The Free Press, Mankato, MN

December 22, 2012

Our View: Mental health care the missing ingredient

The Free Press

— Rahm Emanuel, then President Obama’s chief of staff, told a business conference a few years ago that “You never want a serious crisis to go to waste.”

While he was referring to the economy, the same could be applied to the shooting deaths in Newtown, Conn.

Already both sides of the gun control debate are digging into their respective and predictable positions. We as a nation are quick to use our bias when the opportunity arises to serve our individual needs — whether it is banning guns or allowing their unfettered use — while missing what could prove to be less contentious and more helpful which is addressing the need for better care in mental health.

Given that President Obama has pledged a response by January, an all-encompassing answer is elusive and appears to be centering specifically on weapons and ammo. And that’s a shame because there is still a presidential commission report that the president could reactivate. An exhaustive report from President George W. Bush’s New Freedom Commission on Mental Health emphasized the need to transform the mental health system in the United States including recommendations for services and support for people of all ages.

On April 29, 2002, the president identified three obstacles preventing Americans with mental illnesses from getting the excellent care they deserve: Stigma that surrounds mental illnesses, unfair treatment limitations and financial requirements placed on mental health benefits in private health insurance, and the fragmented mental health service delivery system.

President Bush said, “... Americans must understand and send this message: mental disability is not a scandal — it is an illness. And like physical illness, it is treatable, especially when the treatment comes early.”

Even today, the inference if not the direct labeling of the shooter in Newtown was “psycho,” “evil,” or, as the NRA said in its statement Friday, “genuine monsters.” We clearly are not getting the message.

Once the report was unveiled, the National Alliance on Mental Illness (NAMI), with prophetic skepticism, asked, “Will the report of this commission result in the wholesale transformation called for by the commissioners? Or will it prove just to be another Washington report gathering dust on shelves.”

The report was met with great skepticism for its cost and attacked as merely a shell for beefing up drug company profits. And frankly it took a great deal of resolve and collaboration that doesn’t exist much in our governance anymore.

So rather than tweak the recommendations to everyone’s satisfaction, it was quietly shunted aside.

Rather than face alternatives to this report, we as a country instead went the opposite way. The National Association of State Mental Health Program Directors (NASMHPD) estimates that states have cut at least $4.35 billion in funding for mental health agencies from fiscal year 2009 and through 2012.

These are chiefly funds for community centers and clinics operated by nonprofits and private firms with the remainder supporting state hospitals which see greater demand during tough economic times. Over the past four years, 12 states have closed or are considering closing public psychiatric hospitals. Some states cut funding that was matched by federal dollars, which itself has decreased in the last 10 years when you factor in inflation.

There is an understanding in the mental health community that there is no magic wand that can prevent incidents like the Sandy Hook killings. But with a wide range of care and helping identify and treat patients earlier in their lives, it will certainly help.

As pointed out in the New Freedom’s conclusion, “The integrated strategy outlined in this final report can achieve the transformation that will allow adults with serious mental illness and children with serious emotional disturbances to live, work, learn, and participate fully in their communities.”

Let’s not miss this opportunity to finally craft a responsible answer to a crying need.