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Friday, December 15, 2017
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Mental Health and Gun Control, ? Aid for Control of Violence – Conclusions and Suggestions #2

6.    It is incumbent on a combination of sincere students of the problem to determine what the factors leading to violence are and to determine ongoing strategies to combat those factors. That process will take decades, but it must begin now; and it must be robust.

7.    Gun rights versus gun abuse must be addressed head-on; and rationality must prevail. Compromise must occur in real time and with real and evidence bases. While study goes on, the killing must stop; and ultimately, the government must make that happen. As James Dudley said in Allowing the Mentally Ill Guns is Insane, Political Magazine, October 5, 2015 said, “Talking about mental health and guns is easy. Doing something is not.” It is time posthumous that we do something.

8.    We must improve our mental health record system to allow a smooth interconnection between the mental health professionals and their findings with the National Instant Background Check and with the NICS [National Instant Criminal Background Check System] at least until guns start turning up at crime scenes and an investigation is opened by law enforcement. “One study estimated that private sales account for 40% of all gun sales in the United States.” Dudley, op cit. The present author agrees with D.J. Jaffe, Huffington Post, Healthy Living, 03.19.2013. “We proposed that county mental health directors be required to accept reports of individuals with serious mental illness who are becoming danger to self or others, directly from family members. This would generate higher-quality reports than those that come from psychiatrists, many of whom still argue persons with mental illness are no more violent than others, and are therefore not likely to report many who are. Mental health directors could triage these calls from families and investigate ones that warrant it. But the mental health industry and mental health directors also opposed letting families report their loved ones need help.

9.    All states must comply completely and promptly via electronic transmission, and all pertinent records must become readily available as soon as they are entered. All records must be entered into the federal system. All responsible and appropriately vetted participants must have ready access to the records. Every gun sale must be entered into the record. The laws that allow a loophole to have free-wheeling gun sales by individuals and flea markets must be rescinded. “When an individual purchases a firearm from an FFL [federally licensed firearm dealer]… he must undergo a criminal background check. First, the buyer fills out a Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) Form 4473 by hand, providing simple yes or no answers to a series of questions about criminal, mental health, and substance abuse history. The dealer then queries the National Instant Criminal Background Check System (NICS) database maintained by the FBI via a toll-free telephone number or through the NICS E-Check System online (in a handful of states the dealer contacts the state police who in turn contact NICS).

“This instant computer check searches the NICS database for any disqualifying records that would prohibit that individual from buying a gun. During the check, the system does not disclose to gun dealers any actual information about these records. Dealers are simply seeing one of three responses from NICS on their computer screen: proceed, denied or delayed. If a potential gun buyer is denied, the FFL is never informed of the reason.” These laws have to be reworked to include any gun sales—by private sellers and buyers as well as FFLs—and the silly restrictions that keep information about the reasons for decisions about sellers must be eradicated, whether the NRA likes it or not. Now, when an individual purchases a firearm from an FFL, he or she must undergo a criminal background check. The same should apply for purchases between non-dealer individuals.

In some states less than one percent of purchases, even from FFLs [federally licensed firearm dealers] are reported to the NICS or the state. All of this poor recording and reporting is asinine, and must be changed to a full disclosure system.

10.    Gun control and responsibility must be universal and not dominated by any subgroup however well-funded, loud, persistent, or uncooperative. The killing has to stop.

11.    Education must begin as soon as the definitions and laws are part of the record, starting with law enforcement and the judicial system. Mental health professionals must become thoroughly conversant with the laws and their responsibilities and must comply forthwith.  Other vitally interested groups should have an ample opportunity to become educated, including, but not limited to, the mentally ill, their families, their caregivers, NAMI, political and religious organizations, military organizations, and school students from grammar school to the end of university careers. The mentally ill need both education—more than any other group–and treatment, if the system is to succeed.

