Is America Finally Ready for Mental-Health Reform?

A year after Sandy Hook, Congress is showing signs of action.

Christmas decorations adorn a business near the former site of Sandy Hook Elementary on December 14, 2013 in Newtown, Conn.
National Journal
Clara Ritger
Dec. 18, 2013, midnight

The New­town school shoot­ing ig­nited a furi­ous de­bate about gun own­er­ship and gun laws. But be­neath the shout­ing, there was a quieter, less con­ten­tious con­ver­sa­tion about over­haul­ing the way the United States treats those who are men­tally ill.

Now, a year later, it ap­pears that men­tal-health meas­ures — and not gun con­trol — could be the tragedy’s le­gis­lat­ive leg­acy.

A bi­par­tis­an pair of sen­at­ors have a mod­est, in­cre­ment­al plan to ex­pand ac­cess to men­tal-health ser­vices at com­munity cen­ters, and — des­pite Con­gress’s deep le­gis­lat­ive freeze — have found a plaus­ible path to get the meas­ure to the pres­id­ent’s desk.

The men­tal-health pro­vi­sion is at­tached to per­man­ent “doc fix” le­gis­la­tion, a meas­ure that would re­place the broken for­mula used to re­im­burse phys­i­cians for Medi­care ser­vices. That bill, boast­ing sup­port in both parties and both cham­bers, ap­pears on track to be­com­ing law.

And the men­tal-health pro­vi­sion seems likely to move for­ward with it. The pro­pos­al was ad­ded by a voice vote in the Sen­ate Fin­ance Com­mit­tee, and com­mit­tee mem­bers cri­ti­cized little of the pro­pos­al sponsored by Sens. Debbie Stabenow, D-Mich., and Roy Blunt, R-Mo., in­stead of­fer­ing praise for their work to ad­dress Amer­ica’s “broken” men­tal-health care sys­tem.

Sen. Richard Burr, R-N.C., ex­pressed dis­con­tent with the meas­ure’s $1.6 bil­lion price tag, but with it at­tached to the $116 bil­lion per­man­ent doc fix, the ex­tra off­set ap­pears minute. And many Re­pub­lic­ans, no­tori­ously strin­gent about the budget, are voicing sup­port for the bill cit­ing a ser­i­ous need for re­form.

“We must take a ser­i­ous look at our na­tion’s men­tal-health sys­tem to de­term­ine how we can bet­ter sup­port and care for in­di­vidu­als and fam­il­ies af­flic­ted by ser­i­ous men­tal ill­ness, and I am en­cour­aged that we are mak­ing pro­gress,” said Sen. Susan Collins, R-Maine, a sup­port­er of the bill, in an email.

“The ser­i­ous­ness of this need is un­der­scored by the fact that men­tal ill­ness has been a sa­li­ent factor in mass shoot­ings, such as the cases at the Navy Yard in Wash­ing­ton and in Con­necti­c­ut, Col­or­ado, and Ari­zona,” she ad­ded. “Un­for­tu­nately, our cur­rent sys­tem too of­ten fails pa­tients with ser­i­ous men­tal ill­ness who may lack ac­cess to the care that they need.”

The mo­mentum be­hind re­form is fueled by a year of tra­gedies linked to men­tal ill­ness. In the wake of the mas­sacre at Sandy Hook Ele­ment­ary, in­vest­ig­at­ors re­vealed that the shoot­er, Adam Lanza, struggled with As­per­ger’s, a form of aut­ism. Closer to Con­gress, there was an at­tack at the Navy Yard by a man who heard voices but did not seek treat­ment, and a fatal Cap­it­ol Hill car chase touched off by a moth­er who was dia­gnosed with post­partum de­pres­sion with psy­chos­is, ac­cord­ing to her fam­ily.

Stabenow knows firsthand the pain of liv­ing with someone with an un­treated men­tal ill­ness. Her fath­er struggled with bi­polar dis­order. He’d stay up all night to talk about his ideas and, dur­ing the day, gave away cars at his job as an Olds­mobile deal­er. The fam­ily even­tu­ally moved in­to a smal­ler, more af­ford­able home. Stabenow’s fath­er wasn’t vi­ol­ent, but, then, most people with men­tal ill­nesses aren’t. Of the roughly 17,000 hom­icides in the U.S. an­nu­ally, less than 5 per­cent in­volve men­tal ill­ness, ac­cord­ing to the Na­tion­al In­sti­tute of Men­tal Health. And people with severe men­tal ill­nesses are 11 times more likely to be vic­tims of vi­ol­ent crime than the gen­er­al pop­u­la­tion.

But for those liv­ing with ser­i­ous men­tal dis­orders who could harm them­selves and those around them, NIMH says, the risk of vi­ol­ence is 15 times high­er without treat­ment.

Data from the Na­tion­al Al­li­ance on Men­tal Ill­ness show that one in four adults in the U.S. suf­fers from a men­tal dis­order. One in 17 has a severe con­di­tion. Few­er than one-third with a dia­gnosed ill­ness re­ceive treat­ment.

Al­though the amend­ment to the doc fix is a scaled-down ver­sion of Stabenow’s ori­gin­al bill, if im­ple­men­ted in full it could ex­pand ac­cess to treat­ment for roughly 1.5 mil­lion people na­tion­wide.

“More and more people are see­ing that the fin­an­cial and hu­man costs of in­ac­tion are far too great,” Stabenow said. “Too many people are sent to emer­gency rooms or are in­car­cer­ated when what they really need is prop­er men­tal-health treat­ment. In­car­cer­at­ing people who need treat­ment alone costs the U.S. $15 bil­lion every year, and lost pro­ductiv­ity and oth­er im­pacts of un­treated men­tal ill­ness cost the coun­try a total of $100 bil­lion per year.”

One of Stabenow’s aides said they were con­fid­ent go­ing in­to the hear­ing be­cause of the bi­par­tis­an in­terest in the pro­pos­al. “At­tached to le­gis­la­tion that is guar­an­teed to get a vote cer­tainly in­creases its chance for suc­cess,” the aide ad­ded.

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