Tag Archives: mental health

Isabelle Robinson Takes Us To School

Nag Nag Nag.  The kids at Parents Promise To Kids have picked up 9,725 parents and family members for their contract project as of right now.  We can do a bit better. They should break 10K today.  Take a minute to make a difference.

Reading material:

This isn’t recommended reading — it should be required reading.  Isabelle Robinson, a senior at Stoneman Douglas HS speaks to the ill informed suggestion that students are responsible for “making peers feel better,” and thus less likely to commit atrocities.  She’s right.  The “WalkUpNotOut” proposal is a distraction, and for my money a very dangerous distraction.   Let’s agree, if only for the sake of the argument, that discussions about mental health and adolescent issues are a diversion from the very real problem of access to guns.

In the aftermath of the Columbine massacre, (April 20, 1999) in which two very disturbed youngsters hauled firearms, and propane tanks, into their high school with every intention of either shooting or blowing their cohorts to bits, we discussed “bullying” ad nauseam — to the detriment of closing the gun show loophole.  No, the kids at Columbine almost twenty years ago were no more responsible for the actions of the criminals than the young people in Parkland, FL are responsible for the damage done to their lives.  Robinson puts it succinctly:

“This deeply dangerous sentiment, expressed under the #WalkUpNotOut hashtag, implies that acts of school violence can be prevented if students befriend disturbed and potentially dangerous classmates. The idea that we are to blame, even implicitly, for the murders of our friends and teachers is a slap in the face to all Stoneman Douglas victims and survivors.”

Please don’t misunderstand me, anti-bullying programs and rules are positive and useful.  However, never mistake an exercise in victim-blaming for a substantive suggestion toward solving our gun violence problems. Never mistake assigning “mental illness” as the culprit when it’s access to guns that increases the lethality of the incidents. Surely no one is suggesting that teens acquire the nuanced information in the current literature on the subject of violence and mental illness.

“Taken together with the MacArthur study, these papers have painted a more complex picture about mental illness and violence. They suggest that violence by people with mental illness — like aggression in the general population — stems from multiple overlapping factors interacting in complex ways. These include family history, personal stressors (such as divorce or bereavement), and socioeconomic factors (such as poverty and homelessness). Substance abuse is often tightly woven into this fabric, making it hard to tease apart the influence of other less obvious factors.”  [Harvard Health]

If the experts admit it is difficult to analyze and evaluate the factors — obvious and obscure — involved in mass killings, then certainly it doesn’t do to prescribe such a bromide as ‘if you’d only been nicer to  him…’ in the present instances of gun violence.

Of all the assaults on the Parkland, Washington DC, Chicago, Los Angeles (etc) students who spoke so eloquently on the subject of gun violence during the March for Our Lives rallies, none seems more insidious than to suggest that they could have ‘prevented’ the heinous crimes IF they had been proactive little saints.  They are the victims.

Has anyone suggested that the concert attendees in Las Vegas might have been more involved in the mental illness factors contributing to the slaughter on October 1, 2017?  Were the movie theater goers in any way responsible for the shooting in Aurora in July 2012?  Were the church members responsible in any way for the outrageous shooting in Sunderland Springs, TX November 5, 2017? The answer if obviously a resounding “no.”  However, too many people have expended too much wind re-litigating the diversionary arguments of Columbine.  I’d urge a careful reading of Isabelle Robinson’s essay, it’s definitely an “A” grade example of student writing. And, an “A” grade rebuttal to the distraction tactics of the radical gun lobby.

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Murphy’s Law: H.R. 2646 and Mental Health Services

Bill Yes, the Republicans have been diverting attention from the regulation of firearms in America by switching to speaking of mental health; and yes, there’s a bill in the House (HR 2646) which seeks to address some of the issues raised by mass shootings.  However, it’s not “gone anywhere” fast; and, it’s not a particularly good bill.

The title is nice, “Helping Families in Mental Health Crisis Act of 2015” – some of the provisions are helpful, others may very well not be.  The bill does provide for more sharing of information concerning a person who has gotten treatment for mental health problems. Section 401 allows for caregivers to receive information about diagnoses, treatment plans, appointment scheduling, medications and medication related instructions, but not any personal psychotherapy notes. This sharing is intended to protect the health, safety, or welfare of the individual or the general public. Caregivers would also have access to educational records in Section 402.  There’s a fine line here. On one hand sharing information could (and possibly should) enable the caregivers involved to have a better understanding of the person’s condition and treatment plan. On the other there’s an element of concern about how much information is shared with whom – especially since mentally ill individuals are 11 times more likely to be victims of criminal acts than to perpetrate them.  [MHA]

Assisted, Involuntary, Mandatory?

