It is a couple days after the nightclub massacre in Orlando that targeted the LGBT community, and my heart is heavy. I sat down with a friend the other day and as we grieved the tragedy and horrific prevalence of gun violence in America, he gave a suggestion most of us have probably heard: “What we need is a comprehensive database of mentally unstable people”.
The idea sounds simple, and mental health checks seem to be one of the only places where gun rights and gun control advocates can find common ground to discuss. In fact, some of the only legislation that has passed in recent years in regards to guns has been focused on mental health, for example a bill in North Carolina passed in 2013 that "requires county clerks of Superior Court to submit mental health adjudications to NICS within 48 hours of a judge’s ruling." In New York, a bill mandates mental-health professionals to report “dangerous patients” to local officials.
In their research, Jonathan Metzl MD, PhD and Kenneth T. MacLeish, PhD found that a key assumption that comes about after mass shootings is that “psychiatric diagnoses can predict gun crime before it happens”.
Doctors may appear to be the necessary link in understanding mental health and securing background checks. Many of the shooters in recent years appear to have documented mental health issues or were disturbed. In general, physicians are ethically and legally required to aid and report a person who could hurt themselves and others; if a physician has a patient who cannot physically see well enough to drive, yet insists to, it is necessary for them to report this for the wellbeing of the patient as well as those around them. The same could be said about someone should not have access to guns because of a mental illness.
On the other hand, the idea of having a rolling database of mentally ill people can be a great challenge for physicians. First of all, the number of people with mental health issues who act violently are far less than the total number of people who have mental health issues. Without research and benchmarks, there is no widespread, set standard at this time to determine who is considered fit to use gun. For physicians this creates another problem: Would this mean that any time a person with a mental illness commits a crime, it puts blood on the hands of the doctor? Would doctors be likely to report many more of their patients who seem mentally unstable in order to take precautions? The focus could potentially shift from whether guns should be available to why a shooter's doctor didn’t stop a tragedy.
One can see how this could possibly lead to a decrease in individuals seeking mental health support. A very foundation for successful physician-patient relationship is trust; a successful physician is one who upholds the values of integrity and privacy. Especially with an issue as stigmatized as mental health, a patient must feel that they can trust their doctor to open up and get help. In coming years, it will be important for physicians to ensure that they do not lose their place as trusting confidants. It is no doubt that the answer to curving gun violence is not a simple solution and will take conversations that include everyone - health professionals, lawmakers and civilians.
