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We hear it with every gun massacre. "Where are the mental health services? Why didn't anyone catch this earlier? How do we make sure these people get the help they need?" All of which are extremely valid questions, asked over and over every time this happens, too often used to distract from the questions about how to keep guns away from these homicidal and suicidal people.

But remember what happened when President Obama and Democrats in Congress thought about maybe addressing some of those questions in the Affordable Care Act? This happened, an entire section of the law devoted to the protection of gun ownership and to shutting down the discussion.

Here's how that works, from the perpective of a physician, Dr. Carolyn McClanahan, the person who would be the first line of defense in identifying and helping—yes, helping—a potentially violent mentally ill person.

In medical training, physicians are taught to screen for potential violence. It is amazing how many people will tell you if they are homicidal or suicidal–you just have to ask. As an extension, we ask about access to guns. If a suicidal or homicidal person has access to guns, they are more likely to use that implement to initiate their violent act. This is why we are trained to ask that question. [...] Unfortunately, the gun rights lobby, mostly funded by the National Rifle Association, has time and time again inserted their hand in attempting to shut down that conversation.

In the Affordable Care Act, the gun lobby’s section is in Title X, starting on page 2,037, line 23.  “Protection of Second Amendment Gun Rights” contains five provisions mostly dedicated to shutting down conversation about guns in medicine.

These sections don't prevent a physician from asking a potentially violent or suicidal mentally ill patient about access to guns, they just do everything possible to discourage it, from explicitly stating that patients don't have to disclose that access (as if patients were ever required by law to disclose anything to a doctor) to expressly forbidding doctors from collecting data about ownership and use of firearms. In Dr. McClanahan's words,
Sounds like an effective way to stifle research related to gun violence so we can no longer prove that easier access to guns increases the risk of mass violence.
Another provision prohibits physicians from maintaining records of patients' access to or use of guns or ammunition, more information that could, at the very least, help in the investigation of an incident. That's part of the link between access to weapons and gun violence that can't be researched and tracked.

The fourth and fifth provisions are so unnecessary as to be ridiculous. The fourth says that health insurance companies can't determine rates or eligibility based on gun ownership. Of course they can't. Guaranteed issue is already a key part of the law. The fifth says that gun owners don't have to disclose they have guns. Once again, patients aren't required by law to disclose anything to a doctor.

The intervention of the gun lobby in the Affordable Care Act was entirely gratuitous and the provisions they inserted mostly utterly unnecessary. The only thing the NRA achieved by meddling in a health care bill was flexing its muscle to stifle one more route to maybe reducing gun violence.

Physicians are trained to have this conversation with patients for their own well-being and that of those around them. The gun lobby, always the first out of the gates with statements about how we need to address the mental health system, did everything in its power to shut that conversation down, to neuter a physician's ability to do anything about a potentially violent mentally ill person. Protecting privacy is a must, but so is protecting the potentially suicidal and homicidal patient and the people around him or her.

We absolutely need to do everything a nation as advanced as our should be doing to help these broken people. But we're smart. We can multi-task. We can take care of the broken people and make sure they can't get their hands on fucking guns. Yes, mental health has to be part of the conversation when it comes to preventing another Newtown, but so does guns. Maybe this time the gun lobby won't shut that conversation down.

Originally posted to Joan McCarter on Wed Dec 19, 2012 at 09:01 AM PST.

Also republished by Repeal or Amend the Second Amendment (RASA), Shut Down the NRA, and Daily Kos.

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Comment Preferences

  •  I am so eagerly awaiting the NRA's... (22+ / 0-)

    ...contribution to the discussion in its Friday news conference. Somehow, I don't think it will be announcing a retreat on issues like the items you describe here.

    Don't tell me what you believe, show me what you do and I will tell you what you believe.

    by Meteor Blades on Wed Dec 19, 2012 at 09:05:57 AM PST

    •  Somehow (7+ / 0-)

      I don't think so either.

      "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

      by Joan McCarter on Wed Dec 19, 2012 at 09:19:45 AM PST

      [ Parent ]

      •  Why would they? (2+ / 0-)
        Recommended by:
        gosoxataboy, quill

        We have already seen the first bits of spin.

        Video games?  Really?

        Anyone fool enough to buy into that discussion given the facts of every single massacre that we have witnessed has no place at that proverbial table.  

        The NRA and the Gun Owners of America and a whole lot of other deranged and twisted people want to shut down the conversation - to curtail the 1st Amendment rights of anyone - who would discuss the realities of gun violence - UNLESS - their speech is that kind that would inspire paranoia and fear that would increase their gun sales.

        On some level this attack on video games has to be viewed as one of those classic marketing rivalries where the gun lobby would prefer that those people who enjoy playing violent video games abandon that virtual experience and adopt the REAL experience of acting out these fantasy shoot-'em-ups marking real people with real guns.

        Next time a gun rights advocate attacks video games in your presence, ask them if they would prefer that people buy guns and act out the games in real life.  

        They won't have a good answer to that question.  I promise.

      •  The NRA represents gun manufacturers not owners (2+ / 0-)
        Recommended by:
        bigforkgirl, murrayewv

        they shifted a few years ago and now exist to help manufacturers maximize their profits.  In return the gun makers give the NRA money that augments dues and makes them a political force.  It is just another GOP scam, and one that costs many lives each year.

        The scientific uncertainty doesn't mean that climate change isn't actually happening.

        by Mimikatz on Wed Dec 19, 2012 at 07:20:41 PM PST

        [ Parent ]

    •  i thought NRA meant financial contributions (6+ / 0-)

      as in maybe creating a fund for the families perhaps as preemptive measure to avoid lawsuits and/or some other $$$ contribution. part of the sick corporate creed of greed with the sick belief that they can buy their way out of everything.

