The Shooting and its Effects on Mental Health Treatment

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digitlnoize

digitlnoize

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Soapbox on.

The Arizona shooting was terrible, and I've seen some talk amongst the news pundits calling for a need to bolster our mental health system. Unfortunately, our profession has been largely silent, at least on the coverage I'm watching.

More psychiatrists need to speak up, call their congressmen and state representatives. Get on the local news calling for more mental health funding.

How about requiring a thorough psychiatric evaluation prior to obtaining q gun license?

This tragic event can be a turning point in our country's mental health system, if we want it to be. Make some noise.

Soapbox off.
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One can hope--but you might recall there was similar outcry after the Virginia Tech massacres. Perhaps someone from that state would care to comment, but I think that such things typically die off as the news cycle proceeds on to the next outrage du jour. :(
 
OldPsychDoc said:
One can hope--but you might recall there was similar outcry after the Virginia Tech massacres. Perhaps someone from that state would care to comment, but I think that such things typically die off as the news cycle proceeds on to the next outrage du jour. :(
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Yeah...I know, which is it's so frustrating. We, as a profession, need to do a better job of capitalizing on these events to encourage new legislation. Doctors need to be more outspoken, both politically and publicly. For too long, we've been content to sit on the sidelines and trust our lobbies to do the work for us. That's fine and dandy, but when the public (on Twitter, in news comments, and elsewhere) are calling for mental health reform, we need to echo that call, and keep it running after emotions have died down.

These events point to a clear need for reform, and it's our responsibility to make sure our lawmakers hear that call. You guys are the ones with the stories of patients who slipped through the cracks that we don't hear about on the news. Use your political connections to get an ear in your local, state, or national political arena. If you have no connections, call your local party office and get some. They'll listen to docs, they want our donations.
 
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Interesting take, but the fact remains that this guy should never have had a gun, and based on his web writings and subsequent actions, shouldve and could've been identified as a risk.
 
Quite a few members of congress are more likely open to change at the moment, because they feel exposed and directly at risk. This, very unfortunate, incident has struck very close to home for congress, so it is possible that they would be more inclined to pass items that might have otherwise failed without so much as a second thought.

I'm not sure a mandatory psychiatric eval when purchasing a gun is the right way to go though.

I'm also torn how I feel punishments should be distributed for the mentally ill who commit violent crimes. I hate to say it, but I think the punishment should fit the crime... regardless of mental illness. I don't feel this is true of non-violent crimes though.
 
MightyMoose said:
I'm not sure a mandatory psychiatric eval when purchasing a gun is the right way to go though.
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Not to mention impossible to implement.

I'm also torn how I feel punishments should be distributed for the mentally ill who commit violent crimes. I hate to say it, but I think the punishment should fit the crime... regardless of mental illness. I don't feel this is true of non-violent crimes though.
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It also has to be punished as a potential threat. If someone is a threat for homicide, the etiology is irrelevant.

Also consider that numerous interest groups will use this as a springboard to advance whatever lens it is they see the world through.
 
Number of comments blaming this on Sarah Palin >>> number of comments blaming this on his mental health.

/not that I think Palin's rhetoric isn't dangerous, but we're very good in this country at missing the point.
 
Watch for an argument in favor of increased authority for involuntary treatment (inpt and outpt), but ending up with no funding for anything that does get passed. Most of the discussions will likely focus on restricting patients' freedoms and incarceration/punishment, not treatment or even study to find out what treatments work.

Two of the services that do have some science behind them are:
A) Mobile Crisis. When you calculate in the cost of police and other emergency services and the cost of treating patients in jail, it becomes "fiscally responsible" to pay MH workers to go see pts in the community before the situation ends up in the hands of police/corrections. Although this service does not reduce the total # admissions for the area (because of increased case-finding), it reduces the costs to the community IF you calculate the police/EMS/jail costs.

B) Assertive Care Team (ACT). For patients who have repeated frequent hospitalizations (or arrests) for behaviors due to mental illness, very frequent visits (sometimes daily) and assistance getting/taking meds, getting to appts (even bringing physician to the pt), supported housing, etc. work to reduce admissions and harm to self/others for the patients identified.

