Our nation is now engaged in a discussion about what to do in the wake of recent mass shootings. I believe such a discussion is essential to the overall well-being of our country.
Part of this national conversation is about legislating more gun control. But the current emphasis of the discussions, in many instances, is about legislating control of people with mental health conditions. I believe this is a bad idea.
While those of us in the mental health profession agree that more resources need to be allocated for mental health, it is imperative to understand that violence and mental health issues are two different subjects. What needs to be done to prevent violence should not, therefore, be linked to national databases of people with mental illnesses.
A database containing the names of people with mental illnesses would be impractical, stigmatizing and ineffective. There is no evidence that such a database would effectively control or limit violent behavior. People with mental health conditions are no more likely than others to commit homicides or other violent acts. Most violent crimes are committed by people who do not have a mental illness.
Would the various legislative bodies consider a database of every American citizen who might potentially commit a violent act? The Orwellian universe this suggests should horrify all of us. Why, then, should those with mental illnesses be subject to such gross violations of civil rights?
While a small number of people with untreated mental health conditions, particularly those with co-occurring and active substance abuse problems, pose a higher risk of harm to themselves or others, there is no known way of identifying which persons in this group will commit violent acts in the reasonably foreseeable future.
Additionally, individuals in this group who are most at risk of harming themselves or others are not connected to evidence-based treatment, and therefore are not connected to the treatment staff who are best equipped to make an assessment of their risk or harm.
Only people connected to a treatment system would be included in such a database. This would violate medical privacy and would have the effect of scaring people away from needed treatment. Confidentiality is essential to effective treatment and recovery.
More involuntary treatment, however, is not the answer. There is no reliable way to identify particular individuals who might harm others. We would be required to confine very large numbers of people with mental health conditions in order to achieve even a modest reduction in the risk posed.
Failure to engage people with serious mental illnesses is a service problem, not a legal one. Outpatient commitment is not a quick fix that can overcome the inadequacies of under-resourced and underperforming mental health systems. Coercion, even with judicial sanction, is not a substitute for quality services.
The problem with our mental health system is not that we fail to hospitalize people with acute mental health conditions. Rather, it is that we fail to take reasonable steps to prevent those conditions from occurring. Risk and resiliency factors are well understood, and the science behind them should be applied to our country’s public health efforts.
What we need is adequately resourced and recovery-based community care. The most effective way to reduce the risk of harm that can be posed by some people with mental health conditions is to make a comprehensive array of evidence-based, recovery-oriented community mental health services available in a timely fashion to all who need them.
In addition to treatment, those services should include supported housing, supported employment, peer support services and psychotropic medications.
Because Medicaid is the largest single source of funding for mental health services in each of the 50 states, states should be encouraged to take advantage of the Affordable Care Act’s Medicaid expansion provisions. Medicaid programs should be immediately required to fully implement Early and Periodic Screening, Diagnosis and Treatment for youth. These are the easiest short-term financial solutions to our underfunded and broken mental health system.
So, yes, let us have a national discussion about the health of our nation, but let’s make sure we do not engage in magical thinking. Rather, let us engage in ideas that come out of knowledge, reason, and compassion.
Ellyn Jeager is the director of public policy and advocacy for Mental Health America of Georgia. She has held that position for 15 years.
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