How to handle mental health

[Vantage]

So here is what I'm afraid of...

It's speculated that the most recent shooter had a mental health problem, and that his mom legally owned guns.

Does that mean that the anti's are going to try and restrict guns from any household that has a member of the family with "Mental Health" issues?

What qualifies as "Mental Health"? If you has a prescription for Prozac or any other anti-depressant does that disqualify you and therefore the entire household?

What if my pregnant wife gives birth and ends up taking a hormone balance medication.... will that mean that I can't own guns?

How will they know who's on what medications? Are we going to have to submit medical records now?

What if we've seen a counselor or therapist for something? Are they going to want to know what I'm talking to them about? Or do I simply just get banned for even having been to one?


I'm just opening up the conversation.

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[DuneHopper]

We can all help by forgetting you ever read this man's name, and remembering the name of at least one victim. You can help by donating to mental health research instead of pointing to gun control as the problem. You can help by turning off the news.

I think we need realize this was a tragedy and not the end of society, the media and alike are making it seem like
the earth is coming to an end.
I have heard every news organization plaster the gun mens names all over but seldom say anything about the familys

 

[bolus]

Im a physician and I can say that the mental health question is massively complex. There is just no simple way to determine if someone is going to snap and harm someone.

One of the most significant difficulties is that the majority of what we know about a person's mental health is what they tell us. Unless they specifically say "im going to kill someone" you may have no idea. Sure there are the exceptions such as schizophrenia where there is an obvious problem keeping a person from even being able to function in society. But I've had people come in and say "im doing just fine" when I ask if they have had any depression or anxiety. Then an hour later their spouse calls up and says "did he tell you he was severely depressed and suicidal?" I cant read their minds..

But this is what we should do. We should work on improving mental health for everyone. Not just in the setting of whether someone can own a gun or not. Mental health care in this country, in my opinion, is abysmal right now. I see patients with significant mental health issues - depression, anxiety, PTSD, chemical dependency, every day. Most of them have very limited access to mental health because of either lack of insurance or lack of mental health providers. There is only one psychiatrist in my entire county and he is only part time! Patients are struggling in jobs with no insurance coverage and no ability to leave work or pay for a therapist visit every week. And a 15 minute visit with me, a primary care doc, to give them some prozac is like a drop in the bucket.

Also, you should not worry that any mental health information in medical records getting out unless you give written consent. It is illegal and unethical to do that. If a state agency called me and asked if a person was competent to own a gun I would say "I cant even tell you if that person is a patient in my practice" The only situation Im able to report if a patient tells me they are going to harm themselves or another.

 

[Vantage]

Im a physician and I can say that the mental health question is massively complex. There is just no simple way to determine if someone is going to snap and harm someone.

One of the most significant difficulties is that the majority of what we know about a person's mental health is what they tell us. Unless they specifically say "im going to kill someone" you may have no idea. Sure there are the exceptions such as schizophrenia where there is an obvious problem keeping a person from even being able to function in society. But I've had people come in and say "im doing just fine" when I ask if they have had any depression or anxiety. Then an hour later their spouse calls up and says "did he tell you he was severely depressed and suicidal?" I cant read their minds..

But this is what we should do. We should work on improving mental health for everyone. Not just in the setting of whether someone can own a gun or not. Mental health care in this country, in my opinion, is abysmal right now. I see patients with significant mental health issues - depression, anxiety, PTSD, chemical dependency, every day. Most of them have very limited access to mental health because of either lack of insurance or lack of mental health providers. There is only one psychiatrist in my entire county and he is only part time! Patients are struggling in jobs with no insurance coverage and no ability to leave work or pay for a therapist visit every week. And a 15 minute visit with me, a primary care doc, to give them some prozac is like a drop in the bucket.

Also, you should not worry that any mental health information in medical records getting out unless you give written consent. It is illegal and unethical to do that. If a state agency called me and asked if a person was competent to own a gun I would say "I cant even tell you if that person is a patient in my practice" The only situation Im able to report if a patient tells me they are going to harm themselves or another.

I agree with your overall statement.

I agree with the idea that we should improve mental health for all (If possible).

What I'm getting at... is that over and over again, the other side of the pond keeps talking about restricting criminal and those with mental health issues.

