The day after the November 5 mass shooting in Sutherland Springs, Texas, President Donald Trump responded by stating: “This is a mental health problem at the highest level.” But don’t expect new attention from the administration or funding from Congress s a result. The fact is, Republican-controlled government at the state and federal levels have spent years doing just the opposite: cutting funding for mental health care.
According to Dr. Fred Osher, associate professor of psychiatry at the University of Maryland School of Medicine and an expert in community psychiatry, more than $4 billion in mental health funding was cut by states in the aftermath of the 2008 recession, and those cuts remain in place. “There still is a deep hole that is yet to be filled,” Dr. Osher told Occupy.com.
Among the results are an increase in the incarceration rate in many of these states, and high recidivism of the inmates – conditions that have only been addressed recently due to the high cost of incarceration imposed on state governments.
The movement to decentralize psychiatric care from large institutions accelerated during the 1960s, when psychiatry began to focus more on pharmaceutical and out-patient therapy for treatments. The Community Mental Health Act of 1963 authorized the federal government to step in and provide mental health care funding when states couldn’t cover the costs. But mental health care providers contend the act was never adequately funded.
Then, in 1981, early in the Reagan era, the federal government further reduced funding for mental health care by creating block grants for states to access and disperse. This had the effect of “only worsening the situation,” said Dr. Osher. Up until the the Affordable Care Act, or Obamacare, signed into law by President Obama in 2010, less than two-thirds of insurance plans carried mental health coverage, and insurers could deny coverage to those with several types of mental illnesses such as bipolar disorder and schizophrenia, according to healthinsurance.org.
Under the ACA, insurance companies were mandated to provide mental health coverage for the insured in most cases. The ACA also expanded Medicaid coverage in states that chose to accept federal funding. For example, according to a July 2017 report from the Louisiana Department of Health, more than 30,000 people have received mental health coverage since the state expanded Medicaid coverage the year prior.
Republicans may not want to believe it, or admit it, but among the many causes of mental illness, in addition to factors such as poverty and heredity, is access to healthcare. Of the 18 states that have yet to accept federal dollars to expand Medicaid, 16 have Republican governors. Virginia and North Carolina are the two exceptions, and each has a legislature controlled by Republicans.
Mental health care experts point out that in addition to talk and drug therapies, those with mental illness can have their conditions exacerbated by lack of housing, nutrition, jobs and a sense of community. This applies to youth as well. For instance, the federal Children’s Health Insurance Program has yet to be refunded, and without congressional support, states will soon run out of money to administer the program.
The White House’s proposed budget cuts 250,000 vouchers for housing and reduces funds for job training programs by 40 percent. The White House’s proposed budget also eliminates funding entirely for the Community Block Grant Development program. So when President Trump asserts that there is a national mental health problem, he is right, but he's clearly not acting to fix it.
There is no question that mental health care providers have moved toward more effective and humane methods of treatment in recent years. But the funding to combat mental illness has been less than what is needed, and under Republican-controlled governments, that support is dropping even further. Meanwhile, mass shootings carried out by deranged people with a history of mental illness continue to occur, on a regular basis, bringing death and tragedy to communities nationwide.
We know Republicans, beholden not to the people but to the NRA, will do anything to prevent passage of gun legislation that would limit people's ability to buy assault weapons designed for mass killing. Now, we also know that they won't try to help the sickest and neediest among us in an effort to slow of slaughter of innocents everywhere.
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