On Tuesday, New York became the first state to pass a tough new law on gun ownership. But not the kind of gun ownership that is actually responsible for most of the murders in the U.S. No, just one targeted at making tragedies like Newtown, CT a little more difficult in the future to pull off.
But in focusing on these one-off tragedies that subjectively seem epic (but objectively, are a drop in our national murder-rate bucket), the over-reaction of the lawmakers was predictable.
So lawmakers have decided to turn every physician, nurse, social worker, therapist and mental health professional in New York into a new kind of mandated reporter — people who turn into police officers when it comes to certain behaviors. In doing so, lawmakers in New York have single-handedly shred the foundation of confidentiality and trust in the doctor/patient and therapist/client relationship.
Is this a sensible reaction?
The New York Times notes the big change:
The most significant new proposal would require mental health professionals to report to local mental health officials when they believe that patients are likely to harm themselves or others. Law enforcement would then be authorized to confiscate any firearm owned by a dangerous patient; therapists would not be sanctioned for a failure to report such patients if they acted “in good faith.”
Currently in most states, mental health professionals already have an ethical duty to report certain kinds of behavior to authorities — active and ongoing abuse (whether child, partner, spousal, or elder), and certain threats of homicide or suicide. But the key difference is that the state has generally left this up to a professional’s experience and judgment to decide when to report, and when not to.
There may be many methods to helping someone in these situations, but most importantly, most of them do not involve immediately betraying the trust of the patient and reporting them to the authorities. From an ABC News article on the new law:
This flexibility allows a therapist to deal with a risk of violence without breaching confidentiality in all cases, he said. And even if those steps are enough to blunt the danger, the proposed law would still require that the patient be reported to mental health authorities, he noted.
“It undercuts the clinical approach to treating these impulses, and instead turns it into a public safety issue,” [said Dr. Paul Appelbaum at Columbia University.]
The new law, if health professionals follow it, completely throws away the therapeutic relationship with the patient, and breaches the patient’s trust and confidentiality. People with mental illness are being scapegoated, despite the lack of research demonstrating a conclusive link between mental illness and violence.
Worse, it encourages smart people to simply not admit to any such impulses of violence — even if they have little or no intent to carry them out. Patients are now encouraged — through the haphazard, quick passage of this law — to self-censor while talking to their therapist. Certain thoughts will be reported to the government otherwise.
If this doesn’t sound like Big Brother, I don’t know what does.
So while well-meaning, New York lawmakers have just managed to completely undermine the good, hard work that therapists do with citizens of that state. And state residents will learn to keep their mouths shut if they want to keep their Constitutional rights intact.
Kudos.
16 comments
In my opinion this is much too subjective a law and represents a loss of another freedom; confidentially between professional and client. I am not at all keen on my thoughts becoming public record and/or property. I have never sought to commit any violent or harmful act against others. However, I do share thoughts of self harm with a physician. The idea that this could be correlated to my harming another is unfounded and unsettling.
“…new proposal would require mental health professionals to report to local mental health officials when they believe that patients are likely to harm themselves or others…”
I am not sure this is the same as requiring that they report *thoughts* of such actions.
Patient walks into a therapist and says, “I have this impulse I want to kill person X. I haven’t given it much thought in terms of how I’d do it, but I just really want to kill them. I hate them.”
Under today’s laws in most states, the therapist would work with the patient to help understand these thoughts, and in most cases, that’s where it would end.
Under New York’s new laws, if the therapist doesn’t report this possible threat, who knows? They say they won’t charge the therapist if something later happens if they acted in “good faith,” but until a case enters the court system, who knows? No therapist wants to be the test case, so guess what therapists are going to do — they are going to err on the side of caution and report the heck out of their patients if they are afraid of prosecution from the state.
And this new law makes it clear — report or else. Because if therapists don’t report, the law is useless. And if the state finds therapists aren’t reporting, do you think they’ll just stand around accepting this disobeying of their authority?
I highly doubt it.
Absolutely Dr Grohol! This is very disturbing to me as a therapist. As a “baby” therapist in my field, I’m disturbed most of the time because many cases, especially involving children and adolescents, pose so many liabilities. I already feel as if I am walking on hot coals, hoping I don’t get burnt.
Aside from my own personal concerns, my clients are not going to report, especially my manipulative clients, that they have weapons, have access to them, or are considering using them.
As you’ve stated, trust and confidentiality will be undermined, and therapists…will be put on the spot.
