January 6, 2013

Opposing the NICS Mental Health Background Gun Check Database

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I have been challenged by schizophrenia, in remission, and I don't want a lousy gun. To hear all the blame of violence on "deranged lunatics," it seems most people hold false or exaggerated stereotypes about schizophrenia and other severe mental illnesses. For example, despite the common misuse of the label, the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) excludes split personality from its list of schizophrenic symptoms. In other words, schizophrenics do not have more than one personality.

And despite all the hype in the news, we are not necessarily violent. Walsh, Buchanan, and Fahy (2002) reviewed the relevant literature and concluded that although the rate of violence among people with mental disorders can be four times higher than the general population, "only a small proportion of societal violence can be attributed to persons with schizophrenia." And in their own study in Victoria, Australia, Wallace et al. (1998) found "the probability that any given patient with schizophrenia will commit homicide is tiny." Even the Surgeon General said, "There is very little risk of violence or harm to a stranger from casual contact with an individual who has a mental disorder.... The overall contribution of mental disorders to the total level of violence in society is exceptionally small" (U.S. Department of Health and Human Services, 1999, p. 7).

Applebaum and Swanson (2010) extensively researched psychiatric gun law and said, "The net increment to public safety from restricting gun access by persons with mental illnesses is likely to be small."

The Criteria for "Mentally Defective" in NICS
As it stands, The Brady Act established the National Instant Criminal Background Check System (NICS) computer database to include people who have been "adjudicated as a mental defective or been committed to any mental institution."

The Code of Federal Regulations defines mental defective as anyone who is "adjudicated by a lawful authority (to be) a danger to himself or to others: or lacks the mental capacity to contract or manage his own affairs. The term shall include a finding of insanity by a court in a criminal case; and those persons found incompetent to stand trial or found not guilty by reason of lack of mental responsibility... " The Code also defines "committed to a mental institution" as "a formal commitment of a person to a mental institution by a court, board, commission, or other lawful authority. The term includes a commitment to a mental institution involuntarily. The term includes commitment for mental defectiveness or mental illness. It also includes commitments for other reasons, such as for drug use. The term does not include a person in a mental institution for observation or a voluntary admission to a mental institution."

But state laws vary in their criteria of which mentally ill people cannot buy a gun. "In the District of Columbia, Hawaii, Illinois, Maryland, and Oklahoma, psychiatric diagnosis and/or voluntary treatment can be enough to trigger a prohibition." (Simpson (2007).

My Position
I am opposed to an expansion of the mental health registry. We should weaken what we already have. An illness is not a crime. NICS should only reference documented cases of violent offenders or individuals who threaten violence, disabled or not. It's unjust to include people who might or might not commit a crime. How does a judge decide if someone is a danger if he hasn't done anything dangerous? It's not so black and white.

But if the government keeps adding names to its list, the general public should never have access to it. The United States has a HIPPA Privacy Rule restricting the release of medical information. We should not relax this law in order to strengthen the others.

What if instead we tallied a list of temper-prone "normal" people who claim they have a constitutional right to assault rifles, as though there's a right to hand grenades, and stopped them from buying guns? It is possible that vengeful people with no psychiatric history, such as bullied teenagers or fired employees, perpetuate the horrific incidents of mass violence we hear about so much on TV. They're not necessarily crazy. Maybe they're just angry. Instead of releasing a punch, they're triggering an automatic weapon. We usually don't call the average young man who gets into a fist fight a "rabid madman," but these two behaviors are somewhat alike, even though the consequences are different. In fact, "…the vast majority of people who are violent do not suffer from mental illnesses (American Psychiatric Association, 1994)."

Stigma
Stigma makes everything worse. A sitcom mocking "mental defectives" is supposed to be funny. Unlike racial slurs, parents rarely correct children who say "psycho." They act as though schizophrenics aren't human since they might lose their ability to reason. These words hurt my feelings. Besides, medication can usually mend the disorganized thoughts.

Stigma causes discrimination. After I told a landlord I had a mental health problem, he told me my illness was his reason for denying me an apartment in a good neighborhood. When I was a teacher at a school for psychiatric children and in the closet about my illness, the principal told me she wouldn't hire a schizophrenic. If it happened to me, it happens to many. How would my neighbors treat me if they found out from a public database I had a mental illness?

A registry of mental disorders makes a bad stigma worse. It could actually cause the next Columbine disaster, because a psychologist can teach a potential shooter how to manage his anger, given the opportunity, but a young man who's been mocked and ostracized for being gay just might say to himself, "I'm not like that list of psychos and I don't need a shrink," then turn up at the next gun show, and riddle his classmates with bullets.

