Like most people around the country I find Newtown, Connecticut in my thoughts and the tragedy of Sandy Hook Elementary School weighing heavily on my mind and heart. And just like everyone else, I find myself at loose ends in wanting to do something about it. Anything. Anything that might help prevent something similar from happening every again. Day in Washington has always been a policy blog and what I know best, what I do best, is policy, whether that is statute, regulation, or judicial law. So I would like to take this space to look at some of the potential legislation and/or policy actions that could be taking that might be steps in a positive direction.
Right now, there is a lot of rhetoric and a lot of high emotions. That isn’t necessarily bad. It is what it is, but to deny our feelings of frustration, anger and grief is a mistake. I freely acknowledge my own bias but am attempting to put forward potential policy responses that accurately reflect reasonable options that could lead to minimizing the chances of a tragedy like this from happening again. Nothing is a guarantee and no law is perfect, but that doesn’t mean we shouldn’t try.
Let’s begin – From a legislative and policy standpoint, historically, most action can be seen in two primary areas: gun control and mental health care. Sometimes they intersect and sometimes they don’t. As my previous experience would seem to overlap most strongly with the mental health aspect, I would like to address that first. It is my hope to examine some of the legislation and policies around gun control such as the Gun Show Background Check Act (S. 35) and the Fix Gun Checks Act (H.R. 1781) in the future, but that will take a bit more research on my end.
This comes up often after mass shooting incidents and the media is quick to label shooters as “crazy” or “suffering from a mental illness” or “autistic.” It is difficult for us to think of someone like us being able to do such horrific things, so it is easier to think of them as “other” or being “broken” or the catch-all term “monster.” The result is stigmatization of people with mental illness who it is believed will “flip out at any time.” Over and over we’re given the research and statistics the highlight how people with mental illness are more likely to be victims of a crime but it doesn’t quite connect with what we see in the media and are told repeatedly.
It could be argued that the lack of mental health supports, social ostracization, and environmental stressors/pressures could, over time, impact someone to the extent they could cold-bloodedly murder children. Meaning that under the right circumstances, more people than we’d like to believe might come to the point where they would break down and do such a terrible thing as was seen in Sandy Hook. Recent efforts to address bullying were launched because of the long term impact on victims – poor grades, emotional trauma and, in a number of cases, suicide. However, there has been poor public, political, and policy response to improving broader mental health services and supports, especially around individuals with significant mental illness. We have a lot of discomfort with the idea that these “others” could be someone like us but for….x,y,z happening. We have a difficult time with the idea that just maybe, we, as a society, make our own “monsters.”
You may agree or disagree with me, but putting that idea aside for now, I’d like to focus on legislation. What are our policy options? What can be done? The legislation below is written to provide supports and services to individuals and families with children and youth with mental health conditions. This isn’t about “locking people away” but really working to improve our societal response to mental illness. There are other bills and other ideas. As always, I encourage you to review the text of the legislation yourself, explore other articles and ideas, and in the end, make up your own mind.
Children’s Mental Health Accessibility Act (S. 3289): This bipartisan legislation would expand the Medicaid home and community-based services waiver to include youth in or at risk of placement in an institution called a psychiatric residential treatment facility (PRTF). Community based services-including mobile crisis services, assertive community treatment, peer supports and supportive housing-are in short supply. While community mental health programs can offer some really great services, often there just isn’t enough funding and resources. The emphasis has been on individuals who are in immediate crisis or those who have been hospitalized many times. We need to look not only at critical care, but at helping people regain stability in their life and prevent them from going into crisis, not wait until they’re spiraling downward.
Mental Health in Schools Act (H.R. 751): This legislation was introduced last year and would expand school-based mental health services for children in grades kindergarten through 12. It allows for a flexible, state-based approach to creating a comprehensive mental health school program and promotes formal collaboration between families, schools, welfare agencies, and substance use and mental health service systems. The bill also encourages schools to incorporate positive behavior supports into their school curriculum. It really looks like a promising bill if it gets the necessary funding and collaboration to make it happen.
