Psychiatric residency programs must educate on firearm issues for the mentally ill

Topic: College of Sciences and Humanities

September 30, 2013

Despite recent shooting sprees by people characterized as mentally ill, nearly a fourth of the nation’s psychiatric residency training program directors believe access to firearms should not be prohibited for these individuals — a sharp contrast to public opinion, says a new study released by Ball State University.

“Psychiatric Residency Directors’ Perceptions of Firearm Access by the Mentally Ill in the United States” also found almost 70 percent of directors believed that rather than focusing on restricting access to firearms, providing more resources for treatment of the mentally ill would be more effective in reducing firearm violence.

Study co-author Jagdish Khubchandani, a member of Ball State’s Global Health Institute and a community health education professor in the university's Department of Physiology and Health Science, said there is a disturbing disconnect.

“The results of the current study indicate that the perceptions of psychiatric residency directors regarding firearms and the mentally ill are contrary to the empirical evidence,” he said. “This confirms the need for psychiatric residency programs to provide education on firearm issues regarding the mentally ill.”

The study analyzed the opinions of 72 members of the American Association of Directors of Psychiatric Residency Training to examine their perceptions of firearm access issues of the mentally ill. It was recently published by the Journal of Community Health. The research team also included faculty from University of Toledo in Ohio and Black Hills State University in Spearfish, S.D.

“The recent increase in firearm violence coverage in the media and approximately 31,000 firearm deaths annually has caused policy makers, law enforcement and the general public to look for solutions,” Khubchandani said.

“People with mental illness have become a population for reducing firearm violence. Yet, the current method of reducing access by the mentally ill to firearms is perceived by psychiatric residency directors as ineffective and burdensome to the mentally ill.”

The majority of directors perceived individuals with chronic dementia and with antisocial personality disorders should be prohibited from having access to firearms.

“However, directors were least concerned about restricting firearm access to alcohol abusers, those with borderline personality disorder and major depression,” Khubchandani said. “This is in sharp contrast to research showing firearm owners who abuse alcohol are significantly more likely than other firearm owners to engage in violent behaviors with firearms.”

According to the study:

• About 94 percent noted they had patients who should not possess firearms but have never been adjudicated or institutionalized as mentally ill.

• About 92 percent supported closing the background check loophole.

• About 54 percent said singling out the mentally ill as a group of ‘‘banned purchasers’’ adds to the stigma of mental illness.

• About 44 percent did not believe reporting the mentally ill to authorities would result in the individuals avoiding treatment.

• All directors believed that persons with mental illnesses could circumvent current laws access firearm through family members.

Residency directors were selected, since they are central to graduate medical education for psychiatric residents. They oversee and organize the activities of residency programs, including helping develop the educational curriculum, selecting and supervising the program faculty and facilitating the residents’ participation in the educational programs.

Psychiatrists and psychologists have minimal training in assessment and management of patient violence or training in firearm anticipatory guidance. Thus, it is not surprising that counselors, clinical psychologists and psychiatrists seldom discuss firearm issues with their patients, he said.

Khubchandani believes more research is needed with other mental health professionals regarding their perceptions of firearms and the mentally ill to see whether any mental health professionals are addressing this issue with their patients. In addition, research is needed to find out if most shooters had been counseled by a mental health professional in the weeks and months prior to their involvement in firearm homicides and/or suicides.

The latest study is part of a series conducted by Khubchandani along with other researchers examining firearm violence in the United States. In 2011, he found that psychiatric nurses could play a role in preventing firearm suicides and homicides among the mentally ill, but few receive training on this issue.

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