Efforts to Prevent Gun Sales to Mentally Ill May Deter Patients From Seeking Help

Thomas B. Cole

doi:10.1001/jama.298.5.503

Cole, Thomas B.

2007-08-01 00:00:00

New legislation designed to prevent homicides such as the mass killings at Virginia Polytechnic Institute and State University in Blacksburg last April may have the unintended effect of discouraging individuals from seeking mental health services, experts say. The bill (HR 2640), which passed the US House of Representatives in June and has been under review in the Senate, would provide incentives for states to submit complete, automated records of involuntary commitments to mental institutions and other data relevant to gun purchases to the National Instant Criminal Background Check System (NICS), for the purpose of disqualifying certain individuals with severe mental illness from purchasing firearms. In addition, the legislation would mandate treatment for persons with reportable mental illness, but it would also require removal of an individual's record in the NICS after a determination that the individual no longer posed a danger to self or others. Campus massacre Campus massacre The impetus for the new legislation was the mass shooting by a Virginia Tech student, Seung-Hui Cho. In hindsight, there were signals that Cho might be a threat to himself and possibly others, including complaints as far back as December 2005 by 2 female students who reported receiving inappropriate messages from Cho. After police officers met with Cho and warned him to leave the women alone, he e-mailed a roommate saying he might as well kill himself. Some members of Congress are supporting legislation to encourage states to submit to a federal database records of involuntary commitments to mental institutions and other data relevant to gun purchases. (Photo credit: Hasan Kursad Ergan/www.iStockphoto.com) Campus massacre A psychologist who examined Cho reported that while Cho's mood was depressed, he did not express thoughts of suicide or of taking action to end his own life. A special justice ordered Cho to receive outpatient mental health treatment, but the troubled student evidently did not receive such help. Campus massacre Because Cho was not hospitalized, his name was not submitted to the background check database, enabling him to buy guns legally in the 2 months before the shootings. On April 16, he killed himself and 32 students and faculty members. Campus massacre Shortly after the shootings, Virginia Governor Timothy M. Kaine signed an executive order directing state agencies to report individuals committed involuntarily to inpatient or outpatient mental health facilities to the state point of contact for the NICS. The intent of this executive order was to block gun sales to individuals determined to be a danger to themselves or others. Campus massacre On the federal level, President George W. Bush appointed a panel to study issues raised by the shootings, such as community safety, individual privacy, and the need for mental health services. A key finding of the panel's 22-page report, which was released June 13, was that mental health records of persons who pose a danger to themselves or others are not readily shared with law enforcement authorities (http://www.hhs.gov/vtreport.pdf). Consequently, if dangerous individuals attempt to buy firearms, information may not be available in automated state and federal databases to prevent firearm purchases. Mental health records Mental health records Although the presidential panel did not recommend specific legislation to improve information sharing, on the day its report was released, the US House of Representatives passed HR 2460 to achieve this same goal. The House bill proposes that only records of mental health adjudications and commitments be reported to law enforcement—not full medical records—and no records at all for the vast majority of persons receiving mental health services. Mental health records Nevertheless, this new push to enter mental health records into a federal database may make some patients uneasy. Epidemiological research suggests that one-half to two-thirds of persons with mental illness in general, and those with serious mental illness in particular, do not pursue treatment when they might benefit from it, and much of this reluctance stems from stigma, says Patrick Corrigan, PsyD, professor of psychology at the Illinois Institute of Technology, in Chicago, and principal investigator of the Chicago Consortium for Stigma Research. Mental health records It is legitimate to identify individuals who are dangerous because of serious mental illness and respond accordingly with the least invasive and coercive intervention, says Corrigan. But if the public erroneously perceives all persons labeled as mentally ill as being weak or a threat, some individuals who could benefit from mental health services might be unwilling to receive them. Mental health records The proposed policy for sharing mental health information does have a provision for removing mental health records of individuals who are determined not to be dangerous. Since this provision implies that the risk of violent behavior can change with effective treatment, the public might perceive that it is the behavior of certain severely ill individuals that is the source of danger, rather than their having a diagnosed psychiatric disorder. Limited impact? Limited impact? However, it is unlikely that transmitting records of involuntary commitment will make much of a dent in the US homicide statistics, says Stuart A. Anfang, MD, assistant professor of psychiatry at the University of Massachusetts Medical School, in Worcester. Only a tiny fraction of crimes involving firearms is likely to be perpetrated by individuals with severe mental illness, he says. Limited impact? Anfang has found that since the 1960s, individuals have been involuntarily committed to mental health facilities because they pose a danger to themselves or others or because they have a grave inability to care for themselves (Anfang SA and Appelbaum PS. Isr J Psychiatry Relat Sci. 2006;43[3]:209-218). “The majority [of these commitments] probably are due to self-danger or inability to care for self, with likely a relatively small percentage involving danger to others [through] using firearms,” says Anfang. Limited impact? It remains to be seen whether the proposed legislation will prevent homicides or cast a pall over mental health care in the United States. Corrigan, who studies public perceptions, acknowledges the public’s fear that people with severe mental illness may acquire firearms. But he wonders how much of this stigma is due to a perceived link between mental illness and violence and how much results from society's concern about the availability of guns. Regulating Gun Purchases Regulating Gun Purchases Businesses that sell firearms to the public are required to request background checks on individuals attempting to purchase a firearm. The National Instant Criminal Background Check System (NICS) maintains electronic records of persons who are disqualified from purchasing firearms and is designed to respond within minutes to requests from firearms dealers. Individuals who are prohibited by federal law from receiving firearms include persons who Regulating Gun Purchases are illegally in the United States or who have renounced their US citizenship are under indictment for or convicted of felony crimes are under a domestic violence restraining order use or are addicted to illegal drugs have been committed to a mental institution Regulating Gun Purchases Most disqualifying records in the NICS are obtained from federal agencies. However, state and local law enforcement agencies may also contribute records.

