Which Came First? The Evidence or the Law: A Look at Recent Examples of Critical Opportunities in Public Health Law

The nature of evidence sufficient to drive (or at least not to impede) public health lawmaking may depend on timely factors such as public opinion or political interest group pressure. Hence, the role of public health law research in critical opportunities is somewhat ambiguous. In some cases, law comes first, spurred by high-profile public concerns; in other cases, the weight of evidence compels reform. Two instances of critical opportunities in mental health illustrate these pathways – “law first,” or “evidence first.” Virginia is one of two states that legally required public colleges and universities to have “threat assessment teams” to identify, evaluate and monitor troubled students who may cause harm. This mandate followed the Virginia Tech shootings in 2007; threat assessment teams were a promising idea with little or no scientific evidence of effectiveness. Outpatient commitment in New York State is an example where a previously existing research evidence base from another state drove enactment of the law, and how further evaluation of the law was built into its implementation with a sundown provision.  It is also an example of how public reaction to a critical incident, a high-profile homicide perpetrated by a person with mental illness, “trumped” apparently null findings from a pilot program study. Recent amendments to AOT in the NY Secure Ammunition and Firearms Enforcement Act of 2013 illustrate ways in which evidence and critical incidents sometimes converge to push a law forward. These examples and the merits of evidence-driven law or law-driven research will be discussed.