Friday, December 06, 2013

Guest Blogger Dr. Erik Roskes with an Update on Gun Legislation and the Mentally Ill

In case you haven't heard enough from the Shrink Rappers on mental illness and gun legislation, I'm stealing a synopsis of the recent legislative changes from The Crime Report, a blog by forensic psychiatrist Dr. Erik Roskes.  Taken verbatim, with permission of course:
--------
On October 1, 2013, Maryland’s modified firearms safety law took effect.  Passed in the aftermath of the Newtown massacre, this law expanded the group restricted from owning certain firearms.  This blog will focus only on the mental health aspects of the law, as I have no claim to expertise outside the mental health arena. 
 Editor's Note: See an official report from Connecticut State's Attorney on The Crime Report here.
Until September 30, 2013, two classes of people were restricted from possessing regulated firearms:
(1) a person who “suffers from a mental disorder… and has a history of violent behavior against the person or another,” and
(2) a person who “has been confined for more than 30 consecutive days to a [psychiatric] facility.” 
Effective October 1, 2013, a new law took effect, expanding and modifying the classes of people restricted from possessing weapons for reasons related to mental illness.  Now, the groups include:
(1) a person who “suffers from a mental disorder… and has a history of violent behavior against the person or another;”
(2) a person who “has been found incompetent to stand trial” (IST);
(3) a person who “has been found not criminally responsible” (NCR – this is Maryland’s version of the insanity defense);
(4) a person who “has been voluntarily admitted for more than 30 consecutive days to a [psychiatric] facility;”
(5) a person who “has been involuntarily committed to a facility” for any period of time; and
(6) a person who “is under the protection of a guardian appointed by a court…, except for cases in which the appointment of a guardian is solely a result of a physical disability.”
It is important to note the following:
Importantly, criminals without mental illness are only restricted if they have been convicted of specific “disqualifying crimes” or if they have received a 2 or more year term of imprisonment for a common law crime.  This disparity regarding removal of weapons from offenders with mental illness whose weapons would not be removed based on the crime alone raises potential disability rights questions.  
Thus, for example, category 1 requires no causal nexus between the individual’s mental illness and his or her history of violent behavior.  Thus, a person with, say, an eating disorder and a history of fighting during his or her adolescence would be subject to the restriction on firearm possession.  Conversely, the person with a history of multiple fights, no mental illness, and no other disqualifying events (such as a conviction for a violent crime) would be permitted to retain his (or, less commonly, her) weapons.  Where exactly is the logic here?
Categories 2 and 3 involve numerous defendants whose crimes themselves might not be dangerous.  In the hospital in which I work, the modal crime for which people are committed as IST is trespassing. 
While few people are found NCR for crimes that are not violent in some way, there are some whose underlying offenses are non-violent. 
Category 4 is especially concerning to those of us treating people with mental illness, in that it targets patients who seek treatment willingly, and who do not meet any of the other criteria for removal.  Thus, this restriction is imposed on people without any history of violence or criminal behavior, and who have sought treatment of their own accord.  Essentially the restriction punishes the very behavior we would wish to reinforce. 
Category 6 is interesting in its leading to bizarre rules, such as the recent report in Iowa regarding the ownership of guns by blind people.  From where I sit, this is simply a head-scratcher, making me wonder who is making decisions on our behalf. 
But most concerning for me is category 5, which was modified in the section of the code regulating involuntary commitment to require the hearing officer to determine if “the individual cannot safely possess a firearm based on credible evidence of dangerousness to others;” if the hearing officer so finds, he or she is to order the individual to surrender any firearms to law enforcement.  Note that no such finding is to be made for individuals civilly committed only due to self-directed dangerousness or suicidality.
According to the US Centers for Disease Control and Prevention, indicate there are over 19.000 firearm suicides per year in the US.  By comparison, there are about 11,000 firearm homicides each year. 
Based on research from the NIMH, at least 90% of those who commit suicide (approx. 17,000) have the sorts of mental illness that could lead to civil commitment.  Research varies with regard to homicide, but for discussion purposes, assume that as many as 10% (approx. 1100) of people who commit homicide by firearm have mental illness.  Simply put, for every gun-related homicide committed by a person with mental illness, there are approximately 17 gun-related suicides. 
If the new Maryland law were to be applied nationally, we would be potentially preventing a small number of people with mental illness from committing homicide by firearm, while doing nothing to protect the vastly larger number of people who might kill themselves with that same weapon. 
As I have already written, reactive gun laws do little more than assuage the public’s anxiety about mental illness, without doing much of anything to actually protect the public.  It makes us believe that our elected officials and appointed policy makers are doing something – anything – to make our communities safer, without regard for whether the things that they do actually will lead to positive results.  From where I sit, the changes in Maryland will do little to make our communities safer.  With apologies to a recent New York mayoral candidate, there are just too damn many guns. 

--Erik Roskes, M.D.