So... if they get the audience and momentum to actually pass something... what (in their minds) would keep those with "mental health issues" from getting guns. This person had mental health issues.... and he got his guns from a gun owning family member. The easy answer is that she should have had them locked up. But she didn't (I'm assuming).. and so how to they intend to LEGISLATE a way to keep him from getting guns.

To be clear.... I'm not arguing in favor of any new controls. I am sorry that this happened to these kids, and to the families, but nationwide more than 18 children die every day due to violence and it never makes the news. This type is stuff is also not new. Human beings have been doing horrific things to other human beings for as long as we have recorded history. This won't be the last time we see this.

I'm just trying to read the other sides playbook to see what, if they were given the chance, would they go after, and how.

Because to me (and apparently to you as well) there is no answer to the mental health problem. I have a brother in law who is on Lithium. He has no criminal record, is a college graduate, holds down a job that is held in high regard in the community and would have no problem passing a background check. But if he ever went out on a rampage and it came out that he was lithium the people would be in an uproar.

So what? Are they going to ask for some sort of medical screening in order to buy a gun?

Personally I think the answer to the latest shooting is what <broken link removed> on his website:

I'll repeat what I said in the Wall Street Journal op-ed section and on the Today show in 1999, after the Columbine High School atrocity: if we simply prepared teachers to handle this type of crisis the way we teach them to handle fires and medical emergencies, the death toll would drop dramatically. We don't hear of mass deaths of children in school fires these days: fire drills have long since been commonplace, led by trained school staff, not to mention sprinkler systems and smoke alarms and strategically placed fire extinguishers that can nip a blaze in the bud while firefighters are en route. In the past, if someone "dropped dead," people would cry and wring their hands and wail, "When will the ambulance get here?" Today, almost every responsible adult knows CPR; most schools have easily-operated Automatic Electronic Defibrillators readily accessible; and a heart attack victim's chance of surviving until the paramedics arrive to take over is now far greater.

The same principle works for defending against mass murders...it just doesn't work HERE, because it is politically incorrect to employ it HERE. After the Ma'alot massacre in 1974, Israel instituted a policy in which volunteer school personnel, parents, and grandparents received special training from the civil guard, and were seeded throughout the schools armed with discreetly concealed 9mm semiautomatic pistols. Since that time, there has been no successful mass murder at an Israeli school, and every attempt at such has been quickly shortstopped by the good guys' gunfire, with minimal casualties among the innocent. Similar programs are in place in Peru and the Phillippines, with similarly successful results.

I just don't see how we can effectively identify those with Mental Health Issues and prevent them (all) from getting access to guns. Just like I don't think we can end all traffic accidents.

 

[Botte Hork]

Keep in mind that in '68 one of the type of people to become a "prohibited person" is a person to be adjudicated as mentally defective or who has been committed to a mental institution. Of course, that does require someone to go through some form of observation or institution, and with the state of affairs in mental healthcare, I wouldn't be surprised if more slip through the net.

On the other hand, probably playing the devil's advocate part these days, one could consider this an infringement on 2A rights: People do benefit from treatment and can be cured enough to decently function in society again. Look at some of the PTSD veterans that get treated returning home: Lost their 2A rights. Might be the best marksman in the corps, but if you decided to work with professionals because of war scars and get helped successfully, you're still effed.

Mental health issues vary widely as said above and many can get treated very well in the doctor's office. Removing rights from people that benefit from treatment might get the opposite effect: People will avoid treatment and problems become bigger. Many people on common anti-depressants are doing just fine in everyday life.

 

[Vantage]

Removing rights from people that benefit from treatment might get the opposite effect: People will avoid treatment and problems become bigger.

That's a very good point as well.

 

[ob1]

I think that this will be the real opportunity for abuse and for them to gradually whittle down gun ownership to next to nothing. Once in place, the standards could be tightened, a little bit at a time, just like raising taxes.
Can you imagine having to take (on your dime) a required Federal test or be interviewed by an anti-gun pysch specialist, in order qualify for an ownership permit ?

Lets say arbitrary standards are imposed in a pass / fail, Federally administered background check and......