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JAMA American Medical Association

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$New legislation designed to prevent homicides such as the mass killings at Virginia Polytechnic Institute and State University in Blacksburg last April may have the unintended effect of discouraging individuals from seeking mental health services, experts say. The bill (HR 2640), which passed the US House of Representatives in June and has been under review in the Senate, would provide incentives for states to submit complete, automated records of involuntary commitments to mental institutions and other data relevant to gun purchases to the National Instant Criminal Background Check System (NICS), for the purpose of disqualifying certain individuals with severe mental illness from purchasing firearms. In addition, the legislation would mandate treatment for persons with reportable mental illness, but it would also require removal of an individual's record in the NICS after a determination that the individual no longer posed a danger to self or others. Campus massacre Campus massacre The impetus for the new legislation was the mass shooting by a Virginia Tech student, Seung-Hui Cho. In hindsight, there were signals that Cho might be a threat to himself and possibly others, including complaints as far back as December 2005 by 2 female students who reported receiving inappropriate messages from Cho. After police officers met with Cho and warned him to leave the women alone, he e-mailed a roommate saying he might as well kill himself. Some members of Congress are supporting legislation to encourage states to submit to a federal database records of involuntary commitments to mental institutions and other data relevant to gun purchases. (Photo credit: Hasan Kursad Ergan/www.iStockphoto.com) Campus massacre A psychologist who examined Cho reported that while Cho's mood was depressed, he did not express thoughts of suicide or of taking action to end his own life. A special justice ordered Cho to receive outpatient mental health treatment, but the troubled student evidently did not receive such help. Campus massacre Because Cho was not hospitalized, his name was not submitted to the background check database, enabling him to buy guns legally in the 2 months before the shootings. On April 16, he killed himself and 32 students and faculty members. Campus massacre Shortly after the shootings, Virginia Governor Timothy M. Kaine signed an executive order directing state agencies to report individuals committed involuntarily to inpatient or outpatient mental health facilities to the state point of contact for the NICS. The intent of this executive order was to block gun sales to individuals determined to be a danger to themselves or others. Campus massacre On the federal level, President George W. Bush appointed a panel to study issues raised by the shootings, such as community safety, individual privacy, and the need for mental health services. A key finding of the panel's 22-page report, which was released June 13, was that mental health records of persons who pose a danger to themselves or others are not readily shared with law enforcement authorities (http://www.hhs.gov/vtreport.pdf). Consequently, if dangerous individuals attempt to buy firearms, information may not be available in automated state and federal databases to prevent firearm purchases. Mental health records Mental health records Although the presidential panel did not recommend specific legislation to improve information sharing, on the day its report was released, the US House of Representatives passed HR 2460 to achieve this same goal. The House bill proposes that only records of mental health adjudications and commitments be reported to law enforcement—not full medical records—and no records at all for the vast majority of persons receiving mental health services. Mental health records Nevertheless, this new push to enter mental health records into a federal database may make some patients uneasy. Epidemiological research suggests that one-half to two-thirds