      The N.R.A. is prepared to offer meaningful contributions to help make sure this never happens again.

      "It is in the shelter of each other that people live." Irish Proverb

      by Patriot Daily News Clearinghouse on Wed Dec 19, 2012 at 09:20:22 AM PST

      [ Parent ]

    •  They're going to blame video games (9+ / 0-)

      Senators Manchin (D-NRA) and Rockefeller (D-NRA) have already been preparing the field today.

      As Hunter said earlier today when discussing Manchin’s comments:

      Prediction: We’re going to limit the number of rounds people can shoot off in video games long before we think about limiting the number of rounds they can fire in real life. Not joking on that one.

      Repeal the 2nd amendment.

      by Calouste on Wed Dec 19, 2012 at 06:09:06 PM PST

      [ Parent ]

    •  I still say they're waiting till the 21st (2+ / 0-)
      Recommended by:
      atana, annieli

      just in case the Mayapocalypse actually does happen -- whereupon they go out having conceded NOTHING.


      by raincrow on Wed Dec 19, 2012 at 06:29:22 PM PST

      [ Parent ]

  •  Can't say it often enough (16+ / 0-)

    this is why the NRA would gain zero traction in any other civilized country.

    A lot of well meaning people on this site insist on falling into the NRA set trap of looking at the gun problem as part of a series of other societal problems.

    Don't make that mistake - there is not one of these extremely important societal problems that wouldn't benefit from making guns really hard to get hold of.

    This is a number of guns problem and the closer we can get that number to zero the better off we will all be. The only possible exception is the NRA crowd who will be put to the massive inconvenience of having to find a new hobby.

    •  The mental health smoke screen won't work, (19+ / 0-)

      people want gun regulation. When there was a gun massacre in Australia, 1996 their government didn't focus on mental health. Within 12 days they had a consensus ready to make gun regulations. They have not had another gun massacre since.

      ❧To thine ownself be true

      by Agathena on Wed Dec 19, 2012 at 09:20:08 AM PST

      [ Parent ]

      •  Very similar story (10+ / 0-)

        in the UK.

        The difference is this - In every other country legislation on everything is formulated on the basis of 'worst case scenario'. This is doubly so when there are obvious physical dangers involved such as weapons.

        To those outside the US this legislative approach is so obvious that it doesn't even require discussion. Here the playing field has been so fouled by the moneyed interests that Americans generally believe that you  legislate with the best case scenario and most responsible individuals in mind.

        •  Something that keeps being ignored in... (13+ / 0-)

          ...the discussion of gun control in Australia and the UK is that they did not start with extremely strict measures in the '90s. In both nations, handguns of all types had been very difficult to acquire long before the new laws. In England, the mass murders that made the laws stricter were done with weapons that were licensed.

          The point is that the population was already primed for stricter gun control to begin with. Here, we have much farther to go on that score having just been through 30 years of propaganda that has generated laws that make it extremely easy to get a permit to carry a concealed weapon in almost every state with minimal training (an hour will do it in Colorado). Countering that won't be done overnight.

          Right now, we need to push for the strongest gun control we can get — banning all sales of "assault-style" rifles, high-capacity magazines, gun-show sales without background checks, Internet sales of guns and ammo, more robust background checks, and limits on number of weapons purchased in a certain period. I think that's all doable. And it has to be done fast before the latest mass murder fades from (political) memory.

          As for the mixing of other issues into this matter by "well meaning people," even with the most draconian new legislation — confiscation of tens of millions of semi-automatic handguns of the sort that Jared Loughner used, legislation that will NEVER pass — we are going to have lots and lots of such firearms in circulation in this country for a long time. So we MUST deal with other issues, the dangerous mentally ill being a key example.

          Don't tell me what you believe, show me what you do and I will tell you what you believe.

          by Meteor Blades on Wed Dec 19, 2012 at 09:45:22 AM PST

          [ Parent ]

          •  Yes, of course (5+ / 0-)
            So we MUST deal with other issues, the dangerous mentally ill being a key example.
            I just want to see the focus aimed on gun control first. There has been an attempt to shift the focus here on DKos to the mental health issue. I don't think that is the general attitude in the real world. The population is "primed for stricter gun control."

            Yes, the playing field for the US to control almost 300 million guns within its borders is unique and not equal to the playing fields of the UK or any other country. Even so, the US can still follow the example of their response to their last gun massacre by acting promptly and decisively. It has to be done right away while the momentum exists.

            ❧To thine ownself be true

            by Agathena on Wed Dec 19, 2012 at 10:02:49 AM PST

            [ Parent ]

            •  I don't think this diary is an example... (7+ / 0-)

              ...of trying to shift, but rather to point out just how infused into all areas the NRA is. (And while the NRA is the biggest and richest, it's not the most extreme.) Gun Owners of America thinks the NRA is a sell-out. GOA succeeded in Colorado in getting the state to disallow sheriffs who issue concealed carry permits from providing counts of the number of such permits.

              Don't tell me what you believe, show me what you do and I will tell you what you believe.

              by Meteor Blades on Wed Dec 19, 2012 at 10:07:13 AM PST

              [ Parent ]

        •  OT, but in the U.S. they won't put in a 4 way stop (1+ / 0-)
          Recommended by:

          on an intersection until there is a serious accident or fatality to 'prove' that a danger exists. Too often it takes several incidents.

          Old style cheapest possible kind of thinking. Reduce taxes for infrastructure, increase tax monies for corporate welfare instead of public welfare.

          My rant for tonite.

          Something that doesn't make good sense, makes bad sense. That means someone is being deliberately hurtful & selfish. Look for motives behind actions & words.

          by CA wildwoman on Wed Dec 19, 2012 at 09:02:52 PM PST

          [ Parent ]

      •  I can't agree.. (3+ / 0-)
        Recommended by:
        JWK, raincrow, ancblu

        Yes, gun regulation of some sort seems indicated here.  I don't suggest that it is isn't hugely important, part of the problem and requires due attention.