Then, lets throw in a new generation MMPI style, psych test (many who have applied for a critical government, police or management job may remember these) with a couple dozen conflicting and or misleading yes/no questions designed to weed out a large portion of the "undesireables"...ie :

Do you have a right to own a gun ? Are you afraid of certain people ? Do expect you will need to defend yourself ? Do you disagree with government policies ? Do you trust elected officials ? Have you practiced tryng to shoot people ? Is owning a weapon important to you ? Do you mistrust people ? Do you often feel the need to defend yourself ? Have you wanted to seek revenge ? Have you ever been in a fight ? Have you ever been angry enough to hit someone ? Do you need a gun ? Have you ever been treated unfairly ? Have you owned more than one gun ? Have you ever had more than 100 rounds of ammunition ? Do you prefer guns with large magazines ? Do you like to shoot guns fast ? Have you been bullied ? Do you have an unfair boss ? Do you like to shoot at human-like targets ? Would you like to be a hero ? Do you always win arguments ? Are you often misunderstood ? Have you ever been fired for misconduct ? Have you had problems paying bills ? Have you ever felt depressed due to a relationship ? Do you believe in armageddon ? Do you like your neighbors ? Are you ever jealous ?

Well...I guess you get the idea.

 

[DMax]

All of this can be written into obammycare as a saftey issue. When the gov pays for your healthcare they own you. They will tell you how to live your life, what you can and cannot eat, what kind of car to drive and if you can have a gun all in the name of health and saftey. If you think it can't then you are not paying attention to other countries that have universal heathcare. Nobody though the fed gov could MANDATE you buy a product either. Look how well that worked out. Lets not forget that the Feds know with the patriot act expanded that they can call anyone American or not a terroist without due process all in the name of National Security. Put those together and hows that freedom lovin America workin out for everyone.

I would like to hear from the Dr Bolus opinion on this

 

[Vantage]

I think that this will be the real opportunity for abuse and for them to gradually whittle down gun ownership to next to nothing. Once in place, the standards could be tightened, a little bit at a time, just like raising taxes.
Can you imagine having to take (on your dime) a required Federal test or be interviewed by an anti-gun pysch specialist, in order qualify for an ownership permit ?

Lets say arbitrary standards are imposed in a pass / fail, Federally administered background check and......

Then, lets throw in a new generation MMPI style, psych test (many who have applied for a critical government, police or management job may remember these) with a couple dozen conflicting and or misleading yes/no questions designed to weed out a large portion of the "undesireables"...ie :

Do you have a right to own a gun ? Are you afraid of certain people ? Do expect you will need to defend yourself ? Do you disagree with government policies ? Do you trust elected officials ? Have you practiced tryng to shoot people ? Is owning a weapon important to you ? Do you mistrust people ? Do you often feel the need to defend yourself ? Have you wanted to seek revenge ? Have you ever been in a fight ? Have you ever been angry enough to hit someone ? Do you need a gun ? Have you ever been treated unfairly ? Have you owned more than one gun ? Have you ever had more than 100 rounds of ammunition ? Do you prefer guns with large magazines ? Do you like to shoot guns fast ? Have you been bullied ? Do you have an unfair boss ? Do you like to shoot at human-like targets ? Would you like to be a hero ? Do you always win arguments ? Are you often misunderstood ? Have you ever been fired for misconduct ? Have you had problems paying bills ? Have you ever felt depressed due to a relationship ? Do you believe in armageddon ? Do you like your neighbors ? Are you ever jealous ?

Well...I guess you get the idea.

You're right. It would weed out a bunch of people. 1.) Some wouldn't pass. 2.) Some who are current fence sitters wouldn't be interested in going through that in order to own a gun. 3.) what would the cost be, and 4.) How often would you need to "renew" in order to keep the guns that you have. and lastly 5.) If anyone in your household fails the test.... then no one in the house can have guns.. i.e. wife,husband, or teenage child.

 

[Vantage]

All of this can be written into obammycare as a saftey issue. When the gov pays for your healthcare they own you. They will tell you how to live your life, what you can and cannot eat, what kind of car to drive and if you can have a gun all in the name of health and saftey. If you think it can't then you are not paying attention to other countries that have universal heathcare. Nobody though the fed gov could MANDATE you buy a product either. Look how well that worked out. Lets not forget that the Feds know with the patriot act expanded that they can call anyone American or not a terroist without due process all in the name of National Security. Put those together and hows that freedom lovin America workin out for everyone.

