Obama's "2nd executive order" regarding HIPAA may not be a good idea

[phantom power]

Listening to a psychologist(?) on NPR yesterday, and reading a few blog posts today. The basic worry appears to be that when patients grappling with violent and/or suicidal thoughts know that they might be reported by their therapist, they just aren't going to get treatment. The net effect will be fewer people treated, not more.

Guns and Mental Health

Here's a .pdf of the twenty-three executive orders and actions that the president initiated just after noon today. The second item allows mental health professionals to report patients who they think are a risk to the community. I worry about that. It's one of the main ways we might have avoided the massacres in Tucson, Aurora, and Newtown, but it also will create a powerful incentive for people steeped in our gun culture to avoid seeking routine psychiatric or psychological care. It's kind of a Catch-22, frankly. You might catch someone who is mentally ill before they can kill a bunch of people. But you also might create a situation where a LOT of mentally ill people go without treatment.

I am not clever enough to know how to get around this conundrum, but I fear that the net effect of that particular executive order will be negative.

Use this thread to discuss the president's speech and his proposals.

Update [2013-1-16 13:16:39 by BooMan]: Here is the full set of proposals (.pdf).

http://www.boomantribune.com/story/2013/1/16/125825/114

[doc03]

1. I suppose that could happen, hopefully a family member would convince them to

seek help. I don't see anything in that list that I am opposed to, looks like common sense
steps to me. I don't think any gun ban or magazine ban will pass congress though.

[Hugabear]

2. What is the alternative?

If a doctor or mental health provider truly believes that someone may pose a dangerous threat, are they supposed to just sit on their hands and remain silent?

[Fire Walk With Me]

3. "Don't suspect your neighbor, turn them in!" -Poster in Terry Gilliams' dystopian film "Brazil".

[Posteritatis]

4. The worry's that it's effectively telling people who'd otherwise seek treatment to sit on theirs. nt

[phantom power]

8. in a word, yes. here's why

The argument is basically a numbers game. I'm going to relate what this therapist on NPR was saying: which is that he works with many patients who have violent or suicidal thoughts at one point or another. The probability that such thoughts lead to actions in any patient is very, very low. Furthermore, there is absolutely no useful way to identify when there is any kind of elevated risk of actual violent behavior.

So, with that all in mind, how does this play out? It puts therapists in the position of needing to report many people for no reason, because there's no way to tell who would "really" need to be reported, and a false negative will go quite badly for them. Patients immediately discover that going to a therapist to try and work out thoughts of violence is going to get them reported. So, who would go? Nobody.

So, what you end up with is almost nobody getting help with violent or suicidal thoughts. Nobody being reported, and if they are reported, it is far more likely that it was unnecessary than otherwise.

This does not sound like a win to me. It's a net worsening of the situation

[Demo_Chris]

11. Very Interesting, thanks!

[backscatter712]

22. My thoughts exactly. The psychologist's couch should have the sanctity of confession.

If someone thinks they're going to get put on the "psycho list", or get Baker-acted and thrown in the psych ward for a 72 hour hold because he discussed suicidal or violent thoughts with their shrink, they're not going to talk about those thoughts. In fact, they're not going to get treatment at all if they think it'll get them locked up, put on a list or stigmatized.

So yeah, I'm skeptical of mandatory-reporting requirements and other state-mandated breaches in the privacy required in a therapist/patient relationship.

[loyalsister]

24. Increased suicide rate

greater isolation, and more stigma. It's a giant step backwards and dehumanizes people who have mental illnesses.

[Fire Walk With Me]

5. Caught a minute of CNN as some microcephalic went on about "crazy people" and guns.

FUCK YOU CNN. You spew ableism as "news" and fact. You are doing far more harm than good. Why don't you do something about having LIED to the citizens of the US regarding conditions in Bahrain, because you were taking $$$ FROM Bahrain to lie about it? Amber Lyon says "Hi" on that count. Fuxers. 25% of US citizens suffer from some type and degree of "mental illness", and by that "logic" we'd be knee-deep in continuous bloodbaths.

[DogPawsBiscuitsNGrav]

6. Their information won't be seen by the public, just as it isn't seen now. Example, when you have

certain health issues (like TB and many others) it's reported to the CDC. That information isn't public. Same will happen here. Not a privacy issue.

