Now Tittl has joined the ranks of Republican lawmakers nationwide pushing to expand mental health treatment, a remarkable turnaround for a party that a few years ago was staking its reputation on cutting taxes and starving government budgets. The renewed GOP focus comes as the party, which lost more than 300 state legislative seats last year, has struggled to convince voters it cares about a host of societal challenges, including mass shootings, opioid and methamphetamine abuse, homelessness and surging suicide rates.
“We used to just brush it under the rug,” said Tittl, chairman of the state Assembly’s Committee on Mental Health, “but the simple fact is we now know we need to talk about it.”
So far this year, Republican state legislators nationwide have proposed 5,372 bills that mention “mental health,” about twice as many as they sponsored five years ago, according to a Washington Post analysis using Quorum, a database of state and federal legislation. Republican governors in several states have made mental health reform a key component of their legislative agendas.
Democratic legislators still sponsor more mental health legislation than their GOP colleagues — about 10,000 bills so far this year. But the number of bills sponsored by Republicans has increased for three consecutive years, according to Quorum.
In Minnesota, GOP state senators have proposed an additional $25 million for mental health services for students, farmers, expectant mothers and homeless people. In Georgia, the GOP legislature formed a committee this past spring to take a comprehensive look at all aspects of that state’s mental health system. And in Utah, Republican legislators and Gov. Gary R. Herbert (R) have been adding mental health counselors to schools.
Even in Washington, President Trump has vowed to consider federal policy changes, including floating a controversial proposal to open more psychiatric institutions. It has become his go-to solution for mass shootings, most recently after August’s back-to-back shootings in El Paso and Dayton, Ohio.
“I do want people to remember the words ‘mental illness.’ These people are mentally ill,” Trump said of mass shooters several days after the incidents. “A lot of our conversation has to do with the fact that we have to open up institutions; we can’t let these people be on the streets.”
Many Democratic lawmakers and advocates say Republican leaders’ growing focus on mental health is at odds with their track record of limiting funding and opposing Medicaid expansion, which generally covers mental health services. They say it’s a political play to latch on to growing public awareness of the issue.
“I call it a facade, because the commitment is somewhat phony,” said Iowa state Sen. Rob Hogg (D), who this summer voted against Republican Gov. Kim Reynolds’s proposed expansion of mental health services, because he said he worried it wouldn’t be adequately funded. “And I know they are just responding, as Republicans usually do, because they know the public wants something done, so they just create an appearance of doing something.”
About 1 in 5 adults suffers from a mental illness each year, according to the National Alliance on Mental Illness. There has been a 31 percent increase in suicides during the past two decades, with rates for farmers, veterans and teenagers rising especially quickly.
Mass shootings also have brought the issue to the forefront.
After last year’s shooting at a high school in Santa Fe, Tex., Gov. Greg Abbott (R) made mental health reform a key component of his legislative agenda. In June, Abbott signed legislation that increases mental health training for teachers while also expanding students’ access to school-based counseling. Later in the summer, after the shooting at a Walmart in El Paso that killed 22 people, Abbott again signaled he would focus on mental health — not guns — to try to calm public angst about gun violence.
“Bottom line is mental health is a large contributor to any type of violence or shooting violence, and the state of Texas this past session passed a lot of legislation and provided funding for the state to better address that challenge,” Abbott said, according to the Texas Tribune.
While some mass shooting suspects have had diagnosed mental health issues, studies have found many others did not. Gun-control advocates have accused Abbott and other politicians of using mental health as a diversion to avoid discussions about gun control, including proposals for “red flag” laws.
Seventeen states and the District have enacted laws allowing extreme-risk protection orders, which let authorities take away firearms from people suspected of being a danger to themselves or others. In other states, GOP lawmakers are blocking red-flag bills in favor of proposed changes to mental health laws or funding.
In Pennsylvania, for example, the House Judiciary Committee chairman, Rob Kauffman (R), announced last month he won’t take up red-flag legislation amid calls from gun rights activists and state GOP lawmakers to instead push for new mental health laws, including more institutionalization.
Nico Bocour, state legislative director at the group Giffords: Courage to Fight Gun Violence, said gun-control advocates need to do a better job fighting back against Republicans’ attempts to use mental health legislation to overshadow the gun debate.
“It’s clearly access to guns, by people, that is the root cause of gun violence in our country,” Bocour said.
In Wisconsin, Gov. Tony Evers (D) and Democratic legislative leaders proposed their own version of a red-flag law last month. But Republicans who control the legislature, including Tittl, are instead pursuing bills aimed at shoring up Wisconsin’s mental health system.
Tittl argues that the Republican proposals — incentives for psychologists to start practices in underserved communities and tax credits for community-based, outpatient mental health facilities — are not in response to Democrats’ push for tougher gun laws. Instead, he said, Wisconsin Republicans are seeking to address constituents’ concerns about the quality of care in a state that has been ravaged by substance abuse and growing suicide rates.
“I really believe that mental health is in the forefront of people’s minds, because all of a sudden they realize, ‘Hey, it’s in my family. It’s someone I go to church with, or someone I interact with day after day,” Tittl said. “The myth that we are just caring now, because of guns, is ridiculous — we cared all along.”
There are differences within the party on the best way to approach the issue. At least in Wisconsin, Tittl said, he and other GOP legislators see community-based care as a more humane and fiscally wise approach than Trump’s call for more institutionalization.
But Wisconsin mental health advocates worry that GOP leaders are not doing enough to produce real improvement in the system, including ramping up funding after years of relative stagnation.
Many state governments froze or cut funding for mental health programs during the recession and have been slow to restore it. When adjusted for inflation and population growth, states in 2015 were spending less on mental health than they did in 1981, according to a study last year by the National Association of State Mental Health Program Directors Research Institute.
Under Wisconsin’s previous governor, Republican Scott Walker, total funding for mental health increased by about $87 million over his two terms in office, according to state health officials. But Walker refused to expand Medicaid, which would have extended coverage to residents who earn up to 138 percent of the federal poverty level. Walker instead expanded a state subsidized health-care plan that capped participation at 100 percent of the poverty limit, which left an estimated 81,000 residents underinsured.
“There has been heightened awareness about the need to support mental health and substance abuse services as the needs continue to rise,” said Martina Gollin-Graves, president of Mental Health America of Wisconsin, an advocacy group. “But it’s a Band-Aid, because we did not accept the Medicaid expansion, and that has limited access to those who needed it and continue to do so.”
Last year, voters in rural western Wisconsin signaled just how important the mental health crisis is to them.
In a December special election, Democrat Patty Schachtner won a state Senate seat after campaigning on mental health, flipping a district that Trump had carried by 17 points. On the campaign trail, she used her experiences as a death investigator for the medical examiner and a school health-care provider to connect with voters and stress the need for more government funding for mental health services, including for children affected by the region’s drug epidemic.
“For the longest time, mental illness hasn’t been looked at as a disease,” Schachtner said. “But now it is finally being looked at as, ‘Geez, this is part of the human body and the brain, and maybe we should treat it as a medical condition.’”
But effective treatment, Schachtner said, will take money. And that is why she remains skeptical that her Republican colleagues are ready to stay in the fight for the long term, considering their anti-tax philosophy.
“No matter who you are, you are there for a reason,” said Schachtner, referring to the Capitol in Madison. “If your reason is not to pay as much taxes, you are not going to focus on issues that have human impacts.”
Quorum data contributed to this report. Quorum is a legislative and public affairs software company based in Washington.