The Shooting and its Effects on Mental Health Treatment

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Let's be honest: the love of the gun in this country is akin to religious devotion. So, I should probably not write anything, but I just can't resist

Two things: (1) There is nothing in the US constitution that specifically deals with gun ownership. The conservative elements in the US have done an excellent job in making the phrase "the right...to keep and bear arms" to include silencers and Hello Kitty assault rifles. The right for gun ownership is not as simple as pro-gun advocates make it seem. (2) The scientific literature overwhelmingly supports the view that gun ownership is a risk factor for mortality/morbidity for every person living in a house with a gun. As scientists who support evidence-based practice, I argue that you should all advocate for less gun ownership

JAMA, NEJM, and the APHA have convincing shown the effects of gun ownership in protecting yourself from strangers, protecting your family, and protecting yourself from yourself. None of it is positive. If these studies were about any other unsafe practice, you would conclude it should be discouraged. As physicians, you should advocate gun-free households to increase positive outcomes in your patients, just as you should discourage smoking and obesity.

And while I'm in fantasy land, can we also have JCAHO require hospitals to use only the metric system to decrease mortality/morbidity from medical errors?

Awesome, thanks :)

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Someone I went to medical school with now practices as a pediatrician in Florida. She told me recently that they're trying to pass a law there that would prohibit physicians from asking patients about their access to firearms. My mind boggled.
 
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...(2) The scientific literature overwhelmingly supports the view that gun ownership is a risk factor for mortality/morbidity for every person living in a house with a gun. As scientists who support evidence-based practice, I argue that you should all advocate for less gun ownership

JAMA, NEJM, and the APHA have convincing shown the effects of gun ownership in protecting yourself from strangers, protecting your family, and protecting yourself from yourself. None of it is positive. If these studies were about any other unsafe practice, you would conclude it should be discouraged. As physicians, you should advocate gun-free households to increase positive outcomes in your patients, just as you should discourage smoking and obesity.

Typical liberal media.... :rolleyes:
;)

And while I'm in fantasy land, can we also have JCAHO require hospitals to use only the metric system to decrease mortality/morbidity from medical errors?.
As if we needed more proof that you're a raving socialist!
:laugh:
 
I'm not sure what's more disconcerting. 1) the imPlication by some that guns are to blame or their banning could have prevented this type of tragedy 2) that people still quote kellermans biased and highly debatable if not fully discredited "studies" or 3) that some of the posts here once again try to elevate paychiatry to the level of ultimate arbiter of who can walk the streets free or exercise their constitutional rights by performing evals on everyone before thy can buy a gun? Given psych's history on how they've handled that type of power in the past, no thank you.

iloveDrStill, and you stereotype those who ignore the phrase "the right of the people" and the ample historical references that negate your claims that they intended a collective right via the militia. the national guard wasn't founded until 1903, so how the hell does the 2nd amendment relate to the National Guard as the miliia? as defined by the Militia act which was passed in 1793 (gee, isn't that around the same time most of the founding fathers where in the government?)
Title 10, United States Code, Subtitle A, Part I, Chapter 13, Section 311:


Sec. 311. - Militia: composition and classes

(a)
The militia of the United States consists of all able-bodied males at least 17 years of age and, except as provided in section 313 of title 32, under 45 years of age who are, or who have made a declaration of intention to become, citizens of the United States and of female citizens of the United States who are members of the National Guard.

(b)
The classes of the militia are -


(1)
the organized militia, which consists of the National Guard and the Naval Militia; and

(2)
the unorganized militia, which consists of the members of the militia who are not members of the National Guard or the Naval Militia

Title 10, United States Code, Subtitle A, Part I, Chapter 13, Section 311:
 
She told me recently that they're trying to pass a law there that would prohibit physicians from asking patients about their access to firearms

There's only one good thing about this. It'll prevent the psychiatrist from having to factor the gun in their decision-making process that further protects us from liability should our patient commit a dangerous acts using a gun.

Not that I agree with it. Just that where I practice a lot of people have guns. So basically it comes down to a significant minority of people with an Axis I disorder with guns and I can only tell them that I recommend there be barriers put into place between the patient and the gun depending on the severity (E.g. giving the locks to the gun to their spouse), or tell them to get rid of it. This sometimes rubs the person the wrong way (especially if they're the more extreme type).

These weren't my patients, but I have done several evaluations for the Court where someone is suicidal, then is claiming to be no longer be so, and the discharge plan is to bring them to a home with dozens of guns and enough ammo to survive the apocalypse. These patients are held in a limbo because they don't want to get rid of the guns but then no one wants to discharge them and this is very frustrating. Most doctors don't know what they would do in this situation that makes them feel comfortable but I have seen some tactics used that are questionable. E.g. the person is held until their next court date on the hope the court will force a discharge or the doctor tries to turf this patient to another doctor.

The only time I had a patient commit suicide within a short time frame from discharge, the family intentionally misled me and told me they didn't have any guns so their daughter could be discharged faster. She killed herself with a gun. Yeah, I has protected because we documented what the family told us but I certainly wasn't happy about it.
 