        Mental health issues, however, are also hugely important, part of the problem and require not only due attention, but a lot of attention and a lot of funding.

        In many states, it is very difficult to involuntarily a potentially dangerous patient, and for good reason.  But the right balance needs to be struck.

        Virtually any effort to address these problems requires some sort of intervention or limitation on liberty, and the intervention when not appropriate will always tread heavily on one or another fundamental right, first, second and fifth amendment rights among others.  It is essential that we guard those rights carefully, but a balance may be struck.

        The problem is that human beings ultimately implement these balancings, and we lose quite a bit when that happens.  For example, defendants acquitted of crimes by reason of insanity can often be held at State Mental Hospitals for terms greatly exceeding the maximum punishment for the charged crime, and indeed after they are considered no longer insane, if considered "dangerous" anyway.  

        Few people notice or care:  persons so convicted are often without resources, family or anyone to advocate for their relief, and a slight burglary can literally result in a life sentence.  There is no constituency for these lost souls.

        Its easy to bluster out an argument, and to suggest that mental health issues are simply distractions to protect gun rights.  I can't agree.  This is a very hard and complex problem, and it is not a time for any faction (pro- and anti- gun both) to try to impose their favorite legislative solutions because of the public reaction to a bad circumstance.

        Its time to do the right thing, and to refrain from the wrong things, whatever they are.  Its time, in my view, at least, to pay attention.

        •  I agree with your assessment as well.... (2+ / 0-)
          Recommended by:
          raincrow, DSPS owl

          Our nation as failed to address two key societal issues that have become a catalyst for disaster...namely gun regulation and mental health. My fear is that we'll only do gun regulation, and leave the those suffering from psychological issues to continue to suffer, forgotten, in a corner somewhere, or riding a bus, sleeping homeless in a store doorway.

          The NRA should be for helping those with mental issues--if all it cared about was gun rights.  But it doesn't. The NRA plain and simple is a quasi-military organization of the Republican party. The NRA continually advocates for Right Wing agendas.

          "Those who can make you believe absurdities, can make you commit atrocities" Voltaire.

          by JWK on Wed Dec 19, 2012 at 07:05:23 PM PST

          [ Parent ]

      •  Not sure the comparison is statistically valid (1+ / 0-)
        Recommended by:

        If you map our annual number of rampage killings vs. population from 1890 to 2012, our rate per million per year varies from 1:58 million (1982) to 1:279 million (2001), with most years running lower than 1:110 million.

        Just eyeballing the data with my non-statistician's eye, the trend in numbers of killings per year picked up in the mid-60s, then jumped up a notch in the mid-70s, and the frequency and number of victims since then does not look so different across 5-10 year windows with the exception of 7 spikes ('84, '90, '91, '09, '09, '12, '12) where 11 to 27 people were killed.

        Australia's history of rampage killings looks much different (despite discouragingly comparable rates of domestic violence, crime against persons, civilian rape, and military rape), with gaps of 5, 10, and sometimes 45 years between rampages.  This may be because they have only a fraction of our population (for instance, in 1996 when they passed their gun regs, U.S. pop 269 million, Aus 18 million = 7% of our pop), and do not have a population large enough to often see a phenomenon that occurs at 1:58 million to 1:279 million.

        This is not to say we shouldn't press for changes to current gun laws. I'm just not convinced that Australia has yet seen a real decrease in berserker killings resulting from their 1996 regulations. I would definitely welcome a real statistician mulling through these numbers and giving us a more authoritative assessment.


        by raincrow on Wed Dec 19, 2012 at 08:44:34 PM PST

        [ Parent ]

        •  For "real statistics" on the USA (2+ / 0-)
          Recommended by:
          triv33, Garrett

          gun culture, remember that NRA bought politicians have been working against the research through Congress.

          On the topic of gun massacres in Australia:

          When Massacres Force Change: Lessons from the U.K. and Australia

          A widely cited 2010 study in the American Journal of Law & Economics showed that gun-related homicides in Australia dropped 59% between 1995 and 2006. The firearm-suicide rate dropped 65%. There has been no mass shooting in Australia since the Port Arthur attack.
          Read more:

          ❧To thine ownself be true

          by Agathena on Thu Dec 20, 2012 at 10:47:08 AM PST

          [ Parent ]

    •  This was just utterly unnecessary (15+ / 0-)

      The injection of gun rights into a health insurance reform law was only to show that the gun rights lobby had the power to do it.

      Maybe that'll change now. I'm not too optimistic on that, but I hope I'm wrong.

      "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

      by Joan McCarter on Wed Dec 19, 2012 at 09:21:49 AM PST

      [ Parent ]

      •  I'd go farther. The intrusion of the gun lobby (2+ / 0-)
        Recommended by:
        annieli, sydneyluv

        into the Affordable Care Act is malicious mischief.

        I think it absolutely should be within the realm of good medical practice to recommend that access to guns be withdrawn from people who are judged to be a danger to themselves and others. Psychiatrists and psychologists can recommmend court-ordered committment and physical restraint. It makes no sense whatsoever to say those same psychiatrists and psychologists couldn't appeal to the court to withdraw access to dangerous firearms.

        In fact, I believe that some mental patients can be required to have their psychologists/psychiatrists sign a form every year to keep their drivers' licenses in force. Why not as much for access to guns?

        “Social Security has nothing to do with balancing a budget or erasing or lowering the deficit.” -- Ronald Reagan, 1984 debate with Walter Mondale

        by RJDixon74135 on Wed Dec 19, 2012 at 06:48:44 PM PST

        [ Parent ]

  •  NRA also shut down funding for research on gun (19+ / 0-)

    violence by the CDC and other federal agencies. Maddow covered last night. good segment for anyone interested.