Then there’s the questionable use of the English language in the term “Assisted Outpatient Treatment.”  It sounds like it would have the emphasis on “outpatient,” but the word that should be emphasized is “assisted,” as in assisted by the courts.  “Assisted outpatient treatment (AOT) is court-ordered treatment (including medication) for individuals with severe mental illness who meet strict legal criteria, e.g., they have a history of medication noncompliance. Typically, violation of the court-ordered conditions can result in the individual being hospitalized for further treatment.” [TAC]  There are studies which indicate the AOT plans in 45 states do help relieve some of the stress on caregivers, and often result in a reduction of hospitalization.  Thus, what we’re really talking about here is mandatory outpatient treatment.  Whatever we call it, “assisted,” “mandatory,” or “involuntary” before jumping to any conclusions we might want to determine if “it” works.

The efficacy depends on how we measure success.  If the criteria include  re-arrest rates, program costs, or crime rates, then the AOT plan appears successful in general societal and economic terms. [TAC] On the cautionary side, the Phelan Study (NYC 2010) included ‘184 people who were in AOT and compared them to a control group recently discharged from a psychiatric hospital and were attending the same outpatient facilities as the AOT group. Both groups experienced similar reductions in psychotic symptoms.’  “The AOT group members were four times less likely to report an incident of serious violent behavior than those in the control group,” which would be good news indeed, except that the AOT wasn’t the sole factor.  The Duke Mental Health Study (Swanson 2000) found “improved outcomes and reduced violence was associated with simply more frequent service visits over an extended period of time (6 months or more).” [PsychCen]  In short, time and treatment were the most significant factors.

And now we’re left with a question:  Is the success of the AOT programs correlated to the coercion element, or is the success of the program correlated to the extension of the treatment services over time?  If the latter, then we’d expect to be allocating more funding to the treatment services necessary.  Another question raised might well be on what basis are we justifying our political decisions concerning the implementation and funding for AOTs?  Are we successful if we reduce policing costs? Institutionalization costs? Or do we measure success in terms of the mental health of the patient?  There is, most likely, a place for AOT in our mental health care system, how much emphasis we want to place on it is a political decision.

Politicians and Policy

“On June 4, Congressman Tim Murphy introduced legislation (HR 2646) designed to dismantle the federal mental health authority – the Substance Abuse and Mental Health Services Administration (SAMHSA) – which has successfully promoted recovery and community inclusion for individuals with serious behavioral health conditions for 25 years, as called for by President Bush’s New Freedom Commission on Mental Health. The bill would replace SAMHSA with a new Office headed by a politically appointed government official, controlled by Congress ….” [MHA]

This is the point at which the two familiar bugbears of politics emerge: Congressional Control and Funding.

“Threats of sequestration in 2013 had a significant impact on people’s ability to access mental health services and programs, including children’s mental health services, suicide prevention programs, homeless outreach programs, substance abuse treatment programs, housing and employment assistance, health research, and virtually every type of public mental health support. The Substance Abuse and Mental Health Services Administration (SAMHSA) claimed it alone would be cutting $168 million from its 2013 spending, including a reduction of $83.1 million in grants for substance abuse treatment programs.” [Forbes]

What hasn’t been cut in Congressional appropriations for mental health care support for the states isn’t faring all that well in the FY 2015 budget.  Sometimes it seems that “block grant” simply means a way to pile the money together and then cut the whole stack.  For example, in FY 2013 the Community Mental Health Services Block Grant program received a total of $437 million, in FY 2014 the figure increased to $484 million, but in FY 2015 the final number is $483 million.  One provision in H.R. 2646 would allow only medical professionals with certain academic credentials to evaluate block grant requests – which sounds very “professional” except when we consider that some substance abuse and alternative programs may be very successful, but aren’t necessarily conducted with the imprimatur of currently medically credentialed individuals – critics have charged that this is a perfect way to “ossify” the field of mental health care and substance abuse treatment.

