This has been an extremely difficult year for people with mental illnesses. Many of the gun-toting spree killers who tormented the country showed signs of mental illness. Media figures, politicians, and experts would discuss the obviously disturbed nature of these men, and then sometimes, maybe even often, add the obligatory disclaimer that most people with mental illness aren’t violent. If they were really educated, they added the fact that people with mental illnesses were actually more likely to be victims of violence than perpetrators. In the wake of the high profile shootings, ubiquitous discussions of gun safety and gun control inevitably focused on keeping guns out of the hands of disturbed people. This is important, of course. However, the side effect of this discussion was two-fold: 1) people were quick to decide that the civil liberties or privacy rights of people with mental illnesses do not matter, and 2) the conversations inevitably took on very stigmatizing overtones. First, there were proposals to set up national databases with the names of every single person receiving treatment for a mental illness. It seemed that very few people except those with mental illnesses and their loved ones were properly aghast at the implications. Understandably, people don’t want their private mental health (health) status stored in a national criminal database. The need to keep guns out of the hands of people who are dangerous, both to others and themselves, is critical. However, any membership on a list of people prohibited from gun ownership should be triggered by the concerns of professionals, and not simply by the status of having a mental illness. Then, there were the conversations themselves. It was difficult not to wince when hearing vast numbers of people make stereotypical, inaccurate statements about people with mental illnesses. The myths were rampant.
But, the agony of this year doesn’t end with heightened stigma stimulated by the actions of a handful of dangerous madmen. This year, like the past few years, marks yet another time when states have underfunded mental health services, doing no less than putting people’s lives at risk. In March 2011, the National Alliance on Mental Illness released a report, “State Mental Health Cuts: A National Crisis.” Last year, they released a second report, “State Mental Health Cuts: The Continuing Crisis,” further lamenting the trend toward defunding services. This year, the sequester threw another punch at people with serious mental illnesses. Beginning April 1st, over 373,000 adults and children with serious mental health disorders saw their services cut. Another 9,000 homeless and mentally ill people will no longer receive the services of the PATH program which attempts to help this group get transitioned into permanent housing.
In the midst of all of this hardship, there was one piece of good news to come out over the past few years: the passage of the Affordable Care Act. Indeed, Obamacare, will have the same substantial benefits for people with mental illnesses that it does for people with physical illnesses. People with mental illnesses will not be denied insurance because of a pre-existing condition; substantially more people will receive insurance, thereby allowing more people with mental illnesses to access treatment; the incentives in Obamacare for providers to care for people across the continuum of care will improve quality of care; and psychiatric medications will be covered as the Medicare coverage gap is filled. Obamacare will work perfectly in tandem with one of the few useful laws that George W. Bush ever signed, The Mental Health and Addiction Parity Act of 2008, which requires insurers to pay for just as much mental health care as they would physical health care.
So then, during this past week, packed with so much political news, one of the President’s initiatives on mental health went largely unnoticed. On Monday, President Obama held the White House Conference on Mental Health, carrying on a tradition started by President Clinton in 1999. Mr. Obama gave a heartfelt speech about the need to end stigma and stop forcing people with mental illnesses to live in the shadows. The President has previously taken steps before to address mental health needs such as issuing an executive order in 2012 aimed at providing greater mental health assistance to the military and to veterans. At this White House Mental Health Conference, Mr. Obama was able to announce that the VA has met its goal of hiring an additional 1,600 mental health professionals and 300 trained peer-to-peer specialists, per his executive order. Given the tragic, and remarkably high, rates of suicide among veterans, this was a critical step to take. The exciting new initiative the President announced this past Monday is a $130 million investment in: 1) a program that will train teachers and other adults to recognize the signs of mental illness in students so that they can refer these youth to mental health services, 2) innovative state-based programs that serve youth ages 16-25, and 3) training of 5000 additional professionals to work with youth who need mental health care. The reason this initiative is particularly well-targeted is that research consistently shows that early intervention with youth just experiencing symptoms of mental illness for the first time helps reduce the severity of the illness, prevents a whole host of negative impacts of the illness (e.g. dropping out of school), and ends up costing less money for services in the long run. In addition, the government will also now have a website, mentalhealth.gov, which will become a clearinghouse of resources citizens can visit for more information.
Perhaps the most encouraging words the President offered on Monday came when he pointed out that it was time to stop concentrating on the divide between mental health and physical health. As he said, “Less is known about the brain, but it is part of the body, too.” Identifying the humiliation that often surrounds having a mental illness, he also said, “There should be no shame in discussing or seeking help for treatable illnesses that affect too many people that we love…We’ve got to get rid of that embarrassment; we’ve got to get rid of that stigma.” Well said, Mr. President. Well said.