How to handle mental health

[jbett98]

The actor Morgan Freeman made a statement yesterday about this issue.

You want to know why {these shootings keep happening}. This may sound cynical, but here's why.It's because of the way the media reports it. Flip on the news and watch how we treat the Batman theater shooter and the Oregon mall shooter like celebrities. Dylan Klebold and Eric Harris are household names, but do you know the name of a single victim of Columbine? Disturbed people who would otherwise just off themselves in their basements see the news and want to top it by doing something worse, and going out in a memorable way. Why a grade school? Why children? Because he'll be remembered as a horrible monster, instead of a sad nobody.

CNN's article says that if the body count "holds up", this will rank as the second deadliest shooting behind Virginia Tech, as if statistics somehow make one shooting worse than another. Then they post a video interview of third-graders for all the details of what they saw and heard while the shootings were happening. Fox News has plastered the killer's face on all their reports for hours. Any articles or news stories yet that focus on the victims and ignore the killer's identity? None that I've seen yet. Because they don't sell. So congratulations, sensationalist media, you've just lit the fire for someone to top this and knock off a day care center or a maternity ward next.

You can 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."

 

[rdt]

Didnt have time this morning to read all the posts, but blaming "mental health" for these shootings is no different than blaming "guns." These atrocities are so terrible we get desperate to identify a "problem" so we can implement a "solution" so we can soothe our survivor's guilt. But the "problem" in this case doesnt have a solution, certainly not a superficial one like gun control or mental health.

 

[DMax]

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.

I have no link. I heard this from an interview with a Dr and Jounalist in the media. According to the Dr being interviewed that thier will be a list of preventative measures that are approved by the gov for a number of conditions and if the patient does not agree to any one of them for the condition if that patient get said illness the patient will be financially responsibile for the entire cost. I just heard this friday. So the regulation may not have hit the main street as of yet. This kind of thing will be ongoing with regulations from a 2700 page law that can take awhile. I assume since you are hanging on this forum you are pro 2A. I would like your take on my previous post about regulating guns as a saftey issue amoung many other items, since the feds pay our healthcare going forward

 

[Vantage]

Didnt have time this morning to read all the posts, but blaming "mental health" for these shootings is no different than blaming "guns." These atrocities are so terrible we get desperate to identify a "problem" so we can implement a "solution" so we can soothe our survivor's guilt. But the "problem" in this case doesnt have a solution, certainly not a superficial one like gun control or mental health.

Didn't read all the posts? Apparently didn't even read the the starting post.

I'm not blaming anything..... the question is: The Anti's keep saying "Keep guns away from Criminals and those with Mental Health Issues". Criminals are easy because you either have a record or you don't. But Mental Health is a different beast all together. So how would THEY go about restricting those with mental health issues.

 

[Vantage]

The actor Morgan Freeman made a statement yesterday about this issue.

You want to know why {these shootings keep happening}. This may sound cynical, but here's why.It's because of the way the media reports it. Flip on the news and watch how we treat the Batman theater shooter and the Oregon mall shooter like celebrities. Dylan Klebold and Eric Harris are household names, but do you know the name of a single victim of Columbine? Disturbed people who would otherwise just off themselves in their basements see the news and want to top it by doing something worse, and going out in a memorable way. Why a grade school? Why children? Because he'll be remembered as a horrible monster, instead of a sad nobody.

CNN's article says that if the body count "holds up", this will rank as the second deadliest shooting behind Virginia Tech, as if statistics somehow make one shooting worse than another. Then they post a video interview of third-graders for all the details of what they saw and heard while the shootings were happening. Fox News has plastered the killer's face on all their reports for hours. Any articles or news stories yet that focus on the victims and ignore the killer's identity? None that I've seen yet. Because they don't sell. So congratulations, sensationalist media, you've just lit the fire for someone to top this and knock off a day care center or a maternity ward next.

You can 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."

No, I don't want to know why these keep happening. I already know why these keep happening, and NO... IT'S NOT THE MEDIA.