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I've had pretty good experience at least not damaging patient relationships by sandwiching my schpiel on the evils of guns in layers of how I respect the constitution and civil liberties and individual rights blah blah, but that we know on average that the risk of people completing suicide with a gun around is significantly increased, even when folks take precautions x, y, and z. I usually tell them that legally and based on the standards of my profession I have to discuss this information with them, and that "I wouldn't be doing my job if" I didn't (I use that quoted phrase for almost every annoying thing I do). I felt like I've had a good number of folks either remove the guns (turn them into the police station) or give them to someone else while they were symptomatic, more than I would have if I would have let my I'm-an-Obamalovin-gunhating-gaypeoplemarryin-guy-who-sleeps-in-on-Sundays self shine through.

Gun issues make otherwise sane people so incredibly defensive that nothing short of a pretty MI-ish approach (or frank totalitarianism, which is sorta undesirable) has much chance of effecting any sort of behavioral change.
 
I'm not sure what's more disconcerting. 1) the imPlication by some that guns are to blame or their banning could have prevented this type of tragedy 2) that people still quote kellermans biased and highly debatable if not fully discredited "studies" or 3) that some of the posts here once again try to elevate paychiatry to the level of ultimate arbiter of who can walk the streets free or exercise their constitutional rights by performing evals on everyone before thy can buy a gun? Given psych's history on how they've handled that type of power in the past, no thank you.

iloveDrStill, and you stereotype those who ignore the phrase "the right of the people" and the ample historical references that negate your claims that they intended a collective right via the militia. the national guard wasn't founded until 1903, so how the hell does the 2nd amendment relate to the National Guard as the miliia? as defined by the Militia act which was passed in 1793 (gee, isn't that around the same time most of the founding fathers where in the government?)
Title 10, United States Code, Subtitle A, Part I, Chapter 13, Section 311:


Sec. 311. - Militia: composition and classes

(a)
The militia of the United States consists of all able-bodied males at least 17 years of age and, except as provided in section 313 of title 32, under 45 years of age who are, or who have made a declaration of intention to become, citizens of the United States and of female citizens of the United States who are members of the National Guard.

(b)
The classes of the militia are -


(1)
the organized militia, which consists of the National Guard and the Naval Militia; and

(2)
the unorganized militia, which consists of the members of the militia who are not members of the National Guard or the Naval Militia

Title 10, United States Code, Subtitle A, Part I, Chapter 13, Section 311:

ownage
 
I've had pretty good experience at least not damaging patient relationships by sandwiching my schpiel on the evils of guns in layers of how I respect the constitution and civil liberties and individual rights blah blah, but that we know on average that the risk of people completing suicide with a gun around is significantly increased, even when folks take precautions x, y, and z. I usually tell them that legally and based on the standards of my profession I have to discuss this information with them, and that "I wouldn't be doing my job if" I didn't (I use that quoted phrase for almost every annoying thing I do). I felt like I've had a good number of folks either remove the guns (turn them into the police station) or give them to someone else while they were symptomatic, more than I would have if I would have let my I'm-an-Obamalovin-gunhating-gaypeoplemarryin-guy-who-sleeps-in-on-Sundays self shine through.

Gun issues make otherwise sane people so incredibly defensive that nothing short of a pretty MI-ish approach (or frank totalitarianism, which is sorta undesirable) has much chance of effecting any sort of behavioral change.

I'm horrified you think owning a gun is a behavior that needs "modifying".

If it's this kind of baseline thinking that is interested in "moar powah" to forcibly hold and or treat people you don't think tow some kind of artbitrary "normal", then I'll pass EVERY single time on giving any of you more power to do ANYTHING as it relates to restriction of the natural liberties of any human being. I'll take mass shootings over a bunch of psychitrists trying to "help me" or anyone else with this kind of nonsense every day of the week.
 
I'm horrified you think owning a gun is a behavior that needs "modifying".

If it's this kind of baseline thinking that is interested in "moar powah" to forcibly hold and or treat people you don't think tow some kind of artbitrary "normal", then I'll pass EVERY single time on giving any of you more power to do ANYTHING as it relates to restriction of the natural liberties of any human being. I'll take mass shootings over a bunch of psychitrists trying to "help me" or anyone else with this kind of nonsense every day of the week.

I don't think he is trying to convince all his patients to give up their guns, probably just those who are a serious danger to themselves.

Using your logic, if I take the keys away from my drunk friend then you could conclude that I "Don't respect the right of people to own cars".
 
I'm horrified you think owning a gun is a behavior that needs "modifying".

If it's this kind of baseline thinking that is interested in "moar powah" to forcibly hold and or treat people you don't think tow some kind of artbitrary "normal", then I'll pass EVERY single time on giving any of you more power to do ANYTHING as it relates to restriction of the natural liberties of any human being. I'll take mass shootings over a bunch of psychitrists trying to "help me" or anyone else with this kind of nonsense every day of the week.

I don't see the term modifying used in the post at all. But if you don't believe ownership of a gun is a risk factor for completing suicide, you're tragically out of touch with the data and reality. Though I get your point that being forced to stay in a hospital to give up something you own is a bit dramatic.

But unfortunately it comes down to liability and the balance of state's rights vs. individual. If someone gets brought into an emergency room involuntarily by the police saying he's suicidal and planning to shoot himself, and then changes his story and says he isn't suicidal, my sending him home with a gun in the house would be negligent.

