Commentary

Mental health reporting laws: A false answer to gun violence

Publish date: February 27, 2018

Second, these types of mandates can perpetuate stigma in mental health, both potentially driving away patients who could benefit from therapy, and straining the relationships between patient and provider for those in treatment. Given the high degree of effort it takes for some populations to engage in mental health services, we can imagine a prohibitive additional hesitation if patients worry that their rights and liberties may be taken away if they said “the wrong thing.” Indeed, it has been demonstrated many times that nothing matters more to the outcome of mental health treatment than the relationship between the providers and their patients,11 an effect that is true even for medication management.¹² Being more wary of one’s treating provider may, therefore, limit the effect of treatment from the patient’s perspective. In the same vein, some therapists may rightly pause to consider whether they should be more vigilant and dutifully extract statements confirming a nonviolent mindset at every meeting, much in the way we perform suicide risk assessment to assess safety. Or, therapists could hesitate to probe for violent themes out of an underlying wish to avoid discovering something that they would have to report. Such tensions created within the therapist also may lend to suboptimal treatment.

Dr. Yash Joshi

As shootings continue to occur, we will continue to see proposals of reporting laws such as NY SAFE. It is our opinion that mental health providers should support and participate in attempts at recognizing and treating dangerousness. However, we must acknowledge that in an effort to stop future atrocities, we may inadvertently identify and label people who will never commit acts of violence, and, in the process, disenfranchise some patients who could benefit from treatment. In anticipation of this possibility, we need to expand the discourse beyond merely agreeing that we should increase surveillance on troubled individuals. The question should not only be whom should we be on the lookout for, but also how do we ensure that mental health providers are more accessible to patients who might benefit from treatment?

Dr. Badre is a forensic psychiatrist in San Diego and an expert in correctional mental health. He holds teaching positions at the University of California, San Diego, and the University of San Diego. He teaches medical education, psychopharmacology, ethics in psychiatry, and correctional care. Dr. Joshi is a research track psychiatry resident at the University of California, San Diego. His current research focuses on developing novel therapeutic strategies to target cognitive impairment in schizophrenia. His interests include graduate medical education and applied bioethics.

References

1. Gun Violence Archive http://www.gunviolencearchive.org/reports/mass-shooting

2. https://www.abc15.com/news/data/mass-shootings-in-the-us-when-where-they-have-occurred-in-2018

3. https://twitter.com/realDonaldTrump/status/964110212885106689

4. http://www.nyspsych.org/index.php?option=com_content&view=article&id=73

5. https://www.politico.com/states/new-york/albany/story/2018/02/15/after-florida-school-shooting-cuomo-again-touts-safe-act-256104

6. MMWR 2004;53(2):1-96

7. J Affect Disord. 1999 Jul;54(1-2):21-8

8. Ethol Sociobiol. 1993;14(4):231-48

9. http://www.dcf.state.fl.us/newsroom/publicdocuments/Headquarters/Records20180219/Petition%20to%20Publically%20Release%20DCF%20Records.pdf

10. Ann Rev Clin Psychol. 2017 May 8;13:445-69

11. Psychotherapy Theory Res Prac. 2001;38(4):357-61