We’ve been covering a lot of medical association news related to the Newtown shooting and gun-related legislation, but that’s because we’re very focused on looking at what research can tell us about reducing firearm injury, and medical associations are closely involved with much of this research.

Just as the American Psychiatric Association issued their remarks last week, the American Academy of Pediatrics sent their own letter, which you can download here, to President Barack Obama and Congressional leaders on December 19.

The organization had published a report on firearm-related injuries affecting children in their journal Pediatrics in October, in which they wrote “The American Academy of Pediatrics continues to support a number of specific measures to reduce the destructive effects of guns in the lives of children and adolescents, including the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on semiautomatic assault weapons; and the strongest possible regulations of handguns for civilian use.”

Unsurprisingly, in their letter to political leaders, they were just as direct regarding policy proposals related to gun control, mental health and children’s exposure to violence:

•    ”New federal firearms legislation that bans assault weapon sales and the sales of high capacity magazines, strengthens mandatory waiting periods and background checks for all gun purchases and promotes strict gun safety policies is a necessary first step.
•    Next, the federal government must take action to improve access to services that meet the mental health and developmental needs of infants, children and adolescents, and ensures that children and families exposed to violence have access to a medical home and other community supports.
•    Finally, we must engage in a national dialogue designed to reduce children’s detrimental exposure to violence in their communities, environments and entertainment.”

We’ll be revisiting the full account of their policy report on firearms for a later blog post, but we also wanted to mention another article with similar recommendations. “Weapons of Mass Destruction,” published in the Archives of Internal Medicine, which is published by the American Medical Association, also offered commentary related to firearm regulation. More »

In the wake of the Newtown shooting, several medical organizations have spoken up about either gun violence itself, firearm safety or about the response of other organizations, such as the NRA.

Since much of the nationwide dialogue after this tragedy has involved discussions on mental health, it makes sense that the American Psychiatric Association issued their remarks. Dilip Jeste, MD, president of the APA, sent a letter December 20 on behalf of the organization to Senate Majority Leader Harry Reid, Senate Minority Leader Mitch McConnell, Speaker of the House John Boehner and House Minority Leader Nancy Pelosi.

The letter, which you can download here, focused on two main points. First, as part of their responsibility to their profession, Dr. Jeste said “psychiatrists stand ready to do whatever we can to help alleviate the suffering caused by the tragedy and to help the survivors cope with life after a trauma of this unimaginable magnitude.”

But more importantly, Dr. Jeste followed that with a reminder that focusing too much on the mental condition of the shooter risks inappropriately increasing the stigma already associated with mental illness. “Stigma remains one of the greatest barriers to early identification, intervention, and treatment for Americans seeking help for mental illness, and we hope that Congress will avoid making generalized assumptions about persons now in or seeking treatment for mental illness,” Dr. Jeste wrote.

After noting that the “vast majority of violence” does not occur at the hands of individuals with mental disorders, Dr. Jeste said that those who do commit the crimes generally are not receiving adequate or appropriate mental health treatment. The statistics he notes are sobering: Public mental health spending has been reduced by $4.35 billion from 2009 to 2012, and 29 states have gotten rid of over 3,200 psychiatric inpatient beds since 2008.

He also brought up an issue which had been in the medical news recently related to doctors’ ability to discuss firearm possession and safety with their patients: “We are also profoundly disturbed by recent efforts in some states to curb or bar the ability of physicians, including psychiatrists, to prudently and confidentially inquire about the presence of firearms in the home when the behavior of their patients warrants such an inquiry,” Dr. Jeste wrote.

An article published in JAMA Pediatrics (formerly Archives of Pediatrics and Adolescent Medicine) provided the history of the Florida law that attempted to prevent doctors from speaking to their patients about firearms, concluding “Dialogue stemming from these questions will help families protect children from multiple forms of harm.”

A few days after sending that letter, the APA spoke up again to express their “disappointment” to the statement by the NRA and specifically the mental health stigmatization that NRA CEO Wayne LaPierre promoted with his comments. The APA wrote in their news release (pdf):

“The association objected to LaPierre’s assumption that horrendous crimes such as the one committed by shooter Adam Lanza are commonly perpetrated by persons with mental illness. In addition, he conflated mental illness with evil at several points in his talk and suggested that those who commit heinous gun crimes are ‘so possessed by voices and driven by demons that no sane person can ever possibly comprehend them,’ a description that leads to the further stigmatization of people with mental illnesses.”

Noting that “only four to five percent of violent crimes are committed by people with mental illness,” Dr. Jeste reminded the press that those with mental illnesses are rarely violent and are much more likely to be crime victims than crime perpetrators. Calling the use of the word “lunatic” by LaPierre “offensive,” Dr. Jeste said, “About one quarter of all Americans have a mental disorder in any given year, and only a very small percentage of them will ever commit violent crimes.”

The letter concludes with a statement from APA CEO James Scully, MD: “The idea that mental illness and evil are one and the same thing is simply a relic of the past and has no place in our public dialogue. People who are clearly not mentally ill commit violent crimes and perform terrible acts every day. Unfortunately, Mr. LaPierre’s statements serve only to increase the stigma around mental illness and further the misconception that those with mental disorders are likely to be dangerous.”