It Is Easier to Obtain a Gun Than Mental Healthcare
Why behavioral healthcare should be more accessible than firearms.
Posted Mar 29, 2019
At the end of February, Trump signed a bill that rolled back an Obama era regulation which required people with some kinds of mental illness to be included in the national background check database. This regulation was rightfully put in place after the Sandy Hook tragedy to prevent people with severe mental health problems from obtaining guns to harm others.
As a psychologist, my most common concern is the ease with which someone who is struggling with depression can readily obtain the lethal means to harm themselves. A few years ago, the state of Florida passed a law banning health care professionals from discussing gun ownership and gun safety with patients. At the time, I was working at a student mental health clinic with bright, young, talented students who were struggling with depression and suicidal thoughts. Assessing risk always involves questions about whether a suicidal student has considered harming themselves and asking about access to that means. Like most mental health professionals at the time, I completely ignored the law and asked the questions. The safety and well-being of my patients were far more important than the gun lobby’s ridiculous law. Fortunately, the courts overturned the law, so I feel safe in sharing this.
Mental health professionals know that most people with severe mental health problems are more likely to be victimized by others than to be a danger themselves. However, the risk of suicide is common among people with depression, anxiety, bipolar disorders, addictions, and other common highly treatable problems. Easy access to highly lethal means of self-harm can put even young, talented, people with tremendous potential at risk.
A case I often reflect back upon is Abraham Lincoln, who struggled with depression most of his life. At one point he was so severely depressed and ruminating about suicide that his friends took the step of removing his guns and hiding them. Had his friends not taken that step, we may never have benefited from the wise leadership of one of our greatest president’s. Taking away guns during a period when someone is at grave risk of self-harm or harm to others is a completely reasonable and necessary step.
In the United States, it is easier to get a gun and die by suicide than it is to get effective treatment for highly treatable mental health conditions.
While obtaining a gun is easy in our country, obtaining effective treatment for mental health problems is far more difficult. Today, the criminal justice system is the largest provider of mental health treatment. Far too often, someone with severe mental illness languishes without treatment until they commit a crime and are incarcerated. Upon release, those formerly incarcerated are removed from Medicaid and often do not receive continuing care.
According to the U.S. Department of Health and Human Services, more than 106 million people in the U.S. live in federally designated areas underserved for mental health. Mental Health America reports that over 12 percent of people with mental health problems are uninsured. Even for those who are insured, finding a therapist is challenging; 56 percent of counties do not have a licensed psychiatrist, psychologist, or clinical social worker. The net result is that 56 percent of adults with mental illness go without treatment. These numbers have not really changed in the past decade.
As we consider public options for healthcare and ideas such as “Medicare for All,” it is essential that we pay particular attention to mental healthcare. Our current system of private payment or insurance reimbursement for care often exacerbates our supply and demand problems. Payment covers individual psychotherapy in either half-hour, 45-minute, or 60-minute sessions. Individual psychotherapy is a limited resource in most areas of the country. Countries that have more extensive public options for mental health care are increasingly adopting a stepped care model that includes multiple levels: self-help, minimally supported help with a case manager, low-intensity treatment with a therapist and short (15-30 minute) sessions, traditional face-to-face psychotherapy, and more intensive team care. In this model, many people with mild to moderate symptoms receive lower intensive treatment and recover successfully. Only those with more severe, complex, and chronic problems receive higher levels of care. This dramatically increases mental health access for far more people. Most people can effectively be treated with internet-based interventions, freeing therapists’ time for those with more serious and urgent problems.
As a country, we urgently need to re-think how we can better distribute mental health resources. This requires rethinking options for the delivery of mental health treatment and problem prevention. We must protect some of our most vulnerable people from harming themselves and others, and we must use digital and online strategies to get effective resources to underserved areas.