Violence in our Lives: What to do?

Several ideas have been swirling around in my head for this week’s blog post. The one that emerged today wins, hands down. I am a believer in Carl G. Jung’s concept of synchronicity. When three or four separate but related items come across my desk or inbox at one time, I believe they are connected in some fashion and should be addressed.

This morning I received an email from the Office of Civil Rights listserv on HIPAA Privacy and Security. It contained a link and reference to a letter of clarification written by Leon Rodriguez, Director of OCR.

In light of recent tragic and horrific events in our nation, including the mass shootings in Newtown, CT, and Aurora, CO, I wanted to take this opportunity to ensure that you are aware that the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule does not prevent your ability to disclose necessary information about a patient to law enforcement, family members of the patient, or other persons, when you believe the patient presents a serious danger to himself or other people. 

The HIPAA Privacy Rule protects the privacy of patients’ health information but is balanced to ensure that appropriate uses and disclosures of the information still may be made when necessary to treat a patient, to protect the nation’s public health, and for other critical purposes, such as when a provider seeks to warn or report that persons may be at risk of harm because of a patient. When a health care provider believes in good faith that such a warning is necessary to prevent or lessen a serious and imminent threat to the health or safety of the patient or others, the Privacy Rule allows the provider, consistent with applicable law and standards of ethical conduct, to alert those persons whom the provider believes are reasonably able to prevent or lessen the threat.

Given all the discussion about mental health interventions related to the perpetrators of the recent violence, Director Rodriguez clearly felt it was necessary to remind healthcare providers of all stripes that the law does not prevent them from involving the authorities when they believe an individual is potentially dangerous.

I was educated in the Tarasoff era. It was controversial, but clear, that mental health providers have a clear duty to protect the intended victim of a violent action to be committed by one of their patients. That protection may well include the duty to warn the potential victim. Given the occurrence of mass killings in recent years, it is easy to wonder if we all ought to behave as if we have at least a moral responsibility to notice and to notify the authorities about the potentially dangerous behavior of others.

As a former mental health provider, I worry about the tendency of our country to blame violent behavior on mental illness. As research in the area indicates, the relationships among mental illness, drug abuse and violent behavior are complicated, at best. Social factors such as ‘poverty, family history, personal adversity, and stress’ also feed into this complex equation.

On January 15, 2013, President Obama presented proposals to control the sale of certain kinds of guns and the ammunition they use. He also proposed a whole raft of other actions that will hopefully make our awareness and ability to intervene before violence occurs an easier job.

The knee jerk reaction of the NRA and other defenders of the ‘right to bear arms’ has been loud, and people seem to quickly line up in one camp or the other. That is why I was so struck by the post of a Friend of a Friend on Facebook that I shared his statement on our SOS page. You may not be able to get to it unless you are a registered user of Facebook, but if you are, please take a look. This is a well thought out, rational, and personal reaction to some of the responses to the President’s proposals.

One of those proposals is that teachers and others who interact with young people need to learn more about the mental health issues that might help them identify youngsters who are in need of assistance. Linda Rosenberg, President and CEO of The National Council for Community Behavioral Health shared her take on President Obama’s proposals.

As part of his recommendations to protect our communities from gun violence, President Obama today rightly called for Mental Health First Aid training to help teachers and staff recognize the signs of mental health disorders in young people and find them appropriate care.

The youth version of Mental Health First Aid is an evidence-based training program to help citizens identify mental health problems in young people, connect youth with care, and safely deescalate crisis situations if needed. The program, focusing on youth ages 12 to 25, provides an ideal forum to engage communities in discussing the signs and symptoms of mental illness, the prevalence of mental health disorders, the effectiveness of treatment and how to engage troubled young people in services.

Mental Health First Aid has become a major push for The National Council. Information and resources are readily available.

After all is said and done, we get to the bottom line. What should people do if they find themselves in an active shooting situation? This is not a thought most of us want to entertain, but first-responder agencies have always believed that being prepared for an emergency greatly increases a person’s chances of surviving a dangerous situation. With a grant from the Department of Homeland Security, the Houston Police Department has prepared an excellent video about surviving an active shooter event.  

Events like the Sandy Hook School shootings stir up primal reactions for most of us. It is important that we not shut those reactions down. Instead, we need to open ourselves to many possibilities of how we and our communities need to intervene to assure that we and our children are as safe as is reasonably possible.

Please share your comments, experiences, concerns below.



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