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Opinion: Pediatrician Asks, Why Can’t I Talk To You About Guns In The Home?

A Seattle public health official demonstrates the use of a gun lock box during a news conference on Jan. 21. (Elaine Thompson/AP)

A Seattle public health official demonstrates the use of a gun lock box during a news conference on Jan. 21. (Elaine Thompson/AP)

Here’s a conversation I was in on recently between a pediatric intern and the parents of a healthy, 1-day-old baby. It occurred in the Yale-New Haven Hospital well baby nursery.

“Your daughter’s physical exam is perfect,” the intern said. “She’s eating well, peeing and pooping well. I want to talk to you a little about how to help you keep her safe and healthy.”

Next came a standard discussion about the baby’s sleeping position and whether she’s got a car seat. Then, the next question:

“Do you have any guns in the home?”

Suddenly, the genial tone changed.

“I don’t think you should ask that question,” said the child’s father.

“Should I take that as a ‘yes’?” the intern pressed.

“I just don’t think you should ask.”

“Sir, we ask because we want to make sure that your baby is as safe as she can be, making sure you keep any guns locked up and away from her.”

“It’s none of your business.”

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Mental Health Parity: If Not Now, When?

According to ABC News, the latest alleged Ft. Hood shooter was struggling with a number of mental health problems, “ranging from depression to anxiety to sleep disturbance,” and in the midst of being evaluated for post-traumatic stress disorder.

If true, it’s a familiar story of a stressed-out soldier with mental health issues and easy access to guns: we’ve been here before.

Of course, we don’t know exactly what kind of care or treatment this shooter was receiving — and the VA system is generally better than others. Still, it’s worth reviewing the history of legislation to put mental health services on equal footing with all other medical care.

(ndanger/flickr)

(ndanger/flickr)

The latest policy brief published in the journal Health Affairs, documents the convoluted history of mental health parity, the idea that mental health care and treatment be comparable with all other types of “physical” medical care (and why make the distinction, anyway)?

Parity efforts began in earnest in the late 1990s, but still aren’t fully implemented today, despite widespread support, including from notable advocates like former Congressman Patrick Kennedy.

The paper examines some of the obstacles remaining to true mental health parity, including these:

…”Critics have argued that parity legislation alone is not enough to fix other underlying problems in how our health system provides access to treatment of mental health and substance use disorders.

The supply and availability of mental health providers has been the subject of numerous research articles. A 2009 Health Affairs article by Peter Cunningham found that two-thirds of primary care physicians reported that they were unable to get outpatient mental health services for their patients–more than twice the percentage who reported trouble finding specialist referrals, nonemergency hospital admissions, or imaging services. Mental health professionals tend to be concentrated in high-population, high-income areas, and the lack of mental health care providers in rural areas as well as in pediatrics has been well documented. Finally, there is still a stigma associated with receiving mental health or substance use treatment. Eliminating the stigma and increasing the availability of high-quality providers are two keys to increasing access to care.

…Much of the debate in implementing parity is around determining equivalence of services between mental health/substance use benefits and medical/surgical benefits. Some of the treatments for mental health and substance use disorders do not have an equivalent medical/surgical treatment, Continue reading

Trauma Report: Kids With Gun Injuries More Likely To Die

"Non-Violence sculpture by  Carl Fredrik Reuterswärd (Wikimedia Commons)

“Non-Violence sculpture by Carl Fredrik Reuterswärd (Wikimedia Commons)

U.S. Congress take note: when kids are injured by guns, they are more likely to end up dead or in the ICU compared to children seriously injured in other ways, a new analysis of trauma data finds.

The report, which began as a study on children’s playground injuries, looked at data gathered from Colorado trauma centers in which 6,920 youths were treated between 2000 and 2008, according to CNN:

Of those, 129 had injuries from firearms, and those injuries were extremely serious compared with the others.
Of the gun injuries, 50.4% required intensive care, compared with 19.3% for other trauma-related injuries. Some 13.2% died, compared with the 1.7% injured in another way. A total of 14% of the gunshot wounds were coded as “self-inflicted.”

Here’s more background from the CNN report:

Dr. Angela Sauaia and her colleagues intended to study the impact modernized playground equipment had on lowering children’s injury rates. They ended up studying kids’ injury rates from guns instead.

The associate professor of public health, medicine and surgery at the University of Colorado’s Anschutz Medical Campus in Aurora said she was neither motivated by the recent mass shooting in her area nor driven by politics.

“My colleagues and I were doing a study on playground injuries, because they were doing some remodeling projects here, and we wanted to see if that would change the playground injury rate,” Sauaia said.

“When we started coding the trauma data, which includes all types of childhood injuries that turn up at these trauma centers, and we noticed the morbid pattern of gun violence-related injuries for children … that shifted the focus of the study to document violence related to injuries involving gunshots.” Continue reading