There is an alternative bill in Congress which does not eliminate SAMHSA, and which shares many of the provisions of H.R. 2646, is S. 1945.  A comparison of the two bills is available here in pdf format.  Whether the administrative situation is changed or not, unless the funding for the programs is enhanced, or at least made equal to the inflation rate, it may not matter much who is administering a smaller portion of an already diminishing pie.

It’s The Money Stupid

Enforced treatment, coerced treatment, “assisted” treatment, or whatever we may chose to call it without addressing the need for “time and treatment;” combined with Congressional micro-management, Presidential politics; and, an underfunded by a block grant system, doesn’t seem like the best approach to addressing mental health services in this country.

First, we need to get some perspective.  If SAMSHA has focused on alcohol and drug abuse it’s probably because as of 2013 we had 17.3 million Americans who were categorized as “alcohol dependent,” and some 24.6 million who had used illicit drugs in the previous month before the 2013 survey. [DAgov]  By contrast, government figures estimate approximately 10 million adult Americans with serious mental illnesses. [NIMH]  The focus issue is only important IF we’ve decided we can afford to address one problem or the other, but not both. Focus isn’t an issue if we decide that we can do two things at once and proceed to tackle both.

Secondly, there most likely is a valid social use for mandatory treatment especially for those who cannot or will not voluntarily cooperate with evidently necessary treatment plans, and whose behavior is such that the individual presents, in the hackneyed phrase, a danger to himself or others.  Further, while patient privacy is a legitimate concern, it should not infringe on the needs of caregivers and others with whom a seriously mentally ill comes in contact.   (While we’re on this topic – why not consider additional funding for local police and law enforcement agencies to allow training in dealing with the mentally ill?  If the motto is “Protect and Serve,” then might not allowing police officers to receive limited but significant information about a patient serve to improve their interaction with him or her.)

Third, it doesn’t make sense to argue for increased institutionalization, on a short or long term basis, if there are inadequate facilities available.  For example, in 2010 Nevada had 302 beds for the mentally ill, which is calculated to be approximately 25% of the total need. [TAC] [see also LVRJ 2013] If part of the solution is AOT, and the coercion element is hospitalization, then the hospital beds need to be available.

Therefore, if we are truly interested in making life safer for the general public (witness: mass shootings by mentally ill individuals) and safer for the mentally ill (who are 11 times more likely to be the victims of crimes), then it should behoove us to consider allocating some resources toward creating a system in which (1) there are adequate and easily accessible mental health care facilities and services, (2) there is adequate funding for mental health care services so that these facilities are maintained and expanded as needed, and (3) we are not overly focused on Silver Bullet Solutions, but willing to advance and develop a spectrum of mental health care services which include a wide range of treatment options.

There are some good portions of both H.R. 2646 and S. 1945, and some definite limitations and foibles exposed in each.  What neither bill manages successfully is to fully fund the mental health care needs of Americans in the 21st century.

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One Great Distraction: Guns, GOP, and Mental Health

blood money The GOP response to gun violence in America is getting tiresome, and no diversion or distraction more so than when its members cite “mental health” as a topic for discussion.

The Republican Party really shouldn’t get anywhere near this distraction, not with their record on making mental health care available to American citizens. [AmerBlg]   It doesn’t do to blather on about Guns and Mental Health in one breath and then take 50+ votes to repeal the Affordable Care Act in the next.

Before the passage of the Affordable Care Act about 1/3rd of those who did have health insurance in the individual market had no coverage for substance use disorder to services, and 1/5th had no coverage for mental health services, including outpatient therapy, and inpatient crisis intervention and stabilization.  Additionally, even when a person did have coverage there was no guarantee mental health services would be covered comparably to medical and surgical care.   The situation in the small group market was a bit better, coverage for substance abuse and mental health services was more common, but many states did not have “parity” laws requiring comparable coverage with medical and surgical treatment.  Then, there were those 47.5 million Americans who didn’t have any health insurance, and the 25% of uninsured adults who have a mental health condition, a substance abuse problem, or both. [ASPE]

After the passage of the Affordable Care Act mental health and substance abuse are categories covered as part of the package of Essential Health Benefits.  With the finalization of rules as of January 1, 2014 consumers buying health insurance policies can be confident that the health plan will cover mental health services, and importantly, that there will be parity for mental health and substance abuse treatment coverage. [ASPE]

And what was the Republican reaction?  “Repeal.. Repeal.. Repeal…” at least 50+ times. [WaPo]  