If you take issue with Psychiatrists being worried about guns then I presume you have issue with involuntary detention at all. And that's fine. But there are clear situations currently when the state rules you don't have a clear mind to make certain decisions for yourself. And the psychiatrist is acting as the agent of the state. Most of us don't really want that responsibility. But we're in that responsibility nonetheless.
 
I'm going to take a devil's advocate approach not so much because I very much agree with it, but because there appears to be a majority opinion for one side.

Take a look at this poll and the numbers. Mind you it's before the shooting and I intentionally got it for that reason. Things like this tend to stir opinions in a way that does not become long-term.
http://www.gallup.com/poll/20098/gun-ownership-use-america.aspx

In several localities, it's not out of the ordinary to own a gun and in fact may become logical for those of you against gun ownership. If you live out in a very rural area such as farmland, forests, out in the desert, where police are not expected to show up quickly (heck they often don't show up quickly even in an urban area), owning a gun is accepted and is even considered part of the cultural identity.

Remember, federal laws that are passed affect everyone in the country. Someone living in NYC may not be factoring in how a gun law they'd support would affect someone living in rural Nebraska.

I used to be very anti-gun ownership. My own views have mellowed with age and accumulating friends that own guns. Many of them gave me specific examples of how gun laws would only affect the law abiding citizen while not hurting criminals. E.g. taxing a gun. Now the guy that lawfully owns a gun has to pay a tax but the guy that got it illegally doesn't have to pay a tax.

Now I do realize that there is more grey to this argument but yes, I see that point to some degree.

Okay, now getting onto my own personal beliefs.

Personally, IMHO, anyone owning a gun without appropriate training, responsible behavior (e.g. a gun lock, the gun is kept in a safe or other some other vault like device) should not be able to own it. I in no way shape or form support the outright banning of guns to the population. I know of too many responsible gun owners and some of them actually needed their gun (e.g. the person had someone stalking them with a dangerous history).

IMHO the debate between gun ownership and laws to regulate it is being dominated by people who are on the extreme on both sides. I find many people who want it banned in a demographic where they never owned one, do not know what it's like to own one, and were never in a position where they may have needed one. You may disagree with me but if someone owns one responsibly and is in a position where the police cannot show within seconds and there is good reason to believe they are in danger, they should have the option to have one. (and yes, I do agree there are other, possibly better methods of protection such as a better security system). I find another side literally equating further gun laws as the signal that America will be the next Nazi Germany.
 
So, as practicing psychiatrists and psychiatrists in training, what would you all suggest in terms of "mental health reform?"

Usually that's a veiled way of saying "more funding." But more funding for what? More psyciatrists? More nurses? More facilities? And funding from where? Taxes? Copayments?

What do you all think should be done but also, how do you want to pay for it?
 
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3) that some of the posts here once again try to elevate paychiatry to the level of ultimate arbiter of who can walk the streets free or exercise their constitutional rights by performing evals on everyone before thy can buy a gun? Given psych's history on how they've handled that type of power in the past, no thank you.

What posts are you reading? It seems to me that most people here are saying that's the last thing they want. The people I see coming out for psychiatrists having the right to put away whomever they want seem to be politicians and pundits who know nothing about mental illness or the practice of psychiatry. Personally, I think it would be a horrible idea to change involuntary commitment laws to be less restrictive or require psych evals before gun purchase. I don't want that level of power over others. I don't want the responsibilty for what others choose to do with their free will that I failed to predict with my non-existent crystal ball. And the thought of the potential abuses of this kind of thing is horrifying.

I don't see anyone here claiming that psychiatry should be the ultimate arbiter of these kind of things. Quite the contrary.

I don't think he is trying to convince all his patients to give up their guns, probably just those who are a serious danger to themselves.

Using your logic, if I take the keys away from my drunk friend then you could conclude that I "Don't respect the right of people to own cars".

Exactly.
 
I don't see anyone here claiming that psychiatry should be the ultimate arbiter of these kind of things. Quite the contrary.

But but but, Sunlioness, are you saying that psychiatrists are going to require people to learn how to actually read instead of spewing forth whatever screed they had in their back pocket when they were googling "psychiatrists are evil mind controllers who want to lock me up and take away my gun and make me gay-marry a gay golden retriever"? Oh my god, you Stalinoperidol-wielding demon banshee psychiatrist, you! :rolleyes:
 
What posts are you reading? It seems to me that most people here are saying that's the last thing they want.

How about the OP? That's the post that caught my eye. Why several are against, there will be others like the OP out there and this idea has been a meme floated by people like the vpc and Brady camp.*

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


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

And this guy who seems to like the idea even if he doesn't wan the implimintation.
 
The biggest problem I see in psychiatry in relation to psychiatrists is lack of DBT training yet we get several in need of it and the strange phenomenon where doctors see a patient and in just a few minutes diagnose them without following the DSM criteria and then giving a medication chosen under further questionable methods.

My recommendation? Have psychiatrists (or other mental health professionals) working under cover and wired as a form of quality control randomly go to a doctor and rate how the interview and treatment choice goes.

My attitude, if the doctor's doing a good job he's got nothing to fear. If the doctor disagrees with the evaluator's report there's objective data (the guy is wired after all).

