Monday, December 17, 2012

Mental Illness And Guns

It can be argued that Pres. Reagan bears some responsibility for the Sandy Hook Elementary School shootings, committed by a mentally ill gunman. Pres. Reagan promoted the near total collapse of publicly funded care for the mentally ill.

Government's primary responsibility is the protection of the citizens it represents through collective defense. This is true of government at every level. Government is meant to protect us from enemies that we can not possibly be expected to individually protect ourselves against. That collective defense can take the form of gun ownership regulation, at least comparable to the regulation applied to owning and operating motor vehicles.

That collective defense can also take the form of care for those in our society who are mentally ill.

Last Friday, a mentally ill 20-year-old man killed his mother with guns that she legally owned. After killing her, he stole her legally owned military-style semi-automatic weapons, several high capacity ammunition clips and hundreds of rounds of ammunition. He then broke into the school, executed the principal and school psychologist in cold blood before entering a 1st grade classroom where he killed nearly everyone in it, including 20 children who were 7 years old or younger.

In the aftermath of another deadly mass shooting at the hands of a mentally ill person, people are again asking questions about what local, state or federal government officials could have or should have done to protect those children, teachers and administrators. They were all American citizens who expected their government to protect them from this kind of horror.

The mass shootings of this year all have two things in common: they involved mentally ill people and high capacity, semi-automatic firearms.  So, our elected representatives in government have two issues that must be addressed simultaneously: mental illness and guns. 

Pres. Reagan is widely lionized by the right for changing the trajectory of America toward a society that functions according to conservative principles. One of the fundamental guiding principles of the modern conservative movement is to end government support of social health programs.

Today, we see conservatives fighting for deep cuts to Social Security, Medicare, Medicaid, school lunch programs, even the public school system itself, and more. Republicans today are fighting to fully convert federal Medicaid programs into state block grant programs. Republicans have further declared that they want to convert the Medicare program into private insurance a voucher program, too.

In President Reagan's time, the prime conservative priority was to cut public funding of mental health facilities and programs. Reagan was successful in his conservative mission to empty the mental hospitals across the nation, dumping the mentally ill on the streets, creating a huge homeless problem in the 1980's, which persists today.

When Ronald Reagan arrived in Washington, he inherited the Mental Health Systems Act of 1980. One of the last achievements of Pres. Jimmy Carter, this was passed by the House 277 to 15, in the Senate, 93 to 3. With as many critics as there were special interests, it was far from perfect. Yet it expanded the federal government's commitment to services, to research, to training professionals, and to patient rights. It identified stigma as an impediment to seeking and receiving services. It established parity in Medicaid and Medicare. It recognized the link between physical health and mental health. And it dedicated $800 million over 4 years to redress the gross neglect of the commitment to mental health in earlier administrations. In short, it moved an agenda that minimized homelessness, the reliance on expensive nursing homes, jails and prisons, and one that to more hopeful choices for those who needed help.

The Mental Health Systems Act was a milestone. It came on the heels of four years of hearings and a presidential task force benefiting from First Lady Rosalynn Carter's active involvement. Philosophically it affirmed Pres. John F. Kennedy's Community Mental Health Centers, an attempt to thwart hospitalizations. It fit into the safety-net values championed by Pres. Lyndon B. Johnson with the passage of Medicaid and Medicare.

Still, by 1980 the nation needed more for those with a chronic illness. Many failures accompanied the attempts to close the miserable hospitals, often little more than warehouses, to help patients succeed in the community. The neglect of government support conspired to form a patchwork system with notable gaping holes. A 1977 GAO report said, "Government needs to do more." Congressional hearings in 1979 re-affirmed the need to strengthen impoverished services and the failed policies.

Although not perfect, the Mental Health Systems Act responded to these problems. For the first time since the National Institute of Mental Health became part of NIH in 1949, mental health was front and center in federal policy.

Then came Ronald Reagan. Within a month, the Office of Management Budget announced it would curtail the budget of the National Institute of Mental Health (NIMH), phase out training of clinicians, interrupt research, and eliminate services. The Reagan administration also directed the Social Security Administration to pare the SSI and SSDI rolls. Social Security administrators responded by developing definitions of mental illness that diverged from those used in the past and those employed by mental health professionals.

Cutbacks to mental health hospitals and services followed; chaos ensued. Experienced professionals left the field, others remained in government service but were forced into menial jobs. Trained professionals were reassigned to labs to dissect dead rats; science writers were reassigned to typing pools. The Mental Health Systems Act would soon disappear.

The 1981 Omnibus Budget Reconciliation Act repealed the provisions of the National Mental Health Systems Act, cut federal mental health and substance abuse allocations by twenty-five percent, and converted them to state block grant disbursement programs with few strings attached. States had the discretion to use block funds however they saw fit, allowing them to cut mental health programs and divert funding to other uses. The pretense for all this was the president's concept of a "new federalism" where government is deemed always the problem, never the solution.

"Many of our dreams were gone," wrote Rosalynn Carter in Helping Someone with Mental Illness. "It was a bitter loss."

Today, Republicans want to do the same thing for Medicare that Pres. Reagan did for mental health care in the 1980's.  Republican vice presidential nominee Paul Ryan, who continues to serve in the U.S. House of Representatives, has twice offered a Republican budget plan that would replace the Medicaid program with a block grant program controlled by states. The Republican controlled House has twice voted approval of Ryan's plan to gut Medicaid.  But that is the wrong direction.

The security concerns of American citizens dictates that America's health support systems must be strengthened, not gutted. Americans should be secure from the suffering of there own health crises, whatever illness befalls them, and secure from from the actions of those who suffer a sever mental illness.    Congress should act, not to gut Medicaid and Medicare, but to strengthen those programs, including creating programs like Pres. Carter's Mental Health Systems Act of 1980.
Currently, Medicaid is jointly funded by the federal government and the states, each of which runs its program under federal guidelines about who must be covered and what benefits they receive. The program is targeted to low-income people and mainly serves poor children and senior citizens in nursing homes, though it also covers some parents of poor children, pregnant women, people with disabilities and a small number of childless adults. Fifty-five million Americans received Medicaid benefits during an average month this year, the Urban Institute estimates.
A Johns Hopkins School of Public Health study found that keeping guns away from high-risk individuals prevents gun violence. These individuals include criminals, those with a history of domestic violence, the mentally ill, people under age 21 and substance abusers. The report also found that the availability of high-capacity magazines increased deaths in mass shootings.
"Mass shootings bring public attention to the exceptionally high rate of gun violence in the U.S., but policy discussions rarely focus on preventing the daily gun violence that results in an average of 30 lives lost every day," said study author Daniel Webster, the director of the Johns Hopkins Center for Gun Policy and Research. "Addressing weaknesses in existing gun laws by expanding prohibitions for criminals, perpetrators of domestic violence, youth, and drug abusers, and closing the loopholes that allow prohibited persons, such as the mentally ill, to obtain guns can be effective strategies to reduce gun violence. It is important to note that making these changes to our gun laws would not disarm law-abiding adults."

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