president of the New York State Psychological Association told the Wall Street Journal, “You’re turning psychologists into police officers.”

To the average person, keeping guns out of the hands of the mentally ill is a no-brainer. But get this: a large body of research suggests that people with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime. One national survey found that those with chronic and severe mental were victimized a whopping eleven times more often than those in the general population.

And if we can’t get that imposing image of the crazed gunman out of heads long enough to consider the numbers, it’s important to recognize that New York’s new law doesn’t target the few mentally ill who could become shooters. It targets those who seek treatment – including cops, corrections officers and other uniformed personnel, who are often most reluctant to seek help. And if we are truly concerned about guns winding up the hands of unstable folks, why not make psychological testing a pre-requisite for getting a gun?

Quite frankly, the biggest issue with New York’s new gun law is not what’s in it, it’s what’s missing. The Secure Ammunition and Firearms Enforcement Act does absolutely nothing to enhance access to mental health services and contains no new funding for such programs. Perhaps that’s because our state is cash-strapped, or maybe it’s because including funds would have prompted some of the more fiscally conservative folks to hold-up the bill. Then New York wouldn’t have been first.

A day later, President Obama rolled out his gun control package. It contained all the high-profile stuff like background checks for gun show shoppers, limits on high-capacity ammunition magazines and the like, but he also called for new federal investments in school safety and mental health counseling. 

In addition to $180 million in school safety spending, the President’s proposal includes: $15 million to help teachers and youth professionals provide “Mental Health First Aid,” to identified students; $40 million to help school districts, law enforcement and local agencies better coordinate services for students in need; $25 million to finance new, state-based strategies to better identify individuals ages 16 to 25 with mental health and substance abuse issues and get them the care they need; $25 million to boost school-based mental health services aimed at treating trauma, anxiety, and enhancing conflict resolution; and $50 million in new funds to train social workers, counselors, psychologists and other mental health professionals.  That money would also provide stipends and tuition reimbursement for more than 5,000 new mental health professionals that want to work with young people in school and community-based settings.

Is it enough? Probably not.  It does, however, restore some of the $235 million the Administration ripped out of the state Safe and Drug Free Schools grants program last year and ensures a more proactive, comprehensive approach to keep our kids and communities safer.

While it’s true that New York, our legislators and Governor Cuomo can now lay claim to passing the first and toughest gun law in the wake of the Sandy Hook shootings, the absence of solid mental health solutions means that it probably won’t prove to be the nation’s best.

Photo: White House Photo