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  Tuesday November 25th, 2014    

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  (ARCHIVES)Back to Current
The Plan (01/20/2013)
By Frances Edstrom


     
“We are going to need to work on making access to mental health care as easy as access to a gun.” President Barack Obama

I think, for many reasons, that President Obama’s “gun control” plan is misguided, as are so many federal mandates. Our government assumes that making new laws, which is of course what they do, creates a quick fix for society. The gun control measures suggested by the president assume that criminals are both law-abiding and sane. The measures assume that guns are like fingerprints: each one can be identified and tracked. The fact is that violent criminals, many already felons, can easily acquire guns in the back alleys of this country, and those guns can neither be identified nor tracked. The government assumes criminals are like the majority of law-abiding, guilt-ridden, meek Americans who break into a sweat when they see a police car, even though they would never dream of speeding. Tougher background checks won’t affect the felon or gangster. Banning “assault weapons” and large capacity magazines won’t faze them, either.

Obama proposes that first, we must spend millions of dollars on tracking violent gun usage in the United States. A simple Google search turns up so much data on violent crime and guns—most of it produced by government—that it would seem that spending precious resources reinventing the wheel in a long-term study, which can then be ignored, as are so many government studies, is not going to be an answer. We will be left with more restrictions on the law-abiding, and have little effect on the violent offender.

Let’s concentrate, though, on the part of the president’s gun control plan that seems to address mental health issues in the United States.

The problem with the president’s plan is that mental health is not like guns. It can’t be found through a friend of a friend, in a dark alley, at a gun show or a pawn shop.

It is government that produced the mental health care provider system that we now have, that for the great percentage of the mentally ill is criminally inadequate. Back in the sixties, it was decided by strange bedfellows—a coalition of fiscal conservatives and liberal do-gooders—that we should stop hospitalizing the mentally ill. Their thinking was that it would save government a ton of dough, and free the institutionalized, creating a population of “free-range” mentally ill people.

This earth-shaking change in public mental health treatment was helped along by the institution of federal programs that make it more difficult to hospitalize mentally ill people who need help. “The creation in the 1960s of federal programs such as SSI, SSDI, Medicaid, and Medicare…provided fiscal support with federal funds for mentally ill individuals who were living in the community. Patients in state hospitals, however, were not eligible (with a few exceptions) for Medicaid and SSI. Since state mental hospitals continued to be almost completely funded with state funds, these federal programs created a huge incentive for states to discharge patients to the community and thus effectively shifted the cost of their care from the state to the federal government.”*

So, we went from 340 beds for psychiatric patients per 100,000 people in 1955 to today’s 17 beds per 100,000. In Wisconsin there are 13 available beds per 100,000 population, and in Minnesota, 26.8.

It is no wonder that, anecdotally, I hear that it is nearly impossible for a family to find hospital care for a mentally ill person without jumping through incredible hoops, or unless the person has attempted homicide or suicide. It is equally difficult, I found, and that I hear from people who know of my interest in mental health care, to find psychiatric care for the mentally ill.

This is not the fault of the hospitals or the doctors, but of government programs that so tightly proscribe easy access to mental health care. There are some very good outpatient treatment options, but sometimes patients cannot be effectively treated on a strictly outpatient basis. Plus, treatment must be sought by the mentally ill individual.

Government has also, misguidedly, dealt families out of the circle of care for the mentally ill who are 18 years old or older. Just when certain forms of mental illness surface in our young people, their families—who support them financially, house them, educate them, and should be their advocates—are made helpless to get them care because of the laws of this country.

Another government mandate, the The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules, or HIPAA, ties the hands of authorities who should be sharing information with the families of patients who are considered adults.

One wonders how different things would be today if the killer of those children in Newtown, Connecticut, had been institutionalized, as it appears his family was attempting to do.

The trouble with the president’s plan is that it is reactive, cynics might say to gain political capital. This country needs to be proactive in caring for the mentally ill, and enforcing the gun laws we already have in place. We don’t need millions of dollars spent on redundant government studies. We don’t need “emergency” grants for more police that inevitably expire, and are left to be re-funded locally and usually are not.

We need to loosen the government hold on delivering good mental health care. We need consistent law enforcement. I don’t see that commitment in the president’s plan.

*http://www.treatmentadvocacycenter.org/storage/documents/the_shortage_of_publichospital_beds.pdf 

 

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