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Gun Rights and Mental Illness

Lewis

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Gun Rights and Mental Illness: Answering Readers’ Questions
This is in 2 post's
By MICHAEL LUO In an article in The New York Times on Sunday, Michael Luo examined how states across the country were increasingly allowing people who lost their firearm rights because of mental illness to petition to have those rights restored.
While several states have had such restoration laws for some time, more than 20 have passed similar measures since 2008. The increase has been traced to a law passed by Congress after the 2007 massacre at Virginia Tech that was actually meant to make it harder for people with mental illness to get guns.
In this post, Mr. Luo is answering questions submitted by readers about the restoration of gun rights for people with a history of mental illness. His answers are posted in reverse order, with the most recently posted answers first followed by earlier answers.

Q.
Why don’t the courts require a mental health professional to assess the person’s current condition and likelihood of relapse before considering requests for restoration of gun rights? I don’t understand how a judge with no mental health training could be making those decisions when the person has a history of violence. — Shelley, San Francisco

A.
You ask a good question. I would say that this is actually a decision that rests more at the level of the legislators in each state. They would be the ones setting down the statutory requirements for these petitions.
As I wrote in the article, the National Rifle Association and other advocacy groups have lobbied in states across the country to keep the requirements to a minimum, within the confines of the federal law. Their argument is that this should not be an excessively onerous process. They would argue, for example, that someone who was involuntarily committed decades ago and has been fine since then should not be required to pay for and undergo a psychiatric examination.
I mentioned in the article what happened in Idaho, where a committee of law enforcement officials initially proposed a law that would have required a recent psychiatric examination: Without the N.R.A.’s backing, the bill went nowhere. Eventually the state did pass a bill, but a different one that the N.R.A. helped to draft — and that did not contain this requirement.
In Virginia, I found that some judges were asking for notes from doctors, while others were not. But even these types of personal notes from doctors can be problematic.
On the other end of the spectrum is the Superior Court in Los Angeles, which actually has a court-appointed psychiatrist examine each petitioner at the court’s expense. This is not required under California law; the court does it on its own initiative. I did not encounter that practice anywhere else in the country. But even the Los Angeles approach is not foolproof, of course, as I point out in the article.
You also touch on the question of who should be handling these petitions. Most states have entrusted them to judges, but some have made different choices. New York, for example, handles them through an executive agency, the Office of Mental Health. In Oregon, a state body called the Psychiatric Security Review Board deals with them.

Q.
Let me change the subject, from people with mental illness to people with a criminal record. Are they permitted to get a gun, and does the N.R.A. have a position on this? I would have thought that it would be very hard, if not impossible, for a person with a criminal record to get a gun, but I was surprised by the article that people with mental illness can get one, so now I wonder.
And I thought that it would put the N.R.A. in a difficult position: On the one hand, they might want to allow a person with a criminal record to be able to get a gun (that is, if the person paid their debt to society and is now law-abiding) because it is a Second Amendment right. On the other hand, they have maintained that the real problem is that we don’t have tougher laws against criminals.

A.
Under federal law, convicted felons are generally not allowed to buy or possess firearms. But there is some language in the statute that allows felons in some states to get their gun rights restored under certain conditions. Sometimes this occurs through the courts; sometimes through a pardon process at the governor’s office; in some states it happens automatically upon the discharge of their sentences. It is a very complicated area of the law.
The Bureau of Alcohol, Tobacco, Firearms and Explosives used to run a federal firearms rights restoration program that allowed convicted felons to apply. But an investigation published in 1991 by the Violence Policy Center, a gun control advocacy group, found that some people whose firearms rights were restored by that agency were subsequently been convicted of crimes. The center also found that the agency had been spending several million dollars a year conducting background investigations for these applications. In the wake of the group’s report, Congress stopped financing the program, and it has not been active since.
I have not asked the N.R.A. specifically about the issue of felon restorations. But the group has been interested in the issue of restoration of firearms rights for a long time, and it generally takes issue with the lifetime prohibitions in the federal statute. I’m not speaking for them, but I believe they would probably argue that someone who was convicted years ago of a felony, particularly a nonviolent one, but has been a law-abiding citizen since then should be able to exercise his or her Second Amendment rights.
 
