The recently enacted state gun control law is requiring mental health practitioners to report potentially dangerous patients at a time when shrinking budgets are resulting in fewer people gaining access to care, according to a regional mental health group based in Lake Success.
Janet Susin, the president of the National Alliance on Mental Illness Queens/Nassau, said the quality of care for New York’s mentally ill population has been in a state of long-term decline that significantly reduces the system’s ability to deter gun violence.
“It’s much worse than it was 20 years ago,” Susin said.
In the month since the mass shooting at a Connecticut elementary school, the debate over gun control has been paralleled by questions surrounding the mental health system in the United States, as lawmakers consider how to prevent future killings.
The state psychiatric hospital system has been in decline for decades, said Susin, describing how the system treated 95,000 patients during its 1960s heydey and currently treats under 4,000. And though the savings from closing those hospitals were intended to support community mental health programs, Susin said, those funds are no longer sufficient.
“That amount of money was finite – it was supposed to be available for every year, but costs go up,” she said.
Now, costs are shifted the Medicaid and the federal government, hospital stays are shorter, and access to mental health treatment is dwindling, according to Susin.
The state law’s reporting provision mandates that therapists report patients who the believe pose a credible threat to themselves or others to a mental health director, who would then be required to report serious cases to the state. Patients could then have any guns confiscated and gun permits revoked.
The gun law passed last week by the state Legislature also strengthens and extends Kendra’s Law – legislation, passed in 1999 after a mentally ill person pushed Kendra Webdale off a subway platform to her death, that allows judges to force people at risk of harming themselves or others to undergo outpatient psychiatric treatment.
And while Susin supports Kendra’s Law, which was pushed for by NAMI when it was originally proposed, she said access to care is a more fundamental issue not currently being addressed in Albany.
“The irony of that is that the person who pushed [Webdale] was somebody… who had tried 13 different times to get help from the mental health system,” said Susin. “His problem was not resistance to treatment, his problem was he could not get appropriate services.”
Susin said she supports measures allowing parents to initiate Kendra’s Law proceedings if they feel their child requires involuntary treatment and the loosening federal privacy requirements to keep parents informed of mental health treatment.
“There are so many ways that the caregivers, the loved ones, whoever they may be, find it very difficult to get treatment for a loved one – particularly a loved one who does not know they’re ill,” Susin said.
Some mental health advocates are concerned about the new gun law’s requirement for clinicians to report dangerous patients, warning of possible harm to the doctor-patient relationship, while other support the measure.
“People troubled by suicidal or homicidal thoughts might avoid treatment, or be inhibited from speaking frankly about their impulses, if they knew they could be reported to state authorities,” wrote Columbia University professor of psychiatry Paul Appelbaum and president-elect of the American Psychiatric Association Jeffrey Lieberman in a New York Times column. “Thus, the very people who should most be in treatment may be least likely to seek it. If rates of suicide and homicide rise as a result, we should hardly be surprised.”
But DJ Jaffe, executive director of the advocacy group Mentaillnesspolicy.org, supports the provision, and told the Wall Street Journal that fears of discouraging treatment were “hyper-theoretical.”
Stigmatization of the mentally ill is a serious problem after acts of mass violence, according to Susin.
“Every time this happens it does that,” Susin said “This is always a disaster for us when there are these high profile killings.”
While people with serious mental illness are more likely to be violent during episodes of psychosis, much of that violence is in the form of self-harm and suicide, according to an article by National Institute of Mental Health Director Thomas Insel.
“We do a lot… to try to destigmatize mental illness,” said Susin. “There are so many wonderful people out there who despite their mental illness are doing terrific things, whatever their diagnosis.”
State and federal governments can do much more to improve access to care, according to Susin.
She said she supports training for educators to recognize signs of mental illness, increased funding for mental health research, regulations to force insurers to treat mental and physical health care equally and the training of additional mental health professionals.
“There’s a tremendous need for more people in the mental health field in general, and particularly in that 16-25 age group when people are more likely to develop a mental illness,” Susin said.