And this guy who seems to like the idea even if he doesn't wan the implimintation.
If I'm interpreting you correctly, I don't think it's a bad idea to ask the question because several people believe that mental health evaluations have a high degree of accuracy in predicting future violence They do not. If they did that would change the debate.
 
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I don't see the term modifying used in the post at all.

Interesting . . .

Gun issues make otherwise sane people so incredibly defensive that nothing short of a pretty MI-ish approach (or frank totalitarianism, which is sorta undesirable) has much chance of effecting any sort of behavioral change.

Is it your contention that effecting a behavioral change is not a "modification"? We should define our terms so that I can understand if you're simply being overly pendantic or intellectually dishonest.
 
I don't think he is trying to convince all his patients to give up their guns, probably just those who are a serious danger to themselves.

Using your logic, if I take the keys away from my drunk friend then you could conclude that I "Don't respect the right of people to own cars".

Do you take away the car keys of the suicidal? They might sit in their garage with the engine running. Hell, do you take away any of their psych meds? Because that tends to be what I see them most commonly comming into my ICU having ingested copious amounts of . . . Do you allow them near anything that might cut, like a steak knife? Or perhaps prevent the existence of bridges over large bodies of water or stop the running of trains trains . . .
 
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

see, this is one of the reasons I enjoy psych... you're going to see dudes like this no matter what specialty you go into, and I'd rather see him on a psych floor than a medicine or surgical one. Crazy abides in all aspects of medicine. I enjoy being the one trained to deal with it.
 
see, this is one of the reasons I enjoy psych... you're going to see dudes like this no matter what specialty you go into, and I'd rather see him on a psych floor than a medicine or surgical one. Crazy abides in all aspects of medicine. I enjoy being the one trained to deal with it.


TUCSON — Law enforcement officials said Friday they have multiple photos of Jared L. Loughner posing with a Glock 9mm pistol next to his naked buttocks and dressed in a bright red g-string.


Police Describe Photos of Loughner Posing With Gun
 
Interesting . . .


Is it your contention that effecting a behavioral change is not a "modification"? We should define our terms so that I can understand if you're simply being overly pendantic or intellectually dishonest.

You used the term "modifying" in quotes. I interpreted the use of quotation marks as to indicate a quote. But I suppose if you were actually quoting, you'd use the SDN quote feature, as I did here. Instead of your condescending response masked as a question, as above.
 
Do you take away the car keys of the suicidal? They might sit in their garage with the engine running. Hell, do you take away any of their psych meds? Because that tends to be what I see them most commonly comming into my ICU having ingested copious amounts of . . . Do you allow them near anything that might cut, like a steak knife? Or perhaps prevent the existence of bridges over large bodies of water or stop the running of trains trains . . .

Your ICU, eh? Your profile says resident, so I'd presume we can all have a little humility when talking about a specialty outside our field of expertise.

I think we do our best to help to prevent suicide. You may be in favor of someone's right to die as part of their life choice. That's a philosophical difference, and you have the right to your opinion. Our job as psychiatrists, and the most we can aim for is to reduce risk, not eliminate it. Even if someone is in a seclusion room in 4-point restraints they could still bite their tongue off. I'm not aiming to eliminate it.

And I get your use of extremes is to elucidate a point. Unfortunately you've never dealt with families who're on the front lines of taking care of a severely depressed family member. Yes, actually, they (the family) often take away knives and many other objects. Because they care, and they see the individual isn't thinking like their normal self.

The downside of guns, IMO, is not the ownership in those with mental illness, it's that it leaves very little room for error or regret. If you've ever talked with someone post suicide attempt, very often they have regret or even a lifting of their mood. Not always, but in my experience a lot. Shooting oneself in the head doesn't leave much room or time to develop insight, or change your mind.
 
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How about the OP? That's the post that caught my eye. Why several are against, there will be others like the OP out there and this idea has been a meme floated by people like the vpc and Brady camp.*

And this guy who seems to like the idea even if he doesn't wan the implimintation.

I know it's a slippery slope, but there's a big difference between getting psych/medical clearance before purchasing a gun, banning guns completely, and omnipotent psychiatrists with Orwellian powers.
 
Forget the gun aspects and what has transpired for a moment. What would you have done if the school asked you to review the numerous reports of disturbances as well as the youtube video which he posted?

Maybe it would be beneficial from a public health perspective if lay people were trained to at least recognize various forms of mental illness so as to know when they should bring in a psychiatrist for consultation. Even then, one psychiatrist's opinion should not be enough to deprive someone of their liberty, second and maybe third and fourth opinions should be obtained.
 
I know it's a slippery slope, but there's a big difference between getting psych/medical clearance before purchasing a gun, banning guns completely, and omnipotent psychiatrists with Orwellian powers.


slippery? not even brian boitono could skate that successfully. prohibite dpersons should only be based on a clearly defined list of crimes or conditions, not some random psychiatrist with unknown political leanings.

now my question to you guys, below is a list of reasons to be denied a firearm by the brady check.