Who Will Be Next?
It feels like the The National Rifle Association is scapegoating us to divert attention off the subject of why we have too many guns. So let me ask the readers of this article, "How would you feel if the FBI had you on a list because of who you were, not because of something you did?" Would it make you more paranoid if you were already prone to paranoia? Besides, in my opinion, given the grand scope of psychiatric DSM illnesses, everyone in the country who might walk into a psychiatrist's office in their worst of times can be diagnosed with some kind of mental disorder. What are we going to do, include everyone in NICS and deny guns to everyone? I ask the reader again, "How do you know you won't be included? You mean you've never been too anxious or depressed?"

Nevertheless, perhaps more critically for the nation than for a small group of its citizens, as we approach the big-brother-is-watching-you society George Orwell predicted in Nineteen Eighty-Four, we should rein in the will of the majority. In our feverish pursuit of security, a restriction on the privacy of one chips away at the freedom of all. The United States has long held the beacon of democracy as a guide for the rest of the world. At what point do we cut off the power to the flame that sheds its light over Manhattan Island? We may never know. Liberty may slip away bit by bit with no clear sign of its moment of departure. Perhaps much later on, when one big chunk breaks off into a wider expanse of time, when we have accumulated a sum total of many smaller losses, will we notice that we are not as free as we thought and wrestle back control from the bold reach of Bush-era government.
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American Psychiatric Association. (1994). Fact Sheet: Violence and Mental Illness. Washington, DC: American Psychiatric Association. See this fact sheet.

Applebaum, P. and Swanson, J. (2010). Law and psychiatry: Gun laws and mental illness: How sensible are the current restrictions? Psychiatric Services. 61, 7. Full Text

U.S. Department of Health and Human Services. (1999) Mental health: A report of the surgeon general.  Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health Full Text

Wallace, C., Mullen, P., Burgess, P., et al. (1998) Serious criminal offending and mental disorder. Case linkage study. British Journal of Psychiatry. 172, 477-484. Abstract/Full Text

Walsh, E., Buchanan, and A. Fahy, T. (2002) Violence and schizophrenia: examining the evidence. British Journal of Psychiatry Psychiatry. 180, 490-495. Abstract/Full Text

12 comments:

  1. Marilyn ArnoldJanuary 07, 2013

    Dave,
    I agree with you. My son has autism, and I am afraid that after the recent shootings in Newtown he will be viewed with suspicion. He actually does have a history of aggression (he's only 8).
    You're right--only people who have actually committed crimes should be in a database.

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    1. Thanks for your comment, Marilyn. It's good to know for sure that people like you are really reading this blog.

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  2. Perhaps the information is not public. Name and social security must be entered with additonal information in order to recover such information. Have you considered that all medical information shall be on database in the USA very soon.....? Lists can not be avoided. And you mention 1 study from Australia in the 1990's? What about ratio of people who do not have disorders? What about Mental evaluation of everyone? What do you propose as the USA has an alarming situation. What about the Australia Model from 1996? It did resolve their crisis. In fact it was a grand success. I call it a miracle beyond expectations. ....Jakewest_tn@yahoo.com

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  3. I agree with you Dave. Mental health is often blamed for many problems in this country. Although I dont agree that violent crime has anything to do with the amount of guns we have in this country. By that standard, we should be the most violent country in the world. Guns are only one of the many means by which to commit a crime, yet most violent crimes in this country are not committed with guns. Yet the media misrepresents the truth and makes it seem like they are an epidemic and that somehow owning a gun makes you turn into a cold blooded killer. I own 4 guns and have gone shooting since I was 14 and never once even though about pulling a gun on someone, simply because I am a person with moral upbringing. The media often tells us that military-style "assault weapons" should not be owned by civilians. But the thing is that these "assault weapons" are no different in lethality or capability than your standard winchester rifle. In fact, they use the same ammo. The only difference is their styling. They are often damned by the media because they are used in massacres. Being that the AR-15 is the most popular selling rifle on the market, its not suprising that this is the case. The media says AR-15 platforms can accept high capacity magazines. So can most handguns and any magazine capatible rifle on the market. To me, its not mental health or weapons. Its our society that is the problem and the violence is just a symptom of something much bigger. Blaming mental illness or gun ownership is just finger pointing and ignoring the real problem. We have become a society that is so self-serving that our children are no longer our core focus in the household. Our children grow up in homes with unstable environments, being ignored and sometimes abused. Then when these children suffer from the symptoms of their environment and upbringing, rather than realizing the core of the problem, we label them as mentally ill and try to medicate them, which only gives a bad name to those who truely suffer from mental illness. You cant medicate away an absent or abusive parent. I know these things from experience.

