Review of the Executive Actions to Reduce Gun Violence, with Specific Regard to Mental Health Issues

By Kacey Heekin (2016)

Introduction

The White House recently released a proposal of executive actions intended to reduce gun violence in the United States. These executive actions come as a response to a decade of an overwhelming amount of gun-related deaths, injuries, and crimes. The Administration has announced that the executive actions are designed to: “keep guns out of the wrong hands through background checks”; “make our communities safer from gun violence”; “increase mental health treatment and reporting to the background check system”; and “shape the future of gun safety technology.” Although the executive actions have been met by criticism in certain political and social arenas, the potential benefits that the mental health-oriented actions can have on the struggling national mental health system are noteworthy.

The Administration is proposing a $500 million investment to increase access to mental health care, the Social Security Administration has indicated that it will begin the rulemaking process to include information in the background check system about beneficiaries who are prohibited from possessing a firearm for mental health reasons, and the Department of Health and Human Services is finalizing a rule to remove unnecessary legal barriers preventing States from reporting relevant information about people prohibited from possessing a gun for specific mental health reasons.

Importantly, the White House has clearly stated that we must continue to remove the stigma around mental illness and its treatment and that individuals with mental illness are more likely to be victims of violence than perpetrators. Most individuals with mental health issues are not violent. Yet, there remains a skewed and widespread public perception of individuals with mental illness as dangerous. Especially troubling is the consistent association of mental illness with mass shootings.

Thus, while the proposed increase in mental health funding is both laudable and necessary and the overall tone of the executive actions with regard to mental health issues is positive, the relationship between mental illness and gun control must be approached cautiously and informed by research and science.

A $500 Million Critical Investment

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2014, approximately 18.1% of adults in the U.S. experienced any mental illness and 4.1% experienced serious mental illness (Center for Behavioral Health Statistics and Quality, 2015). However, despite the prevalence of this condition, many individuals with mental health problems do not have access to necessary services. As reported by the White House, less than half of children and adults with diagnosable mental health issues receive the treatment that they need. SAMHSA further indicates that less than one-third of adults with mental illness receive a minimally adequate type or amount of treatment (SAMHSA, 2013).

The proposed $500 million investment to increase mental health treatment is accordingly much-needed and a critical step toward alleviating the ailing mental health system. This investment, if approved by Congress, will purportedly be used to “help engage individuals with serious mental illness in care, improve access to care by increasing service capacity and the behavioral health workforce, and ensure that behavioral health care systems work for everyone.”

The behavioral health workforce exists in a precarious state, with a serious shortage of workers. This already limited workforce will continue to be strained as the number of individuals with health coverage increases due to the enactment and enforcement of the Affordable Care Act (ACA) and parity laws. According to a recent report to Congress on the nation’s mental health workforce issues, almost 91 million adults lived in mental health professional shortage areas, 55% of U.S. counties had no practicing psychiatrists, psychologists, or social workers, and 77% of counties had a severe shortage of mental health workers (SAMHSA, 2013).

The U.S. mental health system is critically underfunded. Thus, actions to invest in the service capacity (i.e., by increasing community-based mental health services, inpatient mental health hospital beds and programs, diversion efforts from the criminal justice system and emergency departments, and strengthening the behavioral health workforce) are highly commendable.

What Obama’s Executive Action Means for Mental Health Funding

Ron Honberg, national director of policy and legal affairs for National Alliance on Mental Illness (NAMI), said the funding could provide a great help for people seeking care.

“First of all, the $500 million would be a welcome step and we certainly applaud that. It’s a very positive thing,” Honberg told ABCNews. He pointed out that states across the country cut mental health funding during the recession by approximately $4 billion.

“That’s a huge figure and very hard to makeup,” he added.

– ABCNews

Gun Control for Individuals with Mental Illness

There are many contributing factors such as substance abuse, early exposure to violence, personal stressors, and socioeconomic status, which can influence violent behavior in both the general population and in individuals with mental illness. These factors, among others, often interact in complex ways, making the prediction of violent behavior difficult. More research into the causes of violent behavior, and specifically gun violence, could aid in the development of screening instruments to more accurately detect at-risk individuals.

Although strengthening the background check system with regard to mental health problems may lessen the number of individuals with problematic access to guns, especially those with serious and untreated mental illness who pose a threat to themselves or others, given that most individuals with mental illness do not engage in violent acts, it is misguided to assume that this action alone will greatly impact the nation’s larger gun violence issue.

The intensified background check system must be arranged in a manner that does not discriminate against individuals with mental illness (and consequently discourage such individuals from seeking treatment), violate the privacy of individuals with mental health issues, and perpetuate the harmful stigma of mental illness and violence. Gun control measures should be guided by available evidence on groups of individuals who are at-risk of committing gun violence.

The potential impacts of gun control measures with respect to mental health problems on suicide, however, may be of greater significance. As stated by President Obama, nearly two in three gun deaths are from suicide. Reducing access to the primary lethal means for suicide for at-risk individuals could be helpful. It is important to note that using investments to identify and treat individuals at-risk for suicide could also be advantageous.

Mental Health Reform

Important strides to improve the national mental health system have been made over the past decade. The ACA and the Mental Health Parity and Addiction Equity Act of 2008 have especially helped to expand mental health coverage for millions of Americans. Yet, access to equal benefits, quality services, and qualified providers remains elusive for many individuals with mental health needs. As reported in the journal, Health Affairs, enforcing the expanded mental health care rights has not been done consistently and many individuals with insurance still experience a lack of care (Health Affairs, 2015). Legislation to increase funding for the mental health system, improve access to mental health services in appropriate settings, enforce parity laws, and coordinate care is imperative. Although encouraging mental health reform is in and of itself positive, discussing mental health policy actions in the context of gun violence and/or control could be detrimental to current mental health legislative efforts.

Mental health legislation complicated by gun control debate

“Republicans are not welcoming Obama’s latest challenge as part of a package of gun-control proposals to “put your money where your mouth is”and support increasing mental-health spending by $500 million. Those arguing for a broader approach to mental-health legislation — one that emphasizes systemic changes to get help to the families and individuals that the system has missed or failed — worry that the hyper-partisan gun-control debate could hurt their cause.

“This bill is not a gun issue, it’s a mental-healthissue,” said Rep. Tim Murphy (R-Pa.) of his bill, which seeks to unite federal mental-health programs under a single office, expand treatment services and better enable commitment procedures to target the most severe cases. “I think it diminishes its importance to say this is the counterpoint to gun control. It’s not.”

The gun-control debate is both a blessing and a curse for mental-health reform backers.”

–Washington Post

The White House’s call for a $500 million investment in mental health is an important step toward helping Americans with mental health issues. Specifics on the content of this investment and Congressional approval will be key in the near future. Attempts to bolster the background check system for gun control with regard to mental health problems will need to be closely monitored and guided by research and science.

Continued efforts to destigmatize mental illness are vital to the improvement of the mental health system. More support and treatment for individuals with mental illness will benefit all Americans.

Overall, mental health reform is desperately needed, regardless of the potential effects on rates of gun violence.