October 01, 2007

PTSD, Guns and HR 2640

There has been a lot of blogfroth regarding HR 2640 and what it will do, and what it will not do.

What it won't do is take the right to own a gun from soldiers who have Post Traumatic Stress Syndrome (PTSD), what it will do is add records from those committed to a mental institution by a court of competent authority who are mentally ill and as a result of that mental illness pose an immediate threat to themselves or others. And there-in lies the problem.

I cannot imagine anyone writing this bill has the least inkling of mental health treatment and/or current methods of treatment. Having said that, lets review what an involuntary commitment is and what it isn't. In my state, one can get committed under one of two methods. The first is a family member or some other concerned citizen who knows a patient goes to a local justice of the peace and presents evidence that an individual has mental problems and as a result of those problems is A) not getting treatment and B) poses a threat to himself or someone else. If the evidence is convincing, a mental health warrant is issued and a constable or other peace officer will pick up the individual and transport them to a mental health facility where a psychiatrist must evaluate the patient within 24 hours and either release the patient as not-commitable under the law or complete a set of paperwork which is presented to a magistrate. Within the next 14 days another psychiatrist must also evaluate the patient and if commitable under the states laws, a hearing is held and the patient is either released due to lack of evidence or committed for treatment for a period not to exceed 90 days. The patient may be released sooner than that, but if further treatment is required, the treating psychiatrist must go through the same motions, another hearing held for the patient and another ruling made. The second process is essentially the same, with a peace officer making the initial complaint and taking the individual into custody. However, the rights of the patient are and should be closely monitored.

In the old days when I first started in the field at a state hospital (way back in the late '60s), typically patients who were not necessarily dangerous per se, but who were troublesome were often committed indefinitely when they were really just troublesome and not really dangerous.

The problem is, that mental health treatments have advanced considerably over the last 40 years. New medications, and new "therapies" are available so that often patients who may have been dangerous at one time, after treatment are not and would never be again. Others, may relapse from time to time, and will require additional treatment. However, only a very tiny minority of the mentally ill pose a significant threat to others. And there in lies the rub.

In the 60's and 70's much was made of the so called government trained killer going on a killing spree here at home (read - Vietnam Veterans). This of course was a calculated lie and Vietnam Vets were no more dangerous than others already in the public sphere. But it was one way for the MSM and the left to make the general population leery of Vietnam Vets.

Over the some 37 years of work in the mental health field I have worked with a lot of PTSD sufferers. None of them were one bit dangerous to others, and only a small portion of them dangerous to themselves, mostly with depression and accompanying self harm ideation or alcoholism/drug abuse problems. That is true of Korea Vets, Vietnam Vets and Gulf War I vets. I've not worked with any Gulf War II vets so I can't say the same for them, but I know of no studies nor have I heard from my fellow psychotherapists of unusual difficulties with these individuals.

I suspect that another round of stories about crazed veterans is about to hit the MSM to turn public attitudes just as happened in the latter years of the Vietnam War and post war period. Rambo I has sunk into the collective consciousness so that a "model" is already there.

I will also state that one cannot accurately predict the future, but we can make judgements based on past behavior. Those truly dangerous are relatively easy to identify and I agree that they should not have access to guns. But the majority of individuals committed to mental health facilities do not fit that mold and it will be just one more way of keeping guns out of the hands of otherwise capable individuals.

One other problem is that government can dicatate health care policy, but they almost always fail when they do so. The outcry for universal health care or single payor is going to be the death of American medical care. Medicare, started in the 60s was supposed to be a low cost method of insuring that the aged could receive medical treatments. The cost is now anything but low. Hillarycare from the early 90s would have been a disaster. Adding SCHIPS subscribors of children whose parents make enough money to be considered fairly well off and who may have to pay the alternative income tax is ludicrous and is just a sneaky way of advancing the universal health care goal of the left. Health care in these United States is the envy of the world, and access to health care is close to being universal, and by law, is available in ER's whether you can pay or not. That is of course, one of the reasons that ER's are so overcrowded.

But, I digress, if the issue is those with mental health problems having access to guns then I can state catagorically, with some 30 plus years experience with the emotionally disturbed and mentally ill, that I would rather that some of those have guns than a lot of people you would consider "normal" and even without a gun, an awful lot of damage can be done by those with "congressman" after their name.

And since we know that future behavior can often be predicted on past behavior, what do we say about Hillary Clinton's fund raising using dolts like Hsu? More of the Clinton's Lincoln bedroom escapades? Hmmmm?

Update: Shrinkwrapped has an excellent post on this trend here

I also might mention that I am a member of Give An Hour a program that offers a free hour of therapy each week to a vet or their surviving family members. There web URL is http://www.giveanhour.org/cms/index.php

If you are a vet reading this and you need some help, see if there is a participating therapist in your area.

Posted by GM Roper at October 1, 2007 11:37 PM

Thank you for this thoughtful post. In my state, Virginia, most people are committed under the grave disability prong of the commitment criteria and have never been found to be a danger to themselves or others other than not being able to take care of themselves in the opinion of a CSB pre-screener and an evaluator. Of course evaluations last about 15 minutes, only 9% of commitment hearings are dismissed and that includes folks who were drunk or stoned and sobered up in the 48 hour TDO period, so we actually have a lot of folks being committed who do not need to be despite the propaganda saying the opposite in our state since Virginia Tech.

Virginia was and is the highest reporting state to the federal database before Virginia Tech., now they are adding even more names. We also have a heavily institutionally based MH system with very little money for basic community MH services and less in the future as AOT will surely pass and take all the funds away from voluntary treatment in the community.

Posted by Alison Hymes at October 2, 2007 12:38 AM

Copy of my comment at Shrinkwrapped.
Many combat vets have transitory PTSD symptoms upon return. Given that they have been in a state of hyperalertness in situations which sometimes allow zero room for error, and have seen horrible things to boot, this is hardly surprising. But it is usually temporary. Even those with persistent symptoms often have them at manageable levels: they simply put up with the occasional nightmares (which can continue indefinitely with decreasing frequency) or avoid situations likely to give them extra stress. As Ken notes above, there are things one can do to cope, and the VA is actually pretty good at working with folks.

Additions for this site: New Hampshire has the dual requirements of 1) dangerous to self or others, 2) by reason of mental illness, specifically excluding substance abuse and developmental delay. We are one of the few states with a conditional discharge provision, which allows a person to be revoked back to commitment at the hospital if they fail to abide by measurable conditions. This is rather a mixed blessing legally; it allows us to release some people yet keep them in treatment, but it is also easily abused by those who mean well but overstep the requirements they pile on.

Posted by Assistant Village Idiot at October 2, 2007 08:37 PM

Currently, we only have conditional release for NGRI's in Virginia, but some are trying to get it for civilly committed as well. One state hospital has been breaking the law for years and giving conditional releases to civilly committed patients and they do abuse it. They have given CR's to folks who are in the hospital for the very first time in their life, which makes no sense at all even if I believed in CR's, which I don't.

So New Hampshire doesn't have gravely disabled. I wondered why TAC never brings it up. Thanks.

Posted by Alison Hymes at October 2, 2007 09:38 PM

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