COMMENTARY: Exploring gun safety from a medical perspective

By Jo Ann Fields, M.D.

How can we reduce gun violence? To help answer that question, several prominent medical associations — the American Psychiatric Association, American Psychological Association and American Academy of Pediatrics — have issued policy statements on the subject of firearm access and violence. I thought it might be helpful to look at their recommendations, and then, think about which ones would be good for Delaware.

The American Psychiatric Association Position Statement on Firearm Access, Acts of Violence and the Relationship to Mental Illness and Mental Health Services, December 2014

Here are the key points.

1. Recognize that most gun violence is not attributable to mental illness.

2. Require background checks and waiting periods on all gun sales.

3. Ban possession of firearms on college campuses, in hospitals, and similar institutions.

4. Fund research on the causes of firearm violence. Fund a national database of firearm injuries.

5. Given that the right to purchase or possess firearms is restricted for specific categories of individuals under federal or state law, the criteria for disqualification should be carefully decided and should provide for equal protection of the rights of those disqualified, including a fair opportunity to have his or her rights restored.

Non-adjudicated events, such as temporary hospital detentions and voluntary mental health visits, should not serve as sufficient grounds for a disqualification from gun ownership. The adjudicatory process provides important protections that ensure the accuracy of determinations, the right to representation and the right to call and cross-examine witnesses.

6. For people with mental illness who may pose an increased risk of harm to themselves or others, remove barriers to accessing treatment, including treatment for substance use disorders.

7. Because privacy in mental health treatment is essential, laws that mandate mental health professionals to report to law enforcement all patients who raise concerns about violence are likely to be counterproductive and should not be adopted.

The American Psychological Association advocates for public education about the warning signs of youth violence to help young people recognize when a friend might be a potential danger to themselves or others.

Here are the key points.

Signs of potential for violence include history of discipline problems or frequent conflicts with authority, serious drug or alcohol use, strong desire to be in a gang, access to or fascination with weapons, trouble controlling anger, withdrawal from friends and usual activities, increased risk-taking behavior, declining school performance, planning how to commit acts of violence.

If someone you know shows violence warning signs, above all, be safe. Do not spend time alone with people who show warning signs. If possible, without putting yourself in danger, remove the person from the situation that is setting them off.

Tell someone you trust and respect about your concerns and ask for help. This could be a family member, guidance counselor, teacher, school psychologist, coach, clergy or school resource officer. If you are worried about being a victim of violence, get someone in authority to protect you. Do not resort to violence or use a weapon to protect yourself. Ask an experienced professional for help. Most important — Do not go it alone and take any signs or threats seriously.

The American Academy of Pediatrics — Firearm-Related Injuries Affecting the Pediatric Population — Policy Statement October 2012

Here are the key points.

1. The most effective measure to prevent suicide, homicide, and unintentional firearm-related injuries to children and adolescents is the absence of guns from homes and communities.

2. Counsel parents who possess guns to prevent access to these guns by children.

3. Guns should be subject to consumer product regulations regarding child access and safety designs such as trigger locks, lock boxes, gun safes, and safe-storage legislation.

4. Mandate waiting periods, close the gun show loophole, and restore the ban on the sale of assault weapons to the public.

5. Fund research related to the prevention of firearm injury and prevention of illegal sales to minors.

We see some common themes. The psychiatrists, the psychologists and the pediatricians are telling us to:

1. Make it a national priority to fund more research on the causes of firearm violence and its effective control. Fund a national database of gun violence statistics.

2. Use the results of the research to better enforce existing gun control laws.

3. Child safety features on guns.

4. Public education about the warning signs of violence and about the safe use and storage of guns.

5. Improve community mental health services for people who are coming out of an inpatient mental health hospital or recovering from an acute mental illness involving violence.

6. Do not put restrictions on the doctor-patient conversation about firearm use.

7. Protect the rights of people who are disqualified from owning a gun and give them a fair and reasonable process for restoration of firearm rights.

I hope that this review of gun safety from a medical perspective will be a constructive addition to the current debate about guns. The American people are ready to rise above polarizing arguments about politics and the National Rifle Association. We are ready for a future where we protect both our constitutional rights and our right to live in a safe community with less gun violence.

EDITOR’S NOTE: Jo Ann Fields, M.D., of Felton, has been a primary care physician in Kent County for 19 years.