Obama Administration Moves Forward With Gun Control Package

With Congress stalled on major gun legislation, the Obama administration quietly is moving forward with a gun control package of 23 executive orders that includes several mental health provisions, the New York Times reports (Steinhauer, New York Times, 6/13).

Background on Gun Control Package

The package -- signed by President Obama in January -- was developed by Vice President Joe Biden in consultation with more than 220 groups, including public health organizations and medical societies, in response to the mass shooting in Newtown, Conn.
Among other things, the plan:

• Mandates that the administration issue final rules implementing the 2008 Mental Health Parity Act;
• Clarifies several mental health-related aspects of the Affordable Care Act;
• Launches a youth program aimed at referring mentally ill youth to treatment;
• Instigates a "national dialogue" led by HHS Secretary Kathleen Sebelius aimed at reducing the stigma associated with mental illness; and
• Directs CDC to "research the causes and prevention of gun violence."

Plan Eases Privacy Rules, Increases Data on National Screening System

The plan also addresses barriers that might prevent states from making information available to a background check system (California Healthline, 1/17). That system -- called the National Instant Criminal Background Check System, or NICS -- is a database made up of about 10 million active law enforcement, mental health and other records maintained by the FBI to screen individuals purchasing firearms. However, states have in some cases been lax about uploading records, particularly those involving mental health issues, the Times reports.

Obama's plan gives states additional funds to add data to NICS and would compel federal agencies to share mental health data on employees (New York Times, 6/13). It also amends the 1996 Health Insurance Portability and Accountability Act to allow state mental health facilities to transmit the records of anyone who has been declared mentally unfit by a court or other authority to the database. The amendment applies only to agencies that order involuntary commitments, perform "relevant mental health adjudications," or who act as repositories for such records.

Medical Groups Criticize Database Amendment

Several medical groups and state authorities have criticized the amendment, arguing that it is unnecessary and potentially could interfere with the patient-physician relationship, the Wall Street Journal reports.

The National Association of State Mental Health Program Directors in a recent letter to HHS wrote that the proposal would "exacerbate the stigma faced by people with mental illness and could potentially have a significant chilling effect" on their desire to get medical help. The American Psychiatric Association, the American Medical Association and the American Psychological Association also wrote letters expressing similar concerns.

In response, HHS spokesperson Rachel Seeger said that the department "do[es] not expect that providers are reporting on their patients directly to NICS," but explained that the law protects doctors who need an exemption to the privacy law to report involuntary commitments to state mental health agencies that then would submit the information to NICS. Seeger added that HHS will consider the comments as it moves forward with the provision (Palazzolo, Wall Street Journal, 6/12).