Has been convicted in any court of a crime punishable by imprisonment for a term exceeding one year;
Is a fugitive from justice;
Is an unlawful user of or addicted to any controlled substance;
Has been adjudicated as a mental defective or committed to a mental institution;
Is an alien illegally or unlawfully in the United States;
Has been discharged from the Armed Forces under dishonorable conditions;
Having been a citizen of the United States, has renounced U.S. citizenship;
Is subject to a court order that restrains the person from harassing, stalking, or threatening an intimate partner or child of such intimate partner, or;
Has been convicted in any court of a misdemeanor crime of domestic violence.

how would you define or firm up the pysch component (I.e. should all schizophrienics be on this list? bipolar with violent manic episodes? any axis II ex?) and is there a way to bridge the medical with the legal as is often required of seizure pts and driving in an equitable manner?
 
slippery? not even brian boitono could skate that successfully. prohibite dpersons should only be based on a clearly defined list of crimes or conditions, not some random psychiatrist with unknown political leanings.

now my question to you guys, below is a list of reasons to be denied a firearm by the brady check.

Has been convicted in any court of a crime punishable by imprisonment for a term exceeding one year;
Is a fugitive from justice;
Is an unlawful user of or addicted to any controlled substance;
Has been adjudicated as a mental defective or committed to a mental institution;
Is an alien illegally or unlawfully in the United States;
Has been discharged from the Armed Forces under dishonorable conditions;
Having been a citizen of the United States, has renounced U.S. citizenship;
Is subject to a court order that restrains the person from harassing, stalking, or threatening an intimate partner or child of such intimate partner, or;
Has been convicted in any court of a misdemeanor crime of domestic violence.

how would you define or firm up the pysch component (I.e. should all schizophrienics be on this list? bipolar with violent manic episodes? any axis II ex?) and is there a way to bridge the medical with the legal as is often required of seizure pts and driving in an equitable manner?

Great discussion, btw.
I would go with a psychotic illness, or more importantly any illness that led to impairment of judgment and behavior, particularly in a dangerous way.

And I really have to say that mental illness is a much better reason for forbidding guns than many of the other reasons in the brady check. Dishonorable discharge? Or just being a convict?
 
You used the term "modifying" in quotes. I interpreted the use of quotation marks as to indicate a quote. But I suppose if you were actually quoting, you'd use the SDN quote feature, as I did here. Instead of your condescending response masked as a question, as above.

Well I do think it's often important before beginning a discussion to elucidate if I'm dealing with an idiot or not. So, you were being overly pedantic. Check.

But unfortunately it comes down to liability and the balance of state's rights vs. individual. If someone gets brought into an emergency room involuntarily by the police saying he's suicidal and planning to shoot himself, and then changes his story and says he isn't suicidal, my sending him home with a gun in the house would be negligent.

If you don't think a patient is safe enough at home with a gun, then maybe that patient isn't safe enough at home at all. As long as we are talking about negligence . . . (you brought it up, not me, and I'm not making a call regarding "negligence" here one way or the other)

If you take issue with Psychiatrists being worried about guns then I presume you have issue with involuntary detention at all. And that's fine. But there are clear situations currently when the state rules you don't have a clear mind to make certain decisions for yourself. And the psychiatrist is acting as the agent of the state. Most of us don't really want that responsibility. But we're in that responsibility nonetheless.

I don't know why you would necessarily presume that. It makes the discussion difficult and frustrating.
 
Has been adjudicated as a mental defective or committed to a mental institution

Point of clarification. I wrote before that private medical records are not in the hands of the government. That is correct but what some people may not have gotten out of that statement is if someone is involuntarily committed, that record may be in the hands of the government because doing so requires court intervention.

Several localities will take efforts to make sure that someone involuntarily committed will not have their private information given out to the public, but the data that they are mentally ill, while not given out to the public could in some localities get to those enforcing gun laws.

In the VTech killer case, he was not involunatarily committed, so he slipped through, as well as in this case. If they were involuntarily committed, it is possible this could've been avoided.
 
Your ICU, eh? Your profile says resident, so I'd presume we can all have a little humility when talking about a specialty outside our field of expertise.

I don't get your point here.

I think we do our best to help to prevent suicide. You may be in favor of someone's right to die as part of their life choice. That's a philosophical difference, and you have the right to your opinion. Our job as psychiatrists, and the most we can aim for is to reduce risk, not eliminate it. Even if someone is in a seclusion room in 4-point restraints they could still bite their tongue off. I'm not aiming to eliminate it.

And I get your use of extremes is to elucidate a point. Unfortunately you've never dealt with families who're on the front lines of taking care of a severely depressed family member. Yes, actually, they (the family) often take away knives and many other objects. Because they care, and they see the individual isn't thinking like their normal self.

The downside of guns, IMO, is not the ownership in those with mental illness, it's that it leaves very little room for error or regret. If you've ever talked with someone post suicide attempt, very often they have regret or even a lifting of their mood. Not always, but in my experience a lot. Shooting oneself in the head doesn't leave much room or time to develop insight, or change your mind.

You clearly misunderstand. I'm not particularly "pro-suicide" (if such a thing is possible) - though as a matter of philosophical point I don't have a problem with every single incidence of someone taking their own life. I'm not against involuntary holds, and I've had to place them myself. I have talked to the suicide patient in the morning after and immediately after attempt . . . you know, when the patient is too "acute" to be "seen" by the psych resident, and I'm cleaning up the medical mess . . . so I've seen the regret . . . however, it's been my experience that those who mean it, finish the job, and a gun leaving little room for error is simply part of the game. Bottom line, if a patient is too dangerous to be near a gun, why the hell should they be anywhere but in a lockdown for a few days if our goal is actually "risk reduction"?
 
