Friday, February 16, 2018

Guns & Mental Health

A teenager returned to the high school in Parkland, Florida from which he had been expelled for behavioral problems.  Armed with a semiautomatic rifle, he shot about 30 students, killing 17.  Many who knew him at the school knew he was deeply disturbed, and that he had guns, and they had predicted that he would do exactly this.

News reports said the FBI was warned but did nothing.

When I read online commentary it seems to me that opinion is divided into two camps.  Guns are the problem.  Or mental illness is the problem.  Of course American gun violence is a complex matter, and the availability of guns and the prevalence of mental illness are both important factors.

Are we going to do something to reduce dramatically the availability of guns?  All the evidence points to No.  We have more firearms in the USA than we have people.  We had a ban on semiautomatic rifles for ten years, but it had little effect on supply, and it sunset without evident effect on crime, partly because these weapons are used in a tiny fraction of incidents in which people are killed with guns, even though they are used in a sizable proportion of mass shootings.  We may have another ban on these weapons, as the public demand to "do something" escalates.  Or we may not.

If we do, I predict it will have little or no effect on mass shootings.  First, weapons like the AR-15 used by the Parkland, Florida shooter will remain abundant unless there is an Australian-style confiscation, which seems exceedingly unlikely.  Second, anyone bent on a mass shooting does not need an AR-15.

Ask a "gun nut" who owns an AR-15 with 30-round magazines and a Glock pistol of heavy caliber (say, .40 or .45 or 10 mm) with 15-round magazines this simple question: given either weapon, with twice as many loaded magazines for the Glock as the AR-15 (to yield the same number of total rounds), is there any real difference in how fast you could shoot and kill how many people?

The answer will be No.  And if your response is, well, then, we have to ban semiautomatic pistols, too, I can assure you that is a much bigger hill to climb, as they have been in US civilian hands in vast numbers for well over a century.  The same is true for high-capacity (meaning more than ten rounds) magazines.  Given the large number of such guns and magazines in circulation now, and the "non-starter" status of any attempt at confiscation, this approach is just not an effective solution.

So, I have a simple idea that might make a small contribution.  Small contributions have the disadvantage of being small, but sometimes they have the advantage of being feasible, so consider this one in that light.

In the spirit of full disclosure, there are three things I should tell you about myself.  First, I am a doctor specializing in emergency medicine, with a longstanding interest in public health, and I've read a lot about the public health perspective on gun violence.  Second, I am a gun owner, and I have read a lot about the American gun culture.  I can tell you how gun owners think and feel, and I can explain the positions of the NRA and the other gun-rights advocacy groups that take an even harder line (believe it or not).  Third, I am running for Congress, so I think a lot about America's problems, including social problems, from the "there-oughta-be-a-law" viewpoint.  If a voter asks me what I am going to do, if elected, about gun violence, "I don't know" is not an acceptable answer.

I live in Pennsylvania.  In my state doctors have a legal obligation to report to the Department of Transportation drivers who have medical problems that may cause them to have episodes of loss of consciousness that would be dangerous if they happen while driving.  This affects mostly people with seizures, but diabetics with repeated episodes of low blood sugar, people with fainting spells of various causes, and alcoholics and other drug addicts who lose control of a vehicle because of an overdose are all reportable.

So how about this?  Why not ask a doctor who encounters a patient with behavioral problems such that, in the physician's judgment, this person should not have access to firearms, to make a similar report to an appropriate government agency?

How would that work?  Here are a few essential points.

1.  Doctors would need guidelines.  So form a panel of experts to create them.  What are the signs a doctor can recognize that mean a person is potentially dangerous in ways relevant to having access to guns?  Require all licensed physicians to learn these guidelines.  State medical boards already micromanage our continuing education, like requiring all licensed physicians to take two or three hours of online education about opioid prescribing and addiction, or child abuse, so this would be easy to do.

2.  Reporting in good faith would be legally protected.

3.  A person who is reported would be investigated with respect to whether s/he should have the right to possess firearms restricted.  There would be built-in due process involving appropriate parts of our legal system, with the right to appeal and the right to petition to have gun rights restored.

Would this identify everyone who is emotionally unstable and shouldn't have guns?  Of course not.  But what do we do now?  The people who are disqualified are those hospitalized involuntarily because of mental illness, and those who are adjudicated mentally incompetent.  That is a small portion of the population of people who shouldn't have guns because they are a potential danger to themselves or others.  And the expansion of the "pool" adopted during the Obama Administration, and reversed by Trump, that would have added people judged by the Social Security Administration as incapable of managing their affairs (financially) was vigorously opposed by both the NRA and the ACLU.  That should catch your eye, because the ACLU does not recognize a Second Amendment individual right, even after the Supreme Court explicitly did.

We need creative solutions.  Lots of them.  And they have to be solutions that can get substantial buy-in from interested parties on various sides of the issue.  This is one.  I will be doing my best, if I am elected, to fashion more that I think can be enacted in the context of an American society that is starkly polarized on this issue.

2 comments:

  1. I like the idea of a Pigovian tax -- call it an annual registration fee -- amount TBD, but hypothetically, say, $200 per firearm.

    The benefits would be numerous. You could raise significant revenue (over $60 billion annually in the above example,) discourage young men (with limited funds) from owning guns (as young men are by far the most likely demographic to use a gun to kill someone other than themselves,) and discourage stockpiles/collections which add to the already ridiculous number of guns in circulation without laying a heavy burden on people who have a couple of guns for hunting or self-defense.

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  2. So ... a middle-aged collector who owns two dozen firearms (which is not an especially large collection) acquired over a few decades would have to pay nearly $5,000 every year just to keep his collection? I cannot imagine how that proposal would ever gain traction in Congress or in most state legislatures. Many states don't even have registration, which means a gun used in a crime can be traced forward (manufacturer to wholesaler to retailer to buyer), but there is no database of owners that can be searched to get a list of what firearms each person owns. If the vast majority of gun owners are opposed to having government possess a list of what they own, they will vigorously (and effectively, I think) oppose any attempt to tax them on the guns they own.

    On the other hand, the vast majority of gun owners support efforts to keep firearms out of the hands of the dangerously mentally ill (which is a small minority of all Americans with mental illness) - so long as the approach to this is carefully constructed, with due process.

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