Improve Mental Health Treatment? If Only We Would!

10/10/2015

What can we say about the latest mass shooting that hasn’t already been said? I have written blog post after blog post on these shootings (no less than seven times). The last one I just recycled because, except for the personal details, everything – who did it, why and how – was exactly the same. And nothing has changed. Nothing. Yet people continue to blather on for the need for a better mental health system.

As a psychologist, I would be first in line to agree that our mental health system is broken. It is extremely damaged, far more than most people even know. I live that reality every single day. And, for the purpose of this blog post, I will ignore the convenient assumption that all of the people behind the thousands of yearly gun deaths in this country are mentally ill. That’s simply not true; facts are beautiful things, people. Almost all mass shootings are done by people who are not mentally ill (only 4% of mass murderers suffer from psychiatric diseases). In fact, a person with a mental illness is about five times more likely to be the victim of violence than be someone who perpetrates it. But ok, let’s just focus on the idea of providing more mental health treatment.

I definitely can support this proposal but somehow I doubt that the very people who are self-righteously trying to emphasize mental health treatment over gun control have done much toward improving the system. If anything, I imagine many of them have actively stood in the way by complaining about government funding and higher taxes and voting for politicians who will not do anything to increase mental health access and programs. But if they insist on boiling down the issue of mass murder into a false equivalency between mental health and guns, then they can’t have it both ways. They must pick one or the other by either increasing mental health services or implementing gun control. So what would improving our mental health system even mean?

In 2013, after the tragic shooting at Newtown, President Obama implemented a mental health initiative and requested millions of dollars for training people to identify mental health issues and sending them to treatment. When I did a search to see what happened with this, I found nothing, so I don’t even know if the initiative was funded (if someone else knows, please tell me). I also investigated the mental health bills that have been introduced in Congress since 2013. Most, if not all, have been stalled for the last few years. Certainly I have seen no changes as a result of any recent federal programs nor will I because based on what I read about them, those things are a drop in the bucket. If we want to implement true mental health reform, it will have to be a huge effort because patchwork attempts just won’t work.

On a recent episode of Last Week Tonight, John Oliver did a brilliant summary of some of the problems with our mental health system. He covered insufficient funding for community mental health centers (most states have cut millions), so-called “Greyhound therapy” – in which mentally ill people get bused out of town – and the huge population of mentally ill people currently being housed in prison. Yet he didn’t cover all of it because it’s only a half hour show. Plus, he has to be funny and our broken system is anything but.

What Oliver didn’t have time to mention was the lack of beds in psychiatric facilities and residential treatment centers, the large population of mentally ill people who are homeless, the lack of screening and preventative services for mental illness and, of course, the high cost of treatment. Of the one in five Americans with a mental illness (and that encompasses tens of millions!), about half either don’t have access to care or can’t afford it. Over 50% of mental health professionals don’t accept private insurance due to low reimbursement rates and, for the same reason, are less likely to accept Medicare and Medicaid than other healthcare providers. Rural regions are especially hard hit as there is an extreme shortage of mental healthcare.

So what are we to do? I actually have a lot of ideas, everything from improving preventative efforts and incorporating the community to increasing provider reimbursement and changing from the medical model of treatment to an integrative one. However, none of those things will work without first reducing the stigma of mental health (by the way, the emphasis on mental health issues after gun violence is not helpful to this goal) and making mental health treatment a priority. This means that people will have advocate for more government programs because private industry just hasn’t worked and this has been increasingly evident over the last 30 years. In other words, it will require a sea change in how we view ourselves, our communities and our government.

Given the need for such a monumental shift, I predict that nothing much will change. Our system will remain broken even though certain people will continue to lament this fact after every mass shooting. And so I’ll see you back here after the next mass shooting for more outrage and hand-wringing. Or, I may just follow Michael Moore’s lead and say that I’ve already said everything that I could.

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