Do you take away the car keys of the suicidal? They might sit in their garage with the engine running. Hell, do you take away any of their psych meds? Because that tends to be what I see them most commonly comming into my ICU having ingested copious amounts of . . . Do you allow them near anything that might cut, like a steak knife? Or perhaps prevent the existence of bridges over large bodies of water or stop the running of trains trains . .

Fair questions but the data is already in most psychiatric texts in their suicide chapter. Pick one up in your medical library. It could explain it better than we could. By the way if someone here wants to type it all out do so by all means. I just thinking doing so when it's already in a readily available source is redundant.

But, by the way, I wouldn't have to take the person's car keys if the person was suicidal because that person would most likely have to be petitioned for involuntary comitment anyway.
 
Well I do think it's often important before beginning a discussion to elucidate if I'm dealing with an idiot or not. So, you were being overly pedantic. Check.

If you review BillyPilgrim's original post, he appears to have been referring to the defensiveness brought on by discussing guns that needed to be modified, not the ownership itself. You can call that observation pedantic if you like, but you are just illustrating his point.

If you don't think a patient is safe enough at home with a gun, then maybe that patient isn't safe enough at home at all. As long as we are talking about negligence . . . (you brought it up, not me, and I'm not making a call regarding "negligence" here one way or the other)

Often I don't think they're safe at home. But I'm working within the law. Unlike the ICU where you have intense control over many variables immediately, we're trying to prevent an outcome not just immediately but days/weeks/months later. Often we have only blunt instruments. We work with what we have, unfortunately.
 
however, it's been my experience that those who mean it, finish the job, and a gun leaving little room for error is simply part of the game. Bottom line, if a patient is too dangerous to be near a gun, why the hell should they be anywhere but in a lockdown for a few days if our goal is actually "risk reduction"?

Again, read a chapter on suicide in a psychiatric text. You could also ask the psychiatry attendings in your hospital. Reason why I bring that up is because it's better explained in that method.

Kinda like asking someone to tell you what happened in the movie or seeing the movie yourself. One manner is long, frustrating, and likely to not be as effective as the other.
 
...I have talked to the suicide patient in the morning after and immediately after attempt . . . you know, when the patient is too "acute" to be "seen" by the psych resident, and I'm cleaning up the medical mess . . . so I've seen the regret . . . however, it's been my experience that those who mean it, finish the job, and a gun leaving little room for error is simply part of the game. Bottom line, if a patient is too dangerous to be near a gun, why the hell should they be anywhere but in a lockdown for a few days if our goal is actually "risk reduction"?

And that's where our experiences diverge. You see them for a day, or maybe a week. You're treating their medical "mess." You're not experienced in treating their depression, or preventing them from getting into the ICU in the first place. Your patient experience has a clear selection bias. Once you've actually worked to prevent suicide and treat depression, then you can critique our practices. You're starting to think outside of immediate crisis management (an ICU or emergency mentality) and what we have to consider, preventing behavior that we don't have immediate control over. Risk reduction doesn't stop in the emergency room.
 
Do you take away the car keys of the suicidal? They might sit in their garage with the engine running. Hell, do you take away any of their psych meds? Because that tends to be what I see them most commonly comming into my ICU having ingested copious amounts of . . . Do you allow them near anything that might cut, like a steak knife? Or perhaps prevent the existence of bridges over large bodies of water or stop the running of trains trains . . .

for what its worth, quite a few bridges are modified to make suicide more difficult, I think there is an entire sub-niche of architecture firms who work on those sort of projects.

And in relation to the steak knives- I know a friend's family was told to hide all their knives out of sight for a couple days after my friend's sibling had considered harming himself.

I'll leave the rest of the post to others
 
I'm not sure what's more disconcerting. 1) the imPlication by some that guns are to blame or their banning could have prevented this type of tragedy

I did not blame guns. I also said nothing about banning them. I did post peer reviewed evidence from some of the world's top journals to show that gun ownership is a risk factor for several bad outcomes, and I said that physicians should therefore discourage owning them.

2) that people still quote kellermans biased and highly debatable if not fully discredited "studies"

I'd very much like to see where Kellermann has been 'discredited'. In fact, his findings have since been replicated in JAMA and in the NEJM. I'd be interested to see if you have any peer reviewed articles to back up your magnanimous posturing.

I'm horrified you think owning a gun is a behavior that needs "modifying".

As I said in my original post, gun ownership for some this is akin to a religious debate. I get the feeling from jdh71 and Hernandez that any amount of scientific literature would not convince you to consider the risk of gun ownership. So, as OPD said, please disregard the libel rag journals mentioned previously :)

iloveDrStill, and you stereotype those who ignore the phrase "the right of the people" and the ample historical references that negate your claims that they intended a collective right via the militia. the national guard wasn't founded until 1903, so how the hell does the 2nd amendment relate to the National Guard as the miliia?

Perhaps it is your sophisticated argument--or your fractured grammar and syntax-- but I don't understand you. My only point regarding the law was that guns are not specifically mentioned in the US constitution. Nothing you said seemed to argue that so I am confused.

