A few more of Bandy’s words:
Bandy Lee
We are assessing dangerousness, not making a diagnosis. The two are quite separate: Assessing dangerousness is making a judgment about the situation, not the person. The same person may not be dangerous in a different situation, for example. And it is his threat to public health, not his personal affairs, that is our concern.
A diagnosis, on the other hand, is a personal affair that does not change with situation, and you require all relevant information — including, I believe, a personal interview. Most people who are dangerous do not have a diagnosable mental illness, and most people with mental illness are more likely to be victims than perpetrators.
Also, once you declare danger, you are calling first for containment and removal of weapons from the person and, second, for a full evaluation — which may then yield diagnoses. Until that happens, physicians and mental health professionals are expected to err on the side of safety and can be held legally liable if they fail to act. So we’re merely calling for an urgent evaluation so that we may have definitive answers.
In doing that, we are fulfilling a routine, public expectation of duty that comes with our profession — the only part that is unusual is that this is happening in the presidency. Perhaps this is reason to build in a fitness for duty, or capacity, exam for presidential candidates, just like for military officers, so that this does not happen again.
We encounter this often in mental health. Those who most require an evaluation are the least likely to submit to one. That is the reason why in all 50 states we have not only the legal authority, but often the legal obligation, to contain someone even against their will when it’s an emergency.
So in an emergency, neither consent nor confidentiality requirements hold. Safety comes first. What we do in the case of danger is we contain the person, we remove them from access to weapons, and we do an urgent evaluation.
This is what we have been calling for with the president based on basic medical standards of care.
Our role is not to intervene in his care, or to interfere in any way in the usual political process. We are just giving medical input as witnessing professionals who can see signs that point to danger as a public health threat that the public or lawmakers may not be aware of or see to its full extent.
The American Psychiatric Association in its code of ethics bans its members from commenting on the mental health of public figures — what’s known as the Goldwater Rule. In March, the APA expanded the rule from not only diagnosing public figures but also to sharing “an opinion about the affect, behavior, speech, or other presentation of an individual that draws on the skills, training, expertise, and/or knowledge inherent in the practice of psychiatry.”