A glimpse under the hood

With barely a week left in the current legislative session, I feel a bit like a marathoner entering the home stretch. Like many states, Maryland faced a flurry of bills aimed at reducing gun violence and the risk of violence posed by certain psychiatric patients.

We dealt with laws regarding the mandatory reporting of potentially violent patients, laws to take guns away from certain psychiatric patients, liberalization of emergency evaluation and civil commitment procedures, as well as involuntary medication laws. We saw laws designed to prevent the release of insanity acquittees by creating a second, redundant review process. At times, it seemed that all of public policy was aligned to single out the people in our care. Frankly, it was exhausting.

In addition to screening and previewing hundreds of bills with the help of our lobbyist, we had to consider the history and intended purpose of each bill, the motivation of the sponsors, the stances of various interest groups, and the implications for clinical practice. We volunteered countless hours of time spent in conference calls, meetings, and the review of draft amendments.

I began to wish that I had a magic wand that I could swish while shouting the Harry Potter-esque charm “excretus ablatus!” which would magically revamp the bill to exclude excess or ambiguous language and send it flying through committee and both houses with the speed and precision of a Department of Defense drone. Either that or make the bill disappear completely.

Alas, there was no magic wand and no spell that could fix some of the proposed bills I reviewed and no way to make them disappear. Instead, I learned a number of valuable lessons about the legislative process.

The first thing I learned was that the Wicked Witch of the West was right. When she was attempting to confiscate Dorothy's magic slippers, she uttered a maxim I found myself repeating to myself over several proposed laws: "These things must be done carefully." A good bill is shaped through careful deliberation with the input of many stakeholders, not cobbled together in a hodgepodge of rushed amendments. A rushed compromise law runs the risk of making things worse rather than better and may result in a challenge that throws the existing law out completely.

Second, there must be a consideration of the risk of compromise versus the risk of drawing a line in the sand. While the ability to compromise is often considered to be a positive quality, where our patients are concerned this can lead down a slippery slope of an even worse compromise later. Psychiatry has dealt with this slippery slope with regard to mandatory reporting of child abuse. Mandatory reporting laws evolved into criminal sanctions for failure to report. A similar risk could arise with regard to mandatory reporting of psychiatric patients. We must actively resist this criminalization of our profession as well as the stigma imposed upon our patients.

The last point is one I am careful to pass on to my students, which is the importance of active involvement in one’s professional organization. At a time when the American Psychiatric Association is under attack for problems associated with the DSM-5 and changes in CPT coding, psychiatrists may forget the importance of the district branch. District branches are crucial to the day-to-day regulation of clinical practice and for patient advocacy. Unfortunately, much of this work is done behind the scenes with little fanfare or public acknowledgment. Like a well-designed car, the only time people think about how it works is when there is a mishap. In the case of legislation, if all goes well, members are unaware that there is actually a lot going on “under the hood.”

Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

With barely a week left in the current legislative session, I feel a bit like a marathoner entering the home stretch. Like many states, Maryland faced a flurry of bills aimed at reducing gun violence and the risk of violence posed by certain psychiatric patients.

We dealt with laws regarding the mandatory reporting of potentially violent patients, laws to take guns away from certain psychiatric patients, liberalization of emergency evaluation and civil commitment procedures, as well as involuntary medication laws. We saw laws designed to prevent the release of insanity acquittees by creating a second, redundant review process. At times, it seemed that all of public policy was aligned to single out the people in our care. Frankly, it was exhausting.

In addition to screening and previewing hundreds of bills with the help of our lobbyist, we had to consider the history and intended purpose of each bill, the motivation of the sponsors, the stances of various interest groups, and the implications for clinical practice. We volunteered countless hours of time spent in conference calls, meetings, and the review of draft amendments.

I began to wish that I had a magic wand that I could swish while shouting the Harry Potter-esque charm “excretus ablatus!” which would magically revamp the bill to exclude excess or ambiguous language and send it flying through committee and both houses with the speed and precision of a Department of Defense drone. Either that or make the bill disappear completely.

Alas, there was no magic wand and no spell that could fix some of the proposed bills I reviewed and no way to make them disappear. Instead, I learned a number of valuable lessons about the legislative process.