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Q.
Reading the comments to your article, it appears that many readers did not understand that, overall, people with mental illnesses aren’t more violent than the general population, but a subset is more violent. Those with mood and psychotic disorders are more violent than the general population, especially when there is drug and alcohol abuse and dependence. There is no cure for these disorders, but medication helps reduce or eliminate symptoms in most people.
Unfortunately many people with these disorders do not have insight into their illness, and do not believe that they have a mental illness — and therefore see no reason to continue taking medication after they leave treatment. People without this insight very rarely change, and they are the ones who should not be given gun permits.
How should a court judge a person’s insight into their mental health? — Randy, Washington

A.
You make a good point about the importance of “insight,” as mental health professionals call it. I don’t pretend to be an expert on violence risk assessment, but that’s obviously an issue that I’ve read about in studies and discussed with mental health experts.
Lack of insight, though, is not the only reason people are inconsistent about taking their medication. Studies have shown a variety of factors contribute to that, and one study published in 2007 found that insight or lack of it did not correlate at all with whether people faithfully took medication.
Your comment on what we know about the connection between mental illness and violence gives me a chance to elaborate a bit more on that subject. I hope readers realize that I grappled a good bit with this issue. I did not want to contribute to the stigmatization of people with mental illness, but I also wanted to be clear-eyed about what the science says about the risks.
It is true, as I wrote in the article, that most people with mental illness will never be violent. But there is consensus among scientists that people with a serious mental illness like schizophrenia, bipolar disorder or major depression are more prone to violence than the general population. The level of risk depends in large measure on the time horizon you are measuring.
In the article, I mentioned a widely cited study by Jeffrey Swanson at Duke University, who found that 33 percent of people with a serious mental illness reported past violent behavior, compared with 15 percent of people without a major mental disorder. In the study, “violent behavior” was defined using a five-point index of fairly serious acts, like using a weapon in a fight, or participating in more than one fistfight as an adult.

In the study, substance abuse was more closely correlated with violence: More than half (55 percent) of people with substance abuse issues but without a serious mental illness reported past violent behavior. The highest prevalence rate, 64 percent, was associated with people who had both major mental disorders and substance abuse issues.
Those figures look back at the entirety of the person’s life. If the focus is narrowed to just the past year, Mr. Swanson’s study found that about 7 percent of people with serious mental illness had been violent, compared with about 2 percent of the general population. When we’re talking about restoring someone’s firearms rights, I thought the more relevant figure was the lifetime rate of violence.
It is clearly a complicated and emotional subject. For additional reading, I found a commentary by Dr. Richard Friedman that was very useful. It was published in The New England Journal of Medicine in 2006 after a prominent schizophrenia expert was killed by a patient.
Dr. Friedman cited Dr. Swanson’s study, but mentioned slightly different figures, based on a three-point index of violence rather than the five points. But he concluded: “It is natural for psychiatrists and other medical professionals who treat psychiatric patients to deny, to some extent, the possible danger. After all, it is hard to have a therapeutic relationship with a patient we fear. Still, we need to remind ourselves that the risk of violence, though small, is real, and we must take necessary precautions.”

Q.
What constitutes a mental illness that prevents a person from buying a gun? — Demo NYC, New York

A.
Under federal law, anyone who has been formally committed to a mental health facility or adjudicated as a “mental defective” is disqualified from buying and possessing firearms.
The first prong is fairly self-explanatory, describing people who have been hospitalized by court order. The second is a little more complicated. It describes someone who has been designated by some legal authority — usually a court, but it also could be a board or commission — to be a danger to himself or others, or to lack the mental capacity to manage his or her own affairs. It also describes people found by a court to be incompetent to stand trial, or found in a criminal case to be insane.
In other words, the fact that a psychiatrist has given someone a diagnosis of mental illness does not, by itself, bar that person from having a gun. Some sort of legal adjudication is required.
That, in fact, is one reason Jared Loughner, the suspect in the Tucson shootings, was not prohibited from buying firearms, despite having some serious mental health issues.
Complicating matters a bit, some states have set their own slightly different mental health criteria for firearms prohibitions. For example, in California, anyone who has been placed on an involuntary psychiatric hold for 72 hours in which they have been deemed a threat to themselves or others is barred from having a gun for five years. Virginia bars people who have been the subject of a temporary detention order and who voluntarily agree to inpatient treatment.