Calif. has a law permitting invol. outpt treatment, but no funding. Also, several groups successfully lobbied to not permit counties to utilize the invol outpt treatment unless they also provide several services that would assist the pt's. This was intended to prevent counties from using invol outpt treatment instead of providing appropriate services - so the requirements are a good thing. But the state would not provide funding for any of this. This was all passed about the same time that the state began cutting funding for MH services every single year and retroactively taking back millions that they had paid to counties for MH services. Since the state is not permitted to issue "unfunded mandates," they made the whole system optional for counties to implement. Therefore, (last I checked) not a single CA county has implemented the invol outpt system.
 
I agree with OPD's take on this.

At least as of now (Sunday afternoon, Eastern time 1/9/2011) I think we're at a stage where there's much more to learn about this before I'd want to add any comments of worth.

It's usually things like this that cause changes in mental health laws if the perpetrator was mentally ill. The involuntary outpatient commitment in NY was written into law after a someone mentally ill was released to the community and pushed someone into an oncoming train.

The shooter in the Arizona case was described as "mentally unstable" but that is IMHO not enough to base any comments on. Heck, anyone committing a crime can be considered mentally unstable.
 
whopper said:
The shooter in the Arizona case was described as "mentally unstable" but that is IMHO not enough to base any comments on. Heck, anyone committing a crime can be considered mentally unstable.
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Did you read/watch his online postings? He was far past your everyday criminal level of unstable. I'd like to hear some pros' takes on his possible diagnoses, as I'm just a lowly 3rd year student who has no idea what he's talking about.

I can't see how it'd be a bad thing to have a mandatory psych eval as part of the normal gun background check (not covered by insurance, of course). Of course, they could still get the guns illegally, but that's another issue.
 
Did you read/watch his online postings? He was far past your everyday criminal level of unstable.
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No I did not. I only heard about them but didn't take the time to read them. I wouldn't want to comment unless I gave what I thought was a thorough evaluation. Reading the news and what's available to the public I don't think is enough. To give you a comparison, Phil Resnick read all of the Unabomber's diaries that he could get a hold of before he gave submitted his opinion to the Court. It was about 40,000 pages. I sometimes wonder if those diaries of the guy in the movie Se7en were in any way a reference to the Unabomber.

The mandatory evaluation thing for guns I disagree with. Not because it's not a terrible idea.

The problem with psych evaluation is that owning a gun is a Constitutional right and even that such an evaluation is going to yield quite a bit of grey area results.

The level of accuracy in predicting future violence is only somewhat better than with no evaluation at all. I know this because the PD of my fellowship advanced the field as far as it is today and he made me very aware of how this works. A few decades ago until this guy touched the research it was actually no better than a layman.

Another problem is a lot of the factors that predict future violence have nothing to do with dynamic factors but static factors such as someone's age, race, and sex. Imagine the furor over withholding someone from having a gun because he's African-American?

If testing was on the order of over 95% accurate, then that'd be different. But withholding someone from owning a gun because they refuse testing that does not yield much information wouldn't fly. I think even if it was very accurate you'd still get a lot of people against the idea because it'd require a change in the Constitution.
 
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And who would want to do the eval for these things? If you psychiatrically clear someone to own a gun and they go shoot somebody, you'd probably be liable somehow. Not worth it.
 
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kugel said:
Watch for an argument in favor of increased authority for involuntary treatment (inpt and outpt), but ending up with no funding for anything that does get passed. Most of the discussions will likely focus on restricting patients' freedoms and incarceration/punishment, not treatment or even study to find out what treatments work.

Two of the services that do have some science behind them are:
A) Mobile Crisis. When you calculate in the cost of police and other emergency services and the cost of treating patients in jail, it becomes "fiscally responsible" to pay MH workers to go see pts in the community before the situation ends up in the hands of police/corrections. Although this service does not reduce the total # admissions for the area (because of increased case-finding), it reduces the costs to the community IF you calculate the police/EMS/jail costs.

B) Assertive Care Team (ACT). For patients who have repeated frequent hospitalizations (or arrests) for behaviors due to mental illness, very frequent visits (sometimes daily) and assistance getting/taking meds, getting to appts (even bringing physician to the pt), supported housing, etc. work to reduce admissions and harm to self/others for the patients identified.

