How is the issue mental health


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dh55
February 4, 2013, 12:41 AM
Its up to the individual psychiatrist to determine if you have freedom or not. What if they believe you are racist and that it is a mental disease? Or what if they are a muslim and declare you addicted to substances for any admission of drinking?

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Solo
February 4, 2013, 12:45 AM
Well, there's the DSM-5 (http://www.dsm5.org/Pages/Default.aspx).

What's wrong? Worried a PETA-sympathizing shrink might declare you a psychopath for being an "avid hunter"?

dh55
February 4, 2013, 12:49 AM
Have you read any local news comments. Psychiatrists come from the same population.

Solo
February 4, 2013, 12:51 AM
Oh yes, the local news comments. I'm sure MDs have nothing better to do than spend tons of time expressing their opinions there.

goon
February 4, 2013, 01:30 AM
The mental health side of this issue is as scary as the gun control side of it. There are millions of people with mild conditions who either get by with no treatment or who are fully functional and harmless with effective treatment who should still be protected.

I hope our representatives are smart enough to come up with a system that takes that into account.

allaroundhunter
February 4, 2013, 01:37 AM
dh55,

Doctors have a moral and legal obligation to do what is right for their patients. While some might be anti-gun, very few of them will use their position to push that agenda if it is up to them to determine if a person is competent to own a firearm. Even if one were to, there are many other psychiatrists (some of whom are pro-gun) that one can get a re-evaluation from.

What if they believe you are racist and that it is a mental disease? Or what if they are a muslim and declare you addicted to substances for any admission of drinking?

What experience do you have with psychiatrists? Or doctors in general for that matter? Neither of these statements are reasonable points because they are both very far-fetched. So far-fetched as to be silly, actually...

Just because one doctor is against gun ownership doesn't mean all are... in fact, that line of thinking is fairly small-minded.

BHP FAN
February 4, 2013, 01:39 AM
Well, you have obviously never had a conversation with a VA shrink.

CLP
February 4, 2013, 01:55 AM
Have you read any local news comments. Psychiatrists come from the same population.
Psychiatrist right here guy. Love steak and have 7 AR's (not including 8 unbuilt lowers). Our only litmus test is whether someone is an imminent threat to themselves or others. Examples would be people who are actively suicidal or homicidal AND have the intention to do something, or if they are manic or psychotic.

CLP
February 4, 2013, 01:58 AM
Well, you have obviously never had a conversation with a VA shrink.
I work at the VA half of the week. VA doctors get bonuses for completing periodic "reminders". These are questionnaires which include questions about firearms. Don't ask the questions, then you don't get the bonuses (not to mention a supervisor will want to know why you're not completing your reminders). If you don't like it, then complain to the Secretary of Veteran's Affairs- asking those questions at every single patient visit is a function of bureaucracy.

SimplyChad
February 4, 2013, 02:02 AM
Well, you have obviously never had a conversation with a VA shrink.


What he said. Ive seen 5 shrinks on active duty or through the VA. All of them wanted to call me unstable. Only one however knew about my guns. She asked me to get rid of them until she deemed me safe. I found out that all of us under her care were basically told the same thing. I HAVE PTSD. I was a medic in an active combat zone. I have a purple heart and a BSV. But she wanted to take away my right to defend my family. WHY?

CLP
February 4, 2013, 02:10 AM
I'd like to add one thing further. As a group, psychiatrists (and all physicians for that matter) cannot be expected to weed out people who oughtn't have firearms because they lack the capacity to use them appropriately and be safe with them. We can't read minds, nor can we predict the future or what someone might do.

There has been absolutely no substantive discussion of mental health and firearms to date in our "national conversation". What do we mean by keeping firearms out of the hands of the mentally ill? Which mental illnesses? Simple cases of mild depression? What about post-partum psychosis? What about personality disorders? Will the measures to prevent these people from obtaining firearms be permanent or temporary? What should be done when one physician diagnoses someone with a severe mental illness and another gives a contradictory diagnosis? Here's a big one- what about people with substance abuse or dependence issues? Alcohol is a factor in a large number of gun related crimes and homicides. Do we ban people who are known to be alcoholics? What about those who've received one DUI? What about someone who was arrested for possessing pot in college without any additional legal issues for decades?
What kind of oversight will exist? There sure are a lot of questions but no one is asking them.

ccsniper
February 4, 2013, 02:24 AM
I hope our representatives are smart enough to come up with a system that takes that into account.

