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.