January 8, 2011:  There was a mass shooting in Tucson, AZ  six were killed, eleven others wounded including a member of Congress, Rep. Gabby Giffords.   January 19, 2011: The House votes to repeal the Affordable Care Act.  On February 19, 2011 the House passed an FY 2011 continuing appropriations bill with several amendments to “severely limit” the implementation of the Affordable Care Act. The measure passed with no Democratic support.  Further votes were taken to carve up and diminish the provisions of the Affordable Care Act on March 3, 2011, April 13, 2011, and April 14, 2011.  On April 14, 2011 a House resolution advised the Senate to defund all mandatory and discretionary spending associated with the Affordable Care Act.  April 15, 2011 the Republican controlled House passed its version of the budget repealing and defunding the Affordable Care Act.  During the four months after the Tucson Shooting the Republican controlled Congress spent much of its time trying to defund, limit, or outright repeal the law requiring health insurance companies to include mental health services as an “Essential Benefit” and on par with coverage for medical and surgical treatment.  And, they weren’t finished.  Republicans tried to gut the Affordable Care Act provisions on May 3, 2011; May 4, 2011May 24, 2011; and on August 1, 2011 the Budget Control Act cut some mandatory and discretionary funding tied to the Affordable Care Act.

October 12, 2011:  Eight people were killed and another critically wounded by a shooter in Seal Beach, California.  Ironically, on October 13, 2011 the House passed the “Protect Life Act” preventing any funding from be applied to abortion procedures.  More Congressional incursions were made on the Affordable Care Act on November 16, 2011, December 13, 2011, and December 16, 2011.  On February 1, 2012 Congress voted to repeal a long term care insurance program (CLASS).  February 17, 2012 the House voted to cut funding for Louisiana’s Medicaid program by $2.5 billion, and cut $11.6 billion including $5 billion from the Public Prevention and Health Fund.  The cut to the Medicaid program was significant because Medicaid is the insurance provider for low income people, some of whom might be in need of substance abuse or mental health care treatment.  On March 29, 2012 the House version of the FY 2013 budget called for repealing and defunding the Affordable Care Act.

April 2, 2012:  A former student at Oakland’s Oikos University opened fire in a classroom, seven were killed and three wounded.  The House attacked the Affordable Care Act again on April 27, 2012, and more significantly voted on May 10, 2012 to replace the automatic budget cuts to the Defense Department by defunding and repealing portions of the Affordable Care Act. June 7, 2012 the House voted to repeal the medical device tax, and limit the reimbursements for over the counter medications.  On July 11, 2012 the House voted to repeal the Affordable Care Act.

July 20, 2012: 12 people were killed and another 58 were injured in the shooting at the Aurora, Colorado movie theater.  Yet again, opponents of gun safety regulations noted that the shooting was the result of mental illness.

August 8, 2012: A shooter gunned down six people and injured three others at a Sikh Temple in Oak Creek, WI.

September 28, 2012: Six were killed and two injured in a workplace shooting in Minneapolis, MN.

October 21, 2012:  Three died and four were injured in a shooting in Brookfield, WI.

December 14, 2012:  Newtown, CT; 27 died including 20 first grade children. On December 20, 2012 the House voted once more to replace discretionary spending cuts enacted as part of sequestration by defunding and repealing several provisions of the Affordable Care Act.  On January 1, 2013 the “fiscal cliff deal” passed the House including the repeal of the CLASS Act and cutting funds for the Consumer Operated and Oriented Plan. 

On May 16, 2013 the House voted to repeal the entire Affordable Care Act. 

June 7, 2013: Five people were killed in a shooting incident in Santa Monica, CA which ended on the campus of Santa Monica College.  On July 17, 2013 the House voted to delay the implementation of the Affordable Care Act for employers by one year.  Also on July 17, 2013, the House voted to delay the implementation of the individual mandate.  On August 2, 2013 the House voted to prevent the IRS from implementing or enforcing any portion of the Affordable Care Act.

September 16, 2013:  12 were killed and 3 injured in a shooting at the Washington, DC Naval Yard.  On September 20, 2013 the House voted to approve a short term FY 2014 continuing resolution in which the Affordable Care Act was fully defunded, including the prohibition of all discretionary and mandatory spending, and rescinding all of its unobligated balances.  On September 29, 2013 the House voted again to repeal the medical device tax, and to delay the implementation of the Affordable Care Act by another year.  September 30, 2013, the House voted to delay the individual mandate, an action which would effectively render the law inoperable.

