Thursday, January 17, 2013
Psychiatrist, not Psychic
Some of my friends think I'm paranoid because the new gun law scares me.
Yes there are gun issues, gun rights, second amendment, self protection and other issues.
This is about my role as a psychiatrist. This is about the state and federal government asking me to be a psychic.
The newly passed New York gun law states:
"Section 9.46 of the Mental Hygiene Law will require mental health professionals, in the exercise of reasonable professional judgment, to report if an individual they are treating is likely to engage in conduct that will cause serious harm to him- or herself or others."
THAT SCARES ME TO DEATH!
Why? We already have a requirement to report anyone who is am imminent danger to themselves or others. It's called a 72 hour legal hold. If someone is an immediate threat to themselves I can call security or the police and have that person held against their will for up to 72 hours.
There is also the Tarasoff Law which requires me to warn a potential victim. If a patient of mine makes a threat against a specific person - I have duty to warn that person or get the police to protect them or something to better ensure their safety.
This new law is different. It doesn't ask a psychiatrist to look at an immediate threat (which is all we can do). This asks us to predict if a patient is "likely" to be violent.
Do you have any idea how horrific psychiatrists are at predicting suicide or violent acts?
In the very short term - we're pretty good. When psychiatrists were asked to predict which patients would be violent WHILE INSIDE the psych hospital - they were right 82% of the time.
Predicting OUTPATIENT violence in the next 3 days we get it right about 65% of the time.
After 1 week our predictions are no better than a flip of the coin in fact we're worse. Psychiatrists trying to predict violent behavior more than a month out were wrong more than 50% of the time.
SO - how liable are we as psychiatrists for our patients behavior? How long are we liable? Does this new gun law change that?
Suing of a psychiatrist for failure to intervene has already happened. The Aurora Theater shooting in July 2012 has led one victim's spouse to sue the shooter's Psychiatrist.
The shooter was making violent threats in June
OVER 30 DAYS LATER he shot those people in the theater. The wife of one of the victims state's that the psychiatrist should have put him on a 72 hour legal hold when he made violent threats to her in June.
I wasn't there, I don't know what happened. I know I have patients threaten me all the time because they don't get the treatment they had expected. I rarely put patients on a legal hold because unless I believe they are an immediate danger to themselves or others, I'm not going to revoke their civil liberties.
I doubt the case will be decided against the doctor - but that's because it's in Colorado. What if this case were brought forth in New York?
Can we sue the shooter's mom? After all - she likely knows him much better than the psychiatrist. What about school teachers, friends, counselors, etc?
What else am I supposed to be able to predict? Robbery, Suicide, Infidelity, going AWOL???
This is a scary slippery slope. I understand the need for mental health treatment, and for reducing gun violence - but calling a medical doctor a mind reader is, well, insane.