Close to 5,000 people who voluntarily admitted themselves to a hospital for psychiatric care have been entered into a state database created as part of the gun-control law passed in response to the shootings at Sandy Hook Elementary School. Each person will be prohibited from owning or buying a firearm for six months.
Under the same law, people committed involuntarily by a probate court are prohibited from owning a gun for five years.
But the legislation left out another group of people committed to psychiatric care: those who are involuntarily hospitalized on doctors’ orders.
“A big mistake has been made here,” said Dr. Harold “Hank” Schwartz, psychiatrist-in-chief at The Institute of Living in Hartford. “It’s hard to fathom how this mistake was made, because intuitively you’d think that patients who were admitted [by physicians] are at higher risk” than people who admit themselves voluntarily.
State law allows doctors to hospitalize for up to 15 days people deemed to be a danger to themselves or others, or gravely disabled. The process is known as a physician’s emergency certificate, or PEC. People committed through the process don’t face any of the restrictions on gun ownership that people hospitalized voluntarily or by a probate court do.
At The Institute of Living, the physician’s emergency certificate process is used in 600 to 800 of the approximately 4,000 admissions that occur each year, Schwartz said.
Mental health advocates and professionals who are aware of the exception in the law generally don’t want the gun restrictions expanded to people hospitalized by physicians.
Instead, most want the mental health-related gun restrictions removed. Advocates and clinicians worry that they could keep people from seeking treatment, and say it targets people based on their diagnosis, rather than behavior, further stigmatizing those with psychiatric conditions.
Schwartz, who is a member of Gov. Dannel P. Malloy’s Sandy Hook Advisory Commission, takes a somewhat different view. It’s inconsistent and “a huge gap in policy” for the restrictions to cover people who admit themselves voluntarily but not those deemed by physicians to be a danger to themselves or others, he said.
He’s not opposed to extending the law to cover people who are hospitalized under the emergency certificate process, but he is concerned about the restrictions on people who voluntarily admit themselves and questions whether the heightened stigma is justified.
“It certainly paints with a very, very broad brush across many people who clearly do not have the potential to be violent with guns. A 20-year-old woman who comes in with an eating disorder, for instance,” he said.
“At the same time, I recognize the other side of the argument, and that is that the largest number of people who die in gun violence die by suicide.”
How it happened
The legislation, crafted by leaders of both parties, covered gun control, mental health and school safety. It passed in early April after hours of debate in the Senate and House, on a tense, emotional day when protesters filled the Capitol. Although the topics addressed in the legislation had been the subject of bipartisan work and public hearings, the language of the bill wasn’t made public until the morning of the vote.
Senate Minority Leader John McKinney, R-Fairfield, said legislators weren’t aware that as written, the bill wouldn’t cover everyone who was committed.
“I don’t believe any of us knew that,” he said.
“I think we just assumed that if people were involuntarily committed, they had to be at some point before probate court, not realizing that they can do it without probate court approval,” he said.
Senate President Pro Tem Donald E. Williams Jr., D-Brooklyn, indicated that the law wasn’t problematic because emergency certificates are temporary and people who need longer commitment would have to go through the probate system, making them subject to the restrictions.
“Let’s say they presented as a potential for commitment because they were not in control and then later a doctor determined it was sheer exhaustion as opposed to mental disability. Then they would release that person, not apply for an involuntary commitment,” Williams said. “And in that case, any approach that we had toward that person based on commitment wouldn’t make sense.”
But if a person is admitted through an emergency certificate and deemed in need of commitment through a probate court, the law would apply, he added.
“If there is an inconsistency, that’s a very, very small number of folks,” Williams said. “The opportunity exists for an application for an involuntary commitment if that is what the medical personnel deem necessary.”
But Schwartz said that’s not an accurate assessment of the way the emergency certificate process works. People don’t get admitted to psychiatric hospitals for exhaustion, he said, but for psychiatric diagnoses. And often, they’re released within 15 days — before the emergency certificate period runs out — because they need fewer days of treatment.
“The fact that somebody doesn’t need to be taken to probate court by that 15th day to turn the PEC into a formal, longer commitment doesn’t mean that the admission was a mistake or that the diagnosis was not a psychiatric diagnosis,” Schwartz said. “It just means that psychiatric hospitalizations, even for very dangerous people, these days are short.”
Changes unlikely
Williams said the issue of physician-initiated hospitalizations being left out of the gun law was raised to him by people who disagreed with the gun restrictions on other psychiatric patients. But he said there’s not likely to be much support for removing those restrictions and said the bill probably wouldn’t have had bipartisan support without them in it.
“Lawmakers gave this issue significant thought, and I think folks on both sides of the aisle are committed to that provision,” he said.
Mental health advocates have said they don’t plan to make removing the restrictions a priority during this session. Getting them changed seems unlikely in an election-year session, and advocates would rather focus on programs they want to see supported and expanded, like supportive housing and access to services, said Daniela Giordano, public policy director for the National Alliance on Mental Illness, Connecticut.
McKinney said he recently met with mental health professionals who had concerns about the law and suggested that they come up with recommendations.
And he noted that they said that, regardless of whether the gun law covers every patient, if they had concerns about a patient’s access to weapons, they would work with family members to make sure the person’s guns were inaccessible.
Tracking system in place
The state Department of Mental Health and Addiction Services began the database of people who were voluntarily admitted last fall. General hospitals have been reporting admissions since Oct. 1, and admissions to state-run psychiatric beds have been included dating back to April 1.
As of Jan. 24, 4,840 people had been entered into the voluntary admissions database. Their names are removed after six months.
Since Oct. 1, 152 people in Connecticut had been committed by a probate court, according to the department.
The department does not track the number of people admitted through physician’s emergency certificates at general hospitals, but since Oct. 1, 97 people have been admitted through that process to the department’s inpatient beds.