Votes were taken in the House on October 17, 2013; November 15, 2013; January 10, 2014; January 16, 2014, March 5, 2014 to weaken the enforcement of the Affordable Care Act.  More such votes were taken on March 11, 2014; March 12, 2014; and, March 14, 2014. [LAT]

April 2, 2014: Three were killed, sixteen injured in Fort Hood, TX, scene of a previous shooting in 2009.

On January 28, 2015 Rep. Bradley Byrne (R-AL) introduced H.R 596, a bill to repeal the Affordable Care Act.  The measure passed the House on February 3, 2015. [RC 58]*

May 23, 2015: Six dead, seven wounded in Isla Vista, CA. June 18, 2015: Nine dead at the Emanuel AME Church, Charleston, SC.  October 1, 2015: Nine dead, nine injured in Roseburg, OR.   Meanwhile, the Huffington Post asked Senators what might be done about the carnage:

“If there’s one issue that these senators wanted to talk about when asked about gun violence, it was the mental health component. Nearly all of those who were interviewed said their attention is on that aspect of the problem, instead of on gun laws.

“What I’ve been focused on, and I think it very much relates to, unfortunately, too many of these mass shootings, is improving our early intervention mental health system,” said Sen. Kelly Ayotte (R-N.H.). “Hopefully we can take some immediate action and find common ground.” [HuffPo]

Improving our “early intervention mental health system?”   What appears to be more than slightly inane (if not outright insane)  is to believe that repealing the Affordable Care Act — such that we cannot assure health insurance coverage for substance abuse and mental health problems, on par with coverage for medical and surgical treatment – is going to augment our attempts at “early intervention,” – or for that matter, for intervention at any stage.

Unless, and until, the Republicans are willing to stop trying to repeal the law that requires mental health treatment coverage as part of an Essential Benefit package, and stop attempting to repeal the provisions saying that the coverage must be on par with other medical and surgical treatment benefits, the noise about “doing something about mental health” is just that – a distracting noise.

Unless, and until, the Republicans are willing to put legislation into the hopper (and bring it to the floor for a vote) increasing (1) federal support for mental health care services, and (2)  increasing the number of low income people in the Medicaid program who have access to expanded coverage, then they’ll have to pardon those who say the “mental health” rhetoric is a hollow, shallow, attempt to distract the nation from any serious and substantive discussion of gun violence as a public health issue.

References: Congressional Research Service, “Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act, July 8, 2015. (pdf) Los Angeles Times, Deadliest Shooting Rampages, October 1, 2015.  Washington Post, House has voted 54 times in four years on Obamacare,” March 21, 2014.  AmericaBlog, “Republicans are using mental health as an excuse to do nothing about gun violence.” October 6, 2015.  International Business Times, “Republicans’ Mass Shooting Response Focuses Not On Gun Control But On Mental Health Reform,: October 5, 2015.  Huffington Post, “Despite Mass shootings, Republicans won’t touch gun laws,” October 6, 2015.

*Nevada Representatives Amodei, Hardy, and Heck, voted in favor of H.R. 596.  Representative Titus voted no.

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Don’t Rush In: Limbaugh’s Unfortunate Mental Health Advice

I usually avoid Rush Limbaugh for the misogynistic racist and irrational person that he is, however when he launches one of his patented rants on mental health issues there’s a reason not to merely push the radio button and make him go away — there ought to be some push back. About 22 hours ago Mr. Limbaugh offered the following commentary on the unfortunate death of Robin Williams:

“He had everything, everything that you would think would make you happy.  But it didn’t.”  Now, what is the left’s worldview in general?  What is it? If you had to attach not a philosophy but an attitude to a leftist worldview, it’s one of pessimism and darkness, sadness.  They’re never happy, are they?  They’re always angry about something. No matter what they get, they’re always angry. ” [link]

Aside from being a mis-characterization of liberal philosophy which conveniently conforms to Mr. Limbaugh’s performance art form, this is about as bad as commentary on depression gets.

First, if Mr. Limbaugh’s advice — just be a conservative and you’ll be happy — were correct we’d not see depression clouding the lives of conservative friends and families, but unfortunately depression doesn’t respect party lines or economic boundaries.  While it may be associated with some groups more than others, the disease doesn’t leave any subset unscathed. [NHI]

Depression ChartSecondly, and perhaps most egregiously, Mr. Limbaugh gives every appearance of advising that should a person want to avoid this mental illness all that’s required is a change of political philosophy.  This is entirely too close to the “Snap Out Of It” school of really poor advice.

