NY SAFE Act

[futureapppsy2]

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I've started to hear some buzz regarding the New Your SAFE act as it relates to mental health professionals--namely, the requirement to report patients and clients deemed at risk of harm to self or others to the state government, which will then open an investigation about revoking someone's firearms license, as well as the guns themselves. So, basically, Tarasoff strengthened with regards to guns. Specific to mental health practice, I've heard concerns re: confidentiality and dissuading treatment seeking as well as comments in favor due to the high lethality rate of fire arms as a weapon or suicide method

Thoughts?

(And please, let's try not to turn this into a gun/Second Amendment debate--we have a sociopolitical forum for that).

 

[MBellows]

I've heard concerns re: confidentiality and dissuading treatment seeking as well as comments in favor due to the high lethality rate of fire arms as a weapon or suicide method .

This.

Plus, I don't want the responsibility of trying to judge risk of harm (something that I've never even heard of an accurate standardized model for) and balance that with the risk of harm to the collaborative process and that of someone losing a possible means of protecting themselves (people with mental health issues and my area in particular (disability) are more likely to be victimized).

 

[Sanman]

I recently received a notification about this law. If I read it correctly, we are required to forward the names of clients to a state office and then they determine whether to bar the person from fun ownership. If we fail to do this, we can be held liable for the person's actions. Considering that last part, why would I not forward a patient's name to this list. In fact, why would I not forward every pt with a psychotic dx? Many of my patients are leaving inpt psych tx and coming to a day care program here. I guess they are all going on the list. My severely ill and terminal pts as well. I mean I would rather them be stripped of a right than myself be sued by the state of NY for not reporting the person and my ability to make a living be ruined. Let the state sort out the real threat from the fake one. 😡 (sarcasm intended)

 

[ClinPsychEnthus]

@Sanman

I appreciate that you said "fun ownership" instead of "gun ownership" 😀

 

[MBellows]

I wanted to point out that it IS our responsibility to make judgement calls on risk of harm.

Formally, risk of harm = intent/plans + means. I don't argue that people who have a gun and plan to use it shouldn't have it taken from them, but if I as a practitioner were subject to making judgement beyond that with the treat of being held responsible for someone else's actions, I'd move to a different state.

 

[MBellows]

In fact, why would I not forward every pt with a psychotic dx?

Give it a year and someone can do a study to track Dx of people on the list. That attitude should prove to make a easy constitutional law case with the obvious effects on people with specific disabilities.

 

[cara susanna]

I recently received a notification about this law. If I read it correctly, we are required to forward the names of clients to a state office and then they determine whether to bar the person from fun ownership. If we fail to do this, we can be held liable for the person's actions. Considering that last part, why would I not forward a patient's name to this list. In fact, why would I not forward every pt with a psychotic dx? Many of my patients are leaving inpt psych tx and coming to a day care program here. I guess they are all going on the list. My severely ill and terminal pts as well. I mean I would rather them be stripped of a right than myself be sued by the state of NY for not reporting the person and my ability to make a living. Let the state sort out the real threat from the fake one. 😡 (sarcasm intended)

Why not forward every patient you have? This is so ridiculous.

 

[Sanman]

@Sanman

I appreciate that you said "fun ownership" instead of "gun ownership" 😀

Lol, that is what I get to quickly typing on an iphone between pts.

 

[Sanman]

Why not forward every patient you have? This is so ridiculous.

Well, my mildly depressed geriatrics and those that cannot walk really don't need to be forwarded. However, I definitely do plan on forwarding all of my psychotic pts or those that are severely depressed and able to go home should this silly law actually stand up. Really though, the only one I would forward using clinical judgement has a felony conviction for attempted murder anyway.

MBellows,

I actually do plan to likely move as soon as I get licensed. This law is just further incentive. Practicing in NY just is not worth it anyway. Better opportunities and lower cost of living elsewhere.

 

[MBellows]

Really though, the only one I would forward using clinical judgement has a felony conviction for attempted murder anyway.

Sounds like a candidate for Downstate...

 

[DynamicDidactic]

if appropriate information is provided by the clinician before start of treatment then I see no issues. Right now the standard consent form includes limits to confidentiality (i.e., harm to self or others, child/elder abuse, court order) and that forwarding to govt thing could be added to it.

