by Julie Fine, Legal Specialist, Legal Division, Pfizer Inc. (Please note: The views presented here are my own and do not reflect positions or policies of Pfizer.)
In the weeks following the 2012 Advancing Ethical Research Conference, what has lingered with me most has been the keynote speech on mental illness and stigma by Elyn Saks, JD, PhD. She discussed how a combination of good pharmacology and talk therapy has allowed her to be a high functioning woman and brilliant scholar. Despite having schizophrenia, her delusions are under control and her mind, with some minor memory lapses, is sharp. After her talk and after the horrific tragedy in Newtown, CT, I’ve keenly followed the debates in the media about our mental health care system and its relationship to gun responsibility.
Research into the public health effects of gun violence has been restricted since the mid-90s. On January 16, President Obama issued a presidential memorandum to lift these limitations and allow researchers to investigate trends in gun violence in an unprecedented way. If federal funds become available in support of gun research, ensuring unbiased study design for objective data collection will be of critical import as we begin to research whether the systems we have put into place are working effectively to combat this issue.
For instance, the Brady Handgun Violence Prevention Act of 1993 mandated the creation of the National Instant Criminal Background Check System (NICS). This system is currently used to determine eligibility to purchase a firearm in the US and contains information from criminal records and about individuals who have been “adjudicated as a mental defective or committed to a mental institution (18 U.S.C. §922 (g)(4)).” Federal and state agencies contribute the information which is protected by the Privacy Act of 1974. The only answers relayed by NICS to a request for a background check are either “Proceed,” “Denied” or “Delayed.”
In the wake of recent tragedies, some have argued that more standardized and comprehensive mental health information should be utilized for NICS decisions. If the NICS were to be expanded to include all individuals who are mentally ill, presumably it would apply only to those individuals who have sought treatment for serious psychiatric disorders – not the undiagnosed and untreated. This kind of personal health information would likely need to be disclosed by health care professionals, a change that would bring with it many new questions. What type of permissions from patients would be needed to allow for that? What impact might the protections offered by the Health Insurance Portability and Accountability Act of 1996 have? The collection of this type of information would be unprecedented – and complicated.
My hope is that, as the debate surrounding this topic continues, mental health experts like Dr. Saks will be engaged in the dialogue and will be invited to help shape the country’s course.