On Mental Health Care and Gun Violence

Monday Musings for Monday May 27, 2013

Volume III, No. 19/122

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Gun Violence Control, Where is the Wisdom?

By Assad Meymandi, MD PhD, DLFAPA*

(Editor’s note: On Tuesday May 28, at 7:30 PM, Congressman David Price, TV newsman David Crabtree and I will participate in a seminar organized by Quail Ridge Books & Music, 3522 Wade Avenue, Raleigh, NC, on the topic of gun violence. Free admission).  Also, the link below for your viewing: 

http://www.wral.com/news/local/video/12435002/

President Obama called the massacre of 20 innocent children and six adults on Dec 27, 2013, in Sandy Hook Elementary school in Newton, Connecticut, the “worst day of his presidency.” History tells us that every president since George Washington has had a/the ‘worst day. ‘ For George W Bush it was September 11, 2011, for FDR it was Pearl Harbor, December 7, 1941.  All our 44 presidents have had a worst day in their presidencies. It would be a meritorious project for some PhD candidate in history to compile a volume on every US Presidents’ worst day in the office.

The December 27 occurrence could have been a turning point in the debate over guns in America. Knowing the history of gun violence- especially since the 1960s- The University of Texas clock tower in Austin Texas, in the 70’s Kent State University Massacre, the 80’s Cleveland School mass killing and the 90’s several schools, including Columbine High School, mass shooting at Virginia Tech, not counting mass murders in other facilities including Sikh Temple, army bases and others, the numbers are staggering. But none was as gruesome as the Sandy Hook massacre. Every one seem to agree that these tragedies must end. Vice President Joe Biden chaired a task force to examine the issue by holding extensive public hearings in which expert testimony was given by representative of American Psychiatric Association (APA), American Medical Association (AMA), American Bar Association (ABA), and forensic authorities. But the matter became politicized; the National Rifle Association’s (NRA), Democrat’s, and Republican’s different interpretations of Second Amendment to the Constitution all began spinning in the media. Gun control advocates brought in an extensive agenda, namely tougher penalties for illegal gun sales, increased school safety programs, expanded background check for gun buyers and mandates to keep guns out of the hands of criminals and folks with history of mental illness.

Republicans and NRA saw this as unnecessary interference by government. So a compromise was generated by Senators Joe Manchin, a Democrat from West Virginia and Patrick Toomey a Republican from Pennsylvania, focusing attention on background checks. It failed.

Issues like gun violence control, abortion, and cloning carry within their constitutional DNA a huge dose of controversy. My focus in this essay is a dispassionate and analytic examination by separating the hype and hysteria from reality and data. It is hoped that cool heads and wisdom will prevail.

In the debate of gun violence mental illness has gotten a bad rap. The alleged connection between mental illness and mass violence is not supported by objective data and science: “substantial research shows that the vast majority of people with serious mental illness never act violently, and the vast majority of violent crimes- 96 % by the best available data- is not perpetrated by persons with mental disorder”,  said Paul Appelbaum, Past President of APA, Professor of Psychiatry, Medicine and Law at Columbia College of Physicians and Surgeons. What we need to do is to face and design program of mental healthcare instead of warehousing the mentally ill in jails and prisons.

The APA position which I am advocating tonight is to appoint a presidential commission to develop a vision for a system of mental health care, creating a mechanism for facilitating responses to key mental health issues such as designating a White House point person, improving early identification of youth with mental health problems and developing sensible, non- discriminatory approaches to ensuring that dangerous individuals cannot gain access to guns.  In his report and testimony Dr Appelbaum stated that people with mental illness who are engaged in regular treatment are considerably less likely to commit violent acts that those who need but do not receive appropriate mental health treatment.

Another expert testimony at the Vice President Task Force was Dr. Thomas Insel, Director of National Institute of Mental Health stated that “Suicide, not homicide, is the most urgent public health problem associated with gun violence. About 90% of suicides involved individuals with mental illness.”  Dr. Insel reported that “the popular association of homicidal violence and mental illness is tenuous at best.”  Despite common public perceptions, there is little connection between gun violence and mental illness.  Only 6 percent of violent crimes are committed by someone with a diagnosed mental illness, as opposed to 96 percent suicides that are associated with mental illness.

What to Do?

For nearly 50 years, I have been involved in various capacities with the North Carolina mental health system. At no time the services to and for our patients have been as chaotic, sparse, and erratic as they are today. Fifty years ago, in North Carolina, we had a system in place that was truly superb. At Dorothea Dix Hospital, where I received my psychiatric training, in the late 50’s and early 60’s patients had predictable, excellent, and academically cutting edge treatment available to them with ready access. No patients had to wait for days and in some instances for weeks in emergency departments of general hospital waiting for a bed.  And no patients were put in jail and prisons because of lack of mental health treatment and shortage of psychiatric beds.  We have certainly devolved and regressed. Taking care of patient with mental illness–and really it is brain disease—is a moral responsibility about which Thomas Jefferson and our country’s other founding fathers expounded.

There is a glimmer of hope.  UNC system President Tom Ross, his chief of staff, Kevin Fitzgerald, Dean of UNC School of Medicine at Chapel Hill, Dr. William Roper, and WakeMed administrator William Atkinson have agreed to provide a psychiatric unit of 40+ psychiatric beds for Wake County. With the projected population growth in our area, to do an adequate job, we need a facility with 500 psychiatric beds.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

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