A person may be angry, or sad, or pessimistic, or in grief; these are simply emotions associated with everyday life on this planet.  Depression isn’t periodic sadness, or situational grief, or even temporary anger — it’s a debilitating mental disease which leaves the individual feeling helpless and hopeless…for weeks, or months, or years.

Instead of listening to Mr. Limbaugh’s misinformation, there are better sources of intelligent discussion about mental illness and depression specifically.  Why not begin with the NIMH site?  Continue on to their definitions and discussion page. There’s better information from the DBSA than you’ll find listening to a right wing radio host.  Want to find out how prevalent depression is in your area? The CDC has some answers for you.  Less interested in statistics than symptoms? The Mayo Clinic offers still more information for you, and discusses the symptoms in greater detail.

No matter what credible medical source of information a person seeks in order to advance his or her understanding of this disease, which may affect some 14 million Americans, it would have to be better than that from a radio host with a reputation for artificially categorizing all things human into a matrix of all things political.

 

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Two Women who are worth more than 40 Senators

GunsApril 16, 2007:  A young man diagnosed with a severe anxiety disorder went on a rampage at Virginia Tech University, killing 32 people and wounding 17 more.

July 20, 2012:  A mentally ill young man entered a movie theater in Aurora, Colorado armed for combat — with innocent movie-goers.  He left 12 individuals dead, and 70 others wounded.

December 14, 2012: A young man with a personal history of emotional problems entered the Sandy Hook Elementary School, Newtown, Connecticut, and killed 20 children and 6 staff members.

In each of these three deadly incidents the person initiating the horror had a history of mental problems.  NRS 202.360 seems to be clear about those who have serious psychiatric problems being among those classified as prohibited from the ownership of firearms, as in someone who “Has been adjudicated as mentally ill or has been committed to any mental health facility.” But wait? What is adjudication?

Adjudication is: “The giving or pronouncing a judgment or decree in a cause; also the judgment given.”  Who pronouns a judgment or decree? — a judge.  The commitment, we can assume, might be either voluntary or involuntary, and if involuntary comes with a requirement for the respect of individual civil rights. [NRS 433.471-472]  In short, the loophole in Nevada law is that a seriously ill individual may retain his or her “right” to the possession of a firearm unless there is a court order on record.

This is tricky territory.  Nearly all mentally ill individuals are NOT violent.  However, we probably need to thank Jill Schaller of Reno, Nevada for preventing a tragedy when she found out her son, who had once been committed for mental health treatment, purchased a gun from a Reno police officer.  Remember this part of the story?

“The young man told his parents about the gun purchase while on a vacation in Southern California last week. He promised to give the gun to his parents when they returned to Reno on Sunday night.But on the flight home, he texted Conklin, saying his mother was upset. Driving home, Schaller said, Conklin called and said she was sorry and that she was “not aware that you did not want a gun in your house.” Conklin offered to buy it back, but when they arrived home, Schaller said her son grabbed the gun and ran out the back door, so she called 911.” [RGJ]

The sale was “private” therefore under Nevada statutes no background check was required.  However, the sale was still impermissible under the provisions of the Nevada Revised Statutes — the young man had been committed for mental health treatment.  The terror Mrs. Schaller experienced when making that 911 call  might have been prevented if Governor Sandoval had not vetoed SB 221 on June 13, 2013. (pdf)  A background check could have discovered, should have discovered, that the young man in question was not one who should be in possession of a firearm.

Governor Sandoval, citing 2nd Amendment protections, and “undue burdens” on gun sellers, sided with the National Rifle Association and put his veto stamp on SB 221 which would have made a background check mandatory.  Jill Schaller prevented a tragedy, nothing Governor Sandoval did served to prevent any negative outcome.

August 20, 2013: The unspeakable almost happened in Atlanta, Georgia. There but for the calm courage of Antoinette Tuff, the McNair Discovery Learning Academy could have ranked with Sandy Hook Elementary in the sad litany of school shootings.  Instead, a mentally ill young man was calmed and mollified by a quick thinking, compassionate school employee.

September 16, 2013: Washington, D.C.