Considering that a supreme court justice thinks that the 14th amendment doesn't apply to women, I don't think it's a stretch to say that the authors of the 2nd amendment didn't foresee the sort of weaponry that we have today, and that we shouldn't just accept things like automatic rifles and silencers ad oculos.

As if we needed more proof that you're a raving socialist!
:laugh:

Shhh....don't tell anyone :)
 
And that's where our experiences diverge. You see them for a day, or maybe a week. You're treating their medical "mess." You're not experienced in treating their depression, or preventing them from getting into the ICU in the first place. Your patient experience has a clear selection bias. Once you've actually worked to prevent suicide and treat depression, then you can critique our practices. You're starting to think outside of immediate crisis management (an ICU or emergency mentality) and what we have to consider, preventing behavior that we don't have immediate control over. Risk reduction doesn't stop in the emergency room.

My point there was please save me the sanctimony . . .

I wouldn't be criticizing your practices if they were consistent.
 
And in relation to the steak knives- I know a friend's family was told to hide all their knives out of sight for a couple days after my friend's sibling had considered harming himself.

Which makes sense if you're seriously worried about someone seriously harming themselves. I think you missed the point. Nitemagi got it.
 
My only point regarding the law was that guns are not specifically mentioned in the US constitution.
In fairness, there's no mention of the Internet in the constitution either, but we assume it to be covered by the first amendment in spirit. I think this is the same spirit in which those that favor of private gun ownership view that particular right being covered by the second amendment.

I'm not on any side on this one, but using the literalist defense for gun control can also be applied by the right to deny rights that I find pretty worthwhile.
 
I think about several suicide risk factors when deciding when/how to discharge someone who was recently suicidal, including whether he has...
- someone else at home, or someone with whom he can stay for a couple days
- a support system
- serious/terminal disease
- a substance use problem
- cognitive impairment (like MR or dementia)
- past attempts
- guns
- access to other suicide means that he has used before (e.g. large supply of sleeping pills)

I don't pass any judgment on whether he should live alone, I just note that he does - and that has bearing on my decision. If we can change the identified risk factors and make it reasonable to leave the hospital sooner (by having him stay with a friends/family for a few days, or by removing guns from the home for a time), then that's what we try to do. In the case of those who've been experiencing the urge to crash the car, we should try to arrange no driving for a time. I don't worry as much about guns in the home of a suicidal woman because of the stats that women significantly less often use guns for suicide- though I'd still prefer that someone else has the keys to the gunsafe for a time. If she is someone who often handles guns, then I presume the risk is about equal to that of a man who handles guns.

It's not about the gun. It's about the risk to the patient. Same reason we keep a patient in the Med/Surg ward a little longer if he lives alone. I don't send the feeble, decrepit and weakened 84 yr-old home until he can show that he can care for himself - unless there's someone at home who truly cares about his health and longevity.

HughHefnerEngagement.jpg


:smuggrin:
 
I did not blame guns. I also said nothing about banning them. I did *post peer reviewed evidence from some of the world's top journals to *show that gun ownership is a risk factor for several bad outcomes, and I *said that physicians should therefore discourage owning them.

physicians should promote safe usage and storage, as even the CDC doesn't buy the argument that gun control decreases crimes.*

I'd very much like to see where Kellermann has been 'discredited'. In fact, his findings have since been replicated in JAMA and in the NEJM.*

these studies have nothing to do with kellerman, nor do they in any way duplicate or even cover the same materials. for the sake of debate, we'll forego discussion of suicide as that is a rather complicated topic that in of it's self isn't related to much of kellermans faults.*

kellerman's initial study in 86 was the paper he quotes as gun ownership leads to 43 time higher risk or murder with firearms, first he included suicides, the he shares some of the same errors he again makes in 93' Schafer does a good job dissecting the errors and bias in the data in NEJM 1993 and the likely reason for the results Kellerman recorded, and i wont reiterate his points.*

but back to your 2 "studies", again, they do not address kellermans data, they arent prospective, randomized, nor do they bother to account for the political or other confounding factors. 1) the safe storage study does not address the percentage of gun owners who abided by the safe storage requirements, and taken in context that accidental firearm injuries has been on the decline since 1903 (citation*Centers for Disease Control and Prevention data from the Firearms Injury Surveillance Study)*when the government started recording that data. this study can not show that this is anything other than correlative, not causative. the Columbia study does not address political upheaval or the violence from columbian nationals during these times, *columbia was increasing their fight against these people in the late 90s, so we hqe to tke this study with a grain of salt.*

I'd be interested to see if you have any peer reviewed articles to back up your magnanimous posturing.

how about the CDCs review of the data?*http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5214a2.htm, they're review of the data shows that they can not find data to support the use of gun control in order to influence crime rates.*

Jonn Lott and Gary Kleck, have put out lots of data that show gun control either has no effect or actually increases crime rates.*

*As I said in my original post, gun ownership for some this is akin to a *religious debate. I get the feeling from jdh71 and Hernandez that any *amount of scientific literature would not convince you to consider the *risk of gun ownership. So, as OPD said, please disregard the libel rag *journals mentioned previously :)

what would you say of i said firearms have just as much data on their prevenitive or stopping of crime?Firearms are used many times to protect and save lives & property, often without a shot being fired. With low figures by admittedly anti-gun groups as many as 1.5 million times, to as many as 2.5 million times a year. This means that each year, firearms are used more than 80 times more often to protect the lives of honest citizens than to take live