Calif. has a law permitting invol. outpt treatment, but no funding. Also, several groups successfully lobbied to not permit counties to utilize the invol outpt treatment unless they also provide several services that would assist the pt's. This was intended to prevent counties from using invol outpt treatment instead of providing appropriate services - so the requirements are a good thing. But the state would not provide funding for any of this. This was all passed about the same time that the state began cutting funding for MH services every single year and retroactively taking back millions that they had paid to counties for MH services. Since the state is not permitted to issue "unfunded mandates," they made the whole system optional for counties to implement. Therefore, (last I checked) not a single CA county has implemented the invol outpt system.
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On a side note, I've been very surprised about how many psychiatry training programs in this country have neither ACT teams nor mobile crisis units associated with them. That could easily be funding-related, but funding doesn't explain why so many programs neglect to teach about these interventions in their didactics. I used to work on an ACT team in San Francisco and therefore was quite surprised when chief residents at other programs in California didn't know what Assertive Community Treatment meant, and hadn't heard the term before.
 
My home is just down the street from the shooting. It was extreme sadness and chaos here yesterday. We are all bouncing back and forth with sadness and anger. The people who tackled him while changing magazines for his glock are amazing people. He had already emptied one extended magazine of 31 rounds and was trying to reload. It could have be twice the tragedy.

Loughner is, without doubt, mentally ill. We are still waiting to learn if he was in any kind of treatment or taking any medications. What we do know about is his erratic behavior.

http://abcnews.go.com/Blotter/jared...lle-giffords-shooter-school/story?id=12575278

http://www.azcentral.com/news/articles/2011/01/09/20110109jared-lee-loughner-gabrielle-giffords-arizona-shooting.html

I would imagine there will be some PTSD for some of these people. I am hoping some services will be made available free in our community for those struggling.
 
whopper said:
No I did not. I only heard about them but didn't take the time to read them. I wouldn't want to comment unless I gave what I thought was a thorough evaluation. Reading the news and what's available to the public I don't think is enough. To give you a comparison, Phil Resnick read all of the Unabomber's diaries that he could get a hold of before he gave submitted his opinion to the Court. It was about 40,000 pages. I sometimes wonder if those diaries of the guy in the movie Se7en were in any way a reference to the Unabomber.

The mandatory evaluation thing for guns I disagree with. Not because it's not a terrible idea.

The problem with psych evaluation is that owning a gun is a Constitutional right and even that such an evaluation is going to yield quite a bit of grey area results.

The level of accuracy in predicting future violence is only somewhat better than with no evaluation at all. I know this because the PD of my fellowship advanced the field as far as it is today and he made me very aware of how this works. A few decades ago until this guy touched the research it was actually no better than a layman.

Another problem is a lot of the factors that predict future violence have nothing to do with dynamic factors but static factors such as someone's age, race, and sex. Imagine the furor over withholding someone from having a gun because he's African-American?

If testing was on the order of over 95% accurate, then that'd be different. But withholding someone from owning a gun because they refuse testing that does not yield much information wouldn't fly. I think even if it was very accurate you'd still get a lot of people against the idea because it'd require a change in the Constitution.
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Hmmm...interesting. I'd like it if you could point me towards any of this literature. PM me if needed to keep your ID private.

I don't claim to have all the answers regarding gun control, but I do know that what we are doing now is not working, and that both this guy and the Va Tech shooter were previously identified as having "issues", yet retained their ability to buy firearms...and used them. Hindsight is obviously 20/20, but perhaps we can improve these prediction methods further, or perhaps it's OK to err on the side of caution and be more cautious about who gets a permit.

I don't know the answer, but this guy should not have been allowed to buy a gun, and this seems to be a case where the mental health system failed, and I think we need to ask ourselves what we can do better.
 
digitlnoize said:
Hmmm...interesting. I'd like it if you could point me towards any of this literature. PM me if needed to keep your ID private.

I don't claim to have all the answers regarding gun control, but I do know that what we are doing now is not working, and that both this guy and the Va Tech shooter were previously identified as having "issues", yet retained their ability to buy firearms...and used them. Hindsight is obviously 20/20, but perhaps we can improve these prediction methods further, or perhaps it's OK to err on the side of caution and be more cautious about who gets a permit.

