As a licensed clinical social worker and practicing psychotherapist, I would like to take issue with the column Kevin Rogers wrote for the Jan. 25 issue of the Bona Venture under the title “NYS Gun Control Law Destroys Doctor-Patient Confidentiality.”
Rogers’ central contention is that the recently passed gun law is bad because it “nullifies one of the most necessary institutions of healthcare: doctor-patient confidentiality.”
It is unfortunate that Rogers did not thoroughly research the nature of “doctor-patient confidentiality” before penning his article.
In the first place, doctors do very little counseling these days. Most of it is done by clinical social workers and professional counselors. Psychiatrists spend the bulk of their time managing medications.
In the second place, no one has an absolute right to privacy under our present legal and medical system, regardless of who is providing their care.
If a client of mine who is a minor, elderly, or handicapped tells me he or she is being abused, or if an adult admits to me he or she has behaved in an abusive manner toward such people, I am required by law to report that fact to the state social service authorities, who will intervene to protect the person from further attacks.
If a client tells me that he or she has a concrete plan to commit suicide and intends to carry it out in the immediate future (e.g., before our next counseling session), I am required to contact the police to escort the person to the local hospital for a more thorough evaluation, and the hospital’s mental health professionals have the authority to detain the person if necessary to protect him or her from harm.
And if a client tells me he or she intends to seriously harm or kill another person or group of people and has a concrete plan to do it, I am required to report that person’s threats either to the person(s) being targeted or to the police, depending on the nature of the threat in an effort to protect innocent people from my client’s actions.
All of these reporting requirements apply regardless of the person’s psychiatric condition, so it is wrong to think that such laws stigmatize the mentally ill.
In other words, this new law does little to change the existing legal reporting obligations of mental health providers. What is new is the provision that would allow the police to secure or remove guns from the possession of people (whether mentally ill or not) who present a credible threat to others before it’s too late.
Given that even the NRA keeps saying we should focus on keeping guns out of the hands of people who are most likely to use them to harm others, I fail to see the problem here. The new law does not require me to file a report whenever a client “say(s) anything that suggests they may do harm to themselves or others,” as Rogers states. The requirement applies only if I should decide “in the exercise of reasonable professional judgment, that such person is likely to engage in conduct that would result in serious harm to self or others.” This is a much higher standard than Rogers allows.
There is certainly room to debate whether the new requirement might cause some people to avoid disclosing their violent intentions to a therapist, but this would require that (a) the client is aware of the therapist’s legal reporting requirements in this area, and (b) the client is thinking rationally enough to weigh the possible consequences of such a disclosure. I question how often this would happen in the real world.
In short, I believe this section of the new law provides a reasonable mechanism for at least potentially stopping an individual who may or may not be mentally ill from causing fatal harm to other people, including but not limited to mass shootings. If gun supporters cannot accept even a provision such as this that aims to do exactly what they are calling for, it’s hard to see how there is any hope for stemming the flow of gun-related violence in this country.
Laurel V. Stanley, RN, LCSW
Olean, N.Y.
