NYAPRS Note: Here’s some news coverage of last Friday’s Senate hearing on the mental health reporting component of New York’s SAFE Act, along with NYAPRS testimony delivered by Public Policy Committee co-chair Carla Rabinowitz.
NY Gun Control: Mental Health Advocates To Air Complaints About New Law
by John Dyer Newsday May 30, 2013
The hearing - to be conducted by the Senate's Mental Health and Developmental Disabilities Committee hearing in New York City - comes almost two weeks after Newsday reported that Hudson Valley mental health professionals have given state officials about 350 names of individuals they consider dangerous and worth investigating under provisions of the new law.
"This hearing is a real opportunity to ensure that we are providing the right balance between public safety and patient confidentiality under criteria associated with the NYSAFE Act," said Sen. David Carlucci (D-Clarkstown), the committee's chairman, in a statement.
Under the law, mental health professionals must notify county mental health departments about patients who could be a danger to themselves or to others. County officials forward the names to Albany, where officials determine whether the individuals possess gun permits. Permit holders' names then go to county courts, where judges decide whether to revoke their permits.
Mental health professionals are concerned that the reporting provisions of the law may violate patient-doctor confidentiality, compromise treatment, in cases, and discourage individuals from seeking help.
"You are going to have an unintended effect of stigmatizing people and discouraging them from either seeking out treatment or fully disclosing in that treatment," said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services.
Rosenthal said representatives of his group expect to testify before Carlucci's committee.
Carlucci's spokesman, Jason Elan, said the senator's office has received substantial input from mental health groups asking for changes to the bill. Elan mentioned that county and state officials have had to cope with the bureaucratic burden of vetting reports and forwarding names without extra funding.
The senator hoped the committee hearing would form a basis for potential changes to the legislation.
"It is my hope we can use this testimony to streamline the overall process and give confidence to those who treat mental illness on a daily basis," Carlucci said in his statement.
Rosenthal said he supports legislation sponsored by Assemb. J. Gary Pretlow (D-Yonkers) to narrow the criteria for reporting patients to state officials.
Laws on the books for many years obligate psychologists, psychiatrists and others to consider alerting authorities or hospitalizing patients who might pose a danger to themselves or others, Rosenthal said.
He said he is worried that the scope of the NYSAFE Act could lead doctors to report patients more out of fear of legal liability than fear the patients will actually hurt someone. He said he was surprised when he read Newsday's story about 350 names reported in the Hudson Valley alone.
"When I saw that number, it again made me wonder if we are in a political climate of overreporting," Rosenthal said.
Cuomo lobbied heavily for the landmark NYSAFE Act, which was enacted in January, around a month after the Newtown massacre in Connecticut. While minor changes to the law have been enacted, the governor has resisted substantial changes.
"The Office of Mental Health worked with the mental health community during the implementation of this critically important section of the SAFE Act and will continue to work with them to ensure that guns do not find their way into the hands of potentially dangerous individuals," said Ben Rosen, spokesperson for the New York State Office of Mental Health.
Mental health experts outline flaws in N.Y. gun law
By Dwight R. Worley Journal News May 31, 2013
NEW YORK - The mental health reporting requirements under the state’s new gun law are a costly burden for municipalities and will inhibit people from seeking treatment, mental health experts said Friday.
Testifying before the state Senate’s Mental Health and Developmental Disabilities Committee - chaired by David Carlucci, D-New City - psychiatrists, nurses, lawyers and social workers detailed a long list of what they said are flaws and inconsistencies in the 5-month-old New York Secure Ammunition and Firearms Enforcement Act.
Marybeth Anderson, director of the Mental Health Project at the Urban Justice Center in Manhattan, said the SAFE Act - part of which requires physicians, psychologists, registered nurses and licensed clinical social workers to report individuals who are “likely” to harm themselves or others - demonizes patients and falsely links mental illness and violence.
Anderson said the law also interferes with the therapeutic relationship. It will keep people, particularly police officers, from seeking treatment, making the law ineffective in its goal of keeping dangerous people from buying or owning guns, she said.
There is “paranoia about being included on some type of government list,” said Anderson, one of nearly a dozen professionals who testified against the reporting requirements. “The Safe Act just increases that paranoia.”
Clinician reports go to local mental health offices and, if agency officials concur, are forwarded to the state Division of Criminal Justice Services. The reports could be used to prohibit individuals from purchasing guns or as justification for police to confiscate weapons.
Jed Wolkenbreit, counsel for the Conference of Local Mental Hygiene Directors in Albany, testified that of the estimated 6,000 reports made since January only 11 resulted in any action. Meanwhile, it will cost local governments millions to hire staff to review reports, he said.
Dr. Glenn Martin, president of the New York State Psychiatric Association, said his group filed a complaint with the federal Office for Civil Rights because they say the law violates federal Health Insurance Portability and Accountability Act privacy protections.
Martin said clinicians should be required to report only when an individual presents an “imminent” danger, a higher threshold than “likely” to cause harm.
“This standard doesn’t make a huge amount of sense,” he said.
Testimony Before Senate Standing Committee on Mental Health and Developmental Disabilities
May 31, 2013
Presented by Carla Rabinowitz Co-Chair, Public Policy Committee
New York Association of Psychiatric Rehabilitation Services
On Behalf of NYAPRS Members and
The NYAPRS Public Policy Committee
Co-Chairs: Ray Schwartz, Carla Rabinowitz
NYAPRS Board of Directors
Maura Kelley, Steve Coe Co-Presidents
Thank you for this opportunity to present to you the concerns of the thousands of New Yorkers represented by the New York Association of Psychiatric Rehabilitation Services. NYAPRS is a unique statewide partnership of New Yorkers with psychiatric disabilities and the community mental health professionals who support them in over 100 community-based mental health agencies from every corner of the state.
