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Mental health care after Newtown

Thirty-six states have increased funding for mental health, but research and services took a hit from sequestration's budget cuts.
On Dec. 21, 2012 a woman kneels in front of a fence with the names of the 20 children killed in the school shooting at Sandy Hook Elementary School in Newtown, Conn.
On Dec. 21, 2012 a woman kneels in front of a fence with the names of the 20 children killed in the school shooting at Sandy Hook Elementary School in Newtown, Conn.

There was a flurry of activity on mental health last week as officials tried to make good on their promise to act after the Newtown school massacre. 

On Tuesday, Vice-President Joe Biden announced that the White House would devote $100 million to increasing access to mental health services, funding community health centers and services in rural areas. Two days later, Rep. Tim Murphy, a Pennsylvania Republican, unveiled a bill that would increase outpatient care, rural access, and funding for mental health research, among other proposals. 

"What we need is not only for Congress to act, but during these next few weeks, while congressmen and women are back home, we need to hear from every doctor and first-responder and teacher and parent and patient and consumer that we must act thoroughly and thoughtfully and must act now," Murphy said Thursday, unveiling his bill on the House floor.

There was also action on the state level, with Gov. Bob McDonnell proposing to devote more than $38 million to critical mental health services in the wake of last month's attack on Virginia state Sen. Creigh Deeds by his son, who then killed himself. 

Advocates welcome the new push, which is just the latest action on mental health in the wake of Newtown. But they stress that dangerous inadequacies remain in mental health care, particularly given the severe cuts made in recent years.

"We know that fewer than 50% with serious mental illness have access to any treatment as all. More than $4 billion was cut just in state funding during the recession. Clearly we need a very, very significant infusion of new resources," says Ron Honberg, national policy director for the National Alliance on Mental Illness. 

State governments across the country are starting to restore the lost funds. Spurred on in part by Newtown, 36 states and the District of Columbia increased their funding for mental health in 2013, according to a recent report from NAMI. Changes included more school-based training to detect the signs of mental illness, early intervention efforts, and new law enforcement procedures to handle the seriously mentally ill. And unlike gun control, mental health reforms have received vocal support from Republican lawmakers.

"The most significant change is that there's been a real resolve to address the issues that involve people with the most serious mental illness. We need all we can get," said Doris Fuller, executive director of the Treatment Advocacy Center. "The fact is most of those funds who are well enough to go to the mental health department and get services. We've seen more of a commitment to look at people who are most at risk."

Despite the rhetoric from Congress, just the opposite has been happening with the federal funding: sequestration meant cuts for federal research on serious mental illnesses as well as a block grant to states funding mental health services. "People stop developing new drugs if it's uncertain whether there will be a funding stream," notes Fuller. 

"At the federal level, at least at the Congressional level, not much has happened," said Honberg. "There's been a lot of talks, there's been a lot of hearings, but there hasn't been a lot of action." 

The White House points out that Obamacare has increased mental health coverage for Medicaid patients in states that have expanded the program, as well as those newly insured under the exchanges. In addiiton, mental illness cannot be the grounds for denying patients insurance as a pre-existing condition.

But the recent reports from Newtown have also made the limitations of mental health reform clear. An investigation from Connecticut's State Attorney described Adam Lanza as having "significant mental health issues," but Lanza declined therapy and health professionals said they didn't see any violent tendencies.  "He was undoubtedly afflicted with mental health problems. Yet, despite a fascination with mass shootings and firearms, he displayed no aggressive or threatening tendencies," the report said. 

"Was he seeing things, hearing things, who knows?" Fuller said. "The lesson sadly from Adam Lanza is that we don't know who will be violent, though we know what the risk factors are."