Wednesday, January 12, 2011

Two things seem abundantly clear to me...

...in the wake of the tragic events in Tuscon last weekend.

The first is that Jared Loughner should have never been able to purchase a handgun. I can't believe any reasonable person would disagree with that.

The second -- and I speak as a parent with first-hand experience -- is that mental health care in this country is confoundingly difficult to access, regardless of your resources.

Jonathan Cohn, writing in the New Republic, says:

Mental health, unfortunately, is probably the illness most likely to go untreated in the U.S. The stigma around mental illness isn’t what it once was, but it still exists. And notwithstanding laws, such as the 2008 Mental Parity and Addiction Equity Act, that have helped to provide more financial support for treatment, funds for care and support of the mentally ill remains woefully inadequate.

Private insurance rarely provides enough coverage for the seriously ill, overwhelming public systems to the point where people who could benefit from therapy, drugs, and community supports--frequently living totally normal, productive lives--instead end up without treatment and sometimes without homes. Inevitably some of these people end up committing crimes, overloading a criminal justice system ill-equipped to handle them. We don't warehouse the mentally ill in asylums anymore. Instead, we warehouse them in jails.

Arizona in this regard is fairly typical. Mental health services in Maricopa County, which includes Phoenix, has been the subject of litigation for more than twenty years. The state has tried contracting out services to two different private companies, but care seems to be getting worse, not better.

A 2009 survey by the National Associaiton for the Mentally Ill reported that, statewide, mental health services had actually improved over the previous three years, to the point where the organization bumped Arizona's grade from a “D+” to a “C.” But, NAMI noted, there are still enormous problems, from shortages of providers to long waits for services. “Having case managers with nearly 100 clients does not allow them to do anything but respond to emergencies,” one survey respondent told NAMI. “Until my family member has an emergency, there is no case management.”

It should go without saying that most mentally ill people are not violent—and that those who are violent might not be if they received appropriate treatment. But, too often, they don't get it. And that's when tragedies occur.

Was this such an instance? Was the Arizona gunman among those the mental health system left out? If so, might a stable, coordinated care environment have offered effective treatment—the kind that might have changed his behavior and, in so doing, spared the victims of yesterday’s violence? If so, were there missed opportunities—and who or what missed them?

Now, if you're a libertarian, your reaction may be, "Tough. We can't afford it." But if you were the parents of that poor 9-year-old girl that was killed, or even if you were the parents of Mr. Loughner, you might see that adequate mental health care is in everyone's interest.

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