Gun Rights and Mental Illness: Answering Readers' Questions - NYTimes.com
 
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Considering that one in four Americans will suffer from depression, and that depression is only one of hundreds of mental illnesses, it's a good chance that the majority of Americans could at any one time be suffering mental unwellness, whether diagnosed or not.

The law is accurately quoted... taking confinement in a mental health institution to pull firearm privileges from someone, so strong is the right to bear arms in this country. This confinement does not include voluntary confinement for stabilization etc, but a court-ordered one. That takes quite a bit.

What concerns mental health care professionals are laws like what was just passed and then put on hold for Florida... where doctors would be limited in their questioning a patient or parent about firearms in the home. I think the NRA is behind this push, to stop the doctor from asking any such question. But I also think they want to stop the questioning because of the current Obama Care bill that requires ALL THIS INFORMATION to be filed by the doctor electronically with the government. (If you haven't been to the doctor lately, be ready to faint. I refused to answer most of the questions...but that's beside the point.)

The concerned people who believe in gun ownership are aware that the government, armed (no pun intended) with such information as to who has firearms and who doesn't, would be a step closer to confiscating them or at the very least targeting those citizens.(Again, no pun intended.)

The real problem though, with blocking doctors from asking about firearms in the home is that it includes psychiatrists and psychologists--the very professionals that the public relies upon to help keep us --and their very ill patients---safe! :o

When considering keeping all firearms from those with some mental unwellness, consider that many of our military troops are suffering under some type of that... and are found to do better with it if they are sent right back out on the field with their units. Should we immediately pull any troop that shows distress? We'd have a useless, unarmed military, I think. ;)


 
I can handle a gun, even though I have some medical conditions.

Think about it, roughly a maximum of one third of mental diseases actually makes it any more dangerous for the person with one to use and own a gun, and most do not significantly hamper a persons life in any way, except for having to take some medication, and a few life style changes.

And look at the court cases where a lawyer has tried to prove his or her client had a mental disorder, when they actually didn't, and everybody knew it. It seems like this will be harder to prove if guns were banned by all who have a mental disorder. But it's also hard to prove if the limits to gun probation where for criminals and the most severe mental cases.

You have to be very careful on how you limit gun access, because these gun owners may be your last line of defense in a war some day.
 
Considering that one in four Americans will suffer from depression, and that depression is only one of hundreds of mental illnesses, it's a good chance that the majority of Americans could at any one time be suffering mental unwellness, whether diagnosed or not.

The law is accurately quoted... taking confinement in a mental health institution to pull firearm privileges from someone, so strong is the right to bear arms in this country. This confinement does not include voluntary confinement for stabilization etc, but a court-ordered one. That takes quite a bit.

What concerns mental health care professionals are laws like what was just passed and then put on hold for Florida... where doctors would be limited in their questioning a patient or parent about firearms in the home. I think the NRA is behind this push, to stop the doctor from asking any such question. But I also think they want to stop the questioning because of the current Obama Care bill that requires ALL THIS INFORMATION to be filed by the doctor electronically with the government. (If you haven't been to the doctor lately, be ready to faint. I refused to answer most of the questions...but that's beside the point.)

The concerned people who believe in gun ownership are aware that the government, armed (no pun intended) with such information as to who has firearms and who doesn't, would be a step closer to confiscating them or at the very least targeting those citizens.(Again, no pun intended.)

The real problem though, with blocking doctors from asking about firearms in the home is that it includes psychiatrists and psychologists--the very professionals that the public relies upon to help keep us --and their very ill patients---safe! :o

When considering keeping all firearms from those with some mental unwellness, consider that many of our military troops are suffering under some type of that... and are found to do better with it if they are sent right back out on the field with their units. Should we immediately pull any troop that shows distress? We'd have a useless, unarmed military, I think. ;)

for the record one can as i did and have symptoms of ptsd and not be so bad that one needs his weapons pulled for the record unlike the movies we dont carry our guns un us unless we are on the range and training and or in combat or other duties.
 
Sure, just by suffering with PTSD does not mean you aren't safe with a firearm (assuming one has training, as no one is safe without training right ?;) )

PTSD symptomology may not include gun violence at all, as many suffer because of abuse.
 
some ptsd sufferers do have sucidical tendencies and cant have weapons but those even then are treatable. its when you ignore the psychosis and bury does it get worse.
 
