Tag: Public Policy

OP-ED: Massacres, gun safety & mental health

The Morning Call, which is my local newspaper, recently published this op-ed that I wrote, following up on the Parkland massacre.  I’m publishing it here because it does touch on mental health, but specifically from the perspective of violence and publish policy.  First, remember, someone who is mentally ill is far more likely to be the victim of violence, rather than the perpetrator.  Second, I’m tired of hearing about, in the aftermath of these shootings, how we must repair our mental health system and then the only things that are done is funding cuts.

Anyway, read on for more.  I hope you find this useful

—

Seventeen dead students and teachers.

Fifty-eight dead concert goers.

Forty-nine dead club attendees.

Twenty-seven dead students and teachers.

These are some of the worst gun massacres in the history of the United States. And they have all occurred within the past five years.

We have reached the point in our society where kindergarteners are being trained how to cower in the event that an armed gunman barges in on their class. Teachers are now being lauded for laying down their lives for their students. There is serious conversation about whether or not school staff, including administrators, teachers and janitors, should walk around school with guns locked and loaded.

We have hit this low point in our society. But we aren’t powerless. We aren’t lambs being led to the slaughter. We are the United States of America. The country that beat the Nazis can surely be the country that stops senseless bloodshed in sacred public places.

We need real gun safety, and we need it now.

•First: Reinstate the assault weapons ban that was in effect from 1994-2004. It is harder for a 19-year-old to purchase Sudafed than an assault weapon. More to the point, the 1994 ban worked. According to one analysis, gun massacres and deaths from assault weapons tripled since the expiration of the assault weapons ban. Military-style weapons are responsible for almost every one of these crimes, and we can do something about it.

•Second, close the loophole that allows for individuals to purchase firearms without being subjected to a background check. If you want to buy a gun, you should always be subjected to a background check, and right now, you can legally purchase certain types of guns at certain types of sales without doing so. This massive loophole allows for terrorists or convicted felons to have access to firearms.

•Third, enact state Senate Bill 501, which would bar individuals who have a protection from abuse order from owning firearms and make it easier to take weapons away from those convicted of domestic assault. Many of the perpetrators of our worst massacres have been convicted of this heinous crime, and no one who beats an intimate partner should have access to a firearm.

It’s also vitally important that we discuss mental health. We frequently hear in this country that there is a need to improve our mental health system to prevent these types of massacres, despite the fact that someone with mentally illness is significantly more likely to be a victim of a crime than a perpetrator of one.

Indeed, opponents of gun safety often shake their heads, offer their “thoughts and prayers” and pledge to deal with our mental health system. That is followed immediately by … absolutely nothing, except attempts to repeal Obamacare and Medicaid expansion, both of which would fundamentally devastate our mental health system by cutting off funding, preventive care and hospital beds.

If you are opposed to gun safety measures, and want to improve our mental health care system, it’s not enough to say words that sound good. You have to stand for something.

Here are some suggestions. First, address the rising shortage of psychiatrists and psychologists by increasing reimbursement rates and Medicaid/Medicare slots for mental health care. Second, increase funding to critical and crisis care treatments, allowing for the creation of additional hospital beds to treat those experiencing a mental health crisis. Third, increase the reach of programs like the nurse family partnership and pre-K education, which have been proven to dramatically decrease mental illness.

Each and every one of us — from the most ill homeless person to the president of the United States — is never more than one moment away from a mental health crisis and running headlong into a system that doesn’t care about us. One in 5 American adults suffer from mental illness; 1 in 20 suffer from an illness so debilitating that they can no longer work. If you don’t care about the mentally ill, fine, but remember, this could be you or someone you love in a heartbeat.

There is no single solution to stopping gun violence, and individual and familial responsibility has an enormous role to play in ending this bloodshed. Background checks and banning the sale of military-style weapons won’t stop every massacre; after all, all of our laws and police activity don’t stop every crime. But our law enforcement — and the laws they enforce — do save countless lives and stop innumerable crimes every day.

