Four Steps to a Safer Society

Assault RifleDon’t talk to me about “mass shootings are just rare manifestations of mental illness,” unless you intend to offer suggestions concerning how we cope with those suffering from mental illness, emotional problems, or behavioral issues.   I have in mind some notions which seem like sound judgment,  not necessarily founded in any specialized knowledge of the subject.

#1. Adequately fund mental health care services at the state and national level.

Nevada, currently being sued by San Francisco for its dubious practice of “transporting” mentally ill individuals beyond its jurisdiction, [NBC]  has been warned — this from a mental health professional back in April 2013:

“Dr. Dale Carrison, the chief of staff and head of emergency medicine at University Medical Center, is more blunt.  “The mental health system has been broken since I got to Las Vegas 22 years ago,” Carrison said. “There aren’t a lot of options for people. Every time they cut the budget they cut the mental health budget first. We do a very poor job of evaluating them and treating them. At some point, you’ve got to say the state just doesn’t care.” [LVRJ]

Nevada wasn’t (isn’t) alone in its refusal to enact budgets which competently address the problems associated with mental illness and substance abuse.  NAMI issued its 2011 Report (pdf)  citing cuts in California’s mental health services totaled $587.4 million, New York cut its budget by $132 million, Illinois cut $113.7 million, and Arizona cut its mental health care budget by $108.4 million.  Nevada made the list of the largest cuts as a percentage of its total mental health care budget:  (1) Alaska by 35%, (2) South Carolina by 23%, (3) Arizona 23%, (4) Washington, D.C. 19%, (5) Nevada 17%, (6) Kansas 16%, (7) California 16%, (8) Illinois 15%, (9) Mississippi 15%, (10) Hawaii 12.1%.   We ought not take pride in being on this “Top Ten List.”

The situation at the national level isn’t much better.  Already at a parsimonious level, the sequestration of federal funds for non-defense discretionary categories further stretches already strained mental health research and service budgets.  Mental Health America, formerly known as the National Mental Health Association, issued this warning about further cuts to mental health care funding:

“These cuts will be disastrous to communities and individuals living with mental health and substance use conditions. States have already cut mental health budgets by a combined $4 billion over the past three years-the largest single combined reduction to mental health spending since de-institutionalization in the 1970s. Cuts enacted by sequestration are estimated to reduce non-defense discretionary (NDD) funding anywhere from 7.5 to 12 percent across-the-board. Given one in every four Americans lives with a mental health or substance use condition, and more than 67 percent of adults and 80 percent of children who need services do not receive treatment, maintaining discretionary federal funding for mental health and substance abuse services is pivotal to ensure citizens have access to behavioral health care.”  (emphasis added)

What efficacy do we expect from a system in which we have reduced the allocation of resources by the largest amount in the past 3 decades?  There are about 316,000,000 Americans, and if approximately 25% need mental health care or substance abuse assistance then that’s nearly 79 million people in need of help and care.  If at present 67% of adults and 80% of children who need help aren’t getting it now, what makes us think that sequestering funds for services and further limiting the funds available for mental, behavioral, and substance abuse assistance will make the situation any better?

#2.  Improve the record keeping and coordination between mental health entities and law enforcement services.   SB 221 enacted by the Nevada state legislature would have helped, but the NRA beholden Governor vetoed it.   It’s going to take personnel to get this done.  People are going to have to be hired to do data entry, to coordinate information sharing, and to maintain the integrity of the records.  Again, if we’re serious about resolving the problems associated with mentally ill persons securing deadly weapons then this is an expenditure which makes sense.

#3. Implement the provisions of the Affordable Care Act which deal with health insurance coverage of mental health care services.    If we are serious about providing adequate mental health care services to individuals who might hurt themselves or others, then it’s fulsomely obvious that 41 votes to repeal, delay, or defund the provisions of the Affordable Care are patently silly.

The Affordable Care Act requires health insurance corporations to issue policies which cover depression screening for adults and behavioral assessments for children at no extra cost.  Further, coverage for mental health and substance abuse is expanded and given the federal parity protections.  Going a step further, an insurance corporation may not decline coverage for pre-existing conditions, including mental illness.

#4. Enact common sense restrictions on the possession of firearms.   (a) Require background checks for all gun sales.  Legitimate, honest gun dealers already do this. The illegitimate, and dishonest ones need to be put out of business.  There is nothing “onerous” about a background check — it takes a matter of minutes, and if our record keeping systems are functional, then some people who should not possess firearms can be weeded out before they cause injury to themselves or others.  (b) Enact limits on the ammunition capacity.   If I haven’t shot “the burglar” after 15 rounds, the chances are I’m not going to.  The only thing I’m going to accomplish is to do more damage to my property than the erstwhile hypothetical burglar ever dreamed of doing.  (c) Crack down on gun trafficking.  There’s an unhealthy level of profit for people who traffic in stolen guns, and who transport guns both stolen and purchased in states with lax gun sale requirements.  New York City police recently arrested two gun smugglers from North and South Carolina who tried to offload 254 guns into the NYC market. [CNN] (d) Ban the sale of “assault weapons.”  Yes, a person can be killed by a bullet from a single shot .22 caliber gun; BUT weapons which are designed to, or can be easily modified for, rapid fire merely serve to increase the carnage.

A few common sense steps might reverse the trends in this chart from GunPolicy.Org.

Gun Death Chart 2*Alpers, Philip and Marcus Wilson. 2013. Guns in the United States: Facts, Figures and Firearm Law. Sydney School of Public Health, The University of Sydney. GunPolicy.org, 27 August. Accessed 18 September 2013.

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