In the wake of yet another tragedy, we collectively feel the gut reaction to “do something.” Democrats say gun reform, Republicans say mental health reform. Unfortunately, it just isn’t that simple. Not every atrocity is preventable, and one talking point isn’t going to solve everything. Some laws have been passed, but more funding and legislative action is needed.
America has slid so far off the spectrum for treating mental health that it would be a joke if it were not so serious. At least 59 percent of those who carried out a mass shooting (having shot four people or more) were diagnosed as mentally ill or displayed serious signs of a mental disorder leading up to the mass shooting. The vacuum of mental health care has left the American prison system as de-facto psychiatric facilities. One in six inmates in state facilities and one in four in local jails suffer from psychosis. One-quarter of those in the prison system with a mental health problem have served three or more previous incarcerations.
Despite the stunning increase in untreated mental illness and its effects on public safety, our nation’s psychiatric bed count is at a record low. Since the 1950’s, state hospital bed count for the mentally ill has fallen 97 percent. This leaves 37,559 state-run psychiatric beds across the U.S. Of those, 17,601 are reserved for those arrested and/or incarcerated. Including county, general, public and private psychiatric care, the U.S. per capita rate is 25 beds per 100,000 people. The only industrialized countries with fewer beds are New Zealand, Chile, Italy, Turkey and Mexico.
As of 2014, eight million Americans battle both mental health and substance abuse disorders.
Why the decrease in psychiatric care?
In the 1970’s, there was bipartisan support for reversing institutionalization, and for good reason. Facilities at the time often resembled warehouses and offered no real treatment and often subjected patients to horrific abuses. The way patients were being committed also raised concerns. Parents could commit unruly children, and husbands could lock up disobedient wives. In a catch-22, laws aimed at preventing these abuses made it harder to involuntarily commit someone who hadn’t done something dramatic. This in turn made psychiatric hospitals less effective at protecting individuals both from themselves and others.
America Must Act
While there are barriers to funding and legislating psychiatric facilities effectively, mental health treatment is a complicated problem that we can no longer ignore. The effects of untreated mental health go far beyond mass tragedies. A 2013 study found that Florida law enforcement conducted 85,276 involuntary mental health exams over a one year period, three times the number of aggravated assault arrests made during that same year. One in eight emergency room visits nationally are for mental health and substance abuse. About 45 percent of those that are homeless have some form of mental illness, and 25 percent have a serious mental illness. Suicide, attributed to depression, is up 30 percent since 1999. The effects of the current mental health crisis are wide-reaching and desperately needing resources.
There are steps that have been taken to rectify the problem. In 2016, the bipartisan 21st Century Cures Act was passed, over 100 pages of which dealt with mental health. The act created a new Health and Human Services assistant secretary for mental health and substance use, and targets early treatment of mental health issues. Increasing the psychiatric bed count is explicitly in the act. However, the act remains largely unfunded and as a result, many initiatives are unimplemented.
“The only certainty is that the [21st Century Cures] act is going to take longer to implement than had originally been anticipated,” said Director Jessica Studness of Novartis Pharmaceuticals.
It’s easy for America’s divided political landscape to turn every tragedy into news cycle talking points. Having a rational conversation about the complex causes of these atrocities, which aren’t always preventable, is an entirely different situation. In times like these, we must remember compassion and humanity. There are so many people in this country crying out for help by committing terrible acts against themselves or others. It’s time we listen.
Follow the author on Twitter @chaimstarkey