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  4. It isn't only the NRA who is stigmatizing people with mental illnesses. I've read comments from anti-gun groups (I do believe the Brady people, but not sure) who ALSO blame people with mental illnesses for widespread gun violence. Few people care about folks with schizophrenia and bipolar disorder, and it is so easy to target us on both sides.

    I fear that these mental health professionals who are supposedly advocating for us will tend towards more forced treatment. Given how toxic many of the psychiatric drugs are, and their poor efficacy, I think forced treatment is usually wrong. I feel that it's a lot like forcing someone with some hypothetical cancer that requires chemo for many years when their cancer may or may not get better with this treatment and there is a good chance the chemo will make the patient worse or the medication may even kill the patient directly. Folks say, oh people with mental illnesses deny that they are sick. That may be true for some people, but I'm sure most people don't like the drugs because they don't help, or they help a little, but it isn't worth it because the side effects cause as many or more problems as the mental troubles.

    I don't mean this as a debate about whether someone should or should not use these medications (to me, they are worthless psychoactive drugs that only made me sicker) but rather, that a person should be able to choose for themselves in most cases. A psychiatrist doing 15 minute med checks has no idea what the patients' values are. I have always valued civil rights, and my ability to think well, but I'll bet you that if I was horrifically depressed and talking about suicide, anything I said about civil rights would be viewed as a symptom of my depression, and the psychiatrist would ignore it with zero qualms. He/she would push me to take an antipsychotic, and fail to warn me that all I would be able to do is watch TV all day and drool and sit on the toilet for hours a day straining to have a bowel movement. Why do I know this? Happened to me for years.

    I am a gun owner, myself, and if these kinds of laws spread across the country, I will probably drop out of treatment and eventually lose my disability income as a result. I don't deserve to be in an FBI database, because I have lived an exemplary life and never harmed anyone. The database issue upsets me even more than losing a civil right because some young men/boys killed people - I am not a criminal!! Other people attacked me as a girl, and so I am messed up, so why do I deserve to be put into a database as if I was the attacker?

    What is going to happen if these laws persist and spread for ONE example is that tens of thousands of rape victims are going to get profiles as potential killers. I'm not into the home defense thing, but if someone would have motivation to keep a gun for that purpose, who would want that more than a rape victim who lives alone? Then she tells her therapist that she has been contemplating suicide, and the police violate her home to seize her gun that is there so she can feel safe?

    I do not have a schizophrenia label, fortunately. Instead it's a bipolar label, which is not quite as dangerous to have, but still plenty awful.
    I hear the conversations about how horrible people with bipolar are and how their relatives wish they were dead etc. and those folks have no idea that I have bipolar myself.


    great post, I saw your link over on the Baltimore paper's site.

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  5. Thank you for your words of support, Anonymous.

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  6. Also thank you for your words, the next Anonymous. It seems to me that you are forming coherently organized sentences and paragraphs.

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  7. How will the government get past "DOCTOR-PATIENT CONFIDENTIALITY LAW" if the people who sell firearms are informed that the person is mentally ill, and is a liability to a privacy law, how will we know that our peace of mind in privacy is safe concerning our condition if there is a firearm seller telling the community to be aware of this person because he has a certain mental illness?

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    1. Great points. How do we know the firearms dealer will keep the confidentiality?

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    2. My thoughts exactly. If the line isn't drawn somewhere, then this universal background check will extend to passports, licenses, government jobs, regular jobs, etc. It's making mental illness seem like a crime, which it isn't.

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    3. Well said, Anonymous.

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  8. I've got ADD. Statistically, without knowing anything about me as an individual, you could say that I am at a higher risk for committing violence than the average person. However, for me, and I'm sure for many other people, that would be quite misleading. I can't remember the last time I even hit someone. Maybe 5th grade? (decades ago). Yes, as a small child I had a terrible temper, but I taught myself to control it. I admit that, some years ago when I was attacked while riding my bike I lost my temper, but even then I didn't try to hurt anyone. So, am I really a risk?

    I think no one should be in this registry without committing some kind of violent act, and with due process. I'm concerned that it could be used rather sloppily.

    If people are concerned about the mentally ill committing crimes, how about making access to treatment a right? I mean voluntary access. It would be the compassionate thing to do and it might even save society money.

    Recently, I knew a kid who had some real problems. He'd never had any treatment that worked, and not much treatment at all. He was tremendously impulsive, and had hostility to anyone in authority that seemed kind of pathological. He also loved to work. Harder than I ever could. He got in the wrong crowd, participated in a severe crime, and now he's incarcerated for 8 years or so. (Fortunately, no one was actually hurt, but that was probably a close thing.) Had he received better treatment, I think he'd be a productive citizen, not an inmate.

    It might help to continue to chip away at the stigma of mental illness too.

    call me Anonymous23

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