In addition, law enforcement (as sad as that is) have little to no experience in mental health. To confiscate weapons from someone unaware of the severity of their illness, is bad!
While I agree to the protection of Americans, primarily our children, and the proper monitoring of gun purchases, I think we have to be wise in how we apply laws. Perhaps with this new gun restriction law, we can now discuss how to properly implement it.
What is even more frightening for providers to have to deal with in future times is we will HAVE to take on antisocial people as patients after the courts deem them mentally impaired and in alleged need of treatment. I mean, you let politicians set the bar deep in the mud, anyone who commits a violent crime must be mentally impaired, so only mental health care providers can “fix” them.
Oh, and with CPT coding being such a wonderful experience, wait until more psychiatrists retire or refuse to take on any people with insurance. 2013 is setting up to be a wonderful year for providers.
Aha~! Certain thoughts are now a crime. 1984 has arrived and in our faces. Thoughtcrime is now punishable and left in the hands of doctors who may themselves have emotional issues. It’s not like psychiatrists are without flaws is it? A chink in the confidentiality between doctor and patient for having “bad thoughts”. I repeat, people are going to be punished for “thoughtcrime” though they may never have any intention of carrying anything out. All patients have to do is say “thoughtcrime” and they will be punished for something they didn’t do. Isn’t that like putting the crime before the jury?
Ted Nugent would be proud of this group. I am surprised the author or a commenter has not suggested arming those who are obligated to report.
If a law like this passes in my state, even though I like my psychiatrist I’m not going back.
I am glad to read that someone brought up the analogy to 1984! The point is that the most onerous of Obama’s executive orders is the one concerning data mining and beefing up the powers of the state.
Now the fall in line mentality is employed to make doctors into snitches…
We live in a world where the president brags about his involvement in targeting people, including American citizens, for drone assassination, and American society has been desensitized and militarized for years. The media never questions much of anything controversial, reporters are embedded amongst troops, and movies like “Zero Dark Thirty” are glorified uncritically.
No wonder we now have calls for gun control following an act of murder against innocents at home, while the state normally promotes it abroad without any questions asked. A state that promotes violent acts has no right to demand that only the police have the right to carry arms!
The ironic thing about this is, most people voluntarily choose to see a mental health professional because they want to improve their lives, not make it more stressful. This whole thing is depressing. I don’t want to have to worry that I may land in some government database and during a routine background check for a job, the thought police has tagged me as potentially violent when I’ve never harmed a flea or even threatened one.
It sucks that the government wants to punish people who sought help because they wanted to make things better. Why does everyone with mental illness have to pay for what Adam Lanza did? I didn’t do it.
If this passes in Texas… I’m ducking for cover! I’ve never met a shrink who wasn’t him/herself a solely money-motivated charlatan and/or crazy as an outhouse coyote!
1. And…Why don’t y’all just admit that as far as psychopharmacology goes, you’re in the position of one equipped only with a pipe wrench, a hammer, and a bottle of dilute hydrochloric acid trying to fix a malfunctioning personal computer? Read the history of psychiatry itself sometime, or the story of Dr. Ignatz Semmelweiss, who was stripped of his license to practice in Vienna around 1860, publicly ridiculed by his colleagues, and beaten to death in an insane “asylum” for suggesting it would be a good idea for OB/GYNs to wash their hands and sterilize their instruments between walking from the pus-dripping autopsy theater to insert said hands/instruments into the bodies of parturient women. The instant fall in maternal mortality rate from 30% to 3% in HIS maternity clinic impressed no one in “The Profession”…
The only real respect I have for psychiatrists as a profession (excluding my warm personal friendships with some) is that they are still “In The Arena, slugging it out with diseases of truly insane complexity and subtlety. But come on, let’s not forget the “First, do no harm!” of your founder Hippocrates, shall we? And don’t try to “you’re a layman” snow me, I worked too long in the Austin State Hospital in the Admissions Unit in my whites not to know what you’re doing. (They liked me because not too many people with B.A.s in Abnormal and Personality Psychology applied for such positions). I’ve personally assisted in psychiatric exams of over 1,500 patients and read many more charts than that- plus it was my job to elicit their relevant whole-person medical and psych history on admission- not that it was ever necessarily read or used in Dx’ing and Rx’ing for the poor victims… Ever worked with a supraorbitally lobotomized patient? I have.
