Guns, mental health on minds of medical organization leaders in wake of Sandy Hook tragedy

Gun control and mental health issues have captured much of the public’s attention in the week since the tragedy at Sandy Hook, including those in the healthcare profession.

“The American Academy of Family Physicians (AAFP) recognizes violence as a major public health concern. This tragedy highlights the need for action to counter the devastating toll it has on our society. It is time for our nation to have an honest and frank discussion on reducing both the tendency and capacity for violence in our society,” wrote AAFP President Jeffrey Cain, MD, in a statement. “As family physicians, we provide comprehensive care that focuses on prevention. The AAFP believes that the public health threat from violence should be similarly treated comprehensively and with a focus on prevention.”

The AAFP also acknowledged the role of firearms in the Sandy Hook tragedy and reaffirmed its support for regulations on gun ownership and use.

“The AAFP has longstanding support for strong and robust enforcement of existing laws and regulations regarding the manufacture, sale, and possession of guns. The AAFP urges support of legislation that requires trigger locks and storing firearms locked away and unloaded. Additionally, the AAFP opposes private ownership of assault weapons,” Cain said. “The AAFP supports efforts to evaluate the effectiveness of regulations, interventions, and strategies for preventing injuries and fatalities caused by firearms.

But are the efforts already undertaken, and statements made, enough? That’s the question Bob Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians (ACP), asked on his blog, “The ACP Advocate.”

“I have struggled for days now to find the right words-how can I, or anyone else for that matter, find the words to describe the indescribable shared grief we have about the indescribable horror of that day and its aftermath?” Doherty wrote. “But I have to say something, we have to say something. Something about what this says about our country, and its repeated inability to rise to the occasion to address the causes and consequences of gun violence.”

The ACP has been on record since 1996 calling for policies to prevent firearm injuries, Doherty said, including a ban on assault weapons such as the one used in Sandy Hook.

“Banning assault weapons and high capacity ammunition may not prevent tragedies like Sandy Hook, but simple logic tells us that there would be fewer casualties resulting from them,” Doherty said. “Most recently, ACP has called for “best practices” to reduce injuries and deaths from firearms, as well as the right of physicians to ask patients about firearms in the home.

Many disturbed and potentially dangerous people don’t have access to mental health services in the United States, Doherty noted. Although many of them may never become violent, and family support could help improve mental health issues, no guarantee exists for either of these statements, he said.

“I believe, and ACP believes, that limiting access to assault weapons and high capacity ammunition can help reduce the death toll. But it is just one piece of the puzzle,” he wrote. “We will need to carefully examine all of the evidence that we can find on the most effective strategies to minimize deaths and injuries from firearms, and strive to seek a national consensus to implement them. … We have an obligation to try, including asking whether the healing professions are doing enough about to curb gun violence in the United States.”

Jeremy Lazarus, MD, president of the American Medical Association, also has weighed in on the tragedy from the perspective of a psychiatrist who practiced in Colorado in the wake of the Columbine shootings. He offered the following tips for dealing with the grief and frustration that will stem from Sandy Hook:

• Educate physicians, other health professionals, and the public about how to respond psychologically to such an event, especially in discussing this issue with children. The Center for the Study of Traumatic Stress provides a resource to facilitate that discussion.

• Train professionals to spot signs and symptoms in people exposed to such a tragedy who may need acute or prolonged psychological/psychiatric intervention.

• Train rapid response teams to help grieving communities with medical advice, education and intervention when necessary.

• Work together to implement available evidence-based interventions.

• Make sure adequate evaluations exist to respond to those who might have a mental illness and are planning to commit violence.

• Protect the doctor-patient relationship, allowing physicians to discuss firearm safety with parents and adults. "We can decrease gun accidents by having frank conversations between the physician and patient," Lazarus said.