Social Justice Presentation: Firearms and Mental Illness

1. Social Justice Presentation: Firearms and Mental Illness Shayna Cox, Maggie McGowan, & Rachel Scheiding

2. General Information • The leading indicators of potential for violence include being young, male, and having a substance use problem (Huffington Post, 2012). • Mental Health America, an alliance of mental health advocacy organizations, is considering taking a stance on gun laws as of January 2013 (Washington Post, 2013). • In 2007, NAMI testified before congress explaining how current definitions in gun control laws are vague and lead to holes in compliance and enforcement. To date, there has been little effort by Congress to change the law in a way that is not overly broad, but also avoids unfair damaging discrimination (NAMI, 2012).

3. Overview • Individuals with lifetime mental disorders were as likely as those without to have access to a gun (34.1% vs 36.3%) or to carry a gun (4.8 vs 5%) (Ilgen et al. 2008). • Appelbaum & Swanson (2010) looked at the federal and state laws to restrict access to firearms among people with MI and found that these laws have little measurable impact. • The contribution to public safety of these laws is likely to be small because only 3%-5% of violent acts are attributable to mental illness, and most do not involve guns. • “The laws may deter people fro mseeking treatment for fear of losing the right to possess firearms and may reinforce the stereotypes of persons with mental illness as dangerous.”

4. Gun Control Act of 1968 • The Gun Control Act of 1968 restricts “prohibited persons” from purchasing firearms, including individuals addicted to controlled substances, those involuntarily committed to a mental institution or adjudicated as incompetent or dangerous, or those who receive a verdict of not guilty by reason of insanity. • The Gun Control Act incentivizes states to further regulate by making it a federal offense to sell firearms to individuals whose possession would violate state law. Given the ineffectiveness of current restrictions on access to firearms for “dangerous” individuals with mental illness, the government must improve safeguards against firearms-related violence.

5. Gun Control Act of 1968 • This Act was ultimately a result of the JFK, Martin Luther King, Jr., and Robert Kennedy assassinations. • 4 months after Robert Kennedy was killed, President Lyndon B Johnson signed this act into law, banning mail order sales of rifles and shotguns and prohibiting most felons, drug users, and people found mentally incompetent from buying guns.

6. HR 2640 • Passed in December 2007 • Gave states permission to create systems for reporting the names of individuals prohibited from possessing or purchasing firearms, including people who have been involuntary committed to psychiatric hospitals • Improvement to the National Instant Criminal Background Check System (NICS) • Used denigrating language when it described persons “adjudicated as mental defectives” • 2 categories used: NGRI & civil commitment • These categories “speak to perceived riskiness at the time of a past crime or hospital admission but do not speak clearly to future risk”

7. Federal Law (NCSL, 2013) • Possession of a firearm by the mentally ill is regulated by both state and federal laws. • Under 18 U.S.C. § 922(d), it is unlawful for any person to sell or otherwise dispose of any firearm or ammunition to any person knowing or having reasonable cause to believe that such person “has been adjudicated as a mental defective or has been committed to any mental institution.”

8. State Law (NCSL, 2013) • Ohio Rev. Stat. §2923.125 • No person shall acquire, have, carry or use any firearm if he or she: • Is under adjudication for mental incompetence, has been adjudicated as a mental defective, committed to a mental institution, found to be mentally ill subject to hospitalization by court order, or is an involuntary mentally ill patient. • Ga. Code Code §16-11-129 • Licenses will not be issued to any person: • Who has been hospitalized as an inpatient in any mental hospital or alcohol or drug treatment center within five years of the date of his or her application. • W.Va. Code §61-7-7 • No person shall possess a firearm if he or she has been adjudicated as a mental defective or has been involuntarily committed to a mental institution.

9. State Law (NCSL, 2013) • D.C. Code § 7-2502.03 • To obtain a registration certificate, an applicant must pass a background check conducted by the Chief of Police (this is in addition to the NICS check required by Brady when purchasing from a federally licensed dealer). Section 7-2502.03 requires that the Chief confirm that the applicant: • Within the 5 years immediately preceding the application, has not been acquitted of any criminal charge by reason of insanity or has not been adjudicated a chronic alcoholic by any court; • Within the 5 years immediately preceding the application, has not been voluntarily or involuntarily committed to any mental hospital or institution. • Very few of the laws mention being hospitalized for substance abuse only.

10. Gun Violence Prevention Proposal • “Now is the Time Plan” • Every person will be required to go through a background check to determine whether they have a criminal history or a diagnosed mental illness • Improving state reporting of criminals of the mentally ill • Obama will put more money into the hands of the states so that they can improve their reporting systems and issue stronger guidelines to let states know when they should report people to the National Instant Criminal Background Check System • Obama wants to encourage mental health providers to report homicidal clients by putting into law that it would not be a violation of privacy/HIPPA to do so

11. Overview of Oppression & Discrimination on Clients in the 21stCentury, continued • Careers • Military, law enforcement • Hunting

12. Federal Bureau of Investigation (2011) • 7.3 million people who are forbidden to own guns as of December 31, 2011 • 1.4 million of the 7.3 million are forbidden to own guns because they were involuntarily hospitalized for mental illness • Once you are on the registry, you can petition to be removed, but it is very difficult.

