Access to treatment is best to avert harm by mentally ill

The recent shooting spree at Sandy Hook Elementary School in Connecticut, which left 26 people dead, including 20 children, ignited a conversation about gun control throughout the nation. With profound emotion during his State of the Union address this week, President Barack Obama implied that the tragedy might have catalyzed efforts to ban assault weapons and high-capacity ammunition magazines.

Proponents of the $32 billion-per-year firearm industry have cause for concern. It is big business. There are more than 129,817 federally licensed firearms dealers in the United States, according to the Bureau of Alcohol, Tobacco, Firearms and Explosives. Of those, 51,438 are retail gun stores, 7,356 are pawnshops and 61,562 are collectors, with the balance of the licenses belonging mostly to manufacturers and importers.

In Hawaii, Senate Bill 932 was introduced with the intention of protecting the public from gun ownership by anyone who is a danger to themselves or others. Such people would be prohibited from possessing, having custody or control of, receiving, purchasing or attempting to receive or purchase firearms or other dangerous or deadly weapons. The law would be enforced by a reporting system and database to be maintained by the Department of Public Safety and accessible to law enforcement, mental health professionals and sellers of firearms. It also requires the Department of Public Safety to make a list of people whose license for firearms or other dangerous or deadly weapons has been revoked.

The spirit of the bill is reasonable but, in practice, risks collateral damage, for example, to people who have been depressed and suicidal in the past but are now in good mental health. Furthermore, while a database prevents those who are mentally ill and dangerous from being granted a gun license, the law does not prevent such people from causing harm by other means.

SB 932 could have other unintended consequences. It might cause some patients to decline medical care for mental illness out of fear that they may lose their right to carry a gun. This week I saw a longtime patient who had just returned from his seventh tour in Af­ghani­stan as a "security contractor." He suffers from post-traumatic stress disorder, agitated depression and severe anxiety. Under medical treatment his problems were under good control.

This time he refused his medication refill, fearful of SB 932. "I cant have anyone taking my guns away," he said.

The best way to prevent mentally ill people from causing harm in our community is to ensure their access to necessary medical care. In the heat of the Great Recession, Hawaii sustained deep cuts in mental health services for the underserved. In my own practice a number of patients who were barely able to maintain themselves with the professional support of case managers became homeless and were lost to follow-up when the case managers were cut back.

SB 932 is intended to keep guns out of the hands of people who might do harm to themselves or others. The benefits of the law must be weighed carefully against the risks to privacy and the constitutional right to bear arms. More important, we must invest in adequate resources to treat the mentally ill and strive even harder to resolve social ills that are the breeding ground for harmful intentions.

———

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.