Your gonna give them that kind of credit? Look at the DMV, post office, over expenditures, and blatant waste our G-ment does.

BHP FAN
February 4, 2013, 02:30 AM
http://www.thehighroad.org/showthread.php?t=700895

goon
February 4, 2013, 02:35 AM
ccsniper - honestly, no.
We've all been busy manhandling congress to let guns alone. I think we need to shift to let guns alone AND come up with a WORKABLE mental health centered way to address the issue.
But I freely admit that I'm not qualified enough to know what can or should be done with mental health to weed out the truly dangerous people and let the people who suffer from relatively minor issues that are effectively treated alone.
To get too hard on this is to risk the exact same thing the anti's are doing to us - jump into a situation that I don't fully understand and start making demands without having adequate information to even understand the demands I'd be making.

I want those who are dangerous dealt with, but I want those who are not a danger to be able to come forward and ask for the help they might need WITHOUT fearing that their rights will be restricted for asking for that help.

Solo
February 4, 2013, 02:53 AM
Psychiatrist right here guy. Love steak and have 7 AR's (not including 8 unbuilt lowers). Our only litmus test is whether someone is an imminent threat to themselves or others. Examples would be people who are actively suicidal or homicidal AND have the intention to do something, or if they are manic or psychotic.

Some days, I feel THR could really use a stickied thread of individuals with professional or scientific expertise in firearms and gun policy related issues so we can address these sorts of concerns and dispel myths more effectively.

Alaska444
February 4, 2013, 03:05 AM
Oh yes, the local news comments. I'm sure MDs have nothing better to do than spend tons of time expressing their opinions there.
I started medical school in 1985. In the last few years, my impression is that a lot of the new docs coming up the pike are more and more liberal. Many support single payor systems and many are into income redistribution in part through the medical system.

The worst aspect is that most of the new docs have forgotten how to be a patient advocate. With the new economics of medicine brain washing these new kids today, they place resource utilization way above individualized patient care. Sorry, not impressed with the new crop.

When I was an Army doc, we had the power to tell a full bird Colonel, no you can't have your soldier and write orders that they had to obey. I did enjoy that aspect of my job telling higher ranking officers to keep their hands off a kid.

When I was reading the report on an orthopedic patient when I got out into the civilian world, the orthopedic surgeon had written specific instructions to the HMO, DO NOT DISCHARGE and documented why. Wouldn't you know it, he was retired full bird Colonel in the Army before he joined civilian forces as well. Being a patient advocate came easy to us Army docs who had to sign off on return to duty slips.

Today, the company economics are MUCH, SUPER MUCH more important than caring for an individual patient. Sadly, many coming out today have no clue what the role of a doc was just 20 years ago.

I would be VERY wary of what you tell SOME docs even today. Just sayin.

HorseSoldier
February 4, 2013, 03:16 AM
Its up to the individual psychiatrist to determine if you have freedom or not. What if they believe you are racist and that it is a mental disease? Or what if they are a muslim and declare you addicted to substances for any admission of drinking?

As was noted up thread, a mental health/behavioral health provider has to apply a real diagnosis from the Diagnostic and Statistical Manual, and those disorders have clearly defined symptoms and diagnostic criteria. So a psychologist can't just label you insane because they perceive your belief system to be racist. If you tell them you have daily conversations with an archangel sent by the Lord instructing you to be a racist, you may be in trouble . . .