** *
Clinton researchers concede that guns are used 1.5 million times annually for self-defense. According to the Clinton Justice Department, there are as many as 1.5 million cases of self-defense with a firearm every year. The National Institute of Justice published this figure in 1997 as part of "Guns in America"—a study which was authored by noted anti-gun criminologists Philip Cook and Jens Ludwig.3 link for reference

Perhaps it is your sophisticated argument--or your fractured grammar and *syntax-- but I don't understand you. My only point regarding the law *was that guns are not specifically mentioned in the US constitution. * Nothing you said seemed to argue that so I am confused.

so what exactly do you think the word arms refer to? hand guns and rifles are by definition small arms.*

I don't think it's a stretch to say that the authors of the 2nd *amendment didn't foresee the sort of weaponry that we have today, and *that we shouldn't just accept things like automatic rifles and silencers *ad oculos.

actually, there is plenty of references where those who actually passed used th e word arms in reference to their large weapons of the day, including cannons*
 
My point there was please save me the sanctimony . . .

I wouldn't be criticizing your practices if they were consistent.

I can't speak to what psychiatrists do at your hospital.

I can speak to the limitations we struggle with, which understandably are an attempt to balance protection with autonomy. California allows for involuntary hospitalization only for 17 days. After that regardless of the level of risk there's not a legal way to keep someone in the hospital. So you do whatever you can to reduce risk.
 
what would you say of i said firearms have just as much data on their prevenitive or stopping of crime?Firearms are used many times to protect and save lives & property, often without a shot being fired. With low figures by admittedly anti-gun groups as many as 1.5 million times, to as many as 2.5 million times a year. This means that each year, firearms are used more than 80 times more often to protect the lives of honest citizens than to take live

Y'know 42% of all statistics are pulled out of thin air.
:D
 
I've not been actively engaging myself in the gun debate because I think a lot of people are inserting their political beliefs into their medical opinions.

It's not always possible to cleanly divide the two, but IMHO they have crossed over a bit more than it should've.

I will say that doctors should not be giving an opinion on owning guns other than to remind the patients of the risks if the doctor has reasonable reason to believe the person is at danger with them. If that data is given it has to be done in a nonjudgmental manner. A patient needs to feel comfortable opening up to his medical provider. He shouldn't have to live in fear of being lectured by his/her doctor with few exceptions, and responsible gun ownership is not one of those exceptions unless the person has done something clearly crossing the line. Legal gun ownership rarely does so.

Yes, I do believe guns have to be a safety factor in cases where you have to consider them. Someone being actively suicidal, there you have to consider it. There is too much data showing that it's just too easy to kill oneself with a gun. You could kill yourself with other methods, but guns are much more effective than most. Another factor is that suicides are often unsuccessful because people don't know how to successfully do it. A gun can overcome that problem.
 
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http://onionuttapam.com/world/world/talibans-search-for-good-americans.html

ps In the UK where even the police are not routinely armed and the government has all your medical records and hand guns are illegal and a shot gun license requires a doctors approval, two "upstanding citizens" eg priest, diplomat, social worker, to sign four photographs confirming your likeness" and any mental illness will require a psychiatric report, finally you will be visited in your own home by the plod to confirm you have a steel gun case attached to a supporting wall and that you have a good reason to own said gun. Thats the short version but these very sad tragedies still happen with firearms in the UK.

People with Schizophrenia kill 50 people a year in the UK on average. Strip out alcohol and drug misuse and the number falls to 2 a year for a population of 60 million. (Those approximate numbers have been steady for some time) Thats compared to 3600 deaths on the road. Make of that what one will.
 
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Make of that what one will.

Another problem here is studies linking mental illness with violence are in a grey area. While many studies show that the typical 1) young, 2) male 3) low IQ or poor education 4) substance abuse/dependence 5) prior history of violence can easily link someone with violence, studies trying to link psychosis for example have yielded mixed results.

IMHO, (and this is opinion, but an opinion after reading several empirical articles on psychosis and violence) some forms of psychosis are more likely to commit violence while others are not. The studies did not separate what characteristics of psychosis can more likely lead to violence and what are protective and thus the two phenomenon cancelled each other out, thus leading to studies where psychosis and violence were not statistically linked.

IMHO negative symptoms of psychosis are likely going to lead to less violence, positive symptoms more likely for violence. While there are studies backing up my opinion...
(e.g. http://pn.psychiatryonline.org/content/41/13/29.1.full)
they are also drown out by several studies where the research did not separate these two phenomenon and as a result yielded no significantly increased risk of violence. Hence if you bring this up, you're going to get several people disagreeing with you that only read the data where the positive and negative symptoms were not separated.

But getting back to the event in Arizona, like I mentioned, the law and mental health didn't mesh well, and for reasons that several would find understandable. Many people don't want the government having access to your healthcare records, and even in this case, if it did, would it have prevented it? I didn't see anything where this guy was given a mental health evaluation. There already are, in waiting period laws, mention that mental illness could delay the process of getting a gun. There will be no way a first-break person can be stopped from buying a gun other than what's already in place and unfortunately in such cases, it happens when it happens. There is no good clinical method to predict someone who's had a psychotic disease process for years until the first-break happens.
 
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