I don't know the answer, but this guy should not have been allowed to buy a gun, and this seems to be a case where the mental health system failed, and I think we need to ask ourselves what we can do better.
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California has a law that if you're put on a 5150 (72 hour involuntary detention), they are forbidden from buying a gun for 5 years. The record is sent to the DOJ. Who knows how much it's followed, but better than nothing.

At the AAPL conference this year there was a talk about instruments for predicting future violence. Apparently the best focused ones out there top out at maybe 67% accuracy. And the speaker made an excellent point that no future instrument will likely ever do better than that, because we cannot the million other variables that haven't happened yet ,and how they'll change the picture.
 
s
I'd like it if you could point me towards any of this literature.
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Sure. The Journal Law and Human Behavior has several great articles on it.
http://www.springerlink.com/content/104390/

My PD, below is a profile on him with his CV and his papers.

http://www.law.uc.edu/faculty-staff/faculty/douglas-mossman-md

The above may be too much heavy reading. I can tell you that I have to read several of his articles with a statistics book on hand and reference it often.

If you want to go a bit lighter: One of the best tests for predicting future violence that is easy to do and does not require extensive months of training is the HCR-20.
http://www4.parinc.com/Products/Product.aspx?ProductID=HCR-20
The advantage of this test is that it uses actuarial data in addition to clinical judgment. Prior tests such as the VRAG only used actuarial.
http://www.tn.gov/mental/policy/forms/MHDDvrag.pdf

The superiority of testing in studies goes like this:
clinical & actuarial > actuarial (by itself) > clinical judgment (by itself).

Despite that the HCR-20 is relatively easy to do, very few programs teach their residents how to use it. In fact very few forensic psychiatry programs know how to use it either. I mentioned in other threads that a mark that a forensic psychiatry program is of higher quality is if the people in it know how to use appropriate psychological testing in their evaluations and are willing to teach you. Many if you bring them up won't even know what you're talking about. Be careful of asking about this because I did once and actually got a doctor angry at me just for asking. The only reason why I can think of why he was mad at me because he had to tell me he didn't know what I was talking about when I mentioned that I was interested in learning the SIRS or other psychological tests used in forensic evaluations.
 
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I think there is now enough data to point that this guy did have some type of Axis I issue, but now there's not enough to parse out what. Drug use, odd internet messages, he couldn't hold it together in a class.
 
sunlioness said:
The idea of the government keeping records of people with mental health diagnoses scares the crap out of me. I would much rather they worked on keeping guns out of people's hands, period. Of course I realize that is a very tall order with constitutional implications.
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I'm mostly in the middle with my political beliefs, but I have to say that I'm starting to think the same thing regarding guns.

It is really interesting to see that half the news organizations are using this to point out the political rhetoric out there and the other half are focusing in on how the school or others could have prevented this from the "obvious signs." I'd like to see more emphasis on mental health treatment in general.
 
At the risk of derailing this further... :)

I consider myself fairly middle ground as well, leaning a little left, but I'm staunchly pro-gun rights. While the statistics out aren't super favorable, I feel that with proper training and planning, you beat the odds. It's just that the population by and large doesn't maintain proper training nor plan adequately. People are going to do bad things. You could take away everything seemingly dangerous, and I could still make kilos of high explosive. People desiring to do harm are going to find a means.
 
After seeing this guy's picture in court, I don't know if I could do psych, if someone with his history looked at me like that my heart may stop.


