Men­tal health and gun vi­o­lence meet at a bumpy cross­road

Modern Healthcare - - POLITICS - By Steven Ross John­son and Shan­non Much­more

In an ad­dress dur­ing which he wiped away tears, Pres­i­dent Barack Obama last week dared Repub­li­cans to fi­nance men­tal health re­form as part of a pack­age of ex­ec­u­tive ac­tions meant to com­bat gun vi­o­lence.

“For those in Congress who so of­ten rush to blame men­tal ill­ness for mass shoot­ings as a way of avoid­ing ac­tion on guns, here’s your chance to sup­port th­ese ef­forts,” he said. “Put your money where your mouth is.”

Obama asked for $500 mil­lion to im­prove men­tal health ser­vices. But even White House press sec­re­tary Josh Earnest ad­mit­ted the ad­min­is­tra­tion doesn’t ex­pect Congress to grant the fund­ing, adding that he would “be happy to be proved wrong.”

While men­tal health ad­vo­cates largely sup­port the call for more fund­ing, they are now stuck link­ing men­tal health and gun vi­o­lence—two is­sues they’ve wished would re­main sep­a­rate.

“We des­per­ately need men­tal health re­form and in­creased fund­ing for men­tal health ser­vices in­de­pen­dent of the whole gun de­bate,” said Ron Hon­berg, na­tional di­rec­tor of pol­icy and le­gal affairs for the Na­tional Al­liance on Men­tal Ill­ness. He and oth­ers be­lieve talk­ing about re­form­ing men­tal health­care as a way to fix the coun­try’s gun vi­o­lence epi­demic prop­a­gates a stigma that’s of­ten re­spon­si­ble for the lack of treat­ment among al­most half of the es­ti­mated 44 mil­lion Amer­i­cans

“For those in Congress who so of­ten rush to blame men­tal ill­ness for mass shoot­ings as a way of avoid­ing ac­tion on guns, here’s your chance to sup­port th­ese ef­forts. Put your money where your mouth is.”

with men­tal ill­ness.

Ac­cord­ing to HHS, peo­ple with se­vere men­tal ill­ness ac­count for 3% to 5% of all vi­o­lent acts. Those in­di­vid­u­als are ac­tu­ally 10 times more likely than the gen­eral pop­u­la­tion to be the vic­tims of vi­o­lent crime.

“The real is­sue here is that there’s a huge prob­lem with men­tal health,” said John Snook, ex­ec­u­tive di­rec­tor at the Treat­ment Ad­vo­cacy Cen­ter, adding that he sup­ports talk­ing about so­lu­tions within any con­text.

And all signs point to the right cli­mate for ac­tual change.

In the af­ter­math of the shoot­ings in San Bernardino, Calif., that killed 14 peo­ple, House Speaker Paul Ryan has called for re­form­ing men­tal health laws. He and other Repub­li­can lead­ers have en­dorsed a pro­posal that was first in­tro­duced by Rep. Tim Mur­phy (R-Pa.) a year af­ter the 2012 Sandy Hook shoot­ings that killed 26, in­clud­ing 20 chil­dren. The bill in­cluded in­cen­tives for states to im­ple­ment court-or­dered treat­ment, but a $15 mil­lion pi­lot pro­gram for that was part of the om­nibus bud­get deal at the end of De­cem­ber.

“A com­mon theme among many of th­ese mass shoot­ings is a theme of men­tal ill­ness,” Ryan said, echo­ing what a re­cent Wash­ing­ton Post sur­vey on gun vi­o­lence found: 63% of those sur­veyed be­lieved a de­fi­cient men­tal health sys­tem was more re­spon­si­ble than weak gun laws for mass shoot­ings. “We need to fix our men­tal ill­ness laws, our poli­cies. They’re out­dated,” Ryan said.

Mur­phy’s bill is one of sev­eral bi­par­ti­san pro­pos­als to re­form men­tal health­care. Sen. Chris Mur­phy (D-Conn.) has a bill that would pro­vide state grants for early in­ter­ven­tion. It would also cre­ate an as­sis­tant sec­re­tary for men­tal health and sub­stance abuse dis­or­ders within HHS. The bill has been crit­i­cized for a pro­vi­sion that clar­i­fies the Health In­sur­ance Porta­bil­ity and Ac­count­abil­ity Act to en­sure cer­tain records can be shared with par­ents and care­givers, who oth­er­wise may find it dif­fi­cult to help pa­tients in their charge.

Obama’s ex­ec­u­tive ac­tions like­wise in­cluded some tweaks to the pri­vacy law, al­low­ing a small num­ber of ad­di­tional or­ga­ni­za­tions to share in­for­ma­tion with the fed­eral data­base that con­ducts back­ground checks for po­ten­tial gun own­ers.

Sen. John Cornyn (R-Texas) has in­tro­duced a bill ap­proved by the Na­tional Ri­fle As­so­ci­a­tion that would en­cour­age states to share more men­tal health record in­for­ma­tion with a na­tional data­base. But Democrats say that pro­posal on back­ground checks would weaken the sys­tem. And fi­nally, Sens. Deb­bie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) in­tro­duced yet an­other bill last week that would in­crease fund­ing to ex­pand the num­ber of com­mu­nity men­tal health cen­ters that of­fer 24-hour psy­chi­atric care.

The flood of pro­posed leg­is­la­tion—of which only one, Sen. Chris Mur­phy’s, has a sched­uled hear­ing— mim­ics what of­ten hap­pens dur­ing a time of cri­sis. Men­tal health ad­vo­cates have his­tor­i­cally watched sup­port for their cause ebb and flow, along with badly needed fund­ing.

The Na­tional Al­liance on Men­tal Ill­ness re­ported that 37 states bumped up their bud­gets for men­tal health­care af­ter a man with largely unchecked psy­cho­log­i­cal is­sues killed those chil­dren and adults at Sandy Hook El­e­men­tary School. The next year, a fi­nan­cially tough one for many states, only 29 states in­creased fund­ing. Med­i­caid ex­pan­sion had a sur­pris­ingly neg­a­tive im­pact on men­tal health ser­vices. Some states pulled fund­ing from com­mu­nity clin­ics, be­liev­ing more peo­ple would use their newly ac­quired ben­e­fits to seek the help of psy­chi­a­trists, a spe­cialty that’s los­ing pro­fes­sion­als and of­ten doesn’t ac­cept Med­i­caid pa­tients.

Paul Gion­friddo, CEO of Men­tal Health Amer­ica, noted a pos­i­tive as­pect of Obama’s fund­ing pro­posal: It did not de­tail how the money should be spent, leav­ing the door open to al­lo­cate those funds to­ward any of the bills be­ing con­sid­ered.

From a leg­isla­tive per­spec­tive, link­ing men­tal health re­form with the ef­fort to re­duce gun vi­o­lence runs a risk of meld­ing a largely bi­par­ti­san is­sue with one that has di­vided Repub­li­cans and Democrats for decades. And with a new pres­i­dent tak­ing of­fice next year and dozens of con­gres­sional seats in play, all bets are off. Still, ad­vo­cates are hope­ful. “I would be very sur­prised if we didn’t see some­thing at this point,” Snook said. “It would be an in­ex­cus­able fail­ure at this point for there not to be some im­por­tant changes made.”

Med­i­caid ex­pan­sion had a sur­pris­ingly neg­a­tive im­pact on men­tal health ser­vices.


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