When Newtown father Neil Heslin testified before a congressional hearing on gun violence last month, his emotional plea for stricter gun laws went viral instantly. Photos of his tearful testimony appeared in newspapers and news programs across the country, with the image of Heslin wiping tears from his eyes as he held up a portrait of his young son Jesse.
At a separate congressional hearing this week, another set of distressed parents hoped their stories would garner the kind of national attention that followed Heslin, who lost his 6-year-old son in the Newtown massacre. But days after a House hearing addressing mental illness in the wake of the Newtown shooting, few people have heard of Pat Milam.
A father from New Orleans, Milam lost his son too, but not to guns.
Speaking on Tuesday to a panel of lawmakers and mental health experts, Milam fought through tears to tell the story of his son Matt, who struggled with psychiatric problems for most of his young life. Unable to control his paranoia, Matt went in and out of psychiatric wards, but every time, the hospital let him out after just a few weeks. During his final inpatient stay at the age of 24, Matt talked about killing himself, and of wanting to blow up his house. He told doctors that he had gun shells and propane tanks in his closet. According to mental health records Milam was only able to see after his son’s death, due to patient privacy laws, Matt’s doctor at Oschner Hospital in Louisiana wrote that he had an “extremely high risk of suicide or another bad outcome.”
The hospital released Matt, despite his mental state and his father’s pleas to keep him in treatment. Milam’s insurance company would no longer pay for Matt’s hospital stay, as is often the case with insurance coverage of psychiatric inpatient treatment.
Just a week later, in October 2011, Matt rigged his bedroom with gas and propane tanks. He killed himself, and the explosion nearly killed his parents in the process.
More than a year later, the Milams are tortured by questions of why and how doctors at Ochsner Hospital were allowed to release Matt despite the obvious warning signs. A spokesperson for Ochsner refused to comment, citing patient privacy laws. Pat Milam ended his tear-filled congressional testimony with an urgent plea for mental health reform. “Good people will die today,” he said. “Good families will be destroyed because we’re not doing anything about this now.”
In the months since the tragic shooting in Newtown, Conn., a heated debate has swirled around gun violence, with Congress seriously considering tighter gun control laws for the first time in decades. Yet advocates for mental health reform say the true culprit is the nation’s broken mental health system that allows warning signs to fall through the cracks in the name of patient privacy, as it did for Matt Milam.
In nearly every mass shooting in recent memory, the mental health warning signs were there: Adam Lanza in Newtown, James Holmes in Aurora, Seung-Hui Cho at Virginia Tech, and Jared Loughner who shot Congresswoman Gabrielle Giffords.
In the latest Gallup poll on gun violence in the wake of Newtown, 82% of American voters say that the U.S. government should increase funding for mental health programs for young people. Given the public support for mental health reform, advocates are wondering why Congress is focusing on controversial gun control bills that many believe are doomed to fail, while they could be addressing the root cause that both sides of the aisle seem to agree on.
“Democrats and Republicans are unified in saying we have to address this,” argues Rep. Tim Murphy, R-Pa., chairman of the House Subcommittee on Oversight and Investigations. Murphy presided over this week’s House hearing on mental health, and told msnbc, “This issue has been kept in the shadows for too long.”
Even a quick glance at the current state of the U.S. mental health system exposes the gaps in proper access and care. While the National Institute of Mental Health estimates that there are 15 million children with mental disorders, there are only 7,500 child psychiatrists. According to the National Alliance on Mental Illness, 55% of counties lack a practicing psychologist, social worker, or psychiatrist. The result is that on average, mental health patients go more than two years before ever receiving treatment.
“I really do think that America does treat illnesses above the neck differently than they do the other illnesses below the neck,” said Dr. Harold Koplewicz, president of the Child Mind Institute.
For Pat Milam and other parents, the problem is not a lack of care but the quality of care. "It's not a matter of asking for federal government funding for us,” he said at the congressional hearing. “We had an insurance policy that we paid every month, and we thought it was there to protect and give the best medical coverage to our son.” Milam accuses medical providers and insurance companies of collusion to the detriment of the patient, pointing to how doctors release mental health patients just when the insurance runs out. Milam was willing to pay the difference out of pocket, he says, but the doctors told him that they needed to get his son out to make room for other patients.
Rep. Murphy is at the forefront of a quiet movement in Washington to improve the mental health system, and as a former psychologist, he is one of just a few members of Congress with a background in mental health. “You have 50 different states with 50 different laws,” he notes. That nationwide quilt of various patient privacy, confidentiality laws and differing ages of consent form the crux of the problem. In Murphy’s state of Pennsylvania, for instance, the age of consent is 14. “What parent thinks their kid is capable of making a serious decision at that age?” asks Murphy. “They can’t drive or drink, but we’re going to make them responsible for the decision of whether or not they’re getting mental health care?”
One particularly broken part of the mental health system is the flow of information from state mental health records into The National Instant Criminal Background Check System, known as NICS. In December 2005, a Virginia judge determined that Virginia Tech gunman Seung-Hui Cho was mentally ill and a danger to himself and others. Cho was directed to undergo outpatient treatment, and would have been prohibited from possessing or purchasing a firearm under federal law. Yet his outpatient commitment records were never uploaded to NICS, so Cho was able to purchase two handguns.
A recent report by the Government Accountability Office found that a total of 17 states have made fewer than 10 mental health records available to the background check system. Over 2.7 million people are prohibited from possessing a firearm based on their mental history. Yet only 1.2 million of them have their mental health records registered with NICS, leaving 1.5 million mentally ill people who can legally purchase a firearm.
Under the Health Insurance Portability and Accountability Act (HIPAA), privacy laws protect mentally ill people by preventing certain states from sharing mental health records with law enforcement of the national background check system. When President Obama announced his proposals to tackle gun violence, of his 23 executive actions, six targeted the mental health system, including addressing legal barriers under HIPAA. Yet two months after announcing those executive actions, that talk has not led to action, as the Obama administration’s response to Newtown has focused on gun control.
“In the ten years I’ve been meeting with members of Congress, I think this is the first time we’ve had this kind of a conversation,” Thomas Insel, the director of the National Institute of Mental Health, told the congressional hearing this week. “It is extremely important and long overdue.”
That sentiment is echoed by other mental health advocates, like Mike Fitzpatrick, executive director of the National Alliance on Mental Illness. According to Fitzpatrick the debate that followed Newtown has allowed him to discuss mental health with members of Congress who he had never spoken to before.
“This is the first time the federal government has really engaged on this,” he said. “Is it driven by the conversation surrounding violence and guns? Sure, but it gives us an opportunity to fix the things we need to fix.”