Human beings have been doing horrific things to other humans since the beginning of time. We fed people to lions for entertainment, Hitler gassed an entire race almost off the face of the earth, our own county enslaved people, took children from parents and sold them... and we still celebrate the south in current pop culture (If the south would have won, The Dukes of Hazard/General Lee, The confederate flag, etc... ). Charles Whitman shot 46 people in 1966. Long before our current media.

The bottom line is that humans are not some great peaceful species. We're animals just like any other. This is not the first act of atrocity in history, and certainly will not be the last.

So No, I'm not wondering why this happened. I'm not naive. I know why it happened, it's because some people are bad. Which is why I carry.

The original post was about opening up a conversation about how WOULD they regulate mental health? How could they? and the point I'm getting to is that they CAN'T. Not with out a huge invasion into privacy. OR... if they did manage to pass something, then it would automatically disqualify such a huge portion of the population that gun ownership would drop significantly. Maybe enough to get enough indifferent people to go along with a greater larger scale ban all together.

My opinion is that this could be the way to a total banishment without actually changing the second amendment. By getting people to agree to mental health restrictions I could easily see a path to cutting down the gun owning population to a very small minority.

 

[bolus]

I have no link. I heard this from an interview with a Dr and Jounalist in the media. According to the Dr being interviewed that thier will be a list of preventative measures that are approved by the gov for a number of conditions and if the patient does not agree to any one of them for the condition if that patient get said illness the patient will be financially responsibile for the entire cost. I just heard this friday. So the regulation may not have hit the main street as of yet. This kind of thing will be ongoing with regulations from a 2700 page law that can take awhile. I assume since you are hanging on this forum you are pro 2A. I would like your take on my previous post about regulating guns as a saftey issue amoung many other items, since the feds pay our healthcare going forward

I have not heard this and even if it was true it would not be feasible. Probably the best preventive care choice is quitting smoking. So they would not pay for care for people who do not quit smoking? That would have as much success as trying to make cigarettes illegal.

Medicare and insurances started paying for some preventive care but its not required. but a few short years ago medicare considered preventive care fraud. If I billed them for talking to a patient about a healthy diet or recommending cholesterol tests or quitting smoking, they considered that illegal. The reasoning at the time was "your patient isnt sick so you cant bill us. If you do bill us that's fraud and you go to jail"

For gun safety, I dont expect to see anything in the new healthcare law around this. For me personally, its about the bottom of the list of preventive topics I discuss with my patients. Eating healthy, not smoking, exercise, wearing seatbelts, cancer screening tests like mammograms..... then perhaps gun safety if they mention they own a gun. Mostly, because Im interested in what they shoot and like to compare hardware. I may recommend a class or make sure they practice proper safety if they have kids in the home. but that's it

Regulation will come from the gun side like assault weapon bans, not from the medical side.

 

[Kevatc]

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.

Great points.

I am seeing the gun control crowd do their usual illogical and irrational gnashing of teeth and that "something has to be done." Well, lets start with being compassionate with our mentally ill by having resources available. In my relatively small community in southern Oregon out local hospital used to operate an in-patient/out-patient mental health facility until it apparently wasn't profitable anymore. An outside provider came in for a very short time but they also bailed. I am sure this isn't unique to my community and if multplied by thousands of communities in this country .... Well, it's no wonder stuff like this happens.

And while I am on the irrational illogical argument kick .... the gun control advocates obviously do not realize that by calling for control of a inanimate object they are letting the perpetrator of the crime off the hook. The answer to this is in prevention and that means increasing mental health availability and not reacting and trying to control hunks of metal, wood, and plastic, or brass and lead.

 

[ob1]

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.

Sounds like we are on the same track Doc...let's see if can get closer to the station:

1) Would you agree that in your profession, those with your views on gun ownership are in the minority ?

2) Given the previously postulated gun owner psych. test, what percentage of your peers would be willing to say "yes" .....after considering their continued standing as a test examiner weighed against the future conduct of any given applicant. To add an additional twist, lets say the professional had some sort of civil liability exposure.