13. How Far Have We Advanced in Social and Economic Justice? • Advancement in Social Work Practice • People have a better understanding that being mentally ill does not necessarily mean being violent • Too far the other direction in Policy? • The overall attitude of society is that “mentally ill people are scary and violent” • Funding cuts in treatment prevent individuals with mental illness from receiving treatment

14. Social and Economic Justice: Duty to Protect

15. Tarasoff v. Regents of Univ. of California, 1976 • When a therapist determines or according to the standard of his/her profession, should determine, that the patient presents a serious danger of violence to another, he/she incurs an obligation to use reasonable care to protect the intended victims from danger.

16. Duty to Protect Options • Notify intended victims • Notify law enforcement • Hospitalization • Increased office visits– medication increase • Other reasonable steps

17. H.B. 71 in ORC 2305.51 • What does it do? • Limited liability to explicit threats of imminent and serious harm to a clearly identifiable victim or structure; AND • The professional believes that the patient has the intent and ability to carry out the threat

18. Increased Threat Risk • Made face to face • More specific • Identity is revealed • Introduced late in a controversy

19. Reasonable steps to reduce potential violence: • Address patient anger in psychotherapy • Increasing the frequency of sessions or meds • Incorporating other parties into treatment • Asking the patient to relinquish weapons • Treatment of substance abuse

20. Case Example

21. Case Example: • 1/90 First psychotic symptoms • 3/90 Philadelphia hospital improvement • 10/90 FFMC M.D. stops prescribing meds • 7/91 M.M. shot his family

22. Morgan v. Fairfield Counseling • Ohio Supreme Court, 1997 • Duty to Protect unidentifiable victims from outpatients • Professional judgment standard • Eviscerates immunity provision • When a psychotherapist knows, or should know, that his outpatient represents a substantial risk of harm to others, the therapist must exercise his best professional judgment to prevent such harm.

23. Duty to Protect • MORGAN • Any danger • Any victim • Remote harm • Hospitalize • HB 71 • Explicit threat • Identifiable victim • Imminent harm • Four options

24. Extent of Duty Comparison • Morgan: Psychotherapist knows or should know the patient is “a substantial risk of harm.” • HB71: Explicit threat of imminent and serious harm and… intent and ability to carry out the threat.

25. Ohio Duty • 1. Limited to explicit threats of imminent and serious harm to a clearly identifiable victim; AND • 2. The professional believes that the patient has the intent and ability to carry out the threat.

26. Limits of Duty • Explicit threat • Directly communicated • Imminent and serious harm • Identifiable victim • Intent and ability to do it

27. Clinician Options • 1. Emergency hospitalization • 2. Voluntary or involuntary hosp. • 3. Treatment plan to decrease risk and consultation (clinical director) • 4. Notify police and victim • DO NOT NEED CONSENT; LEGAL RIGHT TO INFORM. • #4 MUST BE SO CONCRETE YOU CANNOT ARGUE IT

28. Ohio Statute • Clinician must document the reasons for choosing or rejecting each alternative. • Clinician is not required to take any action that increases danger to self, the intended victim, or the patient.

29. Risk Reduction Plan • Notify potential victims • Notify police • Remove weapons • Anger management • Relative for early warning • Frequent visits

30. Remember: • Risk to human life ALWAYS trumps confidentiality. • Consider getting a consultation in these cases. • MAKE SURE TO DOCUMENT

31. Do you Engage in Practices that Advance Social and Economic Justice? • Rachel • Shayna • Maggie • Being proactive about learning the steps that people can take to have themselves removed from the National Instant Criminal Background Check System in order to have their gun rights reinstated

32. References National Conference of State Legislatures [NCSL] (2013). Possession of a firearm by the mentally ill. Retrieved from http://www.ncsl.org/issues-research/justice/possession-of-a-firearm-by-the-mentally-ill.aspx U.S. Department of Justice. Bureau of Alcohol, Tobacco, Firearms and Explosives (2005). Federal Firearms Regulation Reference Guide. Washington, D.C. Retrieved from http://www.atf.gov/publications/download/p/atf-p-5300-4.pdf Federal Bureau of Investigation (2011). National Instant Criminal Background Check System. Huffington Post (2012). Gun control laws fail to keep mentally ill away from guns. Washington Post (2013). Sandy Hook shooting reshapes the lobbying landscape on gun laws, mental health services.

33. References National Alliance on Mental Health [NAMI] (2012). Gun laws and mental health. Retrieved from http://blog.nami.org/2012/08/gun-laws-and-mental-health.html whitehouse.gov (2013). Now is the time: The president’s plan to protect our children and our communities by reducing gun violence. H.R. 2640 (110th). NICS Improvement Amendment Acts of 2007. GovTrack. US. Retrieved from http://www.govtrack.us/congress/bills/110/hr2640 Appelbaum, P.S. & Swanson, J.W. (2010). Gun laws and mental illness: How sensible are the current restrictions? Psychiatric Services, 61, 652-654. Ilgen, M.A., Zivin, K., McCammon, R.J. & Valenstein, M. (2008). Mental illness, previous suicidality, and access to guns in the United States. Psychiatric Services, 59, 198-200.