“A gunman killed a dozen people as the workday began at the Washington Navy Yard on Monday, creating an improbable moment of horror at a military facility with armed guards at every gate and leaving investigators seeking clues about what spurred the attack.

The FBI identified the shooter as Aaron Alexis, 34, of Fort Worth, who in 2011 received a general discharge from the Navy Reserve, a designation that usually signals a problem in his record. Alexis was arrested but not charged in a gun incident in Seattle in 2004 but still had a security clearance with a military contractor that allowed him access to the Navy Yard, officials said.”  [WaPo]

We don’t know why Mr. Alexis went on this latest workplace rampage.  What we can say is that a disturbed individual brought firearms into a workplace, and used them, on 12 innocent people to deadly effect.

And, now we’ll hear it all again.

The old bromide: “Guns don’t kill people, people kill people.”  Yes, and armed people do kill other people.  In fact, guns have killed 8,236 people have died by gunshot since the Sandy Hook tragedy. [Slate]

The old excuses: “It’s violent video games.”  Interesting, but young people in Japan, the United Kingdom, Sweden, etc. play video games, but we’re the one country with the singularly highest death by gun fire on this planet.

The older excuses: “It’s mentally ill people!” No, actually it’s not most mentally ill individuals.  Most mentally ill people aren’t violent — either to themselves or to others.  But what happens when mentally ill people have easy access to firearms — and don’t have a concerned parent in the immediate vicinity to prevent the acquisition of a gun?

The latest excuse:  “The Constitution preserves everyone’s right to bear arms.”   Extrapolated to the extreme, and some folks are perfectly willing to take it there, “we” have a right to the armaments of war.  Do we wait until there is a mass market for shoulder fired missile launchers before we draw the line?  At what point does good old fashioned common sense limits on the acquisition and possession of firearms kick in?

The old distraction dodge: “But, but look…there are more murders in Chicago…”  Yes, and we could be helping to prevent those, too, by enacting gun trafficking laws helping the cities like Chicago and New York rein in the importation of stolen and purchased guns from states with few if any common sense regulations.

There are answers for these excuses.

The American Public Health Association published a peer reviewed study with some not-surprising results:

“Gun ownership was a significant predictor of firearm homicide rates (incidence rate ratio = 1.009; 95% confidence interval = 1.004, 1.014). This model indicated that for each percentage point increase in gun ownership, the firearm homicide rate increased by 0.9%.

We observed a robust correlation between higher levels of gun ownership and higher firearm homicide rates. Although we could not determine causation, we found that states with higher rates of gun ownership had disproportionately large numbers of deaths from firearm-related homicides.”

When a scientific piece of research says things like “robust correlation” we should be taking the findings seriously.  Seriously enough, that we ought to be taking the antics of the radical  gun-enthusiast crowd who’d like to recall State Senator Justin Jones [NYT] because of his efforts in SB 221.

Nevada doesn’t need any replication of Virginia Tech, nor is a repeat performance of the Aurora movie theater disaster desirable,  no one wants to see another Sandy Hook Slaughter.  We can’t depend on the compassion and eloquence of a school clerk, or upon the determination of a concerned mother for the safety of her son and her community, to resolve our problem.  Especially in light of the fact that we might have taken action to make their lives much easier, less frightening, by enacting common sense limits on the acquisition and possession of firearms.

We certainly don’t need our own version of the horrendous workplace shooting in the Naval Yard.   We could have seen SB 221 enacted.  But Governor Sandoval was more concerned with his rating from the NRA than with the safety of all Nevadans?  We might have seen universal background checks enacted at the federal level, but then Senator Dean Heller (R-NV) and his GOP cohorts successfully blocked the bill.  [HuffPo]

We might have applied some common sense to the issue of gun and weapon purchases — universal background checks, limits on ammunition capacity, limits on the types of rapid fire guns for sale to the general public,  putting the skids to the gun traffickers — but so far we haven’t.   And, we may not until we can summon up the quiet courage of the Atlanta school clerk who discouraged violence armed only with heartfelt empathy, and the unconditional love of a mother who didn’t want her son to hurt himself or anyone else.

We’ll be a better nation when we learn to emulate Antoinette Tuff and Jill Schaller, rather than glorifying the verbal excesses of Wayne LaPierre or the blustering proponents of the Yosemite Sam School of Inter-Personal Relations.

Now have we Had Enough?

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