Shrink Rap News

An open letter to legislators about laws that require mental health professionals to report dangerous patients


 

On Friday, March 1, 2013, I joined 1,300 other people in giving public testimony to the Maryland General Assembly on a variety of proposed bills related to firearms legislation. As you might guess by the numbers, it was quite the dog-and-pony show, and I’ve written a detailed account of my 11 hours there over on our Shrink Rap blog in a post called “My Day With Our State Legislature.” If you read that post, you'll know that it didn’t all go so smoothly. I did it as a story, rather than as bullet points or a plea, and that was its own risk. Because of the number of people, we were each given 1 minute, though my talk was prepared a couple of days before when I thought I had 3 minutes. Here is the text of my intended (and mostly given!) testimony:

My name is Dinah Miller, I am a psychiatrist in Baltimore and I consult to the Johns Hopkins Community Psychiatry Program and I’m a past president of the Maryland Psychiatric Society. I’ve discussed some of my concerns about this legislation in an op-piece that appeared in the Baltimore Sun on February 11th. I hope you’ll have a chance to look at it.

Please bear with me while I take you on a brief journey.

Can you imagine that one morning you might wake up only to dread the coming day, that you’ll want to stay in bed and not listen to a single whining constituent? Perhaps you are feeling down because you have overwhelming problems, or perhaps, through no fault of your own, you’ve been struck with a soul-crushing episode of depression. Either way, in some of those very dark moments you may start to see suicide as a possible way to end the pain. So my question to you today is quite simple, and very personal. Will you go for help knowing that when you tell a therapist your darkest thoughts, you may be reported to an FBI database? Why do I think you might say no? Even if you never want to own a gun, will you hesitate to get treatment, knowing your state has a law that requires mental health professionals to report people who are “likely to be dangerous”?

The truth is that a psychiatrist can’t be your agent and also be the agent of the state; it just doesn’t work.

Maybe you can’t come on this journey with me. Perhaps you’ve already lived through terrible times without ever entertaining the thought of harming yourself, much less anyone else. So let me take you instead on a similar journey, only this time, it’s with your teenage child. Your wonderful son has been feeling down since his girlfriend dumped him for his best friend. He was in love, and he just can’t shake it, no matter how many times he hears about those other fish in the ocean. As teenage boys do, he grunts and keeps to himself and you suspect he smokes some of that medical marijuana stuff, and oh my, he’s playing Call of Duty on his Xbox. Finally, he makes a comment about not wanting to live without her, and he’d like to kill her new boyfriend. Obviously, figures of speech, right? But teenagers do kill themselves over emotions that will pass. So let me ask again: Will you pause before you get him help, knowing your son’s name might be placed in an FBI database? Will it matter that he loves to hunt with his dad, and he may never again be legally allowed to hunt? Or will it be a shock – 25 years from now and long after he’s gotten over his teenage heartbreak – when the Wal-Mart clerk says he can’t buy a gun because he’s in a database for felons and the mentally ill?

In Maryland, the Tarasoff requirements already spell out what actions we must take in the case of an imminent threat. But this law is about populating a database; there is nothing in it that compels law enforcement officials to seize weapons from a dangerous person in a timely manner. And nothing in it that would prevent a school shooting.

It’s likely some therapists will ignore these mandates; they do, after all, legislate what we believe, and what goes on inside our heads is probably not subject to legislation. I would contend that the details don’t matter, that the fear of being reported will be enough to stop people who are dangerous, especially gun owners, from seeking care. And some of those people, feeling there is no help to be gotten and no where to turn, will their end their lives and perhaps the lives of others. That said, I hope you never find yourself in that miserable, dark place.

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