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Editorial: Gun debate must include care for mentally ill

Fri., Jan. 25, 2013

Gun control is only part of the issue when it comes to mass shootings in the United States. Adam Lanza in Newtown, Conn., Jared Lee Loughner in Tucson, Seung-Hui Cho at Virginia Tech and James Holmes in Aurora, Colo., all had histories of mental illness. Better mental health services must be significant component of the nation’s response to mass shootings.

Access to mental health care needs to be expanded, but that poses financial and political challenges. From 2009-2012, states have slashed funding for mental health services by $4.35 billion, according to a report by the Pew Center on the States. But help is on the way with the imminent expansion of Medicaid and the implementation of health care exchanges through the Affordable Care Act.

Though Republicans agree that mental illness has been a factor in mass shootings, many are loath to lean on programs proffered by President Barack Obama. U.S. Rep. Tim Murphy, R-Pa., is a psychologist on the House Energy and Commerce oversight subcommittee who says he will hold hearings on improving the nation’s mental health system, according to a Politico article. But he’ll have to come up with comprehensive – and expensive – legislation to match the wider path to access that is already available.

The Medicaid expansion is a great deal for states. For the first three years, the federal government would pick up 100 percent of costs, with the federal match slowly scaling back until it reaches 90 percent. If all states took the deal, an estimated 13 million more Americans would obtain mental health benefits through Medicaid next year, according to the Congressional Budget Office.

However, 10 governors – all Republicans, including Gov. Butch Otter of Idaho – have said no to immediate expansion. Twenty governors, including Washington’s, have said yes, and the rest have yet to make a decision. If Idaho were to accept the deal, 80,000 more people would have access to mental health services. About 500,000 more Washingtonians are going to have access.

The problem for the states turning down the deal is improving the mental health system some other way. The gun lobby isn’t happy with some of the gun control proposals, but it does agree with the focus on mental illness.

Apart from the Medicaid expansion, all states will have health care exchanges next year. Some mental health coverage expansion will occur there, but the feds have yet to delineate the “essential services” those health care plans must carry. Kevin Quigley, Washington’s new director of the Department of Social and Health Services, told The Spokesman-Review that mental health parity would go a long way toward expanding those services. Currently, health plans can proscribe the number of visits to mental health care providers. Under a parity policy, the number of visits wouldn’t be limited, just as they aren’t for other health care issues. This would be beneficial for those who need more intensive care.

The mass shooting in Newtown has galvanized the nation. Gun control is one piece of the puzzle; another is mental health care. Our leaders need to rise above politics and expand access to care.