(MintPress) – With more than 8,500 gun-related homicides each year in the United States and 270 million firearms in circulation, the raging national gun debate has focused on legislating firearm restrictions in the wake of the Sandy Hook school shooting. The taboo mental health issue remains on the periphery of discussions relating to gun violence, as millions suffering from undiagnosed but completely treatable illnesses go without care.
Enforcing the late Senator Paul Wellstone’s (D-Minn.) mental health parity requirement would help an estimated 80 million Americans suffering from mental illness receive the mental health coverage they require at little to no cost to private insurance companies, a shift that is desperately needed in a country plagued by mental illness and general malaise.
No single policy is the panacea for the gun violence pandemic, but mental health experts believe that requiring insurance companies to treat mental illness the same as physical illness is long past due.
Wellstone’s advocacy for mental health parity
Following the December 2012 Sandy Hook massacre resulting in the deaths of 26, President Obama issued a set of 23 executive actions encouraging Congress to immediately address the epidemic of gun violence in the United States.
The National Rifle Association (NRA) and other pro-gun organizations have focused much energy opposing these presidential decrees in the wake of the Sandy Hook shooting, most dealing with bans on assault rifles and high capacity magazines.
More than 10,000 people demonstrated in Albany, N.Y. on Feb. 28 to protest a state law prohibiting the sale of assault weapons and high capacity magazines. The New York Secure Ammunition and Firearms Enforcement Act resembles the proposals put forth by President Obama, angering many pro-gun advocates across the state.
“The SAFE Act has awoken the sleeping giant, is what it’s done,” said Thomas King, president of the New York Rifle & Pistol Association. “I have never seen the people of New York as incensed as they are over this issue.”
An immediate action that would not infringe upon Second Amendment rights would be a requirement to issue mental health parity, requiring private insurance companies to treat all illnesses, whether physical or mental, equally.
In the January 2013 executive actions, President Obama called upon Congress to “finalize regulations clarifying essential health benefits and parity requirements within ACA exchanges,” and “commit to finalizing mental health parity regulations.”
Federal regulators could enforce Paul Wellstone’s 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) already on the books. If regulations were applied to finalize the requirements for private insurance companies, these essential executive actions could be easily enforced.
For the late Senator Wellstone, mental health was a personal issue because his older brother, Stephen, suffered from bouts of schizophrenia. Wellstone served Minnesota from 1991-2002 as a member of the Democratic-Farmer Labor Party, a progressive wing of the Democratic Party.
The former community organizer and college professor died in a plane crash Oct. 25, 2002 while traveling to attend a funeral in Eveleth, Minn. Among the victims were Wellstone’s wife, daughter, three campaign managers and two pilots. An outspoken opponent of first Gulf War and later, the invasion of Iraq after Sept. 11, Wellstone championed a set of progressive ideals even when voices within his own party pushed for military action.
Working with sympathetic legislators like Patrick Kennedy (D-R.I.) Paul’s surviving son, Dave, helped get the MHPAEA passed in 2008. The bill was signed into law six years after Wellstone’s passing.
The legislation closed several loopholes in the previous 1996 Mental Health Parity Act, also championed by the late Senator Wellstone. The 1996 bill made it more difficult for insurance companies to put annual or lifetime caps on behavioral treatments.
This was an important step forward for millions suffering from substance addiction who are now able to receive coverage for 30-60 days in rehabilitation facilities, depending upon the mental health condition and the insurance provider.
Previously, the standard stay for alcoholics and drug addicts in rehabilitation facilities was just seven days. Even under the best care, it is impossible to cure an individual of drug or alcohol addiction in such a short amount of time.
After Sandy Hook, some members of Congress feel a new sense of urgency to finalize a set of regulations that would finally put a set of requirements in place requiring that insurance companies apply the same coverage to treat mental illness.
“I’m frustrated. The real problem is that the interim regulations are unenforceable,” said Senator Al Franken (D-Minn.). “We’ve made hundreds of phone calls, written letters, but on the question of whether or not the intent of the law has been carried out, the answer is comme ci comme ca,” meaning in part.
