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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.)

You're correct Doctor. And if you were thinking that your column would dissuade people from trying to fix the mental health system and instead crack down on guns, it didn't work. At least not for this guy. I don't care how much it costs - we should do it. Because in the end it'll do a heckuva lot more to curb gun violence that banning guns. Are you listening Republicans who don't want gun control?!?!?!?! Put your money where your mouth is!!!

Jim, mental illness is huge part of many problems. I do not see how we do a great deal than is being done with the current system - just not enough MH workers. So how can we change the system to meet more needs? I believe we need more willing souls as MH workers. The Psychs & Phys are just not enough. Not unlike the military manpower system, I think a "force" of MH workers could be one piece of the solution. Like the military with generals, major, Lts all the way to privates - we could MH workers with MD/PhD/MSs/BSs and then on to trained civilian staff. Of course, you would not give the civilian staff criminal schizophrenics is crisis but distribute the needs of folks to the capabilities of your team. People who get well enough to just need someone to talk to or reinforcement of care plans by professionals could be a good match. We need a much larger team and (metaphorically) we do not need need a 747 pilot on every plane leaving the airport. Yes, its a radical change but the system is inadequate. On the topic of tracking illegal weapons; doctor - stop & think about that a for a moment. if the criminal justice system could know about could know about all illegal activities - there would not be much of crime problem. Who is telling you to be more afraid of a law-abiding citizen with a weapons than assailants, rapist and murders? Why are they trying to sell you that message. "Don't look over here - look at the shiny moving thing over there...."

Of course the doctor is correct. It will never happen, though, because the only purpose for raising the mental health issue is simply to deflect attention away from any attempt to enact stricter gun control laws. That's all. The NRA doesn't care a whit for improved access to mental health care. All it wants to do is to change the subject. I hope that some of our regular anti-gun control commenters will chime in and prove me wrong by showing that they take the need for improved access to mental health care so seriously that they would be willing to pay more for their health insurance or to support a single-payer system so that the care that Dr. Fieseher describes could be made more generally available.

Last time I checked Publius many of us are already paying 40% more for our insurance since the ACA started. That includes folks on fixed incomes. Where would you suggest we get the money?

There'd be enough money if we switched to single-payer. As we all know, we pay 2-3 times as much as most other westernized countries for our health care.

No..you are wrong. There would NOT be enough money. Think about it for more than a second.

Maybe we would, maybe not. Either way we'd have more people with better coverage than with the current system. What's your solution?

Simply amazing..."There'd be enough money.."..."Maybe we would, maybe not."....Amusing.

Gen-x-er. Ah yes the panacea of a single payer HC system. Talked with a Canadian Pain Doc recently. he stated their HC system but it now takes 3yrs to get an appoint at his clinic in a large metro city. "3 yrs sez I" with incredulity in voice), "You mean 3 month?" "No sez he - 3 yrs" He went on to say all that could afford to, came over here for care. would we want a clearly 2-tiered HC system. One for the rich and another for everybody else? This is where the rubber meets the road re: expectations vs. reality with "universal HC systems"

That was supposed to read, "Our HC systems is free but now takes....."

TCB, we already have a multi-tiered health care system. Those with money or good health insurance get too much care because doctors know they're going to get paid for doing test after test, treatment after treatment. The poor don't get enough health care at all because they don't have insurance or money to pay out of pocket. As far as Canada goes, opponents always site individual cases. In fact, Canadians as a whole are very happy with their system. The idea that they're all coming here for our superior care is a myth.

Gen-x-er, So you are calling that Canadian physician a liar? You are more qualified than he to render that opinion? As to different standards of care based on insurance - another myth. After 30 years in HC, I tell you most providers do not know or do care to look whether a patient is Com Ins, Caid/Care Ins or self pay. Maybe the bean counters but providers are, on the whole, another story. In addition there are very stringent regulations about anything that might even appear as different levels of care. THERE is another myth by the radical left.

TCB--again, I was talking about the health care system of an entire country, not of an individual physician or patient and I think you're smart enough to know that. If you work in health care you probably already know that we pay twice what Canada pays and they have 100% coverage for their citizens with comparable result to us. And Canadians don't lose their life savings or go bankrupt because they had the misfortune to contract cancer or get into a serious accident. Now, if you disagree that wealthy people in the US with top-level health insurance do NOT get better health care overall than those with poor, or no health insurance then we're just going to have to agree to disagree.

Reply to Gen X er...there are options. You can purchase a catastrophic plan so you don't go bankrupt. People are going to have to buy insurance or pay a fine next year. Buy a catastrophic plan now and get used to it.

Reply to TCB below: Wait times in Canada for some procedures are an issue, but one the system is actively working to improve. Overall, Canadians like their system, and find it preferable to ours. A 2011 Gallup Poll found that 57% of Canadians were "satisfied" or "very satisfied" with their health care system. That same question in the U.S. found only 25% having those responses. http://www.washingtonpost.com/blogs/wonkblog/wp/2012/07/01/everything-you-ever-wanted-to-know-about-canadian-health-care-in-one-post/

Bruce, let's put that Canadian poll into perspective. Canada has a population of 34,500,000 and 19,650,000 are happy with their health insurance which means that 15,000,000 people are not. That is a lot of people. Next, the Washington Post link is a blog and it is not credible that out of 300,000,000 people that only 75,000,000 Americans were happy with their healthcare. It sounds like the poll that 90% of NH residents support gun control. If polls mattered, why did progressives not drop Obamacare efforts when 68% of those polled did not support it when it was being crafted? It depends how the questions are asked in polls and how they are slanted. To the comment above from Gen-X, there would be enough money for single payer or because everyone would pay more, your cost would somehow be less than what you pay now. What I find about single payer advocates is that they claim to care about the uninsured but they are really worried about their own tab.

Itsa: I have no ulterior motive for supporting single-payer. Simply put, it the right thing to do. I am extremely healthy and if anything I am one of the "young healthy" clients insurance companies love. But I am very concerned that my health care as well as the health care of my family is tied to my job. It's just asinine. And I bristle at the thought of (some, not all) doctors, hospitals, insurance companies, drug makers and medical devise makers all making fat profits from treating sick people. It's one thing to get ripped off by say, a car dealer because you chose to buy a car and an entirely different thing to get ripped off by a hospital where you didn't chose to get treatment. You got sick and NEEDED it.

Maybe you are not looking for a free ride but the majority of folks supporting single payer want their way paid. Period. I do not agree about employment and insurance. If more companies offered comprehensive benefits and good perks, people would stay longer, be more productive, etc.

So I take that as a "no."

Pub, I guess the NRA makes a convenient bogyman to scare small children. Neither the NRA or its members had anything to do with tragedies. I could the the current resident was the cause with the same force of evidence. Time to look a little deeper. its not the NRA, its violent behavior.

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