I wish there was a constitutional way to reduce the number of guns and gun carriers in the US. That said, if it is a right, I don't think it should be restricted just because somebody's been deemed a little bit "crazy." Its easier than you think to end up with a psychiatric diagnosis, and restricting gun rights based on a hospitalization or diagnosis would basically mean treating the "mentally ill" like 2nd class citizens.
 
IMO there are several issues involved, even mentioned in this thread. Yes, in some realms it is "too easy" to be inaccurately diagnosed with a mental illness.

PTSD is not a form of psychosis.

Truly psychotic members of society are inherently not allowed weapons licenses to my knowledge.

One has to remember and refer to statistics and consider just who would have the weapons if they were removed from law-abiding citizens. Law-abiding citizens, including those who have carry licenses, are not the ones performing the killings and woundings by said firearms in general. Firearms do not kill people, people kill people, right? ;)

The mental wellbeing of a citizen and the need for licensed psychological evaluators to be able to ask about that and the ownership is necessary, imo.


 
i beg to differ.

The Relationship between PTSD and Psychotic Symptoms

By Matthew Tull, PhD, About.com Guide
Updated January 25, 2009
About.com Health's Disease and Condition content is reviewed by the Medical Review Board

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PTSD and psychotic Symptoms can co-occur. In clinical terms, PTSD is described as consisting of three clusters of symptoms: re-experiencing symptoms, avoidance symptoms, and hyperarousal symptoms. However, some mental health professionals believe that the experience of psychotic symptoms should be considered as an addition to that list, given that they commonly occur among people with PTSD.
Psychotic Symptoms

Before the relationship between PTSD and psychotic symptoms is discussed, it is first important to describe what would be considered a psychotic symptom. Psychotic symptoms can be divided into two groups: positive symptoms and negative symptoms.
Positive symptoms are characterized by the presence of unusual feelings, thoughts, or behaviors. Positive symptoms include such experiences as hallucinations or delusions. A hallucination could be hearing voices that no one else can hear, or seeing things that are not really there. Delusions are ideas that a person believes are true despite the fact that they may be unlikely or odd. For example, people with delusions may believe that the CIA is spying on them, or that aliens are controlling their behaviors or thoughts.
Negative symptoms are characterized by the absence of experience. For example, a person with negative symptoms may not be emotionally expressive. She may have difficulty speaking, may not say anything for days on end, or be unable to persist at simple tasks or activities, such as getting dressed in the morning.
These positive and negative symptoms are often associated with the diagnosis of schizophrenia; however, they are also seen in other disorders, such as PTSD.
Psychotic Symptoms in PTSD

Researchers at the University of Manitoba, Columbia University, and the University of Regina examined the data on 5,877 people from across the United States in order to determine the rates with which people with PTSD experience different psychotic symptoms.

They found that, among people with PTSD, the experience of positive psychotic symptoms was most common. Approximately 52% of people who reported having PTSD at some point in their lifetime also reported experiencing a positive psychotic symptom.
The most common positive symptoms were:
  • Believing that other people were spying on or following them (27.5%)
  • Seeing something that others could not see (19.8%)
  • Having unusual feelings inside or outside of their bodies, such as feeling as though they were being touched when no one was really there (16.8%)
  • Believing that they could hear what someone else was thinking (12.4%)
  • Being bothered by strange smells that no one else could smell (10.3%)
  • Believing that their behaviors and thoughts were bring controlled by some power or force (10%)
The researchers also found evidence that the more PTSD symptoms a person was experiencing, the greater the likelihood that they would also experience positive psychotic symptoms.
To take their study a step further, the researchers also looked at what traumatic events were most commonly related to the experience of psychotic symptoms. They found the following to be most strongly connected:
  • Being involved in a fire, flood, or natural disaster
  • Seeing someone get seriously injured or killed
  • Experiencing tremendous shock as a result of a traumatic event that happened to a close relative, friend, or significant other
What This All Means


