It sounds good: Provide easier access to mental health care.
It seems right: Keep guns out of the hands of those deemed mentally ill.
But what some health care professionals fear are the unintended consequences of President Barack Obama’s gun-control measures unveiled this week.
Some gun violence prevention legislation, they said, may further stigmatize mental illness, and those who need treatment might not seek it.
“If any time someone made an emotionally reactive comment and there was a report made, the mental health profession would become defunct,” said Dr. Larry Gelman of Northern Illinois Counseling Associates in Crystal Lake. “Because no one would feel safe enough talking in private, talking in confidence to their mental health provider.”
While some patients could censor themselves, others might fear losing their rights to own a gun.
“I predict that people who are hunters and people who shoot guns for sport will be very anxious about identifying themselves as having sought any kind of mental health services for fear their guns will be taken away from them and they will no longer have that legal right,” Gelman said.
Obama’s executive orders require “relevant data” be made available during background checks to buy a gun. From this, a new debate emerges – one in which privacy rights are weighed against the safety of the public.
“Privacy is of paramount importance in doctor-patient relations – it’s almost sacrosanct,” Gelman said.
Furthermore, if medical records are open for inspection in order to buy or own a gun, individuals might not get the most effective treatment.
“They would know what not to say,” said Dr. Linda Bedsole of Creative Counseling in Crystal Lake. “ ... [dangerous or violent individuals] might not share that information with anyone if they’re told that their confidence [would be] broken. In that circumstance, they wouldn’t share [violent thoughts], so then the law is really having no effect, in essence.”
Doctors already are required to notify authorities when it’s suspected, probable or there is imminent risk that individuals will harm themselves or others. Patients know this, too, Bedsole said. It’s discussed during their appointment.
Physicians must weigh statements and decide whether threats are actual or an emotional response to situations, Gelman said. In marital counseling, for example, one might say his or her spouse made them so angry they could strangle them, but it takes careful assessment to determine whether that is a genuine threat.
“There are clinical judgments at play with regard to the duty to warn or otherwise notify the authorities,” Gelman said.
But Chris Gleason, the director of Rosecrance McHenry County, said easier access to mental health care removes the stigma on those who are mentally ill.
One executive order the president signed committed to finalizing mental health parity, which prohibits limiting insurance benefits to those seeking mental health treatment. In essence, it orders that mental health care be covered to the same extent as medical or surgical care.
“It will open the doors,” Gleason said. “People who wouldn’t generally ask for service will seek it because they can afford it. If we provide more access, it normalizes mental illness.”
Unfairly or not, the finger often is pointed at the mentally ill when gun violence occurs, and the public is quick to link the two. But research indicates the majority of those who are mentally ill do not commit acts of violence.
“Not everyone who is violent is mental ill, and not everyone who’s mentally ill is violent,” Gleason said.
“The vast majority of people who are violent do not suffer from mental illnesses,” according to the American Psychiatric Association.
Furthermore, those with alcohol or substance-abuse disorders were more than twice as likely as those with a severe mental illness, such as schizophrenia, to report violent behavior, a National Institute of Mental Health study found.
Predictably, mental health professionals lauded the presidential order that starts a national dialogue on mental health.
“For as long as I’ve been in practice, I have always been astounded at how low a priority mental health services are in our society,” Gelman said.