    "It is in the shelter of each other that people live." Irish Proverb

    by Patriot Daily News Clearinghouse on Wed Dec 19, 2012 at 09:27:25 AM PST

  •  read the bill's text more closely (2+ / 0-)
    Recommended by:
    annieli, raincrow

    the gun provisions only apply to "wellness and prevention programs," not private counseling, or even regular doctor visits.



    26 A wellness and health promotion activity implemented under subsection (a)(1)(D) may not require:

    2 the disclosure or collection of any information relating to—
    4 ‘‘(A) the presence or storage of a lawfully possessed firearm or ammunition in the residence or on the property of an individual; or
    7 ‘‘(B) the lawful use, possession, or storage of
    8 a firearm or ammunition by an individual.

    here is what subsection (a)(1)(D) is all about:

    (b) Wellness and Prevention Programs.--

    For purposes of subsection (a)(1)(D), wellness and health promotion activities may include personalized wellness and prevention services, which are coordinated,
    maintained or delivered by a health care provider, a wellness and prevention plan manager, or a health, wellness or prevention services organization that conducts health risk assessments or offers ongoing face-to-face, telephonic or web-based intervention efforts for each of the program's participants, and which may include the following wellness and prevention efforts:

                ``(1) Smoking cessation.
                ``(2) Weight management.
                ``(3) Stress management.
                ``(4) Physical fitness.
                ``(5) Nutrition.
                ``(6) Heart disease prevention.
                ``(7) Healthy lifestyle support.
                ``(8) Diabetes prevention.

    how likely are guns to come up in a convo about diabetes, anyway?  stress is the only thing that would be remotely relevant to guns, and you can bet yer bippies wellness programs don't go that in depth.  

    Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

    by Cedwyn on Wed Dec 19, 2012 at 10:07:46 AM PST

    •  But could (9+ / 0-)

      certainly come up in discussion of "stress management," or "healthy lifestyle support."

      Discussions, within the context of a wellness session, that will be occurring with a physician.

      The point remains that none, none of these provisions are necessary, that gunowners' rights are a completely superfluous thing to be inserted into a health insurance reform law.

      They're there because the gun lobby wanted to prove they could be them there.

      "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

      by Joan McCarter on Wed Dec 19, 2012 at 11:00:09 AM PST

      [ Parent ]

      •  Yup Patient is totally 100% healthy (7+ / 0-)

        but they live with someone who has, say, a mood disorder or addiction?

        Is it safe to ask if they have guns?

        Gynocologists and PCPs often get into these sorts of convos with women. At least mine have. They asked and knew when I was dating/living with guys who had mood disorders and they asked if there was anything dangerous in the house,  specifically a gun, that we needed to worry about.

        They weren't worried about domestic violence because there was never any of that in my case, but just that "you never know" thing that very attentive physicians worry about.

        That's not allowed now?  Swell.

        © grover

        So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

        by grover on Wed Dec 19, 2012 at 11:34:56 AM PST

        [ Parent ]

        •  it is totally allowed (0+ / 0-)

          "wellness programs" are not part of regular care.  the legislation is not talking about private counseling, or even regular doctor visits.  

          read the legalese again; the prohibition has very limited application.

          Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

          by Cedwyn on Thu Dec 20, 2012 at 08:52:43 AM PST

          [ Parent ]

    •  "Stress management" = 'Mental Health", (2+ / 0-)
      Recommended by:
      Williston Barrett, lotlizard

      Cedwyn.  As in depression, anger management, suicidal thoughts, agitation, do we need to put you on psych meds.

      So the questions (from docs or in checklist/questionnaires) couldn't include 'Any guns in the house?' as a follow-up to questions about suicide, etc.

      Yes, the first quote you gave proscribes " the disclosure or collection of any information relating to".  In practical terms, that will come out to the medical personnel being told 'don't even ask -- they could sue us'.

      •  i've participated in "wellness programs" (1+ / 0-)
        Recommended by:

        for insurance purposes.

        and i am here to tell you they just don't go that in depth.  lotta questionnaires and websites with info to read.  feeling stressed?  make sure to get good sleep and exercise more!   yadda yadda.  

        Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

        by Cedwyn on Thu Dec 20, 2012 at 08:46:54 AM PST

        [ Parent ]

    •  I always asked my patients or their parents (5+ / 0-)

      when I was a mental health counselor in private practice this question, "do you have firearms in your home and how are they stored?"  Anyone with a mental health issue should not have access to any firearms.  Period.  I started doing this after I had one session with a 20 something who was despondent after his girlfriend broke up with him.  2 days later I opened the newspaper to see his picture-he was lying prone on the hood of his car with a rifle pointed under his chin, outside his girlfriend's home.  Police talked him down. He was hospitalized.  

      •  yes, counseling in private practice (0+ / 0-)

        you would not be prohibited from asking the question.

        all this precludes is generic wellness programs from asking those questions of participants.

        Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

        by Cedwyn on Thu Dec 20, 2012 at 08:48:26 AM PST

        [ Parent ]

  •  Cost of treating gunshot injuries (9+ / 0-)

    I have been doing some research on the cost of treating gunshot injuries in the US.

    It has been estimated that the direct hospital costs of treating gunshot injuries is between $2.1 - 2.5 billion dollars a year.  Somewhat between 5- - 80% of those costs are paid for with public dollars.

    Of course the proftis from gun and ammo sales are private.  But the costs of treating the results of gun use are largely bourne by the public.

    "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

    by Hugh Jim Bissell on Wed Dec 19, 2012 at 10:08:54 AM PST

  •  I've been incredibly impressed by the fact that (10+ / 0-)

    very same people who ranted, raved and screamed about Obamacare are the same people who are now ranting, raving and screaming that "it's not guns; it's a lack of adequate mental healthcare in this country."