of persons with mental illness in general, and those with serious mental illness in particular, do not pursue treatment when they might benefit from it, and much of this reluctance stems from stigma, says Patrick Corrigan, PsyD, professor of psychology at the Illinois Institute of Technology, in Chicago, and principal investigator of the Chicago Consortium for Stigma Research. Mental health records It is legitimate to identify individuals who are dangerous because of serious mental illness and respond accordingly with the least invasive and coercive intervention, says Corrigan. But if the public erroneously perceives all persons labeled as mentally ill as being weak or a threat, some individuals who could benefit from mental health services might be unwilling to receive them. Mental health records The proposed policy for sharing mental health information does have a provision for removing mental health records of individuals who are determined not to be dangerous. Since this provision implies that the risk of violent behavior can change with effective treatment, the public might perceive that it is the behavior of certain severely ill individuals that is the source of danger, rather than their having a diagnosed psychiatric disorder. Limited impact? Limited impact? However, it is unlikely that transmitting records of involuntary commitment will make much of a dent in the US homicide statistics, says Stuart A. Anfang, MD, assistant professor of psychiatry at the University of Massachusetts Medical School, in Worcester. Only a tiny fraction of crimes involving firearms is likely to be perpetrated by individuals with severe mental illness, he says. Limited impact? Anfang has found that since the 1960s, individuals have been involuntarily committed to mental health facilities because they pose a danger to themselves or others or because they have a grave inability to care for themselves (Anfang SA and Appelbaum PS. Isr J Psychiatry Relat Sci. 2006;43[3]:209-218). “The majority [of these commitments] probably are due to self-danger or inability to care for self, with likely a relatively small percentage involving danger to others [through] using firearms,” says Anfang. Limited impact? It remains to be seen whether the proposed legislation will prevent homicides or cast a pall over mental health care in the United States. Corrigan, who studies public perceptions, acknowledges the public’s fear that people with severe mental illness may acquire firearms. But he wonders how much of this stigma is due to a perceived link between mental illness and violence and how much results from society's concern about the availability of guns. Regulating Gun Purchases Regulating Gun Purchases Businesses that sell firearms to the public are required to request background checks on individuals attempting to purchase a firearm. The National Instant Criminal Background Check System (NICS) maintains electronic records of persons who are disqualified from purchasing firearms and is designed to respond within minutes to requests from firearms dealers. Individuals who are prohibited by federal law from receiving firearms include persons who Regulating Gun Purchases are illegally in the United States or who have renounced their US citizenship are under indictment for or convicted of felony crimes are under a domestic violence restraining order use or are addicted to illegal drugs have been committed to a mental institution Regulating Gun Purchases Most disqualifying records in the NICS are obtained from federal agencies. However, state and local law enforcement agencies may also contribute records.$

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Efforts to Prevent Gun Sales to Mentally Ill May Deter Patients From Seeking Help

Efforts to Prevent Gun Sales to Mentally Ill May Deter Patients From Seeking Help

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Efforts to Prevent Gun Sales to Mentally Ill May Deter Patients From Seeking Help

Efforts to Prevent Gun Sales to Mentally Ill May Deter Patients From Seeking Help

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