In the anguished days following the mass shootings at Sandy Hook Elementary School, President Barack Obama called for a renewed national focus on mental health.
His plea went nowhere in Congress. But states from South Carolina to Oregon have taken up the challenge.
At least 37 states have increased spending on mental health in the year since Adam Lanza shot dead 20 children, six school employees and his mother in Newtown, Conn. It’s not just about money, either. States are experimenting with new — and sometimes controversial — ways to raise awareness about psychological distress, to make treatment more accessible for children and adults and to keep firearms away from those struggling with mental illness.
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Nevada, for instance, is launching a pilot program to screen children in secondary schools for mental health concerns. Texas not only boosted mental health funding by a record $300 million over two years, but required public school teachers and students to be trained in recognizing mental illness. Utah will require school districts to offer parents an annual seminar on mental health, including depression and suicide. Colorado established a 24-hour crisis hotline.
The new initiatives don’t make up for the more than $4 billion cut from state mental health budgets during the lean years of the recent recession. And they weren’t universal: A half-dozen states cut funding on mental health this year, including Louisiana, Maine and North Carolina.
But overall, advocates say they are thrilled at the breadth and depth of the commitments from lawmakers of both parties.
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“Sandy Hook, horrible as it was, provided the impetus for state legislatures to take mental health seriously,” said Sita Diehl, director of state policy and advocacy for the National Alliance on Mental Illness, which recently released a comprehensive report on state actions.
The most contentious measures are laws passed in more than a dozen states that require some reporting of mental health status as part of background checks for firearms purchases.
The statutes vary considerably by state. Connecticut enacted the toughest restrictions. It blocks individuals who have voluntarily admitted themselves to psychiatric hospitals from obtaining a gun permit for six months after the admission. Maryland took similar steps: The state bars firearms possession for anyone who has been involuntarily committed or has stayed more than 30 consecutive days under a voluntary admission. (Those affected can petition for exemptions.)
And New York now requires mental health professionals to report to authorities any patient they believe is likely to cause serious harm to himself or others. Law enforcement can then seize any firearms the patient owns, suspend any gun license he holds and block him from obtaining a license in the future.
Such measures have raised concerns among psychiatrists and psychologists who worry that patients will shy away from treatment or be reluctant to trust therapists.
There’s another concern as well: “To put this into legislation now really creates a misperception, a nonfactual link, that people with mental health conditions are more likely to commit violent crimes,” said Daniela Giordano, public policy director for NAMI Connecticut.
Lanza, who was 20 when he shot his way into Sandy Hook, had been diagnosed with Asperger syndrome as a teenager. A report released last Monday by Connecticut State’s attorney Stephen Sedensky III noted that he had “significant social impairments and extreme anxiety,” and that “he lacked empathy and had very rigid thought processes.” Clinicians recommended medication and behavioral therapy, but Lanza refused both.
The report makes clear though, that none of the mental health professionals who saw Lanza ever thought he could commit such violence. Neither, apparently, did his mother, who worried about his increasingly eccentric behavior and self-imposed isolation — but wrote him a check shortly before his rampage so he could buy himself a pistol for Christmas, the report said.
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Given the difficulty in identifying which patients may turn violent — and the vast number of patients who never pose a threat — NAMI urges states to focus on expanding access to treatment rather than on restricting gun purchases for people who voluntarily seek help, Diehl said.
Connecticut has done both. In addition to the gun control package, the state hiked funding for community treatment teams that fan out seeking people who need help. The teams include peer counselors who have suffered mental illness themselves and can offer very personal advice. The state also passed a law requiring teachers to receive training on children’s social and emotional development.
Perhaps the most innovative approach comes from Minnesota, where the Legislature appropriated an extra $17.2 million in funding over two years for a fledgling network of clinics that provide mental health treatment for children — even children without insurance — right at their schools. The clinicians provide treatment during or after the school day, which saves parents from having to take time off work and find transportation to therapists’ offices. They also collaborate with teachers to address behavioral issues in the classroom.
The funding boost will support as many as 135 public school clinics in Minneapolis, up from 25 this year, said Mark Sander, the clinical psychologist who runs the program in Hennepin County. It also will greatly expand services in rural areas.
Sander has no doubt the new clinics will be busy. At least 20 percent of children seen to date have been diagnosed with such serious emotional disturbances that they are at risk of being hospitalized — yet they have never received mental health care. The school setting allows them to get regular counseling, week after week, with far fewer “no shows” than is typical in high-poverty urban environments, Sander said. “Families are really grateful,” he said.
Another novel approach comes from South Carolina, where the state increased mental health spending by $20 million this year in addition to a $17 million boost last year, in part to expand telepsychiatry services that let psychiatrists consult virtually with medical staff and patients in rural communities.
“With the stigma around mental illness, [lawmakers] tend to look the other way until a tragedy like Sandy Hook … calls their attention to it,” said Geoff Mason, deputy director of mental health services for the state.
On the federal level, Congress did little this year other than hold hearings. An amendment to the Manchin-Toomey gun control bill would have boosted funding for mental health, but the bill went nowhere.
Advocates hope for more progress this year by separating mental health funding, which has fairly broad bipartisan support, from the far more volatile issue of gun control.
Sens. Tom Harkin (D-Iowa) and Lamar Alexander (R-Tenn.) have promoted efforts to bring more mental health services to schools, train first responders to recognize mental illnesses and increase funding for community mental health centers. The House could take up similar bills within the month, under the leadership of Pennsylvania Republican Tim Murphy, according to Andrew Sperling, NAMI’s director of legislative affairs.
As for the administration, it cites as a signature accomplishment regulations requiring private health insurance plans to cover mental health services at parity with traditional medical coverage. Obama also launched a website to raise awareness of the issue, mentalhealth.gov.
The site lists dozens of states, cities and civic organizations that are taking up the president’s call to launch a national conversation on mental health, from Texas State University, to the Urban Libraries Council, to the Eisenhower Presidential Library and Museum.
Several are promoting a social media discussion of mental health on Thursday, to be organized under the hashtags #TextTalkAct and #MentalHealthMatters.
Advocates are motivated to keep pushing for conversation and legislation by the perpetual “what ifs.”
“If someone, anyone who interacted with Adam Lanza could have said, ‘There’s something very wrong here’ and gotten him the help he needed …” Sperling said.
He didn’t have to finish the sentence.
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