    These people don't hear themselves. I often want to link back to their own Facebook posts. But they're the same ones that when a friend recently died from suicide by gun, they were angry at him. Furious, in fact. The blame always falls elsewhere.

    I don't know that there is much we can do with them. I really don't.

    I lost my best friend from suicide 20 years ago. I miss her every day. The NRA and its supporters don't care about human beings. They don't care about mentally ill citizens. They don't care about 20 dead children or the 6 heroic women who died valiently to save many more lives.

    They just don't.

    And Congress who allowed that language in Affordable CARE Act? Shame on every one of them.  Joan, I just don't see how we'll ever get that language out of the Act. And we'll never know how many more citizens we could have saved if we had the will to do so. But on that, I'm not an optimistic. Unringing that bell doesn't seem likely.  

    © grover

    So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

    by grover on Wed Dec 19, 2012 at 11:46:41 AM PST

  •  Doing everything to help (1+ / 0-)
    Recommended by:

    How about making psychiatrists, psychologists, and certified social workers responsible for immediately reporting to public officials any patient who might possibly pose a danger to himself or others? Perhaps we should make failure to report such a patient, if the patient then commits a serious crime, a matter that results in an immediate licensing hearing.

    •  I agree that this would be the right direction. (1+ / 0-)
      Recommended by:
      Faeya Wingmother

      But could it have the effect of discouraging people from getting help if they think their personal information is going to be reported to others?

    •  "Might possibly pose" (1+ / 0-)
      Recommended by:

      How is a psychiatrist supposed to know that?

    •  No. ABSOLUTELY not. (2+ / 0-)
      Recommended by:
      raincrow, Batya the Toon

      That would not only be an outrageous invasion of privacy, it would be incredibly harmful to public mental health. Stigma is already one of the greatest obstacles to getting people in the door, and mandatory reporting of "possible" danger to self or others would make it virtually impossible to get anyone to seek help until the point of a crisis. Think about it from the perspective of someone with a mental illness that isn't yet severe enough to be a danger to self or others: would you take the risk of having someone tell public officials that you might be dangerous?

      I was accused of plotting mass murder the day after the Virginia Tech shootings, just because I had a mental illness and someone (not a professional) thought I might fit the profile of the gunman. It destroyed my career and caused my mental health to get much worse, and even a successful lawsuit didn't fix that.

      •  But if this is true (0+ / 0-)

        and if a psychiatrist isn't supposed to be able to know who poses a danger, what, then, is the point of asking for better mental health care as a preventative for such tragedies?

        •  The psychiatrist's primary role (0+ / 0-)

          to treat the patient. The vast majority of patients are not violent, and treatment can reduce the risk of violence. The fact that you're asking this question suggests that you're at least subconsciously linking mental illness with violence; most diagnoses have no connection whatsoever with violence, and those that do have some link to violence are all very treatable.

          And better access to mental health care means people are less likely to fall through the cracks and become violent. It's not a reporting problem that you should worry about, it's a treatment problem. It should be obvious that better mental health care means people are less likely to reach the point where they become dangerous. Treat the illness, reduce the risk.

    •  Those laws already exist in some states, (0+ / 0-)

      based on the California Supreme Court's holding in the 1976 Tarasoff v. Regents of University of California case, that psychotherapists could be liable for failing to exercise reasonable care when they know or should know their patient presents a serious danger of violence to a third party. But certainly not all states have such standards, and proving one way or the other in court is a formidable task. Warning a 3rd party of danger is a direct violation of patient confidentiality, so the warning can only go to law enforcement. However, some states give the therapist the option to report (e.g., Texas) to law enforcement, and there is no duty to report or liability for not reporting.

      I can't say for sure, but I have a feeling the most widespread mandatory duty-to-report has to do with health care providers, teachers, ministers, etc., who suspect or know of child abuse.


      by raincrow on Wed Dec 19, 2012 at 09:00:11 PM PST

      [ Parent ]

      •  It's actually a VERY limited duty. (1+ / 0-)
        Recommended by:

        Tarasoff only requires psychotherapists to report a serious danger to a specific, identifiable person. If the target is not identifiable, reporting the patient is still an unlawful breach of confidentiality.

        •  Yes. (1+ / 0-)
          Recommended by:

          That is as it should be, IMO; but I also understand giving the therapist the choice whether or not to report. Otherwise some people who need help the most will not dare seek treatment.

          Individual liberty is supposed to be so highly valued that the nation tolerates some risk to maximize that liberty -- and this may mean that a person perceived as possibly dangerous is allowed to remain at large. As you found out in such a horrible way, the consequences to the individual when the state fucks up are catastrophic. This is one reason why involuntary commitment is such a thorny issue -- who decides, who chooses the deciders, what sanctions can be made on deciders who turn out to be incompetent, what happens when a grievous mistake is made, how do we set up a process that allows a wrongfully committed person to be substantively compensated when their reputation and/or career has been damaged or destroyed, etc.


          by raincrow on Thu Dec 20, 2012 at 03:54:48 PM PST

          [ Parent ]

  •  Shrinks do not actually have a good track record (4+ / 0-)

    of "fixing broken people". Their track record is almost entirely one of expanding markets for Big Pharma, to help medicate out of view the fact that we have a completely broken society. Many mass shooters were already on psychiatric medications.

    While I strongly support health care for all, including mental health care, I think it is naive to assume that this will somehow prevent mass shootings. Psychiatrists are not able to predict such things. Medicalizing the problem of American violence will simply increase the number of American children taking psychiatric medications.

    Limiting access to guns, on the other hand, would make a big difference.

