Mathis and others also worry that in their haste to act, lawmakers in the states and on Capitol Hill could end up doing as much harm as good. “Mental-health care, in a time of national crisis, is easy to get behind,” said J. Reid Meloy, a forensic psychologist and clinical professor at the University of California at San Diego. But that alone is not enough, he said. “It’s much easier to pass laws than to provide the funding to support those laws.”
Another problem: “There is a danger you write bad policy,” Meloy said.
That fear already has begun to play out in certain states, said Debbie Plotnick, senior director of state policy for the advocacy group Mental Health America.
“We’re very concerned about reactionary legislation . . . that impinges upon people’s rights,” Plotnick said, adding, “We’re seeing a push come out of these episodes to have more coercive laws.”
The gun-violence law recently enacted in New York is one example, some mental-health advocates say, of legislation that could have troubling consequences. It includes a provision requiring physicians, social workers and other therapists to report potentially dangerous patients to local health officials. That information would go into a state database that could be used to revoke a patient’s gun license or confiscate legally owned guns — a scenario some critics say threatens civil rights and could discourage some people from seeking treatment.
Another complicating factor is that not everyone agrees on precisely what changes are most needed. “There is no unanimity where you put very scarce resources,” said Robert Glover, executive director of the National Association of State Mental Health Program Directors.
There is broad agreement that the system remains woefully underfunded in much of the country. And there is little opposition to early identification and prevention programs for people with mental illness, as well as making more treatment available for young people — all principles supported by Obama, among others. Advocacy groups also are pushing the administration to spell out the specifics behind federal legislation that requires more expansive insurance coverage for mental-health services.
But certain issues remain divisive. Efforts in numerous states to make it easier to commit the most severely mentally ill patients against their will have troubled many advocacy groups but have pleased people such as Doris Fuller, who have long pushed for such changes as necessary to treating severely ill patients.
“We are seeing interest in reform in states that haven’t looked at it in a decade or more. . . . It’s certainly created opportunities that we have rarely seen before,” said Fuller, executive director of the Arlington County-based Treatment Advocacy Center. “We’re trying to improve the laws in such a way that legal barriers to timely and effective treatment are removed.”
Fuller said she realizes that many people in the mental-health community “are at odds with us.” But given the limited resources, the focus should be on those with the most severe mental illnesses — a population also at the highest risk for violence, she said.
Despite the disparate goals and legislative ambiguity, most mental-health advocates seem thankful for the spotlight, if only because of the hopes that it will bring more funding and attention to mental-health issues.
That would be a welcome change. The budget cuts of recent years have translated to fewer beds at psychiatric hospitals, fewer crisis centers and decreased access to treatment for low-income patients.
The tide, advocates hope, is beginning to shift. “It would be good if we could undo some of the damage of recent years,” Plotnick said. “We’ve had years of cuts, and they’ve been drastic. We’re seeing a rethinking of that. I wish it would turn on a dime.”