The experience of psychotic symptoms may tell the story of just how severe a person's case of PTSD is and how well he or she is coping with the condition. It may also raise red flags about the likelihood of potentially dangerous behaviors.
It has been suggested that the experience of psychotic symptoms in those with PTSD may be connected to the experience of dissociation. Frequent dissociation may increase the risk for the development of psychotic symptoms. And studies have shown that people with PTSD who experience psychotic symptoms, as compared to those who do not, may be at greater risk for a number of problems, such as suicidal thoughts, suicide attempts, and greater overall distress. If a loved one has PTSD and is experiencing psychotic symptoms, it is very important that they seek out treatment. Positive psychotic symptoms can be effectively managed through medication. Addressing PTSD symptoms in treatment may also result in a reduction in psychotic symptoms. A number of different resources are available for people seeking help for their PTSD.


from here
http://ptsd.about.com/od/relatedconditions/a/Psychosis.htm
 
You may (differ) but it doesn't change what actually is:
309.81 DSM-IV Criteria for Posttraumatic Stress Disorder A. The person has been exposed to a traumatic event in which both of the following have been present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

PTSD is not a psychotic disorder.
There are issues with high comorbidity and psychoticism. One cannot include such a statement (that it is a psychotic disorder) unless it is a definitive symptom of all those with PTSD, and it is not and will not be (even in the upcoming DSM V TR).
 
if i had all those would you let me posses a gun? if i loose it when i have stress and its minor is it wise to let them have a gun. even the military takes the guns from then and ships them home. we discharged a man for his severity of ptsd and he wasnt in war. he got from being around when a soldier who was in combat commited suicide he was there at the bar just a few minutes before him.

its rare but some dont need weapons. that have ptsd. i did agree that not all. and you forget i have had some of the symptoms. would you want a spooked easily guy to have a gun at night answered the door bell?
 
The real issue, imo, is the right of a citizen to own a firearm regardless of the severity of his or her mental unwellness. MOST people experience some unwellness some time in their lives.

Singling out PTSD, while I realize you have current experience, just doesn't display fairness to those who have suffered with PTSD since maybe childhood and who haven't shot anyone, nor threatened.

I think it's important to the mental health/illness community to move away from the stereotypes of general population grouping, and realize that nothing fits everyone and all should not be punished or otherwise disabled because of a few, recognizable, disordered patients.

And for those who are not so easily recognizable, they can't be pidgeon holed either. We don't know who they are. I suspect, though I haven't checked for any stats, that it is generally those who fall through the cracks, those who aren't receiving any support, that act out violently. The rest, well, are due to human error in not dxing and keeping close wraps on them, do you think?

I support everyone in their right to answer a door bell at night...and most of us are a bit spooked when that occurs anyway. ;)
 
my wife wants a gun. she has bipolar type 2 and has anger issues. i asked her doc on this. NO was his word. remember vt tech that was done by a man who wanted help and never got it.

he had bp. are all like that, no, but we should have a doc clear them. if they can handle it but again i know my wife better then you i deal with her fits of rage daily on the bad months even on meds. she has hit me and i have used my wrestling training to grapple and pin her and take her back and talk her down.

when one is like that,no. that is why i support that cancelled bill some person dont need weapons. a pro gun christain cop friend of mine advise those that want ccl to check themselves if they have anger issues.


i live by the philosophy, if pull the gun, i will id the the target first and then decide if he or she is a threat and then shoot. not shoot blindly , not that those that have guns will.

i have done some shoot no shoot and that can get real tricky and discpline is needed and no to mention level headedness.


sorry i disagree strongly. some persons that have bp can handle that but a doctor should ask them question and also the patient should have that trust.

let me ask you this given the highest rate of sucides in the army. should this soldier not be asked about suicidal thoughts and anger issues?
 
Yes, Jasoncran, in your wife's case I would agree. Does anger management help at all? May God bless you and give you strength and patience (and her as well ;) )

For those who suffer bipolar disorder, a psychosis, there is always that risk of violence against him/herself or others, especially in the manic phase. That some do exhibit such psychotic features would also prevent their owning firearms, imo. One of the miserable elements of bipolar disorder is that it's really tough to stabilize on medication(s) --sometimes years-- and any major crisis or stressful event can upset that balance causing the patient to begin "all over again" trying to stabilize on medications.

:chin
i live by the philosophy, if pull the gun, i will id the the target first and then decide if he or she is a threat and then shoot.

I, on the other hand, will only pull once I decide there is a threat and I need to shoot rather than handle it another way.

 
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