Treat gun owners like drivers

AGEING or impaired drivers are required to requalify for their licence regularly, but gun owners can continue to hold their firearms licence indefinitely regardless of their mental state, physical condition or capacity to make decisions, a situation described by one expert as “incredible” and “crazy”.

Dr Anne Wand, conjoint senior lecturer in psychiatry at the University of New South Wales, and a practising psychiatrist in the public health system, was commenting on an article published today by the MJA on the legacy of the Port Arthur massacre and the National Firearms Agreement (NFA).

The MJA report by Dudley and colleagues reflected on the 20 years since the signing of the NFA and the need to revisit gun control legislation in Australia.

“The national weapons stockpile has now returned to pre-1996 levels, highlighting the need to maintain and strengthen the national regulatory regime,” Dudley et al wrote.

“Complacency has somewhat eroded the NFA. For example, in New South Wales, the pro-gun lobby succeeded in weakening the regulation of pistol clubs — arguably causing at least one homicide. NFA opponents hope to overturn the ban on semi-automatic long arms.

“We need a review, revision and tightening of existing laws and more effective restrictions and controls on possession, import and sales of handguns and other firearms, especially via the internet and by illicit imports.”

• Related: MJA -- The Port Arthur massacre and the National Firearms Agreement: 20 years on, what are the lessons?
  
• Related: MJA InSight -- Port Arthur’s legacy
• Related: MJA -- Firearms, mental illness, dementia and the clinician
• Related: MJA InSight -- Dementia concerns with guns

The authors also refuted gun lobby and media claims that “mental illness underpins gun violence and should be a key site for intervention”.

“[Studies] confirm that most violent individuals do not have mental illness, and that the vast majority of individuals with mental illness are not violent,” Dudley and colleagues wrote. “They are more likely to be victims not perpetrators of violence.

Media portrayal of violence by people with mental illness reinforces public perception of their dangerousness, further stigmatising and endangering them.”

Dr Wand, who co-authored a 2014 MJA ethics and law article called Firearms, mental illness, dementia and the clinician, told MJA InSight that there was nothing in current firearms legislation to prevent gun owners with diminished capacity, for whatever reason, from continuing to hold their licence.

“The onus is on the owner of the firearm to self-report any impairment they might have,” she said.

• Related: MJA – Firearms, mental illness, dementia and the clinician
• Related: MJA InSight – Dementia concerns with guns

“We make people of a certain age do a driving test regularly, and have guidelines about not driving for defined periods with certain medical illnesses, there is no such resource for clinicians with guns."

“It’s incredible that we rely on self-reporting even when the person may not have the capacity to do so. The biggest issue with the National Firearms Agreement legislation is that there is no stipulation to independently review whether the licence holder still meets the requirements to store and use a firearm, or process for assessment of potential risks."

“It’s crazy.”

For driver’s licences, age is the trigger forcing people to retest. In NSW, for example, once a driver reaches 75 years, an annual medical review is required. After age 85 years, drivers need an annual medical review and have the choice of either accepting a modified licence restricting either time of day or distance driven, or taking a practical driving test every 2 years to maintain an unrestricted licence.

Health professionals can access an online resource for assessing the fitness to drive of their patients.

Medical conditions which can result in restriction of licence include blackouts; cardiovascular conditions; diabetes mellitus; hearing loss; musculoskeletal conditions; neurological conditions, such as dementia, epilepsy, vestibular disorders, Parkinson disease, multiple sclerosis and stroke; and psychiatric conditions, such as schizophrenia, bipolar affective condition, depression, anxiety and post-traumatic stress disorder, and aggressive and impulsive personality conditions.

No such resource exists for physicians assessing the fitness of their patient to own a firearm. Dr Wand said something similar for general practitioners would be useful, but she did not believe age was an appropriate trigger for reassessment of gun owners.

“There are physical conditions – such as stroke or seizures – and mental conditions, such as dementia, which reduce capacity, that [are a better trigger],” she said. “GPs have a good set of skills for assessing their patients.

“I believe Dudley’s point is that we should not just be screening people with a mental health illness for firearm ownership. Mental health is only one part of this.

“This is about doctors in general thinking about the capacity of any of their patients [to make safe decisions about firearms].”

Dudley and colleagues concluded their article by urging doctors to participate in “firearm risk management” while resisting the targeting of those with mental illness.

“The campaign to deflect social concern over firearms availability into a debate about whether people with mental illness histories should access such weapons should be exposed as a calculated appeal to prejudice.”