[Fumesucker]

14. It won't matter, being reported to the government is what's going to stick in people's minds

People kind of instinctively know that a national security state is a one way ratchet with no built in release mechanism.

Just the idea of being on a government list of crazy people will zip a great many troubled lips.

[Jefferson23]

7. I need to read more about this b/c as far as I know, providers can't ignore

such threats..they need to do an immediate safety assessment and make a judgement
call based on that and their understanding of their client.

IF this suggests something loser than what is already in place, then privacy rights and
an over-reaction may end up hurting a lot of people...we'll see.

[hopemountain]

9. aren't mental health professionals,

family and other m.d.'s already required mandated reporters - required to report any client or patient who threatens to harm themselves or another?

it seems a "psychologist" would already be aware of this requirement and the content of their professional oath.

so, i call b.s. on the psychologist's "fear (????) that the net effect of that particular executive order will be negative."

this does not sound like a professionally practicing psychologist's statement to me.

[former9thward]

15. No.

Mandated reporters are professionals who, in the ordinary course of their work and because they have regular contact with children, disabled persons, senior citizens, or other identified vulnerable populations, are required to report (or cause a report to be made) whenever financial, physical, sexual or other types of abuse have been observed or are suspected, or when there is evidence of neglect. Not every state has the same definitions or reporting. The things talked about today are not covered.

[hopemountain]

21. thank you for the clarification

i missed the distinction.

[HereSince1628]

10. It'd mean more if that psych pro had cited a studyshowing what keeps people out of treatment

The V.A. actually already implements this policy of reporting in its in and out patient clinics. The VA seems to believe it helps more than it interferes.

Very large numbers of Americans don't seek mental health treatment even though they have symptoms.
I have to wonder if a new reason to not show up could even be detected in the number of no-goes

[markpkessinger]

12. This has been a major concern of mine...

... The problem is, it polls well. But, as Andrew Rosenthal pointed out in a New York Times editorial concerning the section of New York's new gun regulations that requires such reporting, "screams unintended consequences."

New York’s new gun control bill further includes a peculiar provision requiring mental-health professionals to report patients who they believe constitute a threat to themselves or to others. It outlines how law enforcement could go about revoking those patients’ gun permits and/or confiscating their firearms.

That provision screams unintended consequences. Dr. Paul S. Appelbaum, the director of the Division of Law, Ethics, and Psychiatry at the Columbia University College of Physicians and Surgeons, told The Times that such a requirement “represents a major change in the presumption of confidentiality that has been inherent in mental health treatment.”

<Sigh> Why do we never seem to get it right when it comes to issues involving mental health in this country?

[JVS]

13. The way our country does mental healthcare needs a rebuild, and putting Arne Duncan on the task...

(see exec order 23) gives me little reason to be optimistic.

[HereSince1628]

16. I also feel Duncan has little to offer, very very little

[cbayer]

17. I think I heard the same NPR story you did and agree that this is potentially

very problematic.

I hope that the mental health professional community has the opportunity to be closely involved in developing the actual rules and protocols for this particular position. We need more and easier access to care and not anything that makes it harder.

[Drahthaardogs]

18. So what? If they are violent and not reported, what has been gained?

It is time to make some changes. Close loopholes and get sick people some help. If they have to receive help against their will to protect society, it is regrettable but necessary.

[JVS]

19. Dr-Patient confidentiality saves lives because it keeps people from avoiding treatment.

[lanlady]

20. I have concerns about this provision for another reason.

I've done professional work in the area of HIPAA and patient privacy. Mental health records are very closely protected, as well they should be. This part of the president's gun control agenda (which, by the way, I fully support) seems to portend a weakening of HIPAA privacy rules. I haven't studied the implications or Obama's proposals in any depth yet, but until now I can't quite wrap my head around how this type of information can be shared around.

[Denninmi]

23. Oh, a list of people with mental illness? What could possibly go wrong?

Last edited Thu Jan 17, 2013, 07:43 AM - Edit history (1)

Um, I'm going to go curl up in the fetal
position in a dark, quiet room with Snow Patrol playing very softly in the background. Someone kindly let me know when the angry mob have taken their pitchforks and torches and gone away, thanks.