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Outbursts of gun violence all the time get Republicans talking about mental health. It will be loads easier to take that talk seriously in that case lots of them didn’t have lengthy, well-publicized records of opposing government initiatives to enhance mental health care.
Texas Gov. Greg Abbott is an ideal example. Last week’s massacre at Robb Elementary School in Uvalde was the state’s sixth mass shooting during his tenure as governor, in line with the Texas Tribune. After each, he has said the tragedy called for presidency motion to bolster mental health care.
But in between the killings, Abbott hasn’t been crusading to bolster state services. Quite the opposite: Just this past April, he approved a $211 million reduction in funding for the agency that oversees mental health programs.
And Texas, of all states, is in a poor position to weather such cuts. When the nonprofit group Mental Health America put together a nationwide scorecard for access to mental health care, it gave Texas the bottom rating.
Now, it’s not hard to determine what’s probably occurring here.
The speak about mental health care sounds loads like a dodge — a way for Republicans and their allies to distract public attention from the wide availability of guns, which the evidence suggests is a rather more likely reason behind this country’s unique gun violence problem.
That will surely explain what Media Matters discovered when it tallied references to mental health care on Fox News: Mentions reliably spiked with each mass shooting and just as reliably dissipated once the shock of the killings wore off.
“Spare me the bullshit about mental illness,” a frustrated Sen. Chris Murphy (D-Ct.) told his Republican colleagues last week — and, really, it’s hard guilty him.
When Fox News talks about “mental health,” it’s actually because someone just used a gun to kill quite a lot of people and the hosts want to vary the topic from gun safety policies. pic.twitter.com/8Oa4UPzEJz
— Matthew Gertz (@MattGertz) May 25, 2022
All that said, the U.S. really does have some big problems with mental health care, with way too many individuals in need of screenings and treatment they aren’t getting. And there are literally some pretty good solutions on the market.
This briefing paper from the Commonwealth Fund has a listing of options. This report from the Bipartisan Policy Center has more. This page on the National Alliance Mental Health website is filled with links, each to a distinct approach.
The sheer multitude of possibilities could make it hard to focus the eye of either politicians or the general public. Nevertheless it’s possible to simplify by dividing the potential solutions into two general categories:
1. Make it loads easier to pay for mental health care.
Essentially the most familiar problem with accessing mental health care is its cost. That’s an issue for individuals with and without insurance, provided that many plans have large out-of-pocket costs — which, inevitably, affect mental health care as surely as they affect other types of care.
In 2018, 38% of Americans said they didn’t get mental health care due to cost, in line with survey data from the Substance Abuse and Mental Health Services Administration. That was actually an improvement from 2008, when the figure was 45% ― perhaps since the Inexpensive Care Act reduced the number of individuals without coverage. But, obviously, it’s still a staggeringly high percentage.
And it has some serious real-world effects. If going to the doctor or getting a test or filling a prescription costs quite a lot of money, more individuals are going to skip that treatment or exam ― and, sometimes, find yourself worse off due to it. A 2020 paper, for instance, shows that folks with schizophrenia were less prone to take prescribed medication when it cost them more.
Fixing it is a matter of constructing sure everybody has insurance after which ensuring everybody’s insurance covers the care and medications they need ― in other words, moving closer to the sort of truly universal coverage schemes they’ve in most developed countries.
After all, in states like Texas, probably the most obvious and simple option to do that might be to expand Medicaid through the Inexpensive Care Act ― a move that would provide greater than 1 million residents with insurance, including coverage of mental health care.
But Texas Republicans have repeatedly refused to take that step, and Abbott has stood with them.
Texas is one in every of a dozen states which have not expanded Medicaid under the ACA, leaving 771,000 individuals with incomes below poverty uninsured.
— Larry Levitt (@larry_levitt) May 27, 2022
2. Make it loads easier to seek out and get mental health care.
It’s why so many individuals can’t find therapists of their insurance networks. It’s why patients with acute mental health needs find yourself waiting for hours, even days, within the emergency room for inpatient psychiatric beds. It’s why many individuals with severe mental illness find yourself in prisons — which have effectively turn out to be warehouses for individuals who needed treatment but didn’t get it.
A giant issue here is funding. The money from each private and public insurers isn’t enough to draw more mental health professionals into the sphere. The low pay also makes it harder to maintain professionals on the job in what becomes a grim, self-fulfilling cycle: They should shoulder greater workloads, increasing their stress and burnout, causing more of them to go away for other lines of labor.
One option to address these shortages is to extend provider salaries, which the federal government can do directly when it’s paying for them through Medicare, Medicaid or other public programs. Other options include latest subsidies for training on the front end (by offering tuition assistance) and on the back end (by offering generous loan forgiveness, especially for those working in underserved areas).
Loosening license restrictions in order that qualified professionals can tackle more duties may make a difference.
But improving access to mental health providers doesn’t just mean getting more professionals into the sphere. It also means putting more professionals in the appropriate places ― specifically, places where the individuals who need mental health care can get it easily.
An example can be working to ensure more primary care providers have mental health professionals physically of their offices — in order that, for instance, a pediatrician could call in a seek the advice of on the office somewhat than referring any person to an expert who could be on the opposite side of town and have an extended wait for appointments.
“We all know that almost all people don’t follow up on referrals, for one reason or one other, and in consequence, people don’t get the care that they need,” Ben Miller, president of the Well Being Trust, told HuffPost. “In the event you bring care to them and also you make it seamless, integrated, they’re more prone to have those needs addressed that immediate moment, which is oftentimes rather more effective for each the patient and their family.”
Miller, a veteran psychologist and scholar, is among the many advocates who see such changes as a part of a much greater transformation of mental health care ― one which focuses on prevention and detection, in addition to treatment, and that reaches people not only in clinical settings but additionally through schools, libraries and other community organizations.
None of those steps could occur quickly. All would require sustained political effort to boost funds — or to maneuver funds around and alter regulations — because, inevitably, there are interest groups, businesses and institutions that profit from the establishment and need to maintain it in place.
It’s the sort of effort that Republicans desperate to improve mental health care could actually provide, although it will require listening to the difficulty even after the memories of the most recent shooting fade.
That hasn’t happened prior to now. But perhaps this time it can.