My Turn: If the focus is mental health, it’s going to be expensive
The gun lobby and some members of Congress blame the mentally ill for the mass shootings that have plagued our public spaces. They have blocked all reasonable attempts for the government to monitor illegal gun activity and have demanded instead to monitor mental health activity. Many members of Congress fight for the right of all Americans to have access to tactical weapons regardless of their criminal or mental health records, while denying universal access for all Americans to have health care.
If we’re serious about decreasing gun violence through mental health care, then the gun lobbyists and conservative members of Congress had better be prepared to enact some pretty expensive and extensive legislation.
For most of us, health care comes from private insurance at an annual premium cost of about $16,000, usually obtained through our employers. But the vast majority of people with serious mental illnesses cannot get work or maintain work because of their disability. It is rare for a mentally ill person with a non-government-funded job to have one that also supplies health insurance. Some people with mental illnesses are “lucky” enough to qualify for Medicaid or Medicare, but those programs have been scaled back due to budget cuts in the economy. The very politicians who support gun rights are cutting back on those programs that most of our mentally ill depend upon.
Private health insurance does little to address the needs of the mentally ill. For those insurers who do cover mental illness, their policy consists of allowing a co-pay for a small handful of generic anti-depressant medications. A Zoloft prescription may earn an “A” rating from the NRA, but it earns an “F” rating from the AMA. There are millions of Americans with mental impairments who receive little or no medical care because their politicians would rather blame them for gun violence than fix a medical system that can’t afford to treat their illnesses.
We also need to agree on the definition of what constitutes a mental illness. Severely depressed and emotionally disturbed teens have been known to commit violent crimes, so do we label everyone with depression as mentally ill? What about post traumatic stress disorder or Alzheimer’s? There are a whole host of disorders that need to be taken into consideration such as schizophrenia, schizoaffective disorder and even personality disorders such as passive-aggressive disorder and borderline personality disorder.
Then there is the problem of screening people. The only way we’re going to find these illnesses is to screen everyone for them. That means that everyone needs access to affordable health care. Now we’re talking about a universal and single payer system: the only type of health care system that covers everybody and is available in every industrialized nation except the United States. If we are really serious about cracking down on mental illness, then we need to establish routine mental health screenings for all Americans – not just those with jobs.
Once we’ve screened every American and diagnosed those with a mental illness, do we put limits on their rights to own a gun? Who decides when that happens – a doctor, a government bureaucrat, a private insurance company employee or an NRA designee?
Mental illness is a serious problem that has been underfunded and as a consequence, undertreated for years. The overwhelming majority of people with mental impairments are victims, not perpetrators of violence. It is a shame that many guns rights advocates and politicians are using mental illness as an excuse for avoiding meaningful legislation to deter or remove guns from the hands of criminals and gun owners who have abused their ownership rights.
If we’re going to curb gun violence in this country by addressing mental illness, then let’s have all of our lawmakers, both conservatives and liberals, enact the comprehensive and costly legislation to back up their empty words.
(Dr. James Fieseher is a family physician in Portsmouth.)