I would like to hear from the Dr Bolus opinion on this

Also.... if your gov't doctor suggests that you start taking a mild anti-depressant and you refuse because you don't want to lose your gun rights, does that qualify as refusing medical treatment? And if so... what will Obama Care do about that?

 

[DMax]

There just came out friday that one of the new rules is thier is a list of preventative treatments so they say and if you refuse any of them then you pay for the full boat if you get sick with out the preventative.

 

[hermannr]

The LAW states, if a person was INVOLUNTARILY committed for 14 days or more...then gives a process to fix this if the condition is under control. I can tell you that involuntary commitment takes a judge. If the person in question is under the care of a mental health professional, their input will be heavily weighed.

Remember, some mental health issues are induced by drugs (SSRI anti-depressants the most common), and some are not. Some "mental health" issues are not even mental issues, but are physicial issues that happen to affect the brain or nervous system. I personally do not like any "prohibited person" law. At the same time, I do not have a problem with a judge suspending a right, temporarily, if, in fact, as shown in a court of law, that you are a danger to society in general.

 

[eldbillbo]

bolus

I got a question for you. What about environment ? I know some will blame the parents and in many case they are to blame but this mother sounded like she was a good mother who did what she could so this guy is just a nut case but Say what if the shooter even being a little off in the head lived in a world where he never played a violent video game and never saw movies like the dark night which glorified the bad guy. And the parent sent him to Sunday school to surround him with good kids and to be learn wrong from right in a positive environment .

Say his mom still took him out to shoot guns for recreation or even let he join the local high school shooting team something schools used to do before the late 80s how likely would it have been for him do something like this ?

 

[ob1]

Also, you should not worry that any mental health information in medical records getting out unless you give written consent. It is illegal and unethical to do that. If a state agency called me and asked if a person was competent to own a gun I would say "I cant even tell you if that person is a patient in my practice" The only situation Im able to report if a patient tells me they are going to harm themselves or another.

OK Doc...I accept that is the norm as we see it today. But in the potential scenario of the future where an individual needs to apply for a gun ownership permit, he may be forced, as a condition of that application, to sign a release of information from all medical professionals. If the patient refuses to sign the release...no permit. If you refuse to release...no permit. Since the act of applying is a voluntary one, he is in effect agreeing to disclosure and therefore not experiencing an invasion of his Doctor patient privacy.

Current examples of this..... DOT and FAA pilot physicals. The only obstacle I could see to this would be the ACLU, but, gun rights and the ACLU have seldom mixed.

 

[bernoulli0912]

There is a problem. It's a hard problem. "It's too hard." is not an answer. I am sure there is no perfect answer, but refusing to accept the problem and trying to deal with it is just plain stupid.

Of course people lie to their doctors. I would hope that doctors expect that. But..., perhaps finding and attempting to help those that need it may be enough for some to help protect our communities.

 

[Swedish K]

Some doctor's also don't want to be the one to label someone when it comes to mental issues. My wife's grandmother has dementia. Her primary care doctor of 10 years didn't want to listen when we told him that the person he sees in the office is far from the person she was when at home. When in the office she was on her best behavior. In fact, the only time she read the paper or paid attention to the news was when she was going to the doctor and in the waiting room. She did manage to recall that they always asked her the date, who the president is, etc. to establish progression of the dementia. When we asked the doc about better meds to calm her down and help with the paranoia and imagined acts of others he blew us off. One of the nurses said that he didn't want her to blame him for labeling her with dementia. Bottom line - after taking her to a different doc and getting her on the proper meds she has, for the most part, returned to being less paranoid and much much nicer than before.
I don't blame the doc for thinking she was less paranoid/delusional than she was as she covered it pretty well in his presence, I do wish he had listened to our concerns after pointing out that he only saw the sweet little old lady acting as normal as possible while in the office. Lets face it, many average docs don't want to make the mistake of labeling someone incorrectly and risking a law suit for liable/slander, violation of rights, etc. Heck, even the grief councilor that came by to see the family after the passing of grandpa didn't have much input or really do anything, she simply showed up to check it off her "things to do to get paid" list and move on to the next family.

 

[Modly]

First and foremost, we need better training for schools in case of situations. Just as they had nuclear bomb drills during the Cold War, they can adapt with a more realistic drill to shuttle kids to safety. Be it bombs, knife wielding loons, or somebody with a gun, laws won't stop these people from doing this kind of thing, so we might as well prepare for it.

