Sunday, 25 March 2018

Before we mess with HIPAA, I have some questions (Guns and Mental Health – Part 1)

This is a multipart post.  Subsequent posts will go up on a schedule. (Hey, I wrote four posts today, I’m getting at least a week’s worth of mileage out of them.) They’ll also link back to the previous posts.

Part 1:  Before we mess with HIPAA, I have some questions

I have seen a lot of people arguing that HIPAA laws need to be changed so that if your therapist decides you’re dangerous, they can tell law enforcement. This was also one of the policy points from March for Our Lives yesterday.  (To be clear, I give the Parkland kids *so much credit* for taking the horrible thing that happened to them and working to make sure it doesn’t happen to the next group of kids.  This is criticism and questions of specific policy proposals, not of their motives or them as people.  We also shouldn’t expect teenagers to put out perfect policy proposals, because of course they lack the experience that adults bring to these issues.)

I have questions. And concerns. This will be long, so I’m breaking it into multiple posts.

First of all, therapists are already *required* to report if they think you’re going to harm yourself or others. This is covered under existing laws.

So what, specifically do you want to change? You want a lower standard for mandatory reporting?  Okay, what specifically needs to be reported and to whom? The therapist reports directly to the background database? Okay, who’s in charge of reviewing the therapist’s assessment? That is, what prevents a therapist who thinks *nobody* should have guns from reporting on people who aren’t actually a danger? What prevents a therapist from using this process selectively, whether deliberately or because of subconscious biases? Is the patient entitled to know that this information has been submitted? If it’s incorrect, what rights do they have to appeal it? What data on a patient’s diagnosis stays in that database, and how is it protected? (If you are found guilty of a crime, that’s a matter of public record. Your health information is not, and it requires a whole different level of security than the existing background check database currently does.)

What do you do in case of a breach? If someone steals the list and plasters it all over the web, who’s responsible, and what kind of damages are those patients entitled to? For that matter, who decides what mental illnesses get you on this list? Is there a list of illnesses? Specific symptoms? Is there a specific screening tool, or is it completely up to the therapist’s discretion? What are the diagnostic criteria? Who’s in charge of updating them as knowledge and understanding of mental illness changes?

Basically, can you ensure that whatever you’re proposing is an accurate reflection of someone’s likelihood of becoming violent, doesn’t inappropriately expose their private medical information, and doesn’t inappropriately take away their right to own a gun.



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