As part of his effort to reduce gun violence, President Obama issued an executive order today that makes it easier to prohibit a small group of the most seriously mentally ill from owning firearms and provides $500 million in additional mental-health funding. The order’s mental-illness–focused gun-control provisions are smart and narrowly tailored to affect only the most seriously ill individuals. But its additional funding won’t go where it could make a difference.
The mental-health industry teaches the public that, as President Obama put it, ‘the mentally ill are not more violent than others.’ But that platitude does not apply to the most seriously ill when they are allowed to go untreated. Eighteen percent of the population has some form of “mental-health issue” and is not violent. But 4 percent of the population has serious mental illness, which, left untreated, causes them to be more violent than others. While gun violence is rare, and mass violence by the seriously ill is even rarer, no one outside the NRA and the politically correct mental-health industry believes the seriously mentally ill should have access to weapons.
Obama’s executive order takes two small, important steps to make sure they don’t. The first step focuses on social-security beneficiaries so psychotic and delusional that they cannot manage their own funds and need a court-appointed representative payee to help them. The executive order prevents this small group from owning guns by requiring submission of their names to the National Instant Criminal Background Check System (NICS). Some in the mental-health industry will join the NRA and argue that preventing people who are seriously mentally ill from owning guns is a violation of Second Amendment rights. They are wrong. It is smart.
The executive order also attempts to clarify a clash between a patient-privacy law (HIPAA) that prevents the disclosure of medical information and health-care providers who need the ability to disclose the names of the seriously mentally ill to NICS. By fiat, it carves out a small exemption in HIPAA to allow health-care providers to send NICS information about people with serious mental illness who have been involuntarily committed, found incompetent to stand trial or not guilty by reason of insanity, or are otherwise prohibited from gun ownership.
Some in the mental-health industry will argue that this provision may cause some future patient with serious mental illness to avoid care so they don’t lose their guns. Research does not support that conjecture. The overriding concern must be keeping the patient and public safe — not some hypothetical future patient. It is an appropriate use of the state’s police powers and parens patriae powers, since those weapons can also be used for self-harm. Some in the mental-health industry will also argue that the provision “stigmatizes” the mentally ill by inappropriately linking their conditions to violence, but that denies the real, empirical association between untreated serious mental illness and violent behavior.
#share#In other ways, Obama’s executive order is less helpful. It proposes “a new $500 million investment to help engage individuals with serious mental illness.” But elsewhere it claims the purpose of the funds is to “ensure that behavioral health-care systems work for everyone” and to “promote mental health as a top priority.” Promoting mental health and serving “everyone” are not the same as providing treatment to the seriously mentally ill. The executive order repeats the mental-health industry mantra that stigma is an important barrier to care, but research shows that stigma keeps far fewer people from seeking help than prohibitive costs, lack of service availability, lack of transportation, and anosognosia (lack of awareness of illness). President Obama has done this before, proposing amorphous programs supported by the mental-health industry that would have no impact on people with serious mental illness. It’s not good enough.
Instead, that $500 million should be narrowly targeted toward increasing access to evidence-based treatments that reduce violence, homelessness, arrest, incarceration, and suicide in adults known to have serious mental illness. That is exactly what the proposals put forth by Representatives Tim Murphy (R., Pa.) and Eddie Bernice Johnson (D., Texas) in the Helping Families in Mental Health Crisis Act (HR2646) are intended to do.
I know no mother of someone with serious mental illness who wants her son or daughter to have a gun or to go without treatment. Obama is taking a small, positive step toward preventing the seriously mentally ill from owning guns, but must do more to ensure that they get the treatment they need.
— D. J. Jaffe is executive director of Mental Illness Policy Org., a think-tank on serious mental illness.