Topline Core Points:
- It is important after these tragedies happen to remember the tremendous impact they have on our communities. The trauma permeates every corner of our communities including families and friends of the victims, survivors, parents, children, first responders, law enforcement—the mental health of our whole country is shaken. It’s also vital to recognize that the vast majority of people with mental illness are not violent.
- While we appreciate the heightened interest and conversations about the role of mental health in our society, we need to make sure that we are not painting all people with mental illness as violent. We need to have an honest and productive national conversation about all of the factors that play into this type of violence and what we can do to prevent these tragedies. Only then can we find meaningful solutions to protecting our children and communities.
- Rather than continuing to perpetuate and reinforce negative stereotypes and prejudice towards people with mental illness, it is time to commit to implementing strategies for engaging young people who are troubled before crises occur.
- There are certain risk factors for violence including a past history of violence, substance abuse and there is some evidence that the untreated symptoms of psychosis can increase the risk of violence but most people with mental illness will never become violent, and most gun violence is not caused by mental illness.
- When we talk about the role that mental illness plays and how we can improve those outcomes, the worst thing we could do right now is to cut Medicaid. Medicaid is one of the best solutions we have seen – both in number of people it provides coverage for, and the types of services it covers – when it comes to mental health. It covers rehabilitation, substance abuse coverage, and other evidenced-based practices that fill the gaps where traditional coverage fails.
- Medicaid is the single largest payer for mental health services in the country. It accounts for 25% of all mental health spending, 21% of all substance use treatment spending, and between 35% and 50% of all medication-assisted treatment for opioids.
Talking Points
- 1 in 5 adults have or will experience a mental illness.
- 1 in 17 have a serious mental illness such as schizophrenia, bipolar disorder, major depression or other conditions that may cause significant impairments in daily functioning.
- Most people with mental illness will never become violent, and most gun violence is not caused by mental illness.
- Studies show that mental illness contributes to only about 4 percent of all violence, and the contribution to gun violence is even lower.
- Risks of violence may increase slightly with:
- Co-occurring substance use of dependence;
- A past history of violence;
- Being young and male;
- Untreated symptoms of psychosis which include paranoia and delusions.
Stigma
- During these national tragedies, we often see people make stigmatizing comments about mental illness, or we see people with mental illness being painted with a broad brush of being violent, which simply isn’t true. And this comes as a punch in the gut to those that are living with a mental health condition and need to seek help and treatment.
- Every time we experience a tragedy like this, people with mental illness are drawn into the conversation. The truth is that the vast majority of violence is not perpetrated by people with mental illness.
- We need to be very careful that the response to these tragedies does not discourage people with mental health conditions from seeking help. Stigma far too often prevents people from getting the help they so desperately need.
Guns and Violence
- Another part of the conversation is acting on common sense approaches to ending gun violence such as gun violence prevention restraining orders, which can allow for the removal of guns from people who may pose a risk of violence to themselves and others.
- We need reasonable options, including making it possible for law enforcement to act on credible community and family concerns in circumstances where people are at high-risk.
- One option for doing so is through Extreme Risk Protection Orders (ERPO) or “Red Flag” laws that are authorized at the state-level and are being considered in a number of other states. These laws provide for case by case determinations of potential dangerousness to self or others and include due process protections to ensure that civil rights are protected. Most importantly, they are not focused on mental illness but rather the assessment of potential dangerousness to self or others.
- To maximize the positive impact of ERPOs and to prevent unintended consequences or abuses of these laws, it is necessary for states to expend resources on educating key stakeholders, including law enforcement, families, and others, about these laws and how to utilize them. Funding for training and the development of written resources for law enforcement, lawyers, judges, health and social service providers, and family members is necessary.
- At the federal level, much of the present focus is on reporting criteria in the National Criminal Instant Background Check System (NCICS). NCICS is flawed in that it is both potentially over-inclusive and under-inclusive. It focuses on broad categories of people rather than individual assessments of dangerousness at given points in time. It also uses terminology that is highly offensive and upsetting, “adjudicated as mentally defective.” Finally, it currently has many loopholes (e.g. purchase of guns at gun shows are not subject to NCICS).
- Only if asked: “NAMI supports the mental health reporting criteria currently contained in NCICS and also supports efforts in Congress to ensure that those who are supposed to be included in NCICS are in fact included.”
Early Intervention and Screening
- Education and early intervention and screening are key to break down barriers, and there are many things we need to do to address mental illness in this country and in our schools.
- Half of all lifetime cases of mental illness begin by age 14. 75 percent begin by age 24.
- Implementing intensive community-based mental health interventions for youth and young adults with the most serious mental illnesses.
- Integrating mental health in primary care and in schools so that mental health treatment is readily available.
Institutionalization and Crisis Beds
- Some have suggested that we re-institutionalize people with serious mental illness. Let me be very clear where NAMI stands on this. Institutionalization, whether in psychiatric hospitals or jails/prisons, is the worst thing we could do. 40-50 years ago, people were institutionalized for long periods of time, sometimes for life, without any sort of legal rights. They were frequently subject to horrific conditions.
- We do need more acute care and crisis stabilization however. The fact that these options are too often not available when people experience emergencies or crises has contributed to problems like criminalization and emergency room boarding. But, hospitalizations for acute or crisis stabilization are typically shorter term and should be part of a community-based continuum of care. And, we need to focus on improving quality and outcomes to ensure that people get the care and coordination they need.
- Increasing access to high-quality inpatient treatment through repealing the exclusion in Medicaid for paying for these beds and increasing reimbursement along with required outcomes.
- Ensuring a well-funded and strong mental health system through fully funding the Medicaid program and requiring private health insurance to provide adequate coverage for mental health and substance use treatment.