Deer_Freak
February 4, 2013, 03:26 AM
Here is what doctors in CA are encountering. A patient comes in for treatment of mild depression. The doctor asks the normal questions and the patient says my supervisor at work makes me so mad I could kill him. The doctor has to report this statement even if he knows this person is non violent to cover his ass. In the future we are going to have to choose our words very carefully if doctors get involved with the RKBA. The doctors at the VA and in CA are going to be setting precedent for mental health evaluations if it goes nationwide. I don't like the idea of doctors being forced to say someone is not fit to have a gun for financial reasons.

We need to focus on providing mental health care for everyone that needs it instead of scaring everyone that owns a gun away from seeking help. Doctors should make real evaluations instead of something cooked up by a congressman that is ignorant of the mental health care system or has a motive to make as many people unfit to own a gun as possible.

The best thing we can do as gun owners is make make mental health care affordable for everyone that needs it. But doctors should not have the final say on your RKBA. It should be a combination of mental health history and criminal record. Just because someone is blowing of a little steam should not be a reason to lose the RKBA. That is exactly what we have going on in CA right now.

I don't have the answers to screening people who are potential mass murders but I can say the examples I have seen are not going to work.

Alaska444
February 4, 2013, 03:30 AM
As was noted up thread, a mental health/behavioral health provider has to apply a real diagnosis from the Diagnostic and Statistical Manual, and those disorders have clearly defined symptoms and diagnostic criteria. So a psychologist can't just label you insane because they perceive your belief system to be racist. If you tell them you have daily conversations with an archangel sent by the Lord instructing you to be a racist, you may be in trouble . . .
Not a matter of declaring someone sane or insane in most instances with mental health issues. Here is a good review of NICS from a mental health perspective for health professionals:

http://www.jaapl.org/content/36/1/123.full

Unfortunately, much in psychiatry is subjective. Have you ever read the DSM V? You would be surprised how many DSM V criteria of specific "diseases" the average person qualifies for. Walk carefully with the new health care folks today. There are a different breed than the Marcus Welby docs of a bygone era.

Lastly, focussing on mental health as a way to reduce gun violence is doomed to fail as well since gun violence by the mentally ill is a very small percentage of violent acts in the US:

The best available national data suggest that only 3%–5% of violent acts are attributable to serious mental illness (13), and most of those acts do not involve guns (14). Most studies concur that the added risk of violence, if any, conferred by the presence of a serious mental disorder is small (15).

http://ps.psychiatryonline.org/article.aspx?articleid=101460

CLP
February 4, 2013, 03:55 AM
Here is what doctors in CA are encountering. A patient comes in for treatment of mild depression. The doctor asks the normal questions and the patient says my supervisor at work makes me so mad I could kill him. The doctor has to report this statement even if he knows this person is non violent to cover his ass. In the future we are going to have to choose our words very carefully if doctors get involved with the RKBA. The doctors at the VA and in CA are going to be setting precedent for mental health evaluations if it goes nationwide. I don't like the idea of doctors being forced to say someone is not fit to have a gun for financial reasons.

We need to focus on providing mental health care for everyone that needs it instead of scaring everyone that owns a gun away from seeking help. Doctors should make real evaluations instead of something cooked up by a congressman that is ignorant of the mental health care system or has a motive to make as many people unfit to own a gun as possible.

The best thing we can do as gun owners is make make mental health care affordable for everyone that needs it. But doctors should not have the final say on your RKBA. It should be a combination of mental health history and criminal record. Just because someone is blowing of a little steam should not be a reason to lose the RKBA. That is exactly what we have going on in CA right now.

I don't have the answers to screening people who are potential mass murders but I can say the examples I have seen are not going to work.
This is not true. It's clear that a person making such a statement in this scenario is being figurative. There is no rule, regulation, or mandate that I record, document, or report such a statement.

If they're being literal, then that's a different story. If they state that they're going to go kill someone when they leave my office then I have to intervene. That intervention basically is me documenting that I've called the police, filed a report and gotten a case number, and also made an effort to contact and warn the person the patient intends to kill. I don't try to stop the person. I might further assess reality testing with additional questions if they stick around.

If I want to "cover my ass", I could include that the patient expressed discord with his employer and made a figurative statement about killing him but that the pt is clearly not homicidal. But I do my job the right way, so I don't need to cover my ass.