Some of the teachers had a good idea, and figured out ways to get the kids in a safe place. It should be school wide practice with all teachers though. Again, this is because no matter what country you are in (despite firearm legality), somebody can still get their hands on something very deadly to seriously injure people with.


With that said; Mental health.

In this country, you are either considered sane, or batbubblegum crazy. Our mental health guidelines do not grant a sliding scale, and once you are subject to a mental health facility, you lose rights (and not just firearm related). You can even be denied a job because of previous mental health issues.

Some people have a very temporary problem that needs treatment, and if they seek help, it turns into a life long status. Friends and family won't necessarily turn people in because they are afraid of damaging their trust.

We need a mental health protocol that allows people to to submit loved ones to get actual help without risk of harming their status to the world. You can be having some depression issues that might resolve with some short runs of therapy. If we could submit people to help without marking them, it would give both sides more ease to help people who might be at risk for harming themselves or others.

If they run through a standard help procedure and still pose a threat to the public, they can proceed into our current system.

 

[bolus]

There just came out friday that one of the new rules is thier is a list of preventative treatments so they say and if you refuse any of them then you pay for the full boat if you get sick with out the preventative.

Do you have a link with more information on that? I have not heard of such a requirement. Obamacare does not mandate anything about forcing patients to do any treatment they dont want. Even if it did it would not matter because Im still the last say. I dont force my patients to do anything. I give them advice on best treatments, best tests, why they should stop smoking. Then it is up to them if they decide to do it. Im an advocate for my patient first. I fight insurance companies every day to get what they patients need to make them better.

Most physicians I know are very independent and want more autonomy. We have no interest in having a bureaucrat, accountant or insurance agent tell us how to practice. Believe me, I fight them every day and routinely tell them to F off. Honestly, private insurance is worst since they always put profits ahead of patients.

 

[bolus]

OK Doc...I accept that is the norm as we see it today. But in the potential scenario of the future where an individual needs to apply for a gun ownership permit, he may be forced, as a condition of that application, to sign a release of information from all medical professionals. If the patient refuses to sign the release...no permit. If you refuse to release...no permit. Since the act of applying is a voluntary one, he is in effect agreeing to disclosure and therefore not experiencing an invasion of his Doctor patient privacy.

Current examples of this..... DOT and FAA pilot physicals. The only obstacle I could see to this would be the ACLU, but, gun rights and the ACLU have seldom mixed.

Yes that would be scary.

It is similar to what people need to go through if they adopt. You have to get medical and psychological clearance before you are allowed to adopt a child. I sign these forms occasionally but have never said no on one. Who am I to decide if someone can be a good parent or not? Sure, if someone what so mentally handicapped that they were in a group home, or a meth addict living on the street I'd say no. But it turns out homeless meth addicts dont try to adopt kids.

 

[bolus]

Some doctor's also don't want to be the one to label someone when it comes to mental issues. My wife's grandmother has dementia. Her primary care doctor of 10 years didn't want to listen when we told him that the person he sees in the office is far from the person she was when at home. When in the office she was on her best behavior. In fact, the only time she read the paper or paid attention to the news was when she was going to the doctor and in the waiting room. She did manage to recall that they always asked her the date, who the president is, etc. to establish progression of the dementia. When we asked the doc about better meds to calm her down and help with the paranoia and imagined acts of others he blew us off. One of the nurses said that he didn't want her to blame him for labeling her with dementia. Bottom line - after taking her to a different doc and getting her on the proper meds she has, for the most part, returned to being less paranoid and much much nicer than before.
I don't blame the doc for thinking she was less paranoid/delusional than she was as she covered it pretty well in his presence, I do wish he had listened to our concerns after pointing out that he only saw the sweet little old lady acting as normal as possible while in the office. Lets face it, many average docs don't want to make the mistake of labeling someone incorrectly and risking a law suit for liable/slander, violation of rights, etc. Heck, even the grief councilor that came by to see the family after the passing of grandpa didn't have much input or really do anything, she simply showed up to check it off her "things to do to get paid" list and move on to the next family.

Find a geriatrician or a geriatric psychiatrist to see. They are much better addressing this than a primary care doc (which I am one).