NEW YORK – The prevalence of guns in the United States is a public health issue that must be addressed head-on by clinicians – including psychiatrists, experts said at the American Psychiatric Association’s Institute on Psychiatric Services.
Part of the challenge is bridging the cultural disconnect between some psychiatrists and patients. About 10% of psychiatrists own guns, but the ownership rate among U.S. households ranges from 40%-50%, said Dr. John Rozel, a psychiatrist affiliated with the Western Psychiatric Institute and Clinic at the University of Pittsburgh. “Most of us psychiatrists might not intrinsically get it.”
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The United States has more than 270,000,000 civilian-owned firearms, which is more than the next 18 countries combined.
Facing the ubiquity of guns in American life might be a good place to start. The United States has more than 270,000,000 civilian-owned firearms, which is more than the next 18 countries combined, Dr. Rozel said, quoting 2007 data from the global Small Arms Survey. “Wouldn’t it be great if you could get your hands on access to mental health care” as fast as you can get your hands on a gun?
The secure place of guns within American life requires “radical acceptance” on the part of psychiatrists, Dr. Abhishek Jain said at the session.
“The Second Amendment is not going anywhere,” said Dr. Jain, also a psychiatrist with the clinic. “Keep in mind how much buying [of guns] there is in your jurisdiction. Pay attention to your own state laws. Variability is considerable.”
An understanding of these laws needs to occur while recognizing that the public is largely misinformed about the tendency of people with mental illness to turn to violence. “Little population-level evidence supports the notion that individuals diagnosed with mental illness are more likely than anyone else to commit gun crimes,” Dr. Jonathan M. Metzl and Kenneth T. MacLeish, Ph.D., wrote in a recent review (Am J Public Health. 2015 Feb;105[2]:240-9). “Databases that track gun homicides, such as the National Center for Health Statistics, similarly show that fewer than 5% of the 120,000 gun-related killings in the United States between 2001 and 2010 were perpetrated by people diagnosed with mental illness,” according to the Centers for Disease Control and Prevention.
People with mental illness are more likely to hurt themselves than others. Furthermore, tighter gun laws are associated with lower rates of suicide. A recent study found a connection between more stringent laws involving waiting periods, universal background checks, gun locks, and open carrying regulations in four states and a drop in suicide rates (Am J Public Health. 2015;105[10]:2049-58). “We should talk about individual safety,” Dr. Jain said.
Talking with your patients about guns
Dr. Layla Soliman encouraged developing a working knowledge about some of the fine points of guns, such as how they work. “After every tragedy, we see [in the comments section of online articles] ‘why can’t psychiatrists stop these people?’ We’re part of the discussion, whether we want to be or not,” said Dr. Soliman, a psychiatric attending on the inpatient unit at the hospital.
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Using motivational interviewing is a good way to get patients to open up about their access to guns and how they view them.
Asking all patients about the role of guns in their lives should be routine, she said. “We are trained to do this [as part of] a checklist. We have to ask in the same way we ask about past violence [and] substance use.” Document these conversations with patients defensively, Dr. Soliman said. “I would suggest an integrated risk assessment in your documentation.”
Dr. Rozel agreed. “We’ve learned a lot of lessons from our colleagues in pediatrics [and] how they talk with patients about vaccinations,” he said. Dr. Rozel is trained as a child psychiatrist and holds a master of studies in law degree.
Using motivational interviewing is a good way to get patients to open up about their access to guns and how they view them. “It’s about collaboration, not confrontation,” Dr. Rozel said. “It’s about accepting their reality [and] not imposing our will on them. They may not want to have this conversation. Express empathy [by saying]: ‘I don’t want to take any unnecessary chances with your life.’ ”
Dr. Rozel, Dr. Jain, and Dr. Soliman are also assistant professors of psychiatry at Western Psychiatric Institute and Clinic. They said they had no disclosures.
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