In the three months since New York’s mental health professionals were first required to report potentially dangerous mentally ill patients to a state database screening gun-permit holders and applicants, thousands of names have been submitted to the state — but fewer than a dozen resulted in any action to remove weapons.
That datapoint emerged amid heated testimony by mental health providers and civil libertarians at a state Assembly committee hearing on Friday about the mental health provisions of the NY SAFE Act, a sweeping gun control law advanced earlier this year by Gov. Andrew Cuomo.
State Senator David Carlucci (D-Rockland/Westchester), who chairs the Senate Mental Health and Developmental Disabilities committee, held the hearing in Manhattan. New York City has been the source of the majority of reports to the database so far, according to testimony.
Officials from the Office of Mental Health and Department of Criminal Justice Services, which both have roles in administering the SAFE Act’s mental health provision, were invited but did not attend. The Department of Criminal Justice Services said that information would only be distributed with a Freedom of Information request.
Under the SAFE Act, doctors, registered nurses, psychologists clinical social workers must report patients they believe are “likely to engage in conduct that will cause serious harm to self or others.”
Yet while county administrators say they have been deluged with reports flagging potentially dangerous patients, only a handful appear to be connected to individuals who have gun permits or have applied for them.
“Of the 6,000 reports that have been filed, 11 have been acted upon,” testified Jed Wolkenbreit, counsel to the New York State Conference of Local Mental Hygiene Directors, Inc., citing figures from the state Office of Mental Health.
His organization’s members are county directors of community services, who under the law must approve or dispute assessments made by mental health providers of the potential of their patients to cause harm.
The flood of SAFE Act reports, Wolkenbreit asserted, is taking time away from commissioners’ other responsibilities in running their counties’ mental health systems: “The biggest problem is the amount of time and resources that the SAFE Act is diverting from all of the other duties of the DCS for what we believe to be a minimal return.”
The law says that reports must be made by the mental health professional. Yet some reports, testified Wolkenbreit, are being filed by someone other than the mental health provider seeing the patient, and many appear to be computer generated, based on existing patient files. In many cases mental health providers listed on the documents, when contacted by community services directors for review, either said that they had not filed the reports or that the patients they had seen did not meet the SAFE Act reporting criteria, according to Wolkenbreit.
More than nine out of ten reports so far have come from hospitals or state psychiatric centers — including hundreds of reports filed in a single day in late April by state psychiatric hospitals.
Benjamin Rosen, a spokesperson for the state Office of Mental Health, acknowledged in an email statement that this spring many psychiatric patients were automatically referred to county officials.
“From March 16, 2013 to May 6, 2013, while OMH was building a reporting portal for state psychiatric hospitals, reports were initiated based on admissions to state psychiatric hospitals, although mental health professionals had the ability to prevent reports from being forwarded for those persons who did not meet NY SAFE Act criteria,” said Rosen, who noted that most would have qualified regardless.
Rosen also countered critics who have said the reporting requirement discourages the mentally ill from seeking care.
“Mandatory reporting requirements for child abuse, sex abuse and under common law, the Tarasoff decision, have long established reporting requirements which do not generally appear to have negatively impacted treatment seeking behavior or the sharing of angers, hostilities, abuse or other required reporting events to clinicians,” he said.
The state psychiatric hospitals stand in contrast to the U.S. Department of Veterans Affairs, which has said that its medical professionals will not comply with the SAFE Act.
One source of confusion, other speakers at the hearing noted, is that the language of the law is vague — particularly the requirement that providers must report anyone considered “likely” to engage in violent activity.
“’Likelihood’ isn’t a standard that we work with. We are not very good at predicting violence at any point in the future,” said Dr. Glen Martin, president of the New York State Psychiatric Association. The association has submitted a complaint to the U.S. Department of Health and Human Services Office for Civil Rights, charging that the New York law may violate HIPAA.
“This standard doesn’t make a huge amount of sense.”
In response to provider outcry, Assemblyman J. Gary Pretlow (D-Mount Vernon/Westchester) introduced a bill in March that would redefine the mental health reporting requirement to allow professionals to reach out directly to law enforcement when a patient poses an imminent threat, a provision not currently included in the bill.
In the end, providers and the New York Civil Liberties Union testified, the harm is not only that someone who is dangerous could end up in the database, but also that people with mental illness are discouraged from seeking treatment because of the possibility that they’ll be reported.
“The NY SAFE Act requires psychiatrists, psychologists and other mental health professionals to report a patient they deemed dangerous, even if that mental health clinician believes that the patient would respond well to treatment and has no reason to believe the patient owns a gun,” said Beth Haroules, senior staff attorney at NYCLU.
“These reporting requirements could have the undesired consequence of deterring people from seeking, and or, fully disclosing during treatment.”
The theme echoed across the nearly dozen advocate and provider organizations that testified.
“Linking gun control with mental illness will increase the stigma associated with treatment,” testified Ari Moma, a registered nurse from Interfaith Medical Center and representing the New York State Nurses Association. “To promote the criminalization of patients with mental illness under this provision is an injustice.”