12.    It is shameful that the United States has such a poor mental health care system—too few trained psychologists, psychiatrists, psychiatric nurses, psychiatric hospitals, inadequate training for the front line family physicians, internists, and neurologists, etc. etc. According NAMI [National Alliance on Mental Illness], “approximately 10% of children and adolescents suffer from mental illnesses. Yet only 20% of this group have been diagnosed and are receiving services. Looking at adults, approximately 1 in 17 live with a serious mental disorder such as schizophrenia, major depression, or bipolar disorder. Yet less than one third receive mental health services.”

A rather novel suggestion has been put forth by Maia Szalavitz in her new book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction, due to be published, April, 2016. It is reviewed in Pacific Standard Magazine, Nov/Dec, 2015. Drug courts have been quite successful in treating abusers who commit crimes but appear to be susceptible to rehabilitation. Drug courts are more successful than imprisonment of those persons and for society, the majority of evidence shows. The same reasoning can be applied to the mentally ill; if they are treated effectively, they may be expected, like drug abusers, to commit less crime, to use guns less often in criminal acts, and to save the taxpayers the huge sums necessary for incarceration. “With at least 1.1 million inmates in the United States suffering from mental illness, expanding access to mental health courts could potentially reduce mass incarcerations.” Mental health courts were introduced in the U.S. in the 1990’s; so, they are not all that new, and have been around long enough to produce a track record. The procedures are relatively simple and are similar to those followed in drug courts: “Defendants charged with crimes linked to psychiatric problems are evaluated and given a treatment plan, which is overseen by a judge. In some mental health courts, defendants plead guilty and receive suspended sentences. If they complete the program, the sentence is not imposed; if not, they do the time. In others, charges are suspended until the defendant completes the program, then dropped when they satisfy treatment requirements. Those who don’t comply are simply returned to the regular court system to face the original charges.”

There are major differences between mental health courts and regular courts. In the mental health system, courts are less punitive and more inclined to consider treatment as opposed to punishment. In general such courts are more lenient than drug courts since the system tends to view the mentally ill as less culpable than the addict. Mental health courts are more forgiving of lapses and “are less likely to use jail terms as sanctions for noncompliance, recognizing that incarceration is likely to exacerbate symptoms and interrupt treatment.” It is generally presumed that use of guns during crimes by the mentally ill can be treated with the same degree of leniency, depending on the seriousness of the crime and the level of involvement of the firearm. Mental health courts pay more attention to medical professionals and, unlike drug courts, and far different from regular courts, “judges do not determine what treatments are allowed… [an indicator of success is that] “on average, about 60 percent of defendants who start these programs complete them.
There is more evidence in favor of mental health courts from scientific studies: There was a significant reduction in the recidivism rate, new arrests, days spent incarcerated—upwards of 44 percent fewer days spent in jail—82 days fewer overall. In one study 75% of defendants who failed to complete the mental health court requirements were rearrested within five years. Only 40% of those who completed the programs were rearrested. Graduates took five months longer to be arrested. In general, at the least, most evidence indicates that the mental health court experience is either helpful or at least not harmful to defendants who fail, whereas there is evidence that failure after drug court is harmful.

It is too early to make judgments about the usefulness of mental health courts because there are too few of them—total 400 for the whole country—and they are administered inconsistently across the country. Some of the negative results from mental health courts suggest that better selection of candidates should be made. There is evidence to indicate that the success of drug court systems is hampered by issues the courts cannot successfully address, such as poverty, co-addiction, unemployment, and association with peer groups with antisocial behavior. It is generally agreed that mental illness does not, by itself, cause crime, but it certainly hampers rehabilitation. Many members of law enforcement, court officials, and mental health specialists question the value of the mental health court system for those reasons.

13.    The disgraceful state of mental health care delivery in the United States is not a problem without a solution. We need to spend the money and expend the time necessary to make the improvements needed. For the purposes of this blogpost, however, all of that is long term; and we do not have the time to wait for such improvements before we act on the immediacy of our gun control/mental illness problem. Stop as much of the killing as possible now, and get on with the creation of critical solutions for the general mental health problems as quickly as possible starting now.

14.    The problem of terrorists of all stripes—apart from the mentally ill—is a governmental, military, and law enforcement, issue that is beyond the scope of this set of blogposts.

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