11_loughner_250x375.jpg
 
OldPsychDoc said:
An actual useful, educational article from TIME.
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Interesting, but what's the solution? I recently assisted in some interviews to place some students in shadowing positions. One student brought up grossly inappropriate and disturbing things during the interview (I really don't want to go into detail on the forum as I'm fairly easily identifiable here, but let's just say I'd put some serious money on ASPD or psychopathy if the student was assessed). Have brought the subject up with a faculty friend who was previously in mental health, and, in concordance with the article, it appears there's really not anything that can be done, even official monitoring. I mean, kind of disconcerting.
 
http://www.huffingtonpost.com/2011/01/11/pima-county-mental-health-services_n_807522.html

Here's another interesting article about the state of mental health services in that area. My friends and former coworkers have been sharing it as massive budget cuts within our state have left us with no state-owned acute-care inpatient psych beds or psych ERs. Community hospitals are left to pick up the slack without much of (if any) increase in funding. CMHCs will not accept uninsured for services, and Medicaid eligibility has gotten so stringent that people are getting dropped left and right. The Medicaid adult psychotherapy benefit is ONLY for psychologists (no LCSW or LPC benefit), most of whom do not accept Medicaid because of low reimbursement rates and bureaucracy of the billing system. We are definitely hitting a crisis point.
 
What about the idea of hiring psychiatrists for all college campuses with one of their key functions being, to triage for dangerousness, psychiatric traffic cops so to speak, who would be directive and intrusive rather than non directive and unobtrusive. Once excellent support was established with campus security and local law enforcement the psychiatrist could then easily remove students that he or she perceived as dangerous from campus or get them hospitalized either privately or at state facilities.
 
Have brought the subject up with a faculty friend who was previously in mental health, and, in concordance with the article, it appears there's really not anything that can be done, even official monitoring. I mean, kind of disconcerting.
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Think of the opposite end of the spectrum. Should there be official monitoring because we witnessed out of the ordinary behavior that could not be verified with hard evidence?

Someone I know in residency was accused of raping another resident. It turned out to be all false and the accuser had some serious problems. The falsely accused resident was put under a status where he had to be observed. HE had near PTSD like anxiety for months and he did not do anything wrong.

Shall we have a society where simply based on one person's report, another can be put on "observation"?

What about the idea of hiring psychiatrists for all college campuses
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IMHO an excellent idea. Based on numbers alone and demographics, the age most students enter college is a virgin on prom night in terms of when mental illness starts. Combine that with the stressors of a completely new environment, being away from friends and family a person grew up with, marijuana use that almost every college student experiments (and with studies that MJ use dramatically increases the risk of a psychotic disorder) and expect at least several dozen, possibly hundreds of students having their first break in college depending on the size of the school.

Of course is that actually being done? I don't see it happening. IMHO there should be a type of fellowship for this type of thing with psychiatrists specializing in first break issues assigned to college campuses or at least in a city with several colleges that can be consulted.
 
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Yes, those were the same issues outlined to me by the faculty, and I completely understand. I'm just wondering what the author of the article propose be done.
 
There will always be a grey-zone where one questions the line between freedom and safety. Even with improvements based on behavioral science, cultural changes will shift the zone, making some advancements irrelevant and outdated.

Banning guns? Can't be done. It's in the Constitution. Or, more correctly, it can be done but don't expect it to happen.

Keeping guns from the mentally ill? Nope. There's already provisions for this in the background check laws but the gov cannot get access to someone's private mental health records. This has been taken as far as it can without new laws crossing that boundary.

Putting people on some type of "observational status" for questionable behavior that seems odd? Again, unConstitutional and it'll lead to a society where people could to do it to others simply based on maliciousness.

As for the argument that's been going on trying to link this to the right-wing, I found this idiotic unless there was specific evidence backing it up. If there were evidence that'd be another thing. Even with evidence it'd still fall under the "there's extremists on every side" category. In fact IMHO blaming the right-wing is just going to make them look better and more emboldened if it turns out that there was no evidence and so far that what it seems to be. I do not say this with any enjoyment because I do think several of things such as Palin's cross-hair images were irresponsible. I also find their "left-wing bias" claims as whining. (I do think there is a bias but it's not part of a left-wing conspiracy, it's more out of ratings and the faults of individual editors and reports.) There's just as much that could be pointed at either side. (E.g. Al Franken trying to get people to move to battleground states calling it Bleeding Kansas during the Bush-Kerry election).