    •  Deviation from the norm is considered mental (3+ / 0-)
      Recommended by:
      atana, annieli, raincrow

      illness in our society.

      "The two pioneering forces of modern sensibility are Jewish moral seriousness and homosexual aestheticism and irony." Susan Sontag

      by Shane Hensinger on Wed Dec 19, 2012 at 06:38:45 PM PST

      [ Parent ]

    •  I run a mental health support forum with 20k users (6+ / 0-)

      I've been doing it for seven years.  That's thousands of people giving testimony every day that proves you're full of shit.

      I take six different psych meds a day.   I would be disabled, if not dead, without them.  

      I hate big pharma.  I hate for-profit medical care period.  I still have to acknowledge that psych meds often work wonders, particularly when combined with therapy.

      Why shouldn't the brain be treated like any other organ when it malfunctions?   Where are the hand wringers calling on people not to medicalize high blood pressure?


      Praxis: Bold as Love

      by VelvetElvis on Wed Dec 19, 2012 at 06:42:43 PM PST

      [ Parent ]

      •  The simple answer to your last question (1+ / 0-)
        Recommended by:
        Shane Hensinger

        is that we know more about other organs than the brain. There are objective measurement of renal function, liver function, pancreas function. There are no objective measurements of psychological "function".

        I full agree that the goal should be a science-based medicine which includes the brain. But there simply is no science based medicine today which can predict who is going to be a shooter. It just isn't here yet.

      •  Psych meds worked wonders for me, my sister, (1+ / 0-)
        Recommended by:

        my stepdaughter, and numerous friends over the years. Some of us would likely not be alive today without those meds.


        by raincrow on Wed Dec 19, 2012 at 09:02:05 PM PST

        [ Parent ]

        •  And thousands of transsexuals who died because (0+ / 0-)

          shrinks would not give them the "psych meds" they needed -- hormones -- would be alive today if the shrinks had not been in control of access to those meds.

          I, like thousands of others, am alive today because the Internet made it possible to get hormones without the approval of transphobic shrinks.

          It was the Internet, not psychiatry, that has freed us.

          •  And this has *what* to do with the effectiveness (1+ / 0-)
            Recommended by:

            of meds? (Don't look now, but you've made my case for me.)


            by raincrow on Wed Dec 19, 2012 at 10:11:05 PM PST

            [ Parent ]

            •  What does that have to do with the purported (0+ / 0-)

              ability of psychiatrists to determine who is someday going to be a shooter.

              And no, the fact that transsexuals were right about our medical needs, while psychiatrists did us immense harm by denying them does not make your case. It simply proves that psychiatry blows around in the political winds. Science based medicine does not.

              •  Honestly, it astounds me how many people on DKos (0+ / 0-)

                view psychiatry/psychology as a religion. They have infinite faith in its omniscience -- "let shrinks screen all school kids to find the ones who will be mass murderers".

                You'd do about as well using Tarot card readers to screen them as shrinks.

                •  Psychiatrists and psychologists get things wrong. (0+ / 0-)

                  Sometimes fatally wrong.  It happens a lot.

                  They also get things right and save lives.  That happens a lot too.

                  It doesn't make any more sense to say "Psychiatrists never helped anyone" than to say "Psychiatrists are infallible."  Of course they're fallible.  That doesn't mean relying on their help is any more stupid than relying on pretty much any other human institution that has ever existed.

                  •  Astrologers say the same thing. (0+ / 0-)
                    •  Possibly true, but irrelevant. (0+ / 0-)

                      Above, you wrote:

                      And thousands of transsexuals who died because shrinks would not give them the "psych meds" they needed -- hormones -- would be alive today if the shrinks had not been in control of access to those meds.
                      Let's be clear here: it is terrible that psychiatrists have failed so many because of unexamined biases about gender and sexuality.  It is monstrous.

                      But it is monstrous precisely because psychiatrists are capable of helping.

                      Unless you're going to tell me that you resent astrology for being biased, I call shenanigans on that comparison.

                      •  No, my point was that psychiatrists (0+ / 0-)

                        don't admit their mistakes or learn from them, any more than astrologers do. This is mark of quackery.

                        The human rights atrocities of the field are just swept under the carpet. The current chairman of the DSM-V gender dysphoria committee has made his career out of human rights atrocities: torturing trans kids to make them gender normative.  

                        Psychiatry is as pseudoscientific and ethically challenged today as it was when it when used forced sterilizations for "feeblemindness" -- or when it "diagnosed" runaway slaves with "Drapetomania".

                        •  I see your comparison with astrology there. (0+ / 0-)

                          But I still maintain that there's a difference between "there is pseudoscience and unethical behavior in the field" and "the field is nothing but pseudoscience and unethical behavior".

                          •  Neuroscience will eventually displace (0+ / 0-)

                            clinical psychology and psychiatry, but (American) psychiatry is far too incestuous with Big Pharma. DSM in particular should be junked entirely; only an international medical body should be involved in defining medical conditions, not the American Psychiatric Society.

  •  The NRA is a cancer on American civil society. (2+ / 0-)
    Recommended by:
    RadGal70, Miggles

    It needs to be cut out, and everything it touched irradiated.  Including now, it seems, the ACA.

    "And now we know that government by organized money is just as dangerous as government by organized mob." -- FDR

    by Mogolori on Wed Dec 19, 2012 at 06:15:43 PM PST

  •  All we do is shoot at you, the whole night through (0+ / 0-)

    "Let's see what fresh fuckwittery these dolts can contrive to torment themselves with this time." -- Iain Banks, The Hydrogen Sonata

    by Rikon Snow on Wed Dec 19, 2012 at 06:21:42 PM PST

  •  If you fear "the government" (3+ / 0-)
    Recommended by:
    tobendaro, ModerateJosh, Miggles

    showing up at your door and prying your pistol out of your hand, then you are, therefore, by definition paranoid and mentally ill and are disqualified fom owning a gun by your own criteria.

