By Jessica Hamzelou
February 27, 2015

Earlier this week, eight US professional organisations, including the American Academy of Family Physicians, the American Psychiatric Association and the American Public Health Association collectively took a stand against a law that on the face of it, seems like plain common sense.
 
For the past couple of years in New York, Colorado and Connecticut, psychiatrists have been compelled by law to report patients with mental illness to the criminal justice system. The idea is to prevent such people from purchasing firearms from licensed gun stores.
 
"These laws go too far, says Steven Weinberger, executive vice president of the American College of Physicians. "Blanket mental health reporting laws can have unintended consequences," he says. Such laws can discourage people from seeking mental health care, he says. "They can create a tremendous disincentive for people to get the support they need."
 
Philip Candilis, a forensic psychiatrist who teaches at Saint Elizabeths Hospital in Washington DC, agrees, and says that only a small proportion of gun violence can be attributed to people with mental illness. Evidence suggests that violent behaviour attributable to mental illness accounts for only between 3 and 5 per cent of the violence in the US. "There is a perception of a link between gun violence and mental health… people think 'you've got to be crazy to do that'," says Candilis. "But it's a false perception. People with mental illness are already vulnerable to stigma, and make an easy target."
 
Divided country
 
Although some states are enforcing mental health reporting, others are heading in the opposite direction. Florida became the first state to enact "gag laws" that limit the ability of a mental health care provider to ask their patient whether they own a gun, or enter such information in the person's medical record, in 2013.
Missouri, where eight people died in the latest shooting spree, on Thursday, followed suit late last year.
"This is absolutely outrageous," says Weinberger. If physicians are not able to talk to their patients about firearms, paediatricians won't be able to advise parents on how to keep weapons safely out of the reach of their children. "There are plenty of cases where a child has got hold of a gun and accidentally shot him or herself, or a sibling or parent, and the consequences are tragic," he says.
 
Doctors should be free to use their clinical judgement, says Richard Bonnie, director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia in Charlottesville.
 
Greater access
 
As far as mental health is concerned, the focus should be on improving access to treatment, Bonnie says. "Everyone agrees that access to mental health care in the US is poor," he says.
 
That is also the recommendation of the draft report released this month from the Sandy Hook Advisory Commission. The commission aims to devise plans to prevent another massacre like the one in December 2012 in Newtown, Connecticut, that killed 26 people. The report made no mention of tightening mental health reporting laws, and instead stressed the importance of improving mental health care more generally.
 
In any case, it might not make a difference whether individuals are listed on databases – there are loopholes in US law that allow people to buy guns without background checks, for example at gun shows. These are the laws that need tightening.
 
"In a society as large as ours with 300 million guns in circulation, and with our culture, laws are not going to prevent every instance of gun crime or mass shootings," says Bonnie. "But by tightening up these laws, over time we will have an impact on gun violence."
 

Why U.S. law on guns and mental health needs to change [New Scientist]