By not setting a concrete deadline for insurance companies to adopt the 2008 MHPAEA in full, millions are being denied coverage because there is no set rules governing out of pocket expenses, premiums and other insurance issues yet to be definitively outlined by federal regulators.
The potential impact
The issue should be a pressing one, given the negative impact that utterly treatable mental illnesses are having nationwide. The National Institute of Health estimates that one in four adults experiences a diagnosable mental health disorder, including depression, during his lifetime. In more than 80 percent of cases, clinical depression can be successfully cured if properly treated.
This has a major effect not just on rates of violence, but also in the labor market.
A 2002 study by the National Institute of Mental Health found that undiagnosed mental disorders cost $312 billion in lost wages due to medical costs and disability.
Among the estimated 3.5 million homeless in the United States, large numbers suffer from untreated mental illness, especially veterans of foreign wars unable to receive treatment for post-traumatic stress disorder (PTSD) and other combat-related illness.
The largest private health insurance companies, including United Healthcare have lodged formal complaints claiming that MHPAEA would increase overall costs for insurers and individuals alike. In reality, similar legislation has helped to decrease costs by reducing the number of expensive emergency room visits when there is no comprehensive mental health coverage.
Bill Clinton established mental health parity bill for federal employees in 1999, helping to slightly reduce overall expenses by around 1 percent.
Beyond dollars and cents calculations is a more pressing imperative to help the millions who are suffering from untreated mental illness. Judith Bentkover, Brown University’s executive master of Health Care Leadership Program believes that the issue should be a top priority for legislators.
“The problem is that the bill has yet to be enforced en masse, a measure that would help an estimated 82 million people in need of mental health services, according to the American Psychological Association. Overall, a potential 113 million citizens would receive increased access to mental health care according to SAMHSA, the U.S. government’s substance abuse and mental health branch,” Bentkover writes.
If the issue passes unnoticed it will continue a long history of ignoring the mentally ill, a marginalized population that has remained on the periphery of discussions, mentioned only when legislators consider cutting funding to mental health programs.
This occurred notably when Ronald Reagan was governor of California from 1967-1975. As governor, Reagan began the dismantling of the welfare state by cutting state funding to a bevy of critical social programs, including mental health. These policies led to the release of thousands from mental health clinics, many of whom were not fit to re-enter public life.
In 1959, there were 37,500 in state-run mental health facilities when Edmund G. Brown was governor. This number fell to 22,000 when Ronald Reagan first entered office in 1967 and continued to decrease during Reagan’s two terms.
”Many of those patients who left the state hospitals never should have done so. We psychiatrists saw too much of the old snake pit, saw too many people who shouldn’t have been there and we overreacted,” said Dr. Robert H. Felix, who was then director of the National Institute of Mental Health.
“The result is not what we intended, and perhaps we didn’t ask the questions that should have been asked when developing a new concept, but psychiatrists are human, too, and we tried our damnedest.”
Given the spate of violent acts committed by mentally ill individuals in recent years, the imperative to increase funding for mental health has never been greater.
Gun violence and mental health
The issue of gun violence had been a national issue dating back to the shooting at Columbine High school in April 1999.
In 2011, there were a 8,583 murders involving a firearm. This is a slight decline from the previous year when the Federal Bureau of Investigation (FBI) recorded a total of 8,775 murders involving a firearm in 2010.
Gun violence has continued daily and remains a national problem, especially for cities like Chicago suffering from high levels of gun violence in recent years. In eight out of nine mass shootings in 2012, the shooter had a previous history of mental illness. On a broader scale, this contributes to an epidemic of violence plaguing the United States. With strained resources, states have relegated whole populations of mentally ill to the general prison population.
“If you look at this jail, with 38,000 inmates who come through here every year, about one third of them suffer from some form of severe or untreated mental illness, said Richard Stanek, a Minneapolis sheriff in a February 2013 statement.
Stanek, a Republican, is a former state representative who opposes new gun controls but is an advocate for more mental health resources.
Gaps in the background checks allow many mentally ill individuals to purchase firearms legally. Just 12 states submit mental health records to background checks that prevent mentally unstable people from purchasing weapons.
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