    Money doesn't talk it swears.

    by Coss on Wed Dec 19, 2012 at 06:25:12 PM PST

    •  And furthermore (0+ / 0-)

      If you truly fear the government, why do you tend to be the first in line demanding that we spend billions more on the same military that will be tasked with taking your weapons away?

      Money doesn't talk it swears.

      by Coss on Wed Dec 19, 2012 at 07:59:55 PM PST

      [ Parent ]

    •  Tell that to the graves of elected leaders (0+ / 0-)

      we helped assassinate to further our foreign policy goals. Tell that to people the CIA subjected to extraordinary rendition.

      You are DEFINITELY paranoid and mentally ill and disqualified from owning a gun if you fear "the government" showing up at your door and...

      Tell that to Kenneth Wright of Stockton, CA:

      Tell that to Seattle Occupy activists:

      Tell that to the corpse of Marine veteran Jose Guerena, and, while you're at it, his wife and child:

      Tell Stephanie Milan and her family:

      Tell it to Ricky Ortega:

      Tell it to this family:

      And this family:

      And her:

      Oh, and this family:

      And these deserving scum:

      More deserving scum:

      Occupy scum:

      Journalist scum -- thank God for Sheriff Joe

      Pot activist scum:

      Just some blah person:

      12-year-old scum who got what was coming to her:

      And as much as I'm no fan of the CATO Institute, this is worth at least a little peek:

      Yep, you are DEFINITELY paranoid and mentally ill and disqualified from owning a gun if you fear "the government" showing up at your door and...


      by raincrow on Wed Dec 19, 2012 at 10:06:38 PM PST

      [ Parent ]

      •  I doubt simple gun ownership (0+ / 0-)

        was the origin of their fear. And that is my point.

        Money doesn't talk it swears.

        by Coss on Wed Dec 19, 2012 at 10:28:07 PM PST

        [ Parent ]

        •  I'm not sure you understand THEIR point. (0+ / 0-)

          Some people do not trust the powerful to use their power wisely or well. Some people believe power corrupts and absolute power corrupts absolutely.

          Some of those untrusting people avail themselves of the law of the land, which allows them to buy firearms as tools of self-defense, hunting, and even insurrection.

          They do not trust that the law of the land will continue, over the long run, to afford them the right to buy firearms; and they fear the mindset of the people who would take away their tools of self-defense, hunting, and even insurrection.

          When that change in law comes, some of them fear the government will actively take steps to confiscate their guns -- because they're not complete fools and know what governmental power can do.

          Other perhaps more trusting people contend that gun owners who fear the potential for governmental confiscation are paranoid and mentally ill, hence should be disqualified from owning guns --- the clear implication being that only people with disordered thinking are afraid of government overreach and abuse of power.

          I have presented to you a few tastes of gross, even fatal, abuse of power by state and federal governments to demonstrate that all of us, not just private gun owners, are justified in some degree of fear of " 'the government' showing up at [our] front door..."

          I would argue this demonstrates that gun owners are reading the possibilities (not yet the realities) quite realistically.

          Now: if the government comes to a gun owner's door one day holding out the list of guns it thinks that gun owner should have in his/her possession, and asking to inspect and confirm the gun owner has those firearms under lock and key, should the gun owner resist? And if the gun owner resists, should that resistance be mounted in a courtroom or at the front door of his/her residence? These questions are entirely separate from a fear of government overreach.

          Well-documented accounts of previous government actions clearly demonstrate that fear of "the government" is not necessarily a sign of paranoia or mental illness.

          I myself don't think there will be door-to-door demands for firearms anytime soon, for what that's worth.


          by raincrow on Thu Dec 20, 2012 at 03:43:59 PM PST

          [ Parent ]

  •  Thank you so much for this information... (0+ / 0-)

    I had no idea.

  •  Let me get this straight (1+ / 0-)
    Recommended by:

    These gun fetishists don't trust the government, but they trust the government to evaluate whether each of us is mentally sound enough to own a gun?


    Money doesn't talk it swears.

    by Coss on Wed Dec 19, 2012 at 06:27:41 PM PST

  •  See Pierce conversation with DeSalvo on this (2+ / 0-)
    Recommended by:
    Williston Barrett, raincrow

    Charles P. Pierce had a conversation with Karen DeSalvo, City of New Orleans Commissioner of Health. The city has a horrendous murder rate.

    ...New Orleans has the highest per capita murder rate in the country. It has had a murder rate of eight times the national average for almost three decades now. Somebody, usually a young black male, is killed almost once every other day, usually with a gun.

    "We have a public-health approach to violence in New Orleans," said DeSalvo. "We believe that violence is a transmissible thing, just the way a disease is. You have a source population, and a means of transmission — that would be the gun — and you have a susceptible population, into which the violence is transmitted."

    DeSalvo's approach has been to deal with each of these three elements of epidemic violence as a part of a greater whole, which means the approach includes law-enforcement, mental-health counseling, and training for public officials, including school teachers, in the techniques necessary to build what DeSalvo calls "a trauma-resistant and resilient community."

    emphasis added

    "No special skill, no standard attitude, no technology, and no organization - no matter how valuable - can safely replace thought itself."

    by xaxnar on Wed Dec 19, 2012 at 06:29:27 PM PST

  •  What would happen if a doctor ignored (0+ / 0-)

    the rule and asked and kept a record for herself?  Would she lose her job?  Have her license stripped?  Because all of us ignore rules we don't like when we can.  

    I hope some doctors keep records anyway.  Someone will need them sometime.

