America has a problem with guns — and some argue that the answer is more gun control. America also has a problem with guns in the hands of people with serious mental illnesses — and an answer to that might be providing treatment for them.
These are two different approaches to a kindred problem. Although most people with a mental illness are no more dangerous than anyone else, some tragic examples suggest that getting treatment for those with serious mental health problems could reduce homicides and suicides.
The examples come in all-too-frequent headlines. The Sandy Hook Elementary School in Newtown, Conn., was just another neighborhood school before Dec. 14, 2012, when a troubled 20-year-old named Adam Lanza shot and killed 20 children and six staff before killing himself. He had earlier killed his mother.
On the first anniversary of the Newtown shootings, Rep. Tim Murphy, a Republican from Upper St. Clair, rose in the House to propose a bill in response to this tragedy and others like it. As the only clinical psychologist in Congress, and in a party that has resisted gun control efforts, his suggestion may seem to some beside the point. That would be a mistake.
The Helping Families in Mental Health Crisis Act, the result of a yearlong investigation by a House subcommittee led by Mr. Murphy, is a serious attempt to reduce gun violence by another means.
Although Mr. Murphy’s HR 3717 may not fix every defect in the mental health system, it is a bold, sweeping attempt at reform. It comes at a time when governments have cut their mental-health budgets for community care, leaving the nation’s prison system the last hope for many with mental illness (up to an estimated 50 percent of inmates have a mental illness).
The first thing Americans should want to know about the legislation is whether it is subversive of the Affordable Care Act. Mr. Murphy insists that it is not, and so it appears. Some $125 billion is spent annually on the nation’s mental health system, and his critique is that the money is not being spent wisely, for lack of data and inter-agency coordination.
He would remedy that by making both large institutional changes and various small adjustments. He would accomplish this by moving some federal money around in order to fund new pilot programs. The bill has not yet been costed out by the Congressional Budget Office.
HR 3717 calls for the creation of an assistant secretary for mental health and substance use disorders within the Department of Health and Human Services. This person would be a psychiatrist or similar professional and would work to ensure that recipients of block grants apply evidence-based models of care as developed by the National Institute of Mental Health.
Other proposals are tightly focused on specific problems. They include clarifying privacy statutes, including HIPPA, to allow physicians and mental health professionals to provide information to parents and care-givers, which Mr. Murphy’s investigation found was a special problem for young people experiencing an acute mental crisis. Also under the bill, certain patients resisting treatment could be ordered by a court to receive it.
The investigation found a severe lack of treatment options. Although the United States had 558,000 inpatient psychiatric beds in 1955, today only 40,000 beds are available for a much larger population. Mr. Murphy believes that thousands more beds can be made available by making some narrow exceptions to Medicaid exclusion rules.
This bill has other good features. It encourages NIMH to undertake more research on serious mental illness and related violence. It proposes specialized training for first responders and corrections officers to recognize individuals with mental illness so as to better interact with them. It seeks improvements in data from the Department of Justice on violence involving people with mental illness.
Still, some caution is advised. Until the CBO weighs in, unfunded mandates will remain a concern. Also, the bill is not kind to the Substance Abuse and Mental Health Services Administration.
SAMHSA is a major player in the system, but Mr. Murphy believes it does not promote best practices. He would transfer many of its responsibilities to the new assistant secretary and sunset its unauthorized programs. Although this may be a sound recommendation, it would benefit from more congressional hearings. The same can be said for the proposal to reduce funding for the National Disability Rights Network, an advocacy group that seeks to protect people with mental illnesses from abuse and neglect.
Overall, however, Mr. Murphy is to be commended. Gun control initiatives after Newtown went nowhere. This bill, complementary not contradictory, does not deserve the same fate. Congress should treat it seriously and advance it.