A step in the right direction is the start of outpatient commitment but that might not have even been applicable in this case. One has to have a history justifying outpatient commitment (e.g. repeated violence or suicide attempts when noncompliant on meds and a frequent history of noncompliance). In almost all first-break situations, it happens when it happens and everything up until that event couldn't have been predicted it with reasonable certainty.
 
whopper said:
IMHO an excellent idea. Based on numbers alone and demographics, the age most students enter college is a virgin on prom night in terms of when mental illness starts. Combine that with the stressors of a completely new environment, being away from friends and family a person grew up with, marijuana use that almost every college student experiments (and with studies that MJ use dramatically increases the risk of a psychotic disorder) and expect at least several dozen, possibly hundreds of students having their first break in college depending on the size of the school.

Of course is that actually being done? I don't see it happening. IMHO there should be a type of fellowship for this type of thing with psychiatrists specializing in first break issues assigned to college campuses or at least in a city with several colleges that can be consulted.
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I know Cornell has about 3 psychiatrists listed as being on staff at the student health center (along with 3 PhD's and about 10 LCSWs and a psych NP), granted there has been a "suicide epidemic" of sorts here that probably caused the mental health services to get beefed up a lot
 
Agreed Whopper, with my own addition that perhaps it is time to reexamine the gun clause of the constitution. I wouldn't say that we should ban all guns, but perhaps tighter restrictions on the purchase would be warranted, given the amount of gun violence in our society. It's gotten to the point where the freedom to bear arms is infringing on our other freedoms. IMO, guns should be regulated at least as tightly as Percocet. Besides, the US military is far too well armed for the US population to be able to mount a real revolt against govt tyranny. So it seems to me that the purpose if the "right to bear arms" is largely mute at this point.

Regardless, my original point is that we need more mental health funding in our country and we should use this opportunity to get some. Will it help? That's a different question...
 
I didn't know about Cornell having the beefed up mental health services but that is great information and not surprising now that you bring it up based on the suicides occurring there and that the guy heading the school is an M.D.

At Rutgers, at least while I was there, a friend of mine was having some mental health issues and the person she was assigned was a graduate student with little supervision. I found this pretty shocking considering that they have a medical school attached to the university, the severity of the problem, and the psychiatric department in the medical school is considered the best in the state. How bad was it? The police had to be called at one point, and no psychiatrist was ever put on board in the case.

The local small college in my area didn't have a psychiatrist working for them, though one particular private psychiatrist was referred all the cases they felt they couldn't handle on their own. He ended up, on his own, doing a lot of work reading up on issues that affected this population such as eating disorders and first-break psychosis. This area IMHO warrants it's own fellowship given that it's a type of population that is rarely seen in a general practice and requires much more "under the microscope" examinations given that first breaks and prodrome often present with symptoms (edit: NOT) on the severity of a full blown psychotic disorder. Very few psychiatrists have skill in treating borderline PD, and eating disorders, another area that often affects this demographic.

There is research showing that treatment during the prodrome stage may halt the onset of psychosis, possibly even give someone that will inevitably develop it to have a better prognosis.

with my own addition that perhaps it is time to reexamine the gun clause of the constitution.
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A very sticky subject. I know plenty of people who own guns and are law-abiding citizens that know far more than many people that enter this debate.
 
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whopper said:
This area IMHO warrants it's own fellowship given that it's a type of population that is rarely seen in a general practice and requires much more "under the microscope" examinations given that first breaks and prodrome often present with symptoms on the severity of a full blown psychotic disorder.
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Well hopefully one of you can get this fellowship up and running in the next 7 years :)

Doing college campus psychiatry is sort of my "dream job" at this point, it seems that college can be such a "tipping point" in people's lives and if someone can "keep the wheels on the car" for a couple years it can dramatically influence someone's course of life for the better.
 
whopper said:
Shall we have a society where simply based on one person's report, another can be put on "observation"?
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No. Not even that person is a psychiatrist or a psychologist. I've run into one too many boundary impaired self-important providers with god complexes who would have no qualms about doing this to people simply for having the audacity to disagree with them. Thankfully I've run into very few people like this, but one is one too many and the consequences to the life of an innocent person just isn't worth it, to my mind.
 
sunlioness said:
No. Not even that person is a psychiatrist or a psychologist. I've run into one too many boundary impaired self-important providers with god complexes who would have no qualms about doing this to people simply for having the audacity to disagree with them. Thankfully I've run into very few people like this, but one is one too many and the consequences to the life of an innocent person just isn't worth it, to my mind.
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How about a "crazy panel?" I'm sure that'd go over well.
 
whopper said:
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Keeping guns from the mentally ill? Nope. There's already provisions for this in the background check laws but the gov cannot get access to someone's private mental health records. This has been taken as far as it can without new laws crossing that boundary.

