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January 14, 2013 | Posted By Jane Jankowski, LMSW, MS

In the wake of the Sandy Hook Elementary tragedy and the movie theatre massacre in Colorado, accounts of mentally ill perpetrators are offered as partial explanations as to how these horrific events came to pass. The public outcry for revised gun control measures is understandable and well placed. I don’t disagree. Yet, the predictability of which firearm aficionados may also harbor a latent predisposition toward violence may be an unreasonable task for agencies tasked with licensing weapon worthy citizens, particularly when it comes to assessing someone with a history of mental illness. The paradox of a system which relies on questions about a personal history of psychiatric treatment does not mean an individual has not needed care.  If behavioral health services are not accessible or available, there would not be any record of such intervention. This does not mean that such intervention has not been suggested, desired, or otherwise indicated.  That said, a history of mental health treatment ought to not automatically suggest the applicant should be denied a right offered other citizens.  Focusing funding and effort on firearm marketplace controls may override the much needed attention on community mental health care which are lacking across the nation.  Ensuring our nation also has accessible, high quality behavioral health treatment programs will have benefits which extend far beyond the gun control debates.  Though we may never be able to fully disentangle the issues of gun rights and mental illness, perhaps we can maximize this opportunity to press our leaders into putting some real muscle, in the form of dollars, behind mental health treatment programs.  

A JAMA article published online this week suggests that gun control ought to be tackled as a public health mission like smoking and seatbelts.  Perhaps this approach could be applied regarding awareness and treatment for mental health issues. I would argue that a public health mission addressing barriers to mental health treatment would be of tremendous societal benefit, but only if we can deliver the treatment and care that is promoted. Current barriers to behavioral health treatment include cost, insurance limitations, social stigma, and long waiting times to even begin treatment. Mental health parity laws intended to help address some of these problems tend to vary by state, and service providers are not compelled to accept any given coverage plan, rather the insurance plans simply have to offer the coverage. Private providers must work with insurers to sustain a viable practice and may or may not accept a given patient’s insurance. Public agencies typically offer more flexibility in fee sources, such as county based clinics, are sagging under the combination of budget cuts and heavy demand for services. Forced to triage requests for care, many patients in need of ongoing service cannot receive the evaluation and therapeutic treatments they need. 

Will increased availability and access to community mental health services have a correlation to reduced gun deaths? This is unknown, and is far too broad a claim for now. Anticipating the cases where firearms and mental health deterioration will result in deadly events is nearly impossible. However, ensuring that individuals with symptomatic behavioral health needs can get the care they need promptly from appropriately trained providers should not be impossible. If some longstanding benefit can come out of these national tragedies, perhaps it can be in the form of robust mental health services across the nation for citizens in times of need. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

1 comments | Topics: Bioethics and Public Policy, Bioethics and the Law, Health Care Policy, Health Insurance, Mental Health, Public Health Ethics

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sheila otto

sheila otto wrote on 01/14/13 6:13 PM

so true...

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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