By Steven L. Dubovsky
The provision in New York State’s new gun legislation requiring mental health professionals to report patients who may be likely to harm themselves or others will turn doctors into agents of the state.
Psychiatry practice rests on the premise that the doctor is an agent of the patient who is there to protect and help the patient. A cornerstone of that premise is confidentiality. As soon as you say, “What you say may be reported to the authorities,” people will stop saying what’s really going on, or they may stay away completely.
According to the provision, if a psychiatrist or therapist thinks that a patient might cause harm, he or she is required to report it to the State Office of Mental Health, which will inform police who would check that patient’s name against a database of gun owners.
That would require the patient’s Social Security number, which psychiatrists do not have. If police find that this patient has a gun permit, do they call the patient or visit the patient’s house? Do they obtain a search warrant? What else do they do? It doesn’t say.
This idea is misdirected. The vast majority of murders are committed by people with no mental disorder. Those with mental illnesses who do become violent constitute a tiny minority of people with such diagnoses. On the other hand, it is very common for all people – not just those with mental disorders – to entertain violent fantasies. But no prospective research tells clinicians how to identify who will pose a danger next month, next year or ever.
What is meant by mental illness? Schizophrenia? Mania? Depression? Anxiety? Bulimia? Adjustment disorders? Substance abuse? Around 40 percent of the population meets criteria for a mental disorder.
People think that anyone who commits mass murder must be mentally ill. It is certainly correct that such behavior is abnormal, but it does not inevitably reflect mental illness. Were Hitler and Ted Bundy psychotic or just evil?
The Newtown murderer is said to have had a psychiatric diagnosis not associated with deliberate, premeditated murder. Most killers are likely not to have a psychiatric diagnosis. Reporting people with psychiatric diagnoses therefore represents profiling that has an extremely low likelihood of being useful. If the American people have consistently rejected racial and religious profiling, why is profiling on the basis of mental disorders suddenly permissible?
With this legislation, a precedent has been established to make physicians into auxiliary police agents and to report suspicions, rather than facts. Societies that have taken this step have done so at the expense of the liberty of their own citizens.
Steven L. Dubovsky, M.D., is professor and chairman of the Department of Psychiatry at the University at Buffalo School of Medicine and Biomedical Sciences.