THE BLOG
04/17/2013 11:28 am ET | Updated Jun 17, 2013

Mental Health and Second Amendment Fears

I am a psychiatrist, and I work at a VA hospital in the state of Oregon. I see veterans on a daily basis in our outpatient mental health clinic and acute psychiatric inpatient unit. All of the veterans I see have had extensive training in the handling of firearms. Also, our state is largely rural and has a long tradition of hunting, self-reliance, and self-protection. Thus, many of these veterans are proud gun owners.

The recent gun tragedies have spurred us to pursue new controls on who can purchase a firearm. A major focus of this effort is to make certain that individuals who might pose a danger because of mental illness do not have access to weapons. I whole-heartedly agree with this effort. However, in recent weeks I have become aware that many of the veterans I see are starting to fear that merely coming for psychiatric help will cost them their right to own a gun. Unfortunately, there is a possibility that the fear of being labeled as mentally ill and subsequently losing their right to own a firearm will prevent both veterans and non-veterans with mental health issues from seeking the help they need and deserve. This is a concern that must be addressed clearly and succinctly.

The laws vary from state to state. However, in the state of Oregon, the only individuals who are barred from gun ownership due to mental illness are those who have been committed to psychiatric treatment by the court system. Merely seeking help from a mental health provider, or being voluntarily hospitalized in a psychiatric unit, does not take away an individual's right to own a weapon. Even being placed on what is referred to as a two physician hold for brief, involuntary treatment in a hospital does not take away these rights if it does not result in court ordered commitment for more long-term involuntary treatment. It must also be noted that, barring other barriers to gun ownership, such as felony conviction, it is possible for such individuals to petition to have their gun ownership rights restored once they have established that they are no longer mentally ill.

Because baseless fear of having their guns taken away might dissuade people from pursuing the treatment they might need, it is imperative that state and federal governments, the Veterans Administration, mental health organizations, and gun owner advocates, such as the NRA, work together to make the relevant facts known to the public. What constitutes grounds to deprive an individual of gun rights due to mental illness must be made clear to all concerned. These facts should be posted in mental health clinics, particularly in VA clinics, and published as public service announcements in newspapers and by broadcast media. The NRA should make a special effort to make these facts known among their membership and in publications and announcements, as their views are respected and widely disseminated among gun owners.

In fact, the vagueness in which the entire subject of mental illness and gun violence is shrouded needs to be fully resolved. An operational definition of improving mental health care to better protect us from gun violence needs to be presented. While we work to increase our ability to identify individuals whose mental illness increases the risk of them being a danger to society, we must also declare a willingness to treat them. Curiously, the voices who most loudly call for more stringent methods to keep guns out of the hands of the mentally ill are often the same voices who cry for smaller government with less involvement in the treatment of mental illness. We must acknowledge the fact that the adequate treatment of the mentally ill will require government involvement and will cost taxpayers money. It would mean increasing funding at the state and county levels so that the mentally ill can go to treatment rather than jail, which is increasingly becoming the case. Early recognition and treatment of mental illness would include placing counselors in schools and rebuilding the all but abandoned tradition of school nurses.

It is also ironic that the same individuals who vehemently argue against gun registration are quite eager to register the mentally ill. This is despite the fact that the mentally ill are far more likely to be victims, rather than perpetrators, of violence. We must thus clarify how identification of the mentally ill is performed, where and by whom it is stored, and who will have access to the information. We must guarantee that such a registry would not jeopardize any individual's ability to obtain insurance, credit, or employment.

Another question of political philosophy is the degree to which we must change the legal criteria for hospitalizing and treating mentally ill individuals against their will. In many states, only those who have already engaged in dangerous behaviors meet criteria for commitment. In many cases, this is the proverbial closing of barn doors after the horses have run away. One way to address this problem is to establish forms of involuntary hospitalization intermediate between brief physician holds and longer term commitments. In the state of Oregon, for example, it is possible to place an inpatient on what is called a 14-day diversion to allow further evaluation and treatment short of actual commitment if all parties agree. This process has worked well in Oregon, and may obviate fear and resentment in individuals who might otherwise have their Second Amendment rights suspended. Whatever one's opinion of guns might be, we must agree to avoid making safety from gun violence a cause for some individuals to fear and avoid much needed psychiatric treatment.