Thus, with that knowledge if a client still reports harm to self/other than I would have no issue or worry about breaking confidentiality.

 

[Sanman]

if appropriate information is provided by the clinician before start of treatment then I see no issues. Right now the standard consent form includes limits to confidentiality (i.e., harm to self or others, child/elder abuse, court order) and that forwarding to govt thing could be added to it.

Thus, with that knowledge if a client still reports harm to self/other than I would have no issue or worry about breaking confidentiality.

what happens when, while knowing this, the pt declines to share said details with their provider and does something. Should the provider have known the pt was at risk and forwarded their name? Any pt with average or higher cognitive function can hide these thoughts and the provider can be held liable. What about existing clients that now may be reported? What about those that need regular mental health tx and are now forced to give up a right in order to participate in tx.

 

[MBellows]

On a side note.

NRA: "IT'S BECAUSE CRAZY PEOPLE ARE THE DEVIL AND THEY HAVE GUNS, YOU SHOULDN'T LET CRAZY PEOPLE HAVE GUNS."

NY: "OK DER DER." *Passes SAFE act*

NRA: "YOU CAN'T TAKE AWAY PEOPLE'S GUNS!"

http://blogs.buffalonews.com/politics_now/2013/03/major-legal-challenge-to-ny-safe-act-coming-tomorrow.html

 

[minorityreport]

I am a big fan of the SAFE act. The more government intrusion we can have in our lives the better. Big Government = Safety = Strong Economy. Barack Obama has made this country great again by building a bigger government! The more patients that get snitched on the better.

 

[DynamicDidactic]

what happens when, while knowing this, the pt declines to share said details with their provider and does something. Should the provider have known the pt was at risk and forwarded their name?

no. of course not. no clinician was ever in trouble for lack of ESP.

What about existing clients that now may be reported?

you tell the client as soon as its officially a requirement. next.

What about those that need regular mental health tx and are now forced to give up a right in order to participate in tx.

hmmmm... I think this is a much bigger question. move out of state? chose what is more important. get involved with legislation to change the laws. do what you mention up top.

 

[futureapppsy2]

It really bothers me how these laws and mental health in general groups together non-lethal self-harm, suicidality, and homocidality into one thing when they really are not equivalent (although they can be correlated or co-occur, it's far from a one-to-one correspondence) . The risk analysis for harm to others, IMO, should be more stringent than the risk analysis for suicidality, which should be more stringent than the risk analysis for non-suicidal self-harm. Same with the potential for legal and social consequences. When the safety of other people comes into play, then our assessment and safeguards need to be more conservative--same with suicide versus other self-harm, IMO.

 

[KillerDiller]

On a side note.

NRA: "IT'S BECAUSE CRAZY PEOPLE ARE THE DEVIL AND THEY HAVE GUNS, YOU SHOULDN'T LET CRAZY PEOPLE HAVE GUNS."

NY: "OK DER DER." *Passes SAFE act*

NRA: "YOU CAN'T TAKE AWAY PEOPLE'S GUNS!"

http://blogs.buffalonews.com/politics_now/2013/03/major-legal-challenge-to-ny-safe-act-coming-tomorrow.html

This made me laugh out loud...although I am still somewhat skeptical of someone whose favorite My Little Pony is (apparently) Pinky Pie 😉.

 

[cara susanna]

The whole holding the therapist responsible for a client's actions is the big problem, IMO. We cannot control a client's actions. And we all know how good we are at predicting violence...

 

[MBellows]

This made me laugh out loud...although I am still somewhat skeptical of someone whose favorite My Little Pony is (apparently) Pinky Pie 😉.

I love that meme, but my favorite pony is Rainbow Dash.

 

[Sanman]

The whole holding the therapist responsible for a client's actions is the big problem, IMO. We cannot control a client's actions. And we all know how good we are at predicting violence...

Read some office of mental health releases last night and the Q&A says that professionals cannot be held liable if they report or not if the decision is considered reasonable (by whom? Will I need a lawyer to prove that?) and in good faith. Who knows what that will mean.

 

[MBellows]

Reason some office of mental health releases last night and the Q&A says that professionals cannot be held liable if they report or not if the decision is considered reasonable (by whom? Will I need a lawyer to prove that?) and in good faith. Who knows what that will mean.

