New York state’s Secure Ammunition and Firearms Enforcement Act, a sweeping piece of legislation designed to curb the growing incidence of gun violence in the state, has become the center of debate in the mental health community.
In addition to provisions banning assault weapons and high-capacity magazines, the act, signed into law Jan. 15 — about a month after the mass shooting by a man with mental illness at an elementary school in Newtown, Conn. — includes a provision requiring nurses, therapists, physicians and social workers to inform government authorities if they believe a patient is likely to harm himself or anyone else.
This is a necessary step, said Mickey Matos, RN, who also is a nurse manager in psychiatry at Petrie. “Many patients have been mandated into care, and they might be less likely to disclose their access to firearms,” she said.
In his announcement after signing the bill, New York Gov. Andrew Cuomo addressed the necessity for the inclusion of a mental health provision.
“People who are mentally ill should not have access to guns. That’s common sense,” Cuomo said. “That’s probably the hallmark of this bill, coming up with a system that allows for mental health screens.”
The disclosure requirement has garnered mixed feelings from those who care for patients with mental illness. At Beth Israel Medical Center in New York City, discussions have begun about the requirements, said Hyacinth Hamilton-Gayle, RN, MSN, NE-BC, PNP, director, patient care services at Beth Israel’s Petrie Division.
“We all agree that something has to be done,” Hamilton-Gayle said, “but breaking the bond of trust between patient and provider will only make it more difficult for the mentally ill to seek care. What we really need is to address the lack of resources for care, treatment and follow-up, especially for the adolescent population.”
Nurses in the psychiatric and chemical dependency departments at Petrie said they are glad something has been done to help decrease incidents perpetrated by people with mental illness, and they are taking steps to protect their patients and those with whom they come in contact. Nursing leadership has initiated discussions of the new requirement and several nurse managers have started to have open dialogue with the staff, said Miriam Fridman, RN,C, MSN, CARN, chemical dependency.
“Our group voiced several concerns,” Fridman said. “Like, how will this impact on other aspects of the patient’s rights? On other laws that apply to mental health?”
Staff is encouraged to know the issue of mental health and its relationship to violent behavior finally is being addressed in a broad forum, said Melody Johnson, RN, MSN, a psychiatric nurse manager at Petrie. “We also realize that we need to take a closer look at existing risk assessments to include specific questions about firearms,” she said.
The SAFE Act also continues enforcement of a law that has been in effect for more than a decade. Named for Kendra Webdale, a young woman who was pushed to her death in front of an oncoming New York City subway train by a mental health patient who had stopped taking his medications, Kendra’s Law allows courts to order certain violent and/or recidivist mentally ill individuals to accept treatment as a condition for living in the community. It also commits the mental health system to providing that treatment.
The law was passed in November 1999 and revised in April 2011 when Assemblymember Aileen Gunther, RN, (D-98th District) introduced A-06987,a bill that proposes changes to the law that would provide for assisted outpatient treatment for people with mental illness who require supervision while living in the community. The SAFE Act will extend Kendra’s Law through 2017, expand outpatient treatment from six months to a year and require reviews before such treatment is allowed to expire.
New York state’s law is the toughest gun control legislation in the nation. If legislation in other states follows New York’s example regarding disclosure, the need for balance between gun control and advocacy for mental health patients will be a much-discussed issue.
“Many are talking today about the need for balance in treating patients and the issue of gun safety,” said Nicholas Croce, MS, executive director of the American Psychiatric Nurses Association, an organization that represents more than 8,000 of the nation’s nurses who work in mental health. “The issue is extremely complex. What we at the APNA will care about is coming up with a program that will provide that proper balance. People will want to be careful to not throw the baby out with the bath water. It’s important that we don’t want to create circumstances that will prevent those who need and want services from seeking them.”
Neither Kendra’s Law nor the SAFE Act requires that patients take medications for their mental illness. The onus is on the healthcare community to provide as positive an experience as possible for those seeking help so compliance isn’t an issue. To do that, Hamilton-Gayle said, more action must be taken.
“Parents and schools are challenged with children with mental health disorders; families are ill-equipped to provide continued care for clients who are at risk,” she said. “The availability of mental health services need to take on the same importance as being able to care for cardiac arrest or stroke victims in our society.”