I recall hearing of a local medical professional who acquired the nickname of "Doctor Bud"....earned from a tendency to "rubber stamp" all of his patients coming in for a medical marijuana card signoff. He reportedly lost his license.
I assume a professional in the above scenario would be held to a similar standard, thereby creating a "gray area" that some applicants would have to make it through.

 

[duldej]

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 think you are referring to a Tarasoff Warning. A person can get screwed by his psychiatrist or by a LEO on similar grounds. Sometimes both, acting in tandem. Or, if you're deemed, by a judge, incompetent to stand trial, you can be screwed for life, there. If you plead temporary insanity, you are screwed for life there, too. And, last but not least, if you are committed to a mental institution involuntarily, you are screwed for life there, too. Welfare and Institutions Code 5250 in California. I'm not sure about the Oregon Statute.

You would know, though, whether you had these problems. The Tarasoff Warning is probably the most nefarious of them, although the least problematic, because you merely express the desire to harm someone (or yourself) to your psychiatrist, and s/he passes that word on to law enforcement, and then you get your gun rights taken away for six months. The other alternatives I mentioned above are life long problems... with no due process. Unconstitutional? you be the judge.

 

[DuneHopper]

I think when humans begin deciding who is mentally stable and who is not we tread heavenly of human selection.
The state of mental illness is natures way of many animals, who are we to put labels on those.

We as a nation are paranoid already of Mien Obama Socialist Party coming about in his third term. If we allow selection for rights were does it end?

The human brain is creative and true sociopaths will never be seen or identified by some stupid evaluation or tests. Not to mention drug illnesses as the result of heavy drug use. Maybe Bob did not choose to use heroin until he was 25 and got a bad batch and friend it brain and takes out a school?

These shootings are already unique and parents thing there children may have disabilities but are not insane, and where is the line drawn to being too psychotic ?

As a boy do we judge little Timmy because he squishes bugs, or do wait until he mutilates a frog, a cat a dog ? Or do we just think of human abuse only.


Everyone in this forum is different some more then others ,
how does one even begin to sort the complications of the human mind?
Have you ever sought revenge, or fantasized about hurting or killing someone?
Does that make you human??? Or Insane ??? And does it take the act or the thought to make one dangerous if so do we then have to wait for harm to judge a person ??

 

[bolus]

Sounds like we are on the same track Doc...let's see if can get closer to the station:

1) Would you agree that in your profession, those with your views on gun ownership are in the minority ?

2) Given the previously postulated gun owner psych. test, what percentage of your peers would be willing to say "yes" .....after considering their continued standing as a test examiner weighed against the future conduct of any given applicant. To add an additional twist, lets say the professional had some sort of civil liability exposure.

I recall hearing of a local medical professional who acquired the nickname of "Doctor Bud"....earned from a tendency to "rubber stamp" all of his patients coming in for a medical marijuana card signoff. He reportedly lost his license.
I assume a professional in the above scenario would be held to a similar standard, thereby creating a "gray area" that some applicants would have to make it through.

I dont know the data on how many physicians are in support of gun ownership. It would be interesting to find out. Though on my staff there are 3 other CHL's. Im the only one that has received permission to carry on site though. The staff are in support of me though. They are sure to let me know when a patient is being threatening.


I've decided this morning that I would never sign a form one way or another about the mental capabilities to own a gun. There is just too much legal liability in doing that. If I sign a form saying someone is mentally capable of owning a gun and then they shoot up a school, who are they going to blame? If I sign a form denying someone a gun and they get shot by a criminal, who are they going to blame because they could not defend themselves? Im already open to way too much legal liability to add anything like that.

 

[DuneHopper]

Not to be negative but evaluation will not work, they do not work for adoption, medical marijuana, disability both mental and physical.
There are instances of unemployment fraud, disability fraud, worker comp fraud, and many people persuade others they have a physical issue, it would be that much harder to say one is too crazy for a gun or not crazy enough to make it illegal.