According to what I have had continuously drilled into me like an inappropriate metaphor, reasonable clinical judgements are basically guaranteed if they are generally not conflicting with ethical rules, research literature, and if you have sought consult with another person with experience in that area who agrees with your course of action.

 

[CriminalPsych]

I've started to hear some buzz regarding the New Your SAFE act as it relates to mental health professionals--namely, the requirement to report patients and clients deemed at risk of harm to self or others to the state government, which will then open an investigation about revoking someone's firearms license, as well as the guns themselves. So, basically, Tarasoff strengthened with regards to guns. Specific to mental health practice, I've heard concerns re: confidentiality and dissuading treatment seeking as well as comments in favor due to the high lethality rate of fire arms as a weapon or suicide method

Thoughts?

(And please, let's try not to turn this into a gun/Second Amendment debate--we have a sociopolitical forum for that).

Well on the bright side, I'd assume they would want mental health practitioners involved in the investigation so that means more jobs for us 🙄

 

[KillerDiller]

I love that meme, but my favorite pony is Rainbow Dash.

I'm an Applejack fan myself.

 

[futureapppsy2]

The whole holding the therapist responsible for a client's actions is the big problem, IMO. We cannot control a client's actions. And we all know how good we are at predicting violence...

ITA. Research has shown that profiling doesn't work as a violence predictor, and many of the so-called "red flags" that the media cites in these cases are only seen as red flags due to hindsight bias.

 

[G Costanza]

ITA. Research has shown that profiling doesn't work as a violence predictor, and many of the so-called "red flags" that the media cites in these cases are only seen as red flags due to hindsight bias.

That's surprising to read. I have not looked into violence prediction much other than as it relates to IPV. I would have thought previous violence would be a predictor of violence.

 

[futureapppsy2]

That's surprising to read. I have not looked into violence prediction much other than as it relates to IPV. I would have thought previous violence would be a predictor of violence.

I don't know the literature, but it most likely is (I do know that substance abuse has been shown to be a predictor of violent behavior, even when controlling for other psychiatric dx'es). Saying profiling isn't effective on a large scale is different than saying that there's nothing correlated with violence, because there obviously is. However, especially with mass murder violence--which is obviously what these laws are in reaction to--there's a whole lot of false positives thrown in with the true positives. Even with something like substance abuse, which has shown a significant correlation with violence, it would be unreasonable to say that all or most people with substance abuse dx'es are going to commit violent acts. I'm admittedly only familiar with the perpetrator literature on the school violence side of things (it may be more well-formed in the IPV literature), but the general consensus is that profiling doesn't work because of the high rate of false positives, which can also lead to ignoring "false negatives"--people who may have some indicators of violent behavior but don't fit the "profile."

 

[MBellows]

I don't know the literature, but it most likely is (I do know that substance abuse has been shown to be a predictor of violent behavior, even when controlling for other psychiatric dx'es). Saying profiling isn't effective on a large scale is different than saying that there's nothing correlated with violence, because there obviously is. However, especially with mass murder violence--which is obviously what these laws are in reaction to--there's a whole lot of false positives thrown in with the true positives. Even with something like substance abuse, which has shown a significant correlation with violence, it would be unreasonable to say that all or most people with substance abuse dx'es are going to commit violent acts. I'm admittedly only familiar with the perpetrator literature on the school violence side of things (it may be more well-formed in the IPV literature), but the general consensus is that profiling doesn't work because of the high rate of false positives, which can also lead to ignoring "false negatives"--people who may have some indicators of violent behavior but don't fit the "profile."

Not to mention that even one false positive would lead to a violation of natural rights. A legally applicable predictor would have to have a functionally impossibly small error rate to not make the law invalid or leave the state with a (or multiple) million + dollar lawsuits.

As far as violence being a predictor of future violence, I may be mistaken, but felons can't legally own firearms, can they? Maybe we should extend this to misdemeanor crimes? Almost certainly IPV/domestic violence?

I still don't see how it's ethically reconcilable to play a part in the violation of a civil right, especially one that empowers individuals. Or maybe I'm missing out on a helping profession that doesn't have empowerment as one of is key driving features?