Mental health bill skirts gun politics
Cornyn’s yearslong reform effort is nearing passage
WASHINGTON — The mass shooting at Sandy Hook Elementary in Newtown, Conn., at the hands of a mentally disturbed gunman sparked a heartwrenching debate about gun control but little action from Congress.
Now, close to the fouryear anniversary of Sandy Hook, Congress is poised to finalize health policy legislation with wideranging reforms for the nation’s mental health system. Some of the provisions could determine how people with mental health issues — particularly veterans — can access firearms.
One of the chief architects of the reforms is Texas U.S. Sen. John Cornyn, who says new funding and treatment options could stave off the sort of gun rampage that erupted in Newtown on Dec. 14, 2012, when 20-year-old Adam Lanza fatally shot 20 children and six adult staff members before killing himself.
“I’ve always thought about Adam Lanza’s mother,” Cornyn said, “who, as she knew he was getting sicker and sicker … what sort of tools might be helpful to her to get him the treatment he needed.”
Though passage of the $6.3 billion 21st Century Cures Act is virtually assured this week, it has not been without controversy along the way — largely because of mental health provisions aimed at keeping troubled people with mental illnesses out of the nation’s streets and jails, and a contentious measure, which was dropped, that would have made it easier for some people with mental illnesses to get guns.
While much of the legislation focuses on cancer research and speeding up the delivery of new medical devices, drugs and therapies, the mental health reforms in the Senate bill are based largely on legislation Cornyn proposed last year promoting pretrial screening to identify criminal offenders with mental illnesses, in some cases diverting them to treatment.
It also mandates mental health court pilot programs, crisis intervention teams, and services for people with mental and substance abuse disorders.
No gun violence cure
Gun control advocates who were thwarted in their efforts to ban assault weapons and significantly expand background checks after Sandy Hook see mental health reform as a poor substitute for long-debated gun restrictions, scapegoating mental illness for America’s problem of chronic gun violence.
Along the way, negotiations involving Sandy Hook families persuaded Cornyn to drop a Republican-backed plan restoring gun rights to certain mentally ill people.
Meanwhile, even as many mental health advocates have welcomed the bill’s new funding for research and treatment — including $1 billion for opioid-abuse prevention — some have balked at measures that make it easier to obtain court-ordered care for people with serious mental illnesses who might otherwise not seek help.
“All of these coercive solutions seem to have been taken up by some people in Congress to say, ‘Oh, we don’t need to do gun control. We’ll just force crazy people to take treatment and that will solve the problem,’ ” said Jennifer Mathis of the Bazelon Cen- ter for Mental Health Law, a group that advocates for the rights of people with mental disabilities.
Cornyn and other lawmakers who have spent years shaping the mental health reforms say they are focused primarily on providing pathways to treatment for people who might otherwise fall through the cracks. Though it has not been explicitly pitched as a gun violence prevention bill, its authors have frequently alluded to Newtown and other mass shootings.
The mental health reform’s chief House sponsor, Republican Tim Murphy, a psychologist from Pennsylvania, said in a committee hearing last week that Sandy Hook stirred him to research untreated mental illness: “That horror is etched on our collective memories.”
The overall health care bill was passed by the House on Wednesday with overwhelming support, 392-26. Six Democrats, including San Antonio U.S. Rep. Lloyd Doggett, voted against the bill. Some cited concerns about provisions streamlining the approval process for new drugs and medical devices.
Twenty Republicans also voted no out of concern for increased federal spending. Among them were Texans Brian Babin, Blake Farenthold, Louie Gohmert, John Ratcliffe and Randy Weber.
A final vote is expected next week in the Senate. Cornyn said he is confident of passage, despite opposition from both liberals like Sen. Elizabeth Warren of Massachusetts and conservative groups like Heritage Action for America. Texas U.S. Sen. Ted Cruz is still reviewing the bill, according to a spokesman.
The bill also would mandate specialized training to better equip police to deescalate conflicts involving people with mental health problems, an initiative patterned after a successful pretrial diversion program in San Antonio championed by Bexar County Sheriff Susan Pamerleau.
Mental health practitio- ners have generally backed Cornyn’s proposals to decriminalize mental illness and emphasize treatment. But views differ on the bill’s expansion of a procedure called Assisted Outpatient Treatment, which allows family members to seek court-supervised care for loved ones whose illnesses make them potentially dangerous.
Some experts say coercive treatments can be counterproductive. Others see them as a humane alternative to neglect.
“They’re ending up in our jails or in emergency rooms and being boarded there,” said Frankie Berger of the Treatment Advocacy Center. “Those are the worst places you can put somebody who is really sick with a mental illness.”
Controversial provision
Even more controversial was Cornyn’s original plan — since dropped — making it easier for some people with serious mental illnesses to buy firearms. Long-standing federal law prohibits people who have been involuntarily committed to psychiatric hospitals from having guns until their rights are restored by a court.
Cornyn’s proposal, based on an earlier plan pushed by Cruz and Iowa U.S. Sen. Chuck Grassley, would have automatically restored patients’ gun rights at the end of their commitment periods — unless authorities obtained another court order.
Cornyn and gun rights groups, including the National Rifle Association, argued that further judicial proceedings are a matter of “due process” under the Constitution. But some mental health experts pointed out that mental patients are at a critical point in their recovery after they are released from a hospital. Gun control advocates also noted that it would allow former patients, no matter how vulnerable, to go directly from the hospital to a gun store. They also argued that it would weaken the FBI’s background check system by invalidating hundreds of thousands of mental health records.
The Sandy Hook families also got involved, with the help of Connecticut U.S. Sen. Chris Murphy.
“If someone is sick, it doesn’t make sense for that person to be discharged and get their gun back,” said Murphy, a Democrat. “It was never going to be part of this bill.”
Cornyn eventually abandoned the provision. He also agreed to water down another that would have made it harder for the Department of Veterans Affairs to block beneficiaries deemed mentally deficient from buying and possessing guns. Under a compromise, those veterans are guaranteed appeals before being denied gun rights.
Gun control groups tracking the legislation say they can live with the compromise, despite a suicide epidemic that claims the lives of 22 veterans a day.
“It gives clarity and protections to veterans who may be dangerously mentally ill without pulling apart the mental health system,” said Lizzie Ulmer of Everytown for Gun Safety.
Closing reporting gap
Cornyn, meanwhile, says the bill strengthens the National Instant Criminal Background Check System, known as NICS, by clarifying the scope of mental health records required to be uploaded and providing incentives to ensure that states promptly share their records.
Lawmakers on both sides of the gun control debate have long lamented the reporting gap that came to light after the 2007 Virginia Tech shooting rampage, in which Seung-Hui Cho, a 23-year-old student, killed 32 students and teachers. A judge had declared Cho mentally ill two years earlier, but state authorities did not report it to NICS, allowing him to pass a background check by a licensed gun dealer.
Texas ranks in the top 15 reporting states — controlling by population. Last year, the Lone Star State submitted 262,069 mental health records to the national background check system, out of more than 1.5 million gun checks in the state.
Nevertheless, gun control advocates say the background check system remains woefully incomplete, notably because of the exemption for background checks at gun show and other types of private sales.
But amid the crossfire from left and right, Cornyn believes he’s found the right balance: “It means we have it just about right.”