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Experts discuss mental health provisions in the executive order on gun control

An emotional President Barack Obama pauses as he speaks about the youngest victims of the Sandy Hook shootings, Tuesday, Jan. 5, 2016, in the East Room of the White House in Washington, where he spoke about steps his administration is taking to reduce gun violence. (AP Photo/Jacquelyn Martin)

While much of the buzz surrounding President Obama's highly-anticipated announcement on gun controls focused on the shrinking of the so-called "gunshow loophole," the efforts of his administration to, "increase mental health treatment and reporting to the background check system," are gaining some attention.


The administration's plan for dealing with mental health as it relates to gun control takes a three pronged approach.

The first is dedicating "significant new resources to increase access to mental healthcare." The administration proposed a new $500 million investment. The White House described that the fund will, "help engage individuals with serious mental illness in care, improve access to care by increasing service capacity and the behavioral health workforce, and ensure that behavioral health care systems work for everyone."

Georgetown forensic psychiatrist and editor and author of "Gun Violence and Mental Health," Dr. Liza Gold described more funding is, "always a good thing."

Through an executive order in 2013, Obama removed the ban on the CDC from conducting research, however, Gold explained during the last two budget proposals, "Congress has killed that part of the budget."


During his remarks in the East Room Tuesday, Obama lamented that "Congress actually voted to make it harder for public health experts to conduct research into gun violence."

Gold stressed the importance of research, "specifically to help guide policy that's effective," adding that it is very unlikely that the addition of another restriction on who can purchase weapons "not based in science is going to make any difference."

This lack of scientific evidence is exactly the reason Gold is concerned about the second element of Obama's proposed executive actions.

The second initiative would include the information from beneficiaries of the Social Security Administration (SSA) in the NICS background check system.

According to the White House, the SSA will be required to report on the, "approximately 75,000 people each year who have a documented mental health issue, receive disability benefits, and are unable to manage those benefits because of their mental impairment, or who have been found by a state or federal court to be legally incompetent."

"Mental health prohibitors based on the misconception that people with mental health issues are dangerous," Gold cautioned.

Gold called this change the addition of, "another of category of mental health prohibitors to the NICS." Gold noted that beneficiaries of SSA qualify by an administrative decision and not based on an "individualized assessment," of their mental health.

This action Gold suggested, "adds another [prohibitor], instead of fixing the ones we have."

"While the words are there going in the right direction on stigma [and] stereotypes, the proposed executive actions actually just do what has been done before and are unlikely to make much of a difference."

"Overall I think it's a wonderful thing [Obama] is taking this on head on, I just wish there was a way people could become more educated of the complexity of mental illness and firearms based on evidence," Gold said.

In an ideal world, Gold suggested there would be "a movement towards doing away with categorical health positions."

Gold suggested other alternative limitations that may be more effective. One example provided was developing a mental health prohibitor for people who are released from a mental health institution.

According to Gold, people are at a higher risk of committing suicide in the year after they are released from a mental institution. This statistic applies whether the person was committed involuntarily or voluntarily, Gold explained.

"Why not?" Gold proposed having a mental health prohibitor for the year after a person is released.

Such a restriction would be more likely to cut the number of deaths by gun violence because, "people with mental illness commit suicide far far more frequently than mass killings."

As tragic as mass shootings are, Gold explained "they are only a tip of the iceberg," citing that statistically they make up less than one percent of all gun fatalities annually. It's challenging, Gold said, "to stop something statistically so infrequent."

Also putting the numbers in perspective, Obama described that, "nearly two in three gun deaths are from suicides."

"So a lot of our work is to prevent people from hurting themselves." Mentioning that aforementioned $500 million for expanding treatment, Obama described the third element of his plan aimed at filling in "the gaps in the background check system."

The third rule mentioned in the executive action is the removal of "unnecessary legal barriers," that keeps states from reporting relevant information to the background check system.

As Politico's David Pittman described, the Brady law, " prohibited gun ownership by individuals who have been involuntarily committed, found incompetent to stand trial or otherwise deemed by a court to be a danger to themselves or others. But, "federal health care privacy rules prohibited doctors and other providers from sharing information without the consent of their patients."

When the rule takes effect in 30 days, Pittman wrote: "for the first time health providers can disclose the information to the background check system without legal repercussions."

The ruling allows HIPPA covered entities, "provide to the NICS limited demographic and other necessary information about these individuals," according to the White House.

As Dr. Jonathan Metzl, Director, Center for Medicine, Health, and Society, at Vanderbilt University described the provision may not be the most effective policy for predicting potential attacks.

"I think in the past, we built on the faulty assumption that there is some psychiatric diagnosis that made people more likely to commit violence," Metzl described. This assumption, experts said is unfounded.

In a February article for the American Journal of Public Health, Metzl and Dr. Kenneth T. MacLeish explained, "four assumptions frequently arise in the aftermath of mass shootings in the United States."

Those assumptions are: that mental illness causes gun violence, that psychiatric diagnosis can predict gun crime, that shootings represent the deranged acts of mentally ill loners, and that gun control "won't prevent" another Newtown.

Conceding that each of those assumption is "certainly true in particular instances," Metzl and MacLeish demonstrate that, "notions of mental illness that emerge in relation to mass shootings frequently reflect larger cultural stereotypes and anxieties about matters such as race/ethnicity, social class, and politics."

"These issues become obscured when mass shootings come to stand in for all gun crime, and when 'mentally ill' ceases to be a medical designation and becomes a sign of violent threat."

Metzl and MacLeish write that there are a number of states that currently mandate "psychiatrists assess their patients for the potential to commit violent gun crime."

"History suggests, however, that psychiatrists are inefficient gatekeepers in this regard."

Gold described New York's Safe Act which gathered "millions of reports of people with mental illness," but resulted in "only a handful of confiscations."

"When you force doctors to be mandated reporters, there is a higher risk of over-reporting, it also raises very complex issues of confidentiality and privacy [and] does so in a context where the benefit to society at large, there's no evidence to support a public benefit."

"Depending on what level you make it reportable you'll just get more and more and more names."

Ron Honberg, Legal Director, National Alliance on Mental Illness warned of the risk of reporting too many cases: "the concern is that we not be overly broad in our reporting.

"That's why we need to do this very, very, carefully and the devil, frankly, is going to be in the details."

As experts point out, conversations regarding gun control often involve discussions over mental health.

"Even though mental illness isn't the cause of gun violence, because that misconception is so widely held [it makes it] difficult to restrict access to fire arms without talking about mental illness," explained Gold.

Metzl described the White House seemed to be making an effort to be sensitize and avoid stigmatizing, and described the way they had included mental health initiatives with a series of others as "encouraging."

Viewing gun control in the broader context, and, "not addressing mental illness in isolation implies that it's not just a mental illness problem," Metzl said, but instead a larger societal one.

Speaking to members of Congress who "rush to blame mental illness for a mass shooting as a way of avoiding action on guns." Obama described his actions as an opportunity to support these efforts.

"Put your money where your mouth is," he charged.

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