I'm Carla Rabinowitz, co-chair of the NYAPRS Public Policy committee. Executive Director and I speak today on behalf of the many hundreds of NYAPRS members who gathered at local forums that were conducted last year in localities across the state. I also am representing NYAPRS executive director Harvey Rosenthal, who apologizes for his inability to join us today due to a previously scheduled out of state commitment.
State mental health policy is a very personal matter for our NYAPRS community. Most of our members, board members, our staff and I all share a common personal journey of mental health recovery. We believe this strengthens our ability to speak to you on behalf of the thousands of New Yorkers with psychiatric disabilities and their supporters that we represent.
I’d like to begin my comments by focusing on the other side of media coverage, the horrific kind our community has endured in the past few months. We have never seen the level of demonization and criminalization that we have experienced in the wake of several recent violent tragedies in Newtown and in New York City.
These tragedies are especially abhorrent to those of us in the mental health community, particularly since studies have shown that people with mental illness are 12 times more likely to be victims of general violence, 5 times more likely to be murder victims and no more likely to be violent unless, like the general public, they are substance abusers.
Nonetheless, horrific acts of violence are often wrongly associated with mental illnesses, often because the motivations for them seem unfathomable... and they end up getting sensationalized front page coverage.
The most egregious examples of this kind of coverage can be found in the New York Post, which over the past few months has published articles entitled “Here Come the Crazies,” “Beware: 11,000 Psychotics on the Streets” and “Scoop the Nuts”.
Such coverage has also been periodically found in the Daily News, which ironically found that an estimated 5 of 494 New York City murders in 2007 were committed by people with mental illnesses. You can be sure that those five tragedies stayed on the front page for weeks in stark contrast to the other 489.
This kind of coverage vilifies conditions that 1 in 5 Americans share. It’s the sort of profiling that used to be the fate of most racial or religious groups... but is no longer acceptable for them because those groups and good minded citizens demanded an end to these wholesale character assassinations.
The stark truth is that the public doesn’t need protection from people diagnosed with mental illnesses; it is we who need protection from these kinds of outrageous mischaracterizations that assail our dignity, our rights and privacy protections... and from the rush to enact laws that provide false solutions to appease public fears.
It’s important to view New York’s SAFE Act in the context of experts’ opinions that “the biggest risk for gun violence is possession of a gun... and there's no evidence that the mentally ill possess guns or commit gun violence at any greater rate than the normal population."
The SAFE Act laudably seeks to curb gun related violence but, in requiring mental health clinicians to report clients who disclose impulses to harm themselves or others for potential inclusion in a DCJS registry to cancel their gun licenses and remove their guns, this raises numerous concerns amongst our community:
We have raised numerous concerns about this approach:
This policy is having an unintended chilling effect of discouraging people from seeking or fully disclosing in what should be trusted confidential therapeutic relationships.
Our concerns are shared by Dr. Eric Cain who heads up the University of Rochester suicide-prevention research center that "clinicians, not really understanding the nature of the law, may report people that the law never had the intention of being reported, and in the process, destroy all sorts of trust that might be there. We're not sure at all that it's going to make anybody safer, and it may have unintended consequences."
As such, we strongly agree with our colleagues that the reporting requirement as currently written improperly intrudes into the clinician-patient relationship.
Further, clinicians have limited ability to predict violence and therefore may report on many more individuals than is appropriate. In fact, a study of experienced psychiatrists at a major urban psychiatric facility found that they were wrong about which patients would become violent about 30 percent of the time. According to the study’s author, that’s a much higher error rate than with most medical tests.
Finally, the SAFE Act uses a much broader reporting standard that will, especially in this highly politicalized environment, lead to over-reporting. It extends beyond the “current serious and imminent threat” standard to the broader and vaguer "likely to engage in conduct that would result in serious harm to self or others."
NYAPRS supports the kind of technical amendment advanced this past session in A6233-A, (Pretlow). (D-Mount Vernon) that clarifies that reporting should be triggered only when the treating professional concludes that there is “serious and imminent danger” to the patient or others
We can’t help but wonder if these the application of these broader standards in this highly politicalized environment is why 350 reports were made in just Rockland and Westchester counties alone from March to May of this year.
Thank you for this opportunity to consider legislative remedies to a SAFE Act that was rushed through without sufficient attention and input from our community. We very much appreciate your interest and attention to these matters.
The New York Association of Psychiatric Rehabilitation Services represents a statewide partnership of tens of thousands of New Yorkers who use and/or provide community mental health services and who are dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their recovery, rehabilitation and rights.
Crime Victimization in Adults With Severe Mental Illness Linda A. Teplin, PhD; Gary M. McClelland, PhD; Karen M. Abram, PhD; Dana A. Weiner, PhD Arch Gen Psychiatry. 2005;
Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods Steadman, H., Mulvey, E., Monahan, J., Robbins, P., Appelbaum, P., Grisso, T., Roth, L., & Silver, E. (1998). . Archives of General Psychiatry, 55, 393-401.
20 percent of US adults experienced mental illness in the past year Substance Abuse and Mental Health Services Administration November 2012 report
Mental Health Gun Laws Unlikely To Reduce Shootings Jon Hamilton National Public Radio Jan. 16, 2013