Guns, mental health and Obamacare

We hear it with every gun massacre. "Where are the mental health services? Why didn't anyone catch this earlier? How do we make sure these people get the help they need?" All of which are extremely valid questions, asked over and over every time this happens, too often used to distract from the questions about how to keep guns away from these homicidal and suicidal people.

But remember what happened when President Obama and Democrats in Congress thought about maybe addressing some of those questions in the Affordable Care Act? This happened, an entire section of the law devoted to the protection of gun ownership and to shutting down the discussion.

Here's how that works, from the perpective of a physician, Dr. Carolyn McClanahan, the person who would be the first line of defense in identifying and helping'yes, helping'a potentially violent mentally ill person.

In medical training, physicians are taught to screen for potential violence. It is amazing how many people will tell you if they are homicidal or suicidal'you just have to ask. As an extension, we ask about access to guns. If a suicidal or homicidal person has access to guns, they are more likely to use that implement to initiate their violent act. This is why we are trained to ask that question. [...] Unfortunately, the gun rights lobby, mostly funded by the National Rifle Association, has time and time again inserted their hand in attempting to shut down that conversation.

In the Affordable Care Act, the gun lobby's section is in Title X, starting on page 2,037, line 23.  'Protection of Second Amendment Gun Rights' contains five provisions mostly dedicated to shutting down conversation about guns in medicine.

These sections don't prevent a physician from asking a potentially violent or suicidal mentally ill patient about access to guns, they just do everything possible to discourage it, from explicitly stating that patients don't have to disclose that access (as if patients were ever required by law to disclose anything to a doctor) to expressly forbidding doctors from collecting data about ownership and use of firearms. In Dr. McClanahan's words,

Sounds like an effective way to stifle research related to gun violence so we can no longer prove that easier access to guns increases the risk of mass violence.

Another provision prohibits physicians from maintaining records of patients' access to or use of guns or ammunition, more information that could, at the very least, help in the investigation of an incident. That's part of the link between access to weapons and gun violence that can't be researched and tracked.

The fourth and fifth provisions are so unnecessary as to be ridiculous. The fourth says that health insurance companies can't determine rates or eligibility based on gun ownership. Of course they can't. Guaranteed issue is already a key part of the law. The fifth says that gun owners don't have to disclose they have guns. Once again, patients aren't required by law to disclose anything to a doctor.

The intervention of the gun lobby in the Affordable Care Act was entirely gratuitous and the provisions they inserted mostly utterly unnecessary. The only thing the NRA achieved by meddling in a health care bill was flexing its muscle to stifle one more route to maybe reducing gun violence.

Physicians are trained to have this conversation with patients for their own well-being and that of those around them. The gun lobby, always the first out of the gates with statements about how we need to address the mental health system, did everything in its power to shut that conversation down, to neuter a physician's ability to do anything about a potentially violent mentally ill person. Protecting privacy is a must, but so is protecting the potentially suicidal and homicidal patient and the people around him or her.

We absolutely need to do everything a nation as advanced as our should be doing to help these broken people. But we're smart. We can multi-task. We can take care of the broken people and make sure they can't get their hands on fucking guns. Yes, mental health has to be part of the conversation when it comes to preventing another Newtown, but so does guns. Maybe this time the gun lobby won't shut that conversation down.