Nearly three years after a deeply disturbed man killed 26 children and adults at an elementary school in Connecticut — and as mass shooting events continue to plague the country — Congress still struggles to reform the nation’s system for diagnosing and treating the mental illnesses that may play a part in the carnage.
A major mental health overhaul bill offered in the weeks following the shootings sits in a House committee, hamstrung by opposition from some mental health treatment experts, privacy advocates and legislators.
Similar comprehensive mental health bills have languished since the Sandy Hook Elementary School massacre, frustrating the mental health community and some politicians.
“We have failed miserably to respond to the need to do much more in the way of mental health treatment,” said U.S. Rep. Emanuel Cleaver, a Missouri Democrat.
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That may be changing. Thursday, in the wake of the shootings in San Bernadino, Calif., and at a Planned Parenthood clinic in Colorado, House Speaker Paul Ryan urged more action on the overhaul legislation. “What we have seen is a theme of mental illness,” Ryan said on CBS. “We need to fix our mental illness laws and policies. They’re outdated.”
Still, the slow pace of reform may become a political problem for Republicans, who have argued that improving mental health treatment is more likely to prevent mass shootings than gun control. But it’s also a continuing concern for mental health experts, including in the Kansas City area, who say the system for treating mentally ill patients remains an underfunded, understaffed hodgepodge of law enforcement, jails, community centers and hospitals.
And, they say, politicians and the public may have moved on since Sandy Hook, making meaningful reform less likely.
“What we end up getting is a lot of media attention at the time,” said Guyla Stidmon, executive director of the National Alliance on Mental Illness of Greater Kansas City. “Then the next crisis comes up.”
Some House Republicans think the criticism is unfair. There is bipartisan support, they say, for a bill offered by U.S. Rep. Tim Murphy, a Pennsylvania Republican, that would increase grant funding for mental health treatment, allow earlier intervention for younger patients and create a new assistant secretary for mental health and substance use disorders.
A House committee is expected to take up the plan early next year.
“Denial does not deliver care and ignoring mental illness is not a treatment,” Murphy said in a statement in early November. He introduced similar legislation in the weeks after the Sandy Hook murders, claiming Washington spends $130 billion annually on mental health programs to little effect.
An estimated 26 percent of Americans suffer from a mental health condition in any given year.
Numerous psychiatric groups have endorsed Murphy’s measure, and it has more than 150 co-sponsors in the House, including U.S. Reps. Sam Graves and Vicky Hartzler of Missouri, both Republicans. It has passed a House subcommittee, and a similar bill has been introduced in the Senate.
But progress has been stalled by a coalition of liberal and conservative lawmakers worried about different parts of the bill.
Some conservatives think it costs too much — an estimated $46 billion to $66 billion over 10 years, according to the Congressional Budget Office.
Liberals have a longer list of concerns. The bill could lead to more involuntary outpatient commitments to underfunded mental health facilities, they say, and could potentially violate the privacy rights of some patients.
“This bill … is really based in an ignorant and fear-based approach to mental health reform,” said Leah Harris of the Campaign for Real Change in Mental Health Policy, an advocacy group. It “keeps the public and policymakers distracted from understanding the root causes of gun violence.”
On the website Mad in America, which calls itself “a resource and a community for those interested in rethinking psychiatric care,” blogger Noel Hunter claims the bill “threatens not only the civil liberties of individuals labeled as mentally ill, but it could also ultimately be detrimental to our society as a whole.”
Some lawmakers also seem wary of the proposal. U.S. Rep. Kevin Yoder, a Kansas Republican, is a co-sponsor of the Murphy measure, yet seemed reluctant this week to enthusiastically support it.
“I don’t think the federal government can solve, on its own, these challenges,” he said. “We need a top-to-bottom review of mental health programs.”
Cleaver said he understood the concerns about privacy and cost, but the Murphy measure may be better than doing nothing.
“It’s going to cost money,” he said. “We need to get away from this idea that we can create the society we want and deserve, and want to pass on to our children, completely cost-free.”
The messy politics of the comprehensive bill have led some lawmakers to conclude it has little chance of passing a divided Congress that’s distracted by the coming election. Sen. Roy Blunt, a Missouri Republican, said he is more encouraged by a more incremental approach he helped push through a year ago.
That measure — passed as part of the bill that fixed payments to doctors under Medicare — will provide federal grants to some states to defray more of the costs of treatment at community mental health centers. In October, Missouri received nearly $1 million to begin preparing its grant request for the two-year pilot project.
“We need to show here that behavioral health can be treated just like all other health problems, and government should recognize that,” Blunt said.
The grants could provide an extra $1 billion for mental health treatment, “the biggest federal investment in mental health and addiction services in generations,” according to the National Council for Behavioral Health.
At the same time, Blunt and almost all other Republicans firmly reject the expansion of Medicaid in the states. Mental health advocates in Kansas and Missouri believe expanding that insurance program for the working poor would allow greater access to voluntary mental health treatment in community centers across both states.
Neither state is likely to expand Medicaid in the next few years.
Some advocates and lawmakers are angry that Congress has shown the ability to move quickly on some issues when it wants to. The House voted to severely restrict refugee immigration from Syria and Iraq just days after the Paris shootings, they point out, yet three years after Sandy Hook there has been relatively little progress on mental health treatment or gun restrictions.
“Not a single Syrian refugee has been put on trial, convicted, accused of anything,” Cleaver said, yet there have been nearly 1,000 mass shooting events in the United States since the Sandy Hook killings in 2012.
Despite that frustration, some in the mental health treatment community believe there is momentum for additional federal resources for treatments and patients, perhaps as early as next year. Even incremental steps can make a difference, they say.
“The system has been so neglected and so scattered for so many years,” said Rick Cagan, executive director of the Kansas office of the National Alliance on Mental Illness. “On a day-to-day basis, in the trenches, the struggles families face … are so severe that any help from the federal level is going to be positive.”
But, he said, the additional money “won’t be enough.”