As our collective rage begins to settle and we mourn the loss of so many innocent lives, we, as a nation, begin to look for answers. How could this happen? Who could do such a thing? What could we have done to prevent it? The unfortunate truth is that the mentally ill commit a disproportionately high amount of crime, and had Adam Lanza, the shooter in the horrific Sandy Hook Elementary shooting, met with a mental health professional, it is unlikely he would have discussed his thoughts, feelings and intentions that led him to such a terrible act.
For centuries, patient/doctor confidentiality has been considered a necessary element to the effective treatment of the mentally ill. The confidentiality once afforded mental health professionals has severely diminished over the past few decades.
Many states now require mental health professionals to disclose any serious threat of physical violence a patient makes toward another. The purpose, of course, is to warn the potential victim of the threat made by the patient so that tragedy can be avoided. But these disclosure laws weaken the necessary confidentiality that must exist in the doctor/patient relationship.
Many mental health professionals argue that this mandatory disclosure has created an environment that damages the necessary free discourse between mental health professionals and patients that is so critical to effective psychological treatment. On one hand, warning potential victims of threats from patients should prevent some homicides, but it is also possible that disclosure laws actually discourage patients from revealing homicidal tendencies and prevent mental health professionals from practicing effective psychology.
I recently tested the effect of disclosure laws on violent outcomes and found that both teen suicides and homicides experienced an increase in response to these laws. Even after controlling for most of the typical factors that are associated with teen suicides, states with mandated breaches of confidentiality are associated with about a 9 percent increase in teen suicides.
A similar story is true of homicides. On average, each state in the U.S. experiences an estimated 200 homicides a year committed by the mentally ill. My research suggests that 20 of those could have been avoided simply by altering disclosure laws and strengthening the doctor/patient relationship.
A myriad of questions surrounding the mental history of Lanza remains to be answered, but we do know that had he seen a psychologist, he most likely did not reveal his awful plan, as the law in Connecticut permits the psychologist to warn the school or his family of his intentions.
We probably will never know if the fear of disclosure discouraged Lanza from seeking mental health treatment that could have derailed this truly gruesome act, but the evidence suggests that there are hosts of mentally ill individuals who are either discouraged from treatment, or are not receiving adequate mental health treatment, due to mandatory disclosure laws.
Griffin Edwards is an assistant professor of economics at Southern Utah University who researches mental health and crime.
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