  •  I don't see a clear connection here at all (1+ / 0-)
    Recommended by:

    Some people just snap - there's no evidence to show that providing more mental healthcare is going to solve the problem. The mental healthcare community keeps diagnosing more and more "mental illnesses" every time it rewrites DSM but there's little to no evidence to show that's actually helping make society a mentally healthier place. Kids who backtalk their parents are now diagnosed with a mental illness - it's absurd.

    "The two pioneering forces of modern sensibility are Jewish moral seriousness and homosexual aestheticism and irony." Susan Sontag

    by Shane Hensinger on Wed Dec 19, 2012 at 06:35:18 PM PST

  •  Speaking as someone who has been suicidal (6+ / 0-)

    This really irks me.  The idea that these people would prevent a mental health profession from doing everything they can to help me not off myself when I'm out of my gourd is offensive.

  •  I would like to know which MoC (0+ / 0-)

    ...inserted that language (was it you Max Baucus?).  If it was Democrats, that should be made known in their primaries.  If it was Republicans, just another reason for the pachyderms to STFU.

    50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

    by TarheelDem on Wed Dec 19, 2012 at 06:42:21 PM PST

  •  Remember, it's the opponents of gun legislation (2+ / 0-)
    Recommended by:
    Miggles, Williston Barrett

    ... who are directing our attention to solving other problems of society. And it's consistent with their argument that only the mentally ill will use a gun to mow down a classroom of children or a Congresswoman meeting constituents.

    Of course, we should devote more of society's resources to identifying, treating and de-stigmatizeing mental illnesses, but NOT instead of legislation to make guns much less available, much harder to get and holding accountable those who own, sell or trade them.

    2014 IS COMING. Build up the Senate. Win back the House : 17 seats. Plus!

    by TRPChicago on Wed Dec 19, 2012 at 06:42:29 PM PST

  •  "Maybe this time the gun lobby won't shut that (0+ / 0-)

    conversation down."

    That seems about as likely as the GOP suddenly demanding a 50% tax rate on income over $250k.

  •  Paragraph long typo in this article! (1+ / 0-)
    Recommended by:


    The above entitled article states:

    "But remember what happened when President Obama and Democrats in Congress thought about maybe addressing some of those questions in the Affordable Care Act? This happened, an entire section of the law devoted to the protection of gun ownership and to shutting down the discussion."

    I am just curious, what Republicans voted for the Obamacare bill?

    Oh wait...none did...

    in either the House or the Senate...

    Thus, I suppose that the article really meant to say that the only reason that the NRA was able to add an entire section to the law and get it passed was because every Democrat in the House and Senate that voted for Obamacare and the President himself that signed it, wanted it written that way!

    How could such a blatant typo slip by the editors of the article?


    •  Good point. n/t (0+ / 0-)

      The Dutch kids' chorus Kinderen voor Kinderen wishes all the world's children freedom from hunger, ignorance, and war.

      by lotlizard on Thu Dec 20, 2012 at 04:42:44 AM PST

      [ Parent ]

      •  One other thing (0+ / 0-)


        I, like many people that are concerned about gun rights do not want to see the ability for truly mentally disturbed people to have access to any weapons they can kill with (be they guns, bows and arrows, sling shots, poison darts, anything...).

        But the real problem is not, how do we ban this gun or that gun, the real problem is how do we solve conflicts between well intended laws that cause unreasonable and unintended circumstances.

        When the HIPPA laws were written (to protect the medical privacy rights of individuals) the intention was perfectly righteous (I support having my medical records private). However, now we have an environment where if a State or Commonwealth releases mental health records to the FBI's National Instant Criminal Background Check System (NICS), in many these States and Commonwealths can then be sued pursuant to HIPPA for doing so by the patient whose records are involved!

        So what do States and Commonwealths do?

        States and Commonwealths are loath to release information to NICS because they cannot afford to be sued. Would it make sense to have an exemption stating that States and Commonwealths could not be sued in such an instance?? SURE...but guess what? Are we going to have a debate about how to really write laws that deal with the mentally ill and their access to weapons or people that live with mentally ill patients and own weapons? Nope...its far more fun politically and in the media to argue over what is an assault weapon and what is not...wonderful...


  •  Lack of mental health (1+ / 0-)
    Recommended by:

    facilities is another problem.  Psychiatrists can only recommend or admit X number of patients for inpatient treatment.  We have a shortage of beds and services.  Thus, several mass murders were committed by people who were asking for help but not receiving it (e.g., the Carson City & Aurora shooters).  Even more often, families asked for help and didn't receive it (e.g., the Seal Beach shooter).  

    President Carter passed a great bill that gave the U.S. a solid national mental health care system and then Reagan destroyed throwing about 20,000 inpatients onto the street where most of them ended up in more expensive jails after proving that they couldn't make it on the outside.  Chances are those children and Adam Lonza's mother were victims of a broken mental health care system and a society that allows deranged individuals and their families to purchase assault weapons.  

  •  I have to wonder if the rabid gun fanatics (0+ / 0-)

    are really afraid they will be diagnosed with their anti--social & psychotic paranoid mental health issues?

    How would they sanely answer questions about large stashes of guns, assault weapons & ammo that would avoid raising red flags?

    I think they really know that survivalist anti-government fantasies are crazy & a public safety concern, esp. with the amount of drug & alcohol use that is so common in our society.

    Something that doesn't make good sense, makes bad sense. That means someone is being deliberately hurtful & selfish. Look for motives behind actions & words.

    by CA wildwoman on Wed Dec 19, 2012 at 09:13:43 PM PST

  •  Hear hear! (0+ / 0-)
    We can multi-task. We can take care of the broken people and make sure they can't get their hands on fucking guns.

    If there's one thing about this discussion (I don't mean just in this diary; the wider discussion) that's deeply bothering me, it's that too many people are talking about which of the possible solutions would be most effective as though we can only implement one of them.

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