Must-Read: Harold Pollack: If you want mental health services to prevent violence, Medicaid expansion is critical

Must-Read: Harold Pollack: If you want mental health services to prevent violence, Medicaid expansion is critical: “Oregon’s mass homicide sparked the usual debate about whether guns or mental health is the best focus in preventing atrocities…

…Given this stark frame, the centrality of gun policy is hard to deny. Compared with other wealthy democracies, America has surprisingly similar rates of car theft, aggravated assault, and other forms of nonlethal violence. Our gun homicide rate is about three times the average…. Gun policy measures such as improved background checks included in the nearly-passed, bipartisan, post-Newtown Manchin-Toomey bill would certainly be helpful. Many conservatives place greater emphasis on the mental health system. In some ways, this rhetoric is misplaced. The fraction of American violence attributable to severe mental illness is… on the order of five percent. We must also avoid reinforcing cruel stereotypes….

Still, it’s always wise to consider how our mental health systems could treat people more effectively, and more-reliably keep weapons away from dangerous individuals… expand the power of police and mental health professionals to temporarily confiscate guns from individuals whose behavior raises real concerns, but who do not meet the stringent criteria required to justify involuntary commitment…. Texas Senator John Cornyn has proposed… [to] expand states’ provision of mental health information to the National Instant Criminal Background Check System…. The potential impact of such data-sharing remains unclear…. Cornyn’s proposal does not address the most glaring issue in American mental health policy: the Affordable Care Act’s Medicaid expansion… the public health cornerstone of ACA…. Medicaid expansion provides financial stability to the whole network of safety-net medical, psychiatric, and addiction care…. In 2013, the National Alliance on Mental Illness (NAMI) released a report endorsing Medicaid expansion…. Addressing the connection between mental illness and violence, NAMI concluded:

In the aftermath of Newtown, many politicians and policy makers have promised to take steps to fix America’s broken mental health system. Expanding Medicaid in all states would represent a significant step towards keeping those promises.

Senator Cornyn is an implacable opponent of Medicaid expansion. Indeed he rallied at the Texas state capitol to oppose it…. Addiction and psychiatric disorders within the population of Texans deliberately left uninsured… 140,000… with addiction disorders… 54,000 live with severe mental illness… indigent criminal offenders and those seeking care at addiction treatment centers and stressed safety-net facilities that have lost billions of dollars because Texas has declined Medicaid. Leaving aside the human consequences for the uninsured, this is very poor violence prevention policy. If any other politician suggests that mental health rather than gun policy is central to reducing mass homicides, ask where they stand on Medicaid expansion. Their answer will be clarifying.