My current job I cannot post what it is, but works with the criminal element and their mental conditions. And many of these people are master manipulators and pretty out there, however they can convince anyone they are good descent people. There is not the man power or efficiency to evaluate the mentally ill for gun access. These same "clients" I will call them, I know convince the system to let them go free and go right back out, it is careless to rely on the human element to evaluate the human mental condition. I know many doctors that vary on how they evaluate a person this presents and even more dangerous condition with varied opinions.

We are arrogant to think as a race we are advanced enough to predict mental illness, sure billions are spend each year on mental health and within those billions, people are set free, and handed over children all on the word of one or two people is careless.

I understand the problem, but evaluation is not the answer, not to mention the selection process alone is dangerous to allow in any society.

 

[ZigZagZeke]

The one common denominator in all of these heinous acts is mental instability. Not just taking Prozac for depression, but out and out psychosis, bad enough that family, friends, teachers, etc are concerned and trying to find help. 40 years ago these people could turn to a state mental health system where dangerous people could be committed involuntarily if a judge agreed. Today that system is non-existent.

Being paranoid about mental screening and testing is just silly. We simply don't have the resources to do that, and nobody is proposing that. The simple fact is that we have homicidal crazy people living at home in order to "preserve their freedoms" and save tax money. As long as weapons are available to these people our gun rights are in danger. Whether we like it or not, either the crazy people or the guns will be removed from that equation. Guess which one is easier to legislate against.

Argue against mental health care all you want, but know that the alternative that will be pursued is to control the guns themselves. We will get one or the other. Which do you want?

 

[JGRuby]

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.

Being from the submarine force where all submariners had to at one time talk to a shrink - how does that play into this scenario. The program was the PRP ( perosnal reliability program ) - i had to go through this for SPecOp work and it was amazing because some of the most horrendous crimes back in the 80's in the Silverdale area were committed by individuals the Navy indicated were ok and had gone through this porgram.

My question is this - how do you objectively identify the sane from the insane? I would say from first hand expereince that many in the service had mental issues when I was in and that many of these were extremely intelligent including one Doctor that was a Navy Commander used for supporting saturation divers. One Easter I woke up from a repeated thud in the lower torpedo room where we berthed - to my surprise I saw this commander hopping around with a set of bunny ears on throwing candy into everyones rack. Very few things really make me think - WTF, this was one of those times. Come to find out this comander had invested heavily into old ICBM centers that were in teh ground and was making enough money off those to retire very happily. He just wanted to be out there on the submarine and he thought it was fun. I question his sanity and mine at that point. I wish him well.

Respectfully

James Ruby

 

[duldej]

this excerpt pertains to CHL licensing in Oregon, but it's a similar problem....

Section 166.293 (2) of the ORS, concerning concealed handgun licensing and revocation of such reads:

(2) Notwithstanding ORS 166.291 (1), and subject to review as provided in subsection (5) of this section, a sheriff may deny a concealed handgun license if the sheriff has reasonable grounds to believe that the applicant has been or is reasonably likely to be a danger to self or others, or to the community at large, as a result of the applicant’s mental or psychological state or as demonstrated by the applicant’s past pattern of behavior involving unlawful violence or threats of unlawful violence.
​

There is no witch-hunt here, as far as what in one's mind is "safe" and what is "dangerous," because there has to be a "reasonabl(e)" cause for a judge predict bad things to happen in the future, if s/he were granted a CHL license. Much like the next clause, that means that there has to be a something akin to a "past pattern of behavior," like a rap sheet, in order for a judge to rule that one is too crazy to get a CHL. The key term, here, being "behavior," which means that one actually did something disagreable, in the past, and not just that one thinks crazy thoughts in one's head.

It should be noted that you could have a schizophrenic patient that is cool with guns on one hand, and a schizophrenic patient that has a history of going in and out of mental hospitals for hurting people, on the other. The latter case, only, is targeted, not because the patient is schizophrenic, but because he has hurt people "as a result of (his/her) mental or psychological state."