As a doctor, I know it can be tempting when treating a complex disease to try and cover up the symptoms instead of diagnosing the source of the problem. America is in the midst of a heated debate about gun control, but guns are not the source of our nation’s problem with violence. Instead of trying to curtail constitutional rights, Congress should address a real root of our violence problem: mental illness.
John Hinckley Jr. allegedly watched Taxi Driver — a film about a man who attempts to assassinate a famous politician — 15 times prior to his assassination attempt on President Reagan. Hinckley was obsessed with Taxi Driver actress Jodie Foster and convinced himself that by emulating behaviors he saw in the movie he would win her attention. Hinckley was found not guilty by reason of insanity and proclaims his act was the “greatest love offering in the history of the world.”
We may never know what led Adam Lanza to commit the horrible acts at Sandy Hook Elementary School on December 14, 2012, but it is impossible to ignore the fact that similar unimaginable incidents are known to have been committed by individuals whose devastating actions can be directly linked to severe and often untreated mental illness.
Once greatly misunderstood by physicians and the public alike, mental illness is now known to be a medical condition that affects the functioning of one’s brain. Untreated mental illness can disrupt a person’s ability to rationally think, feel, or relate to others. The National Alliance on Mental Illness estimates that the consequences of untreated mental illness cost the nation over $100 billion each year, not to mention the preventable joblessness, homelessness, substance abuse, incarceration, and loss of life.
Coordinated and consistent treatments, both medical and psychosocial, are proven to be effective in treating 70-90% of individuals with mental illness. Unfortunately, access to proper treatment is inhibited by a slew of obstacles, including a lack of mental health facilities and insufficient or nonexistent medical coverage. Even when treatment is affordable and available, many with severe mental illness refuse treatment — convinced they are not ill.
Between 20% and 40% of our chronically homeless are mentally ill. Ten percent of homicides are committed by the mentally ill. Sixteen percent of adult inmates in our nation’s jails and prisons are mentally ill and there are three times as many mentally ill people in our jails and prisons as there are in our mental health hospitals.
The individuals behind these statistics are the victims of a failed and fragmented system that has been ignored by policymakers at all levels for far too long.
In 2005, the American taxpayer funded 61% of behavioral health expenditures. The annual cost for Medicaid, Medicare, SSI, and SSDI benefits for individuals with mental illness exceeds $105 billion. Addressing the need for coordinated, effective, and accountable mental health care is both the fiscally responsible and the morally right thing to do.
Unfortunately, Congress is only in the beginning stages of exploring how to improve our mental health system. But several ideas merit further discussion. One idea is to block grant Medicaid and Medicare funds currently used to pay for mental health services to the states, so that the states are responsible for caring for the mentally ill. States would be assessed on their performance by the Institute of Medicine and the Government Accountability Office. It may also make sense to allow states to place conditions on the collection of SSI and SSDI benefits for those with mental illness (such as participation in a treatment program) to encourage those recipients to access the care they need. Perhaps HIPAA and PAIMI laws should be clarified to ensure they do not create unnecessary barriers between individuals and mental health treatment. These are just a few of the policy ideas Congress should examine.
Improving our mental health system must be a priority for the 113th Congress. It is good that the House Energy and Commerce Subcommittee on Oversight and Investigations, which is headed by clinical psychologist Tim Murphy, will examine mental health programs across the federal spectrum. The House and the Senate must join in a dedicated effort to enact real change.
Rep. Bill Cassidy (M.D.) represents Louisiana’s Sixth Congressional District.