We aren’t powerless. There are solutions. American ingenuity and know-how can save thousands of lives, and the only way to guarantee that the problem only gets worse is to do nothing.

All of us have an obligation to each other to make the world a better place, and we should be tired of living in a society which allows for over 13,000 gun deaths every year, including 17 dead children and adults on the floor of the freshman building of Marjory Stoneman Douglas High School in Parkland, Fla..

Mike Schlossberg of Allentown is state representative from the 132nd District.

Physician shortages: The biggest challenge facing mental health in America

I often write about stigma and the devastating role it can play in terms of keeping people out of treatment.  I think a big part of the reason I discuss it so frequently is that it’s the one area that people can actually get involved in and feel like they are making a difference.

That being said, I need to be clear about this one: Stigma reduction, though important, is not the most critical issue facing mental health.  That, I would argue, is a lack of capacity, largely in terms of mental health practitioners.

The facts on our ongoing physician shortage crisis are staggering:

  • According to a report by the Association of American Medical Colleges, over the next eight years, the United States will experience a doctor shortage of between 61,700 – 94,700.
  • That problem is much more acute in the area of mental health.  According to one report, in order to meet demand, the United States needs to add 70,000 providers over the next eight years if we are going to meet a growing demand.  The problem is even worse for people who live in rural areas; 60% of all people in rural areas live in a mental health professional shortage area.  In general, according to NAMI, only 41% of all people with mental illness are treated, while that number increases to 63% of all people with a serious mental illness.
  • The shortage doesn’t just affect personnel, but facilities.  It can be extremely difficult for the mentally ill who need inpatient care to have access to it, with some surveys estimating that the United States needs a whopping 123,000 psychiatric beds.

How did we get here?
As you can imagine, there are a variety of culprits, including:

  • Incredibly high standards to get into medical school and a long length of time for training.
  • Crushing medical student loan debt (averaging $207,000).
  • A shortage of residency slots for hospitals.  These slots are almost entirely funded by Medicaid, and that funding has not increased since 1997.
  • High cost of malpractice insurance.
  • Varying reimbursement rates for different specialties (more on this later).

Why is this problem so much worse in mental health?
This problem is even more acute in the mental health universe, where amount of psychiatrists declined 10% from 2003-2013.  The shortage gets even more severe as you go into mental health specialties, such as pediatric and geriatric care.

Again, there are many reasons that this issue is so problematic for mental health.  For one thing, hospitals and insurance companies pay doctors more if they are involved in specialties that turn a profit, like orthopedic surgery and urology…not psychology or psychiatry.  Additional public cuts to human services and mental health further exacerbate the problem. As a result, there is less staff in this area, regardless of it’s importance.

Physician burnout is also a problem, with one study noting that “86 percent reporting high exhaustion and 90 percent reporting high cynicism.”

Another problematic area is physician training, where there are concerns that training models have not evolved enough to introduce more medical students to mental health areas.

There’s more – much more than a simple blog entry can handle.  For a more in-depth look, I highly recommend that you review this report by the National Council for Behavioral Health.

What can we do about it?

  • Increasingly utilize technology and telehealth, which some studies have shown to be promising in the area of mental health.  With additional capacity, telehealth can help overcome geographic shortfalls that occur.  Other systems, such as bed and doctor registries, can help patients in need of treatment find appropriate resources.
  • Expanded number of residency slots.
  • Adjustment to reimbursement rates to ensure that mental health services achieve parity with other areas.
  • Adjustment to licensure laws in order to allow for other certified professionals – with appropriate training – to treat patients.

It is important to not lose sight of this simple truth: The mental health practitioner shortage can devastate the quality of life of the mentally ill.  It can kill people, frankly.  In my government job, my office regularly fields calls from constituents who need help but can’t find it.  Mental health is an issue that society is only truly starting to understand and deal with.  We must ensure that the mentally ill have the access to the resources that they need.