Putting people on some type of "observational status" for questionable behavior that seems odd? Again, unConstitutional and it'll lead to a society where people could to do it to others simply based on maliciousness.
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Unfortunately the honus is on the hospital to disclose to the DOJ when someone is at risk. And obviously they're not taking that responsibility very seriously.

Involuntary committment isn't going swimmingly I hear for psychopaths in the UK. Do a pubmed search on DSPD (Dangerous and Severe Personality Disorder) and take a look at their trends. Really arose because of sensationalized episodes just like this one, leading to a public outcry and the government passing laws to hospitalized someone for a potentially indefinite period of time. Maybe it would violate the constitution, maybe with the current supreme court it wouldn't...
 
nitemagi said:
California has a law that if you're put on a 5150 (72 hour involuntary detention), they are forbidden from buying a gun for 5 years. The record is sent to the DOJ. Who knows how much it's followed, but better than nothing.
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In my limited experience (in California) the police don't or can't take it seriously. A couple times this year I have called the police to notify them that I am discharging a patient who has been on a 5150 who has told me they have a gun in their possession (and refused to allow a friend or neighbor remove) and the response I get is, "if they're so dangerous why are you discharging them?" Well, officer, they no longer meet hold criteria so keeping them would be illegal...

One time when I called and was asked, "what am I supposed to do about that?" I brought up that having a gun was illegal and the person refused to relinquish the gun so couldn't they go remove it from the house before I discharged the patient? I was told that "yes its illegal but people do illegal things all the time." They said they don't have the right the remove the firearm unless the patient was found actually holding the gun.
 
5150 is also a pretty good Van Halen album, as well as a GREAT guitar amp.
 
Don't expect the interface between the law and psychiatry, though improving, to be able to solve these problems for some time to come.

A prominent forensic psychiatrist I know of (and not in Ohio) argued on the stand that criminals in psychiatric units that assault staff members shouldn't be prosecuted even if their actions were not due to mental illness. Of course the fact that he was being paid by the defense where the defendant was someone with only an Axis I of substance abuse and an Axis II of Antisocial PD of course shouldn't have any bearing on this at all as a possible conflict of interest.

(hmm, I'm thinking the FP may have had antisocial PD as well....)

Like I said, the field is still in an phase where you can be terrible but the places of high prestige still have to hire you because there's no one else available.
 
whopper said:
I agree with OPD's take on this.

At least as of now (Sunday afternoon, Eastern time 1/9/2011) I think we're at a stage where there's much more to learn about this before I'd want to add any comments of worth.

It's usually things like this that cause changes in mental health laws if the perpetrator was mentally ill. The involuntary outpatient commitment in NY was written into law after a someone mentally ill was released to the community and pushed someone into an oncoming train.

The shooter in the Arizona case was described as "mentally unstable" but that is IMHO not enough to base any comments on. Heck, anyone committing a crime can be considered mentally unstable.
Click to expand...

Aren't those what criminals are?

Just my quick 2 cents about gun control; Criminals will be criminals. The law abiding will be law abiding.
 
Aren't those what criminals are?
Click to expand...

And that's why not only was this person's testimony a difference of opinion, but one that IMHO begged the question that he didn't even believe in it and was just saying what he said because he was paid well.

A problem is that Courts look to forensic psychiatrists for guidance, and if a Court makes a decision it set's a precedent. If the Court takes the person's testimony and makes a decision based on it, it makes it that much easier in the future for antisocial people who intentionally assault others on a psychiatric unit for them to not get prosecuted.

Taken to the worst extreme, in such a situation, someone could fake psychiatric symptoms, then rape another patient or staff member and then not get prosecuted at all.
 
Sigh. Collectively this whole conversation is causing me to visualize a scenario in which someone who may or may not have a mental illness does something violent. He isn't prosecuted because he's "ill", but the psychiatrist whose crystal ball wasn't clear enough to predict this behavior is.
 
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