The article below was first published on the NC Advocacy yahoo group site.  It is shared with permission by its author, Geoffrey Zeger.

Out of the events of the last few years there has been an impetus to “DO SOMETHING” and there is an over-rotation to target people with mental illness. (http://www.nytimes.com/2012/12/18/health/a-misguided-focus-on-mental-illness-in-gun-control-debate.html?_r=0). Perhaps this is because (unfortunately) it seems like an easy population to target.  The targeting is misguided based upon known information (http://depts.washington.edu/mhreport/facts_violence.php).

When I see news about the violence in Chicago (http://www.huffingtonpost.com/tag/gun-violence-in-chicago) I don’t see any mention of mental illness.  I do see insult-retaliation and gang related causes.  

We are aware of the high correlation of alcohol and violence (http://www.ncadd.org/index.php/learn-about-alcohol/alcohol-and-crime).  Should we say “Ah HA…now we know what causes violence and we should go back to Prohibition”?

How about the fact that being in a relationship is a correlation to violence (I know that sounds silly, but I’m purposely pushing the issue) – Almost one-third of female homicide victims that are reported in police records are killed by an intimate partner (http://www.ncadv.org/files/DomesticViolenceFactSheet(National).pdf).  Should we require ani-violence pre-marital counseling?

The causes of violence are many and unfortunately in the last few years (Fort Hood, Virginia Tech, Aurora, Gifford-Loughner, Washington Navy Yard, Newtown) there have been mass shootings – some of which were done by someone with prior mental health treatment.  Could we have prevented these?

The Federal proposal for having States submit information to the FBI data base for those adjudicated mentally ill or who have been involuntarily committed to inpatient or outpatient treatment is concerning. The following study is sited in support of this proposal: (http://jhupress.files.wordpress.com/2013/01/1421411113_updf.pdf) – They found that background checks had a “positive effect” for those with mental illnesses. Violence rates among this group declined by a stunning 69 percent a after the state began reporting gun-disqualifying mental health records to the federal background check database.  This study reported that not only was there a reduction of harm to others but there is a noticeable drop in suicide rates with the background checks (which is a good thing).  But I want to consider the following:  Would any of the people of the past few years have been red-flagged with the new Federal law?  In other words, if the law was in place, would the events at Virginia Tech, Newtown or even Columbine be prevented?  I don’t recall (and I am only going on the information available) any of the people involved with said events having ‘been adjudicated’ or ‘having an involuntary commitment’ in the past – they did have outpatient treatment (which would not be reportable) – so their names would not be in the Federal Database.  Thus, the Federal proposal would not have prevented their acquiring firearms.  Furthermore, I believe Lanza used guns that were purchased by his Mother and thus the Federal proposal would not have prevented Lanza’s access to firearms.

Let me pause for a minute – I don’t want to start a debate about 2nd amendment nor am I supporting or opposing anything at this time.  I am trying to take a wise mind or rational mind (ala DBT) approach to this and ‘think through’ proposals.  The questions are:  A) What is the best intervention? and B) would it work – would it have the desired results or would it be a lot of spinning for little positive impact?  In clinical work, we triage Harm to Self or Others as a top priority, Functioning as the next level, and Quality of Life as the next level.  I hope we can all agree that we want to prevent harm to self or others for those we serve.  HOW we effectively do that is the question. 

Since working as a Social Worker since 1986 I have had many occasions where I needed to balance a client’s right to self determination versus preventing harm to self and others.  Most of the time, harm was averted.  There are two occasions where despite using my best objective clinical judgement, tragedy occurred.  The guilt and “what did I miss” and would-of/could-of/should-of as well as fears of liability wracked me. Should I use these two events to over rotate, force treatment, do the proverbial ‘if I have a hammer then everything looks like a nail’ and move to the stringent side of the two competing ethics (Self determination/Prevent Harm) and activate Chapter 122C involuntary commitment procedures on a more regular basis…..or would this just be a reaction-formation based in fear?

There have been prior posts on NCadvocacy concerning the topic of outpatient commitments.  In North Carolina, over-using outpatient commitments and letting the ‘forced treatment’ agenda dictate policy would be ineffective.  Conscientious and clinically appropriate use of outpatient commitments may be helpful but what is paramount is the availability of services.  If someone is forced to pursue treatment but services are not available then the purpose is defeated.  Forcing someone into treatment who has to negotiate the labyrinth of the current NC public mental health system with screenings and referrals and authorizations and then waiting to see the doctor since the doctor is COMPLETELY booked defeats the purpose of trying to provide timely and appropriate care to prevent decompensation.  This would be like forcing someone with diabetes to take their insulin but every time they go to the pharmacy the Pharmacist says “sorry…you need to get an authorization for the insulin and then we’ll put you on the waiting list and then we have to do a full assessment and treatment plan AND THEN you can get your insulin.”

So….Although I may have rambled, let me say I appreciate Laurie’s keeping us informed.  I hope that clearer minds will prevail and that fear based agendas will not force an ineffective over-rotation that makes us FEEL like we are doing something but in the end is a lot of work and blame with minimal positive results.

 

Geoffrey Zeger, ACSW, LCSW