Illinois Amends Mental Health Reporting Requirements

Illinois Gov. Bruce Rauner last month signed into state law a bill that amends mental health reporting requirements for clinicians in the state that were the result of Illinois’ 2013 concealed firearm carry law.

The original Firearm Owners Identification Card Act, enacted in July 2013, required inpatient and outpatient mental health facilities, as well as individual clinicians, to report to the Illinois State Department of Human Services “any person determined to be developmentally disabled or intellectually disabled.” Additionally, unlike the federal National Instant Criminal Background Check System, which allows reporting of information only for “adjudicated” admissions (that is, those mandated by the judicial system), the original Illinois law required reporting of “nonadjudicated” admissions, including voluntary, informal, detention, evaluation, and emergency admissions that do not have judicial oversight.

Those individuals reported would be prohibited from obtaining a gun.

But since the original law’s enactment, APA’s Department of Government Relations, together with the Illinois State Medical Society (ISMS), the Illinois Psychiatric Society, and past APA Trustee and Chicago psychiatrist Sidney Weissman, M.D, helped to convene a loose-knit coalition of local and national groups to advocate for changes to the reporting requirements.

The team worked with gun rights groups and others in the state to pass last month’s law that amends the original statute in several important ways:

“The Illinois State Medical Society is pleased Gov. Rauner signed into law much needed mental health reporting changes related to Illinois’ 2013 concealed firearm carry law,” ISMS President Scott Cooper, M.D., an emergency room physician, told Psychiatric News. “The 2013 statute imposed a rigid reporting threshold for minors from birth through age 18. ISMS received feedback from our members that mandated reporting for all minors required the reporting of patients with issues that sometimes resolve during cognitive maturation.  

“The Illinois State Medical Society is pleased Gov. Rauner signed into law much needed mental health reporting changes related to Illinois’ 2013 concealed firearm carry law,” ISMS President Scott Cooper, M.D., an emergency room physician, told Psychiatric News. “The 2013 statute imposed a rigid reporting threshold for minors from birth through age 18. ISMS received feedback from our members that mandated reporting for all minors required the reporting of patients with issues that sometimes resolve during cognitive maturation.  

“Working with the Illinois Psychiatric Society, we successfully supported changes that limit the mandate to age 14 and older—an age threshold when developmental and intellectual disability conditions generally stabilize and, therefore, can be sufficiently evaluated,” Cooper said. “ISMS-backed changes also pushed back the reporting window from 24 hours to one week for patients who are not identified as a clear and present danger. This type of issue can often be wrought with controversy, but a strong bipartisan contingent of Illinois lawmakers backed our bill. These very practical changes are medically appropriate and ensure a more thoughtful reporting process.”

The original 2013 statute and its rigid reporting requirements raised issues about the complex interface of mental illness, dangerousness, stigma, gun rights, and clinical appropriateness.

Last year, Steven Hoge, M.D., chair of the APA Council on Psychiatry and Law, told Psychiatric News that “legislation based solely on diagnosis is discriminatory and is based on unfounded prejudice toward those with mental disabilities.” He added, “The extension to nonajudicated admissions would sweep into the gun registries many voluntary patients and those who may be determined at a legal proceeding not to have been dangerous. To the extent that inclusion of those with mental illness has any rational basis, it must be restricted to those who have been adjudicated to be dangerous.”(See Psychiatric News, April 4, 2014).

And Weissman said of the original statute that it placed clinicians in the “absurd” position of having to report 2-year-old children who may demonstrate signs of potential developmental delay or autism.

The newly passed law, amending the reporting requirements, is an improvement, but still stigmatizes mental illness, Weissman said. “What the act does is change the reporting requirements to the Illinois Department of Human Services for individuals with developmental disabilities by raising the age to 14,” he told Psychiatric News. “If someone is reported, he or she can appeal the designation that they have a disorder that prevents them from obtaining a gun. And if an examiner supports that they have only a ‘mild’ disability, they can obtain a gun.

“The change in the law is not as strong as I would like but it moves the reporting age to adolescence and offers a route for appeal,” he said. “In essence, the restriction would hold only for individuals with severe disabilities. That’s better than where we started with the state creating a list of everyone from birth who has a disability when the diagnoses of children can change.  The stigma is, however, still there.” ■