(Note From Day on the legislation below) – The K-12 education system does have issues with regard to mental illness and youth. However, compared to the issues faced by young adults who are transitioning to adult systems and college, the difficulties rise astronomically. Many schools do not have comprehensive policies for responding to students with mental health issues or funding to support appropriate mental health services. We want these young people to seek counseling when they feel depressed or overwhelmed or for any other potential crises; and we want them to do so easily and without feeling that they’ll be discriminated against or punished.
The Mental Health First Aid Higher Education Act (S. 3325/H.R. 5996): This bill creates a 5-year demonstration program on 10 college campuses to implement a mental health first aid training program. Basically, public education program that seeks to help faculty, on-campus counseling center personnel, dormitory resident advisers, members of threat assessment and disciplinary committees, coaches and other athletic department employees, and other administrators or personnel identify, understand, and respond to signs of mental illnesses and substance use disorders. The program would teach participants how to interact with a person in crisis and how to connect the person with professional, peer, or other help so the student can avoid more costly behavioral health care down the road and stay enrolled in school. Studies have shown that similar quality programs, when focused on meeting the individual’s needs (versus being used for punitive or discriminatory action) successfully increases assistance provided, increases referrals to professional help, and improves concordance with health professionals about treatment. I’d be very curious to learn more about these other programs.
Mental Health on Campus Improvement Act (H.R. 1833): This bill would assist colleges and universities in successfully attending to students’ growing mental health needs by improving access to mental and behavioral health services on campuses. The legislation would establish grants to eligible colleges and universities to foster a comprehensive approach to campus behavioral health issues, including developing and disseminating best practices and expanding campus mental health services and mental health training.
As for why I’m focusing on schools and colleges, I just want to quote some of the opening facts from the Reducing Barriers to Learning Act of 2011
- School mental health programs improve educational outcomes by decreasing absences and discipline referrals and improving test scores.
- Students who receive social-emotional support and prevention services achieve better academically in school.
- While it is well recognized that mental health directly affects children’s learning and development, in a recent study one-third of school districts reported decreased funding for school mental health services at the same time that two-thirds reported increased need for such services.
- School counseling programs are essential for students to achieve optimal personal growth, acquire positive social skills and values, set appropriate career goals, and realize full academic potential to become productive, contributing members of the world community.
And for legislation addressing adults -
Excellence in Mental Health Act (H.R. 5989 & S. 2257): This bill makes it easier for community mental health and addictions organizations to become Federally Qualified Community Behavioral Health Centers, increasing access to community behavioral health services for all Americans. The bill also improves Medicaid reimbursement for these services. It promises to reduce the use of emergency rooms for routine care and improve the management of chronic health conditions by requiring these centers to partner with primary care providers. Most importantly it will help cultivate a more robust and accessible community mental health and addictions treatment system by requiring specific administrative requirements, reporting standards, and treatment objectives
Additional funding for research: I don’t have specific legislative bills here but mental illness is one of those areas where there is still a vast amount of information we don’t know. We’re still unsure of how the brain works and how various chemicals interact. Different medications are tried and combined and mixed and tested in an effort to address the needs of each individual. We need to be better about this. It impacts millions of people, with some estimates as high as 1 in 5, and has devastating impacts on families, financially, emotionally etc. People with mentall illness, on average, die 20 years earlier than individuals without mental health conditions. This should not be acceptable.
One of the most heartbreaking of issues is around children. Most mental health medication and health interventions were never built around minors, so attempting to address their needs and the needs of their families effectively is an ongoing struggle. What we know about mental illness in adults isn’t the same for children. What kinds of behavioral approaches are most effective? What about the influences of age, gender, school system etc. We just don’t know. And that answer shouldn’t be good enough, not by a long shot.
The president said: “In the coming weeks, I’ll use whatever power this office holds to engage my fellow citizens—from law enforcement, to mental health professionals, to parents and educators—in an effort aimed at preventing more tragedies like this.”
No one holds all the answers. In fact, I think we’re all struggling for any answers. And we may or we may not find them. But in the interim, all we can do is hold each other close, care for each other, and continue work for a better world.
Photo by EssjayNZ