Mental Health Ethics: There's A new Sheriff In Town!

Giffords and Kelly Group: Get Help? Surrender Your 2A Rights | Shall Not Be Questioned:

If you look at all the mental health “reforms” that the gun control crowd is pushing these days, if even half of them passed, the end result would be that I’d never seek medical help for any problem I might have ....

Sebastian makes a simple, yet elegant case against the "Mental Health Reporting" issues which are current in Gun Control America today.   If we seek health for emotional issues, with the very fact of seeking help result in confiscation of our firearms?

Duty To Warn:

I'm not confident that the issue has been intelligently researched, let alone resolved.  It doesn't help that the "reporting issue" hasn't been widely discussed (in public) my the Mental Health Practitioners whose newly assigned duties are being bandied about ... are prepared to assume that responsibility.

My understanding is that Mental Health Practitioners (let's call them "Shrinks" for the purpose of brevity) are not entirely on board with this newly defined responsibility.

This is an extremely "touchy" issue for Psychological therapists:

When law and ethical standards diverge (e.g., when a confidential communication does not qualify as privileged in the eyes of the law), the situation becomes extremely complex. One cannot, however, ethically fault a therapist for divulging confidential material if ordered to do so by a court of competent authority. On the other hand, one might reasonably question the appropriateness of violating the law if one believes that doing so has become necessary to behave ethically. Consider, for example, the clinician required by state law or court order to disclose some information learned about a client during the course of a professional relationship. If the practitioner claims that the law and ethical principles conflict, then by definition the ethical principles in question would seem illegal. The therapist may choose civil disobedience as one course of action, but does so at his or her own peril in terms of the legal consequences. The American Psychological Association ethics code advises psychologists to attempt to resolve such conflicts, but also provides that when such conflicts seem unresolvable, psychologists may ethically adhere to the requirements of the law, regulations, or other governing legal authority.

This contretemps is usually judged on a "case by case" basis.

Essentially, if the therapist has cause (based on conversation with the patient) that there has been a statement of deliberate intent to SPECIFICALLY cause 'great bodily harm' to the patient's self or  other individual(s), the Ethics Code allows the therapist to warn the 'target' individual, or to alert the authorities that the patient is at risk of suicide.

This comes, of course, at the risk of "peril in terms of the legal consequences".

However, there's A New Sheriff In Town:

Consider, for example, the clinician required by state law or court order to disclose some information learned about a client during the course of a professional relationship.

If "Local Law" changes to REQUIRE the therapist to inform The State about unfounded, unsubstantiated, general 'threats uttered by the patient .. where does the duty lie?

To preserve the confidence of the patient?  Or to pass on the specifics of general statements posited by the patient?

Sebastian makes a good case for the specific instance: if patients have learned that their private thoughts to a supposedly trustworthy practitioner are subject to "outside distribution", it's clear that disturbed individuals will soon quit talking to the only source of resolution available to them.

The problem is that between clinicians and law-enforcement practitioners.

For clinicians, it's just talk; or LEOs, it's "A Threat".  Both agencies are obliged to address the statements:

• Clinicians must address the source of the information, to resolve the issues;
• LEO's must address the source of the information, to resolve the threat.

It's clear that there is a wide "middle ground" between delusion and reality.

We talk about the need to NOT ignore a clear threat; but what happens if the threat s not "clear"?

One thing we MAY know:
Remember how the Santa Barbera shooter was pronounced "a nice guy" by the police who had been alerted by his parents?  They were obviously not qualified to evaluate his true mental attitude, or his threat level.

When we obligate mental health-professionals to "report" marginal cases, we end up with so many 'threats' that it's impossible for the Laity to separate the wheat from the chaff.  As a consequence, we have so many 'false positives' that all the "True Threats" may be lost in the crowd.

Obviously, the SB Shooter had decided to eschew further psychological counselling.  And if everyone who accepts that counselling knows that he faces public and private penalties for the mere fact that he has sought counselling,

It will not help to PUSH counselling on troubled individuals, when they know that their sessions are subject to public scrutiny.  Rather than limit the number of fatal encounters, it will increase the number as more and more people are unable to seek help.  The crux of the value of counselling is the sanctity of the dialogue .... just as the sanctity of the confession provides succor to practicing Catholics.