Republican and Democratic lawmakers are struggling in the heat of the 2016 campaign to find new ways to help treat millions of long-neglected mentally ill Americans.
While the two parties are light years apart on Obamacare and health care reform more generally, they are eagerly seeking common ground on mental health issues in the wake of numerous mass shootings over the last few years.
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Republicans argue that gun-related violence can best be addressed through increases in mental health programs and spending, rather than by toughening gun-control laws. “We have seen consistently that an underlying cause of these attacks has been mental illness, and we should look at ways to address this problem,” House Speaker Paul D. Ryan (R-WI) said recently.
President Obama and the Democrats agree that it is essential to revamp the federal mental health system to begin to address increased violence and mass shootings in the country. But Democrats also feel strongly that the gun laws, especially regarding background checks of gun purchasers, should be addressed in tandem with the mental health proposals -- and that could prove to be a major sticking point.
“If we’re looking at the gap between the parties, Democrats are very fearful that Republicans are going to use the mental health issue to basically say, ‘See, we’ve done something about guns,’” Norman Ornstein, a congressional scholar with the American Enterprise Institute, said on Tuesday. “They’ve got a point, certainly. But if the idea is that you basically kill action on a bill because some people are going to use it as traction on the gun issue, it’s pretty unfortunate.”
While the federal government spends an estimated $130 billion a year on more than 100 mental health programs, the mental health treatment system is most notable for its glaring deficits. The House Energy and Commerce Subcommittee on Oversight and Investigations calls it a “chaotic patchwork of antiquated programs and ineffective policies across numerous agencies.”
For instance:
- More than 11 million Americans suffer from severe schizophrenia, bipolar disorder and major depression, by some estimates, yet many go without treatment as their families struggle to find affordable care. There is a shortage of nearly 100,000 psychiatric beds nationwide, in part because of outmoded restrictions on Medicaid spending.
- Prisons and jails have long been used as dumping grounds for profoundly mentally ill people, which has led to unspeakable abuses, neglect and deaths. According to a report by CBS’s Sixty Minutes, the mentally ill now make up more than 40 percent of the inmate population in New York City’s notorious Rikers Island prison.
- Federal privacy rules often prevent family members of mentally ill patients from obtaining needed information from doctors and hospitals about the condition and treatment of their loved ones.
- There is no federal mental health czar or top level official to coordinate the work of federal and state programs.
Members of Congress ranging from Sens. Christopher Murphy (D-CT), Lamar Alexander (R-TN), Al Franken (D-MN) and John Cornyn (R-TX) to Rep. Tim Murphy (R-PA), a trained psychologist, and Rep. Eddie Bernice Johnson (D-TX) have offered a wealth of ideas on how to proceed.
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Tim Murphy and Johnson, for instance, have advanced legislation that would consolidate federal mental-health programs under a single assistant secretary; spend more to expand treatment services; and reform commitment procedures to better target the most severe and potentially dangerous cases.
The bill would also eliminate an anachronistic Medicaid Institutions for Mental Disease (IMD) exclusion dating back to the mid-1960s. That provision strictly limits the use of Medicaid to cover the treatment of people with mental illnesses and drug addictions in residential facilities.
Many of the legislative proposals from both sides of the aisle and both chambers are complicated and controversial, especially over issues of federal privacy restrictions on doctors in discussing their patients’ conditions with family members. And the various proposals have pitted mental health advocacy groups against one another.
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Sen. Chris Murphy, a Connecticut freshman who took office shortly after the Sandy Hook shootings, sponsored a bill similar to Tim Murphy’s measure in the House. But it has been significantly watered down in the Senate Health, Education, Labor and Pensions Committee (HELP) and lacks many of the features of the House bill, including a provision addressing the limit on the number of hospital beds eligible for coverage under Medicaid.
Champions of mental health reforms are hopeful a compromise can still be worked out to make the Senate version palatable to the House. But there is another obstacle to passage of legislation this year that won’t be as easy to overcome.
Democrats have pressed for consideration of new gun control measures as amendments to the new health reform legislation, despite strong opposition from Senate Majority Leader Mitch McConnell (R-KY).
The Morning Consult reported last week McConnell and other Senate GOP leaders are determined to oppose bringing a bill to the floor this year if it means that vulnerable GOP senators up for reelection would be forced to vote on controversial gun amendments before the November election.
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Democrats nonetheless have been aggressive on the gun issue, and appear bent on forcing votes whenever possible and “keeping up a steady stream of passionate floor speeches about gun violence,” according to Morning Consult.
“This bill is not a gun issue, it’s a mental-health issue,” Tim Murphy, the House member, told The Washington Post earlier this year. “I think it diminishes its importance to say this is the counterpoint to gun control. It’s not.”
A spokesman for McConnell said last week that no decisions have been made yet on the timing of bringing the mental health legislation to the floor, nor whether gun control amendments would be made germane.
For now, agreement on the first major rewriting of federal mental health legislation in a half century seems a long-shot at best, yet some believe the two sides will come together, either before the election or during a lame-duck session in late November or early December.
John Snook, the head of a non-partisan group that fights for legislative reforms of programs that help mentally ill Americans, said last week that until recently he was highly skeptical that Congress could wrap its arms around an issue so complex and approve major legislation this year.
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However, in the past several weeks, he said, House and Senate Democratic and Republican players have begun talks that could potentially lead to new landmark legislation before the end of the year.
Just as the epidemic of heroin and opioid drug abuse has captured the attention of millions of Americans, mental health issues have captivated the concern of lawmakers from across the country in the wake of the mass shootings at schools, colleges, churches and the workplace.
“Honestly, before these discussions, I probably would have told you that we were at a point where things were just too polarized and too broken,” said Snook, the Executive Director of the Treatment Advocacy Center in Virginia. “But you now have members of Congress – representatives and senators – who typically aren’t talking about any other issue, but they are having conversations on these mental health issues. And I’m really optimistic that we’re getting things done.”
