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Jacob M. Appel

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Want a Gun? Get a Prescription!

Posted: 01/09/11 10:16 AM ET

One of the positive consequences of this weekend's "Safeway Massacre" in which Judge John Roll was killed and Congresswoman Gabrielle Giffords critically injured -- if it is even possible to speak of silver linings after such a horrific event -- appears to be a backlash against hateful political rhetoric. Another should be an increased effort to keep firearms out of the hands of mentally unstable individuals. The easiest way to prevent psychotics from obtaining guns, in a manner that is low-cost, constitutional and minimally infringes upon the prerogatives of law-abiding gun owners, is to require a brief psychiatric examination and a prescription in order to purchase a gun.

The Gun Control Act of 1968, passed in response to the assassination of Robert Kennedy, bans gun ownership by anyone who "has been adjudicated as a mental defective or has been committed to any mental institution." In a rare act of bipartisanship in 2008, following deranged student Seung-Hui Cho's murder of thirty-two people at Virginia Tech, Congress passed legislation that essentially required states (through threat of lost funding) to provide data on psychiatrically unfit individuals to the National Instant Criminal Background Check System (NICS). These efforts are certainly commendable, but they have done far too little to protect the public. If we continue to stand back and wait for psychiatrically disturbed individuals to come to the attention of authorities through their own actions, we will continue to have massacres like those in Virginia and Arizona.

American society has a long history of accepting -- and even embracing -- appropriate medical screening prior to engaging in potentially-dangerous activities. We require would-be drivers to take eye examinations; we do not merely wait around for blind folks to plow vehicles into traffic and then incarcerate them. We require airplane pilots to blow into breathalyzers, and train engineers to have their urine screened for narcotics, and physicians to have skin tests for tuberculosis. If you want to adopt a child, we send a well-trained social worker to your home to make sure that you are at least superficially fit for the challenge. Gun-ownership stands out as one of the only areas in which we do not screen for a public threat before approving a potentially lethal activity.

A prescription requirement need not be onerous. Requiring a brief psychiatric check up prior to issuing a gun license, and possibly a renewal every fixed number of years, could be done in a manner to impinge only minimally upon the activities of psychiatrically healthy gun owners. While mental health remains in some respects a nuanced art, it does not require great psychiatric acumen or years of Freudian analysis to determine that a man like Jared Loughner ought not to be packing heat. In states with significant gun-owning populations, mental health workers might even be employed by the state to conduct such screenings on-site. Needless to say, if we are to ensure compliance and to prevent a backlash against such screenings, the government would be wise to pick up the entire tab. With time, gun owners would surely come to see such screenings as routine -- like annual car inspections -- and the massacres prevented might change public perceptions regarding lawful gun ownership.

Firearm prescriptions, if they ever do gain traction, are not likely to do so overnight. In the interim, medical and mental health professionals need a more effective mechanism for preventing dangerous patients from carrying weapons and for removing firearms from the homes of those unfit to possess them. The reality is that psychiatrists see many patients who are a chronic threat to the public, but do not meet the narrow prohibitory standards of the 1968 statute or require permanent institutionalization. Healthcare workers are rarely (if ever) willing to go to court to have patients declared "mentally defective" if their primary concern is the potential misuse of firearms. What is needed in the short-run is a "do not shoot" registry akin to the federal government's do-not-fly list. Under such a system, two independent physicians could evaluate a patient in a clinic setting and then -- if they deem it necessary for public safety -- they could refer his name to the state, through a simple, standardized mechanism, for suspension of his privilege to hold firearms, pending further review. This reference would also trigger a home visit by authorities to remove firearms.

Nobody can say with certainly whether such a policy might have prevented any particular shooting massacre. However, common sense suggests that increasing the barriers to gun possession for the mentally ill will inevitably save human lives.