I'm not following the non sequitur about doc's saying people aren't fit to own firearms because of "financial reasons".

"I don't have the answers to screening people who are potential mass murders but I can say the examples I have seen are not going to work."--- No one has these answers. All attempts at predictive screening for violence has failed miserably.

PoPo22
February 4, 2013, 05:19 AM
In my area of the country (Texas) I am certified as an "MHO" (Mental Health Officer) for my department, which is a large police dept. which services an area population of over 1.5 million residents. We normally respond to many, many, many mental health emergencies on a given "shift". We will typically "evaluate" individuals who are exhibiting different issues that are "perceived" as erratic and dangerous.

When we do evaluate an individual it is based on whether the individual is "an imminent threat of serious injury or death" to someone/anyone. If the individual is determined to be "an imminent threat" we will typically perform a "POEC" (Police Officers Emergency Commitment) and take that individual into "protective custody" for the safety of everyone. We then take the individual to either a mental health facility or to an area "emergency room" (whichever is immediately available) to be evaluated by a "Mental Health Professional" (Doctor/Psychiatrist) to be examined.

If that person determines that the individual is an "imminent threat" as a result of a violent mental health issue, they will hold/observe the individual until a more extensive evaluation can be done. If the "doctor/ psychiatrist" determines further that the individual cannot be safely treated and released then they are referred to a "Mental Health Judge" and the individual will be "adjudicated" in a prescribed manner. "ONLY" after this minimum process has been completed is there a possibility that the individuals right to possess a gun "may" be removed.

It certainly is not a perfect system but it is what we currently have in place to deal with "potential IMMINENT threats". I also work at the main "trauma ER" for the area on my days off to help evaluate their patients who are brought in for these type issues and am in constant contact with their doctors. There is definitely a wide range of views and opinions about the issues but no one seems to be able to come to a consensus on what is the "best practice". At present I think the "adjudication" requirement by a "trained judge" who consults with the "mental health professionals" before taking away individual "rights" is the best option we have. I certainly would not want it to be left up to "police Officers" (who simply are not normally trained well enough to make that determination) and not simply left to the discretion of "any" one doctor/psychiatrist who may also be unaware of all the issues involved. So having multiple areas of "oversight" is probably the safest practice for now, but then, I'm just a cop and what do I know? Good Luck.

G.barnes
February 4, 2013, 07:10 AM
There is a big difference from being baker acted and having a 24 - 72 hour observation period and actually being commuted to an institute.

wooly bugger
February 4, 2013, 09:07 AM
Psychiatrist right here guy. Love steak and have 7 AR's (not including 8 unbuilt lowers). Our only litmus test is whether someone is an imminent threat to themselves or others. Examples would be people who are actively suicidal or homicidal AND have the intention to do something, or if they are manic or psychotic.
I'm an MD and have called more than my share of psychiatric consults....

I agree with CLP that, regardless of their personal views, few psychiatrists will abandon their basic fiduciary relationship with the patient to push it. As he said, the criteria are quite clear. If a psychiatrist determines that a patient is suicidal or homicidal, a lot more is going to happen than just taking that patient's guns, so it's not something that will be taken lightly.

Still, I remain concerned that with universal screening of a generally healthy population and the obvious liability issues, psychiatrists will tend to err on the side of caution, leading to a lot of false positives.

Good parallel would be mandatory mammograms of all 18 year old girls. A LOT more harm will be done by nervous radiologists ordering core biopsies on healthy girls than good from catching the 1 in a million true cancer. Not to mention all the unnecessary radiation, which will likely cause more cancer than it detects.

Unfortunately, pretty much zero percent of our politicians have even a rudimentary understanding of statistics and epidemiology. If a doctor were to make decisions based on such a level of ignorance, he would be guilty of malpractice.

Robert
February 4, 2013, 09:28 AM
That is a good place to stop. While the mental health issue is tied to the current forearms debate, a broad spectrum discussion of the medical field is not really on topic for THR.

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