Please discard your “Cuckoo’s Nest” movie preconceptions: he was a happy, cheerful man with a physically active, helpful life. The definition of “life” is open to debate, though…
Practicing mental health law and representing your unfortunate patients at Mental Health Code detention hearing trials for several years didn’t hurt my insights, either. But that was 4 years later and lasted for years. I loved it: nowhere else could could you get such great facts!
In our Legal Ethics course they gave us a relevant hypothetical to this proposed bust-your-client/patient matter. Here: Dr Grohol, I need help!
A good civil-business client of ours desperately calls & begs to meet me at my office at 9 PM. I tear yourself away from a lurid murder of a police-officer case on the news and see him. He pulls a smoking pistol out of his jacket, slams it onto my desk, and says “I did it! You’re my lawyer and the only person I can trust with my best interests!” Then he runs off, leaving his cellphone on the same desk.
I drop the reeking weapon into my office safe (after picking it up with a plastic rod in the barrel) and bagging it. The cellphone follows with similar handling.
Then I bury my face in my hands. It’s 10 PM and the sirens are loud, all over the city.
What do I do? (There IS an ethical answer, but no physician usually ever reasons it out easily.. although you have all the same ethical duty-parsing tools and ethical teachings and (most importantly) obligations to our troubled clients/patients that I do- and maybe more I don’t know about. Law students have a lot of trouble with this one, too.
There was a psychiatrist in my Law School class, but he… well… (shaking head sadly). Let’s just say the professor found fault with his proposals, although we gave him center stage to tell us the applicable medical ethics. But he tended to the easier solution(s).
Who here will take up my challenge and consult with me, bringing the highest standards of Medical Ethics to this man’s defense team TONIGHT? Our Trauma-Team’s Golden Hour clock has just begun to tick…(Oh yes, he’s a multi-millionaire -if that makes any difference to you.)
You, Dr. 5-Facility-Privileged, civically and philanthropically active Board-Certified 25-yr APA Member with almost $1M income per year?
You, Dr. Psychiatry Resident, slumping with exhaustion, but nonetheless holding that precious State Medical Board License? You, Ms. Ph.D Clinical Psychologist of great repute and professional standing & even much experience with… “Offenders”? Who will stand for the accused with me?
The Mayor, State Senator, and Police Chief are VERY upset, as is the sobbing family of the officer, fallen in the line of his (also sacred) Duty… but now WE have to get cracking on the practice of our Professions. This Emergent Case is in OUR hands! Action first, press releases (if any) later… Who’ll speak first?
Fear not, the professional guidelines (and pitfalls) here are very hazy for each of us… and any idea is welcome.
PS: The non-MD/JD “lay” folks usually get it closest to “right” first, in my seminars…
The way I understand it Obama’s gun law also has this in it. As they say it’s not paranoia….How will anyone get help if they cannot be honest with their doctor? Next are they going to go after the priests and ministers? Big brothers out there and civil rights are a dream of the past.
right now patients in new york should as a call in to cancel appointments protest and new york sportsmen and women should hold a protest againt this ignorant governor we should have a recall election and oust Quomo and his thugs there were few shootings in New York this man goes around appoint ing doctors and nurses to turn their patients in it smacks of gestapo tactics to me
In my opinion, federal HIPAA preempts this state law. Further, constitutional challenges include violations of the 4th and 14th Amendments. This law also triggers a 2nd Amendment challenge. The doctor-patient privilege dates back to Ancient Rome, I believe.
Go get ’em, docs. Good luck!!
I am just a public school teacher, slammed by angry parents a few times for doing the mandatory reporting of child abuse that we have to do by law. NO ONE seems to be trained properly in this mandatory reporting. NO ONE examines the entire process from top to bottom, beginning to end and NO ONE protects me when my principal threatens me with disciplinary action (breaking the law, I guess) when I am asking the questions you have to ask to find out if Mommy made those bruises. Especially when Mommy has an Ivy League degree. Mommy can march into the office and almost get me fired. This system does not work. AND I can’t even lock the door to my classroom if a nut with a gun strolls into my school.
God bless U for being a teacher. I’m part of the silent majority who R in awe of (most) teachers. don’t let a few self-absorbed parents get to you.
As our priest said this morning, the Latin root of the word “humility” is TRUTH.
Be glad U don’t have to work at Wal-Mart. Customer divas come in with their boxing gloves on, solely to cause havoc, and using it to get “their” discount(?)
Have a great school year and thank you.