With Mental Health Legislation Stalled In Congress, States Act
By Kathryn Smith Politico June 2, 2013
States looking to address gun violence are overhauling mental health laws - and sometimes exposing rifts over how to best address the small but serious threat of violence.
There’s not much controversy among advocates when it comes to restoring funding that states had slashed during the economic lean years. But changing policies on involuntary commitment, or requiring therapists to report potentially dangerous patients, are stirring fears that well-intentioned policies could increase stigma and deter the very people who most need treatment from getting it.
“We’re seeing really a regressive response to mental health, instead of proactive,” said Debbie Plotnick, senior director of state policy for the advocacy group Mental Health America.
At the federal level, mental health got tied up with gun control legislation after the Newtown, Conn., shootings in December. That’s stalled in Congress but not in the states. Karmen Hanson, program manager at the National Conference of State Legislatures, said just about every state is looking at some aspect of mental health care, and about two dozen have introduced targeted legislation this year.
But many in the mental health advocacy community worry about a backlash.
“Newtown, for us, was really a double-edged sword,” Bettie Reinhardt, legislative and public policy consultant for the National Alliance on Mental Illness, California, said. “It really does raise the profile of people that need mental health services. On the other hand, it does increase stigma.” Most mentally ill people are not violent; in fact, they are more likely to be a victim than a perpetrator. But some of the horrific mass shootings in recent years have been carried out by people with serious mental diseases, reinforcing stereotypes.
The state bills mostly fall into three broad categories: boosting funding, broadening the rules for court-ordered treatment or commitment, and putting in place duty-to-warn standards for mental health professionals to report patients who could be a threat to themselves or others.
Following the shooting last summer in an Aurora, Colo., movie theater, Colorado lawmakers in May passed a $20 million expansion of mental health services. The state wants to create walk-in crisis centers, a 24-hour mental health hotline, mobile and residential crisis services, and a public mental health awareness campaign.
State Rep. Tracy Kraft-Tharp, a Democratic sponsor of the bill, said Colorado’s mental health program funding had been cut back drastically in 2002 and, until recently, restoring that money had never been a high priority for the state government.
The Aurora shooting, Kraft-Tharp said, “really pushed our governor and pushed our legislature to really make this a priority. I think that helped everybody be aware that something had to be done. Unfortunately, it takes a real tragedy for people to pay attention.”
The recession has taken its toll on state mental health budgets across the country. From 2009 to 2012, states cut their mental health budgets by about $4.35 billion, according to the National Association of State Mental Health Program Directors.
Sita Diehl, director of state policy and advocacy for the National Alliance on Mental Illness, said, “After several years of disproportionate cuts of the public mental health systems at the state level, we’re seeing at least those cuts are halted and, in some cases, they’re reversed. We’re seeing kind of a trend toward restoring the mental health budget and strengthening.”
Responding to the Sandy Hook school shootings, Connecticut lawmakers are considering a bill to improve and increase access to children’s mental health services, with a focus on early intervention.
California, where the budget crises led to deep mental health cuts in recent years, is debating spending more on crisis health services. Wisconsin lawmakers are debating a budget with a proposed $29 million increase in mental health funding.
But the legislatures aren’t looking only at money and community-based services.
New York - the first state to pass a bill after the Newtown shooting last December - enacted gun control legislation in January that includes a “duty to warn” provision for mental health professionals. They must report patients they deem a threat to themselves or others to the county health department. The law also allows police officers to suspend those individuals’ gun licenses and confiscate their guns.
Plotnick said Mental Health America is concerned the “duty to warn” laws can actually discourage people from seeking care. Some of the efforts states are pursuing “are things that make people less likely, not more likely to engage in services,” she said.
New York’s law, she noted, could intimidate certain people who would need mental health services but don’t want to run the risk of having their guns taken away.
Still other states are evaluating their “involuntary commitment” or “civil commitment” laws, which establish the standards by which an individual can be court-ordered to receive mental health treatment. Generally, the current standard is that the person poses an immediate risk to themselves or others. But some states are moving to clarify or review the definitions written into their laws.
Washington state will now allow courts to consider additional information from friends or families when deciding whether to order mental health treatment. Colorado has created a task force to review and redefine existing terms in its civil commitment law.
Mental health advocates are deeply divided over just what the standard should be. Some worry stricter laws will trample an individual’s civil liberties. But other advocates point to cases where families have not been able to get the people with mental illness into treatment - and the ill people ended up harming or killing themselves or someone else.
“This is where we are firmly divided and where we need to come to a higher level of understanding,” Plotnick said.