The first thing I learned was that the Wicked Witch of the West was right. When she was attempting to confiscate Dorothy's magic slippers, she uttered a maxim I found myself repeating to myself over several proposed laws: "These things must be done carefully." A good bill is shaped through careful deliberation with the input of many stakeholders, not cobbled together in a hodgepodge of rushed amendments. A rushed compromise law runs the risk of making things worse rather than better and may result in a challenge that throws the existing law out completely.

Second, there must be a consideration of the risk of compromise versus the risk of drawing a line in the sand. While the ability to compromise is often considered to be a positive quality, where our patients are concerned this can lead down a slippery slope of an even worse compromise later. Psychiatry has dealt with this slippery slope with regard to mandatory reporting of child abuse. Mandatory reporting laws evolved into criminal sanctions for failure to report. A similar risk could arise with regard to mandatory reporting of psychiatric patients. We must actively resist this criminalization of our profession as well as the stigma imposed upon our patients.

The last point is one I am careful to pass on to my students, which is the importance of active involvement in one’s professional organization. At a time when the American Psychiatric Association is under attack for problems associated with the DSM-5 and changes in CPT coding, psychiatrists may forget the importance of the district branch. District branches are crucial to the day-to-day regulation of clinical practice and for patient advocacy. Unfortunately, much of this work is done behind the scenes with little fanfare or public acknowledgment. Like a well-designed car, the only time people think about how it works is when there is a mishap. In the case of legislation, if all goes well, members are unaware that there is actually a lot going on “under the hood.”

Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

With barely a week left in the current legislative session, I feel a bit like a marathoner entering the home stretch. Like many states, Maryland faced a flurry of bills aimed at reducing gun violence and the risk of violence posed by certain psychiatric patients.

We dealt with laws regarding the mandatory reporting of potentially violent patients, laws to take guns away from certain psychiatric patients, liberalization of emergency evaluation and civil commitment procedures, as well as involuntary medication laws. We saw laws designed to prevent the release of insanity acquittees by creating a second, redundant review process. At times, it seemed that all of public policy was aligned to single out the people in our care. Frankly, it was exhausting.

In addition to screening and previewing hundreds of bills with the help of our lobbyist, we had to consider the history and intended purpose of each bill, the motivation of the sponsors, the stances of various interest groups, and the implications for clinical practice. We volunteered countless hours of time spent in conference calls, meetings, and the review of draft amendments.

I began to wish that I had a magic wand that I could swish while shouting the Harry Potter-esque charm “excretus ablatus!” which would magically revamp the bill to exclude excess or ambiguous language and send it flying through committee and both houses with the speed and precision of a Department of Defense drone. Either that or make the bill disappear completely.

Alas, there was no magic wand and no spell that could fix some of the proposed bills I reviewed and no way to make them disappear. Instead, I learned a number of valuable lessons about the legislative process.

The first thing I learned was that the Wicked Witch of the West was right. When she was attempting to confiscate Dorothy's magic slippers, she uttered a maxim I found myself repeating to myself over several proposed laws: "These things must be done carefully." A good bill is shaped through careful deliberation with the input of many stakeholders, not cobbled together in a hodgepodge of rushed amendments. A rushed compromise law runs the risk of making things worse rather than better and may result in a challenge that throws the existing law out completely.

Second, there must be a consideration of the risk of compromise versus the risk of drawing a line in the sand. While the ability to compromise is often considered to be a positive quality, where our patients are concerned this can lead down a slippery slope of an even worse compromise later. Psychiatry has dealt with this slippery slope with regard to mandatory reporting of child abuse. Mandatory reporting laws evolved into criminal sanctions for failure to report. A similar risk could arise with regard to mandatory reporting of psychiatric patients. We must actively resist this criminalization of our profession as well as the stigma imposed upon our patients.

The last point is one I am careful to pass on to my students, which is the importance of active involvement in one’s professional organization. At a time when the American Psychiatric Association is under attack for problems associated with the DSM-5 and changes in CPT coding, psychiatrists may forget the importance of the district branch. District branches are crucial to the day-to-day regulation of clinical practice and for patient advocacy. Unfortunately, much of this work is done behind the scenes with little fanfare or public acknowledgment. Like a well-designed car, the only time people think about how it works is when there is a mishap. In the case of legislation, if all goes well, members are unaware that there is actually a lot going on “under the hood.”

Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.