Mental health prescription?

Thank you for supporting our journalism. This article is available exclusively for our subscribers, who help fund our work at The Baltimore Sun.

Psychiatrists, psychologists, therapists, social workers and other mental health care practitioners rejoice: It appears a lot of elected officials, including a remarkable number of conservatives, have your back. Since last week's shooting at Umpqua Community College that left 10 dead, there has been a steady drumbeat of calls for better care for the mentally ill.

For a moment, let's assume it's a genuine concern and not what doctors might describe as a defense mechanism — as in, "The National Rifle Association won't allow me to advocate for universal background checks on gun purchases, so what can I say to sound sympathetic after a mass shooting?" At least some of these politicians and their right-wing allies sound interested in improving access to mental health care, if only to make their constituents feel safer.


Let's also set aside the question of whether potential mass shooters might be identified before they take up their Glocks, Berettas and Smith & Wessons and turn an Oregon classroom into a kill zone — frankly, it's something of a fool's errand, at least until heretofore fictional "Minority Report" clairvoyants use their extrasensory perception to spot crimes before they happen. That the mentally ill are rarely responsible for gun violence — even mass shooters like Christopher Harper-Mercer are seldom diagnosed with any mental illness, let alone one that might justify forced hospitalization or even an involuntary evaluation — seems lost in the equation as well.

In reality, mental health care is in an abysmal state in this country, and no lifeline tossed by politicians or even conservative media gadflies ought to be ignored. Want to improve access to treatment for the mentally ill, Donald "It's not a gun problem, it's a mental illness problem" Trump or Sean "We need to look at mental health" Hannity? There are plenty of ways Congress, governors and state legislatures could make a difference.


Start by expanding Medicaid coverage, a benefit that is 90 percent paid for by the federal government but which certain GOP-led states have refused, chiefly because the expansion was part of President Barack Obama's Affordable Care Act and therefore must be resisted. If all 50 states expanded Medicaid by 2020, as a recent study found, the nation's health centers would accrue nearly $230 million more in revenue, providing more than $11 million for mental health services, a boost that translates into more than 70,000 paying patients seen.

Here's another: Get the mentally ill out of prison where they don't belong and aren't getting proper medical care. Comedian John Oliver made that point forcefully on his HBO show this week, and he's right: America's jails and prisons have become de facto warehouses for an estimated 2 million mentally ill people. One Justice Department study estimates that 15 percent to 24 percent of inmates could be diagnosed as psychotic. The costly problem translates into hundreds of thousands of people clogging up the criminal justice system. Correcting the horrific situation might start with training more police to deal with the mentally ill in a less hostile, more helpful manner.

And another: Support greater parity for mental health care. Even states that have parity laws now are often falling woefully short. Diagnosed with diabetes? You qualify for long-term care. Diagnosed with depression? You may find severe restrictions on who you can see, how often and what care can be prescribed. The bottom line is that all these services cost money. Will the same conservative lawmakers who resist gun control measures support either the health insurance mandates or the government dollars that would make them possible?

Still, there is hope for bipartisan support for these reforms. Even before the Oregon shooting, comprehensive mental health care reform bills were pending before Congress that would provide greater help to the mentally ill caught in the criminal justice system. Sadly, only one of the four Republican senators running for president, Sen. Lindsey Graham, is a co-sponsor of the Comprehensive Justice and Mental Health Act of 2015.

Improving access to mental health services is unlikely to prevent the next mass shooting or even significantly reduce violence on the streets, as the mentally ill are far more likely to be victims of an attack than to perpetrate one. But it could greatly improve the quality of life for the estimated 5.6 million Americans with a mental illness, perhaps even saving more lives than are lost in mass attacks by reducing the number of suicides. If the price of that achievement is to allow some hypocritical politicians to say they're doing something about people like the Oregon shooter, maybe that's the kind of delusional disorder we can tolerate.