MASS SHOOTING after mass shooting, Democrats call for more gun regulations while Republicans stress the importance of improving mental-health care. Both are necessary. Yet the depressing result of this partisan routine has been that nothing happens on either issue.
That might soon change, at least on the mental-health front. Solid, bipartisan mental-health bills are poised to move in both chambers. They should be passed, reconciled and signed into law.
The House’s version is the stronger of the two. Championed by Rep. Tim Murphy (R-Pa.), it would start by reforming the way Medicaid treats mental-health care, making it easier to reimburse hospitals for treatment and removing a rule blocking payment for mental and physical health care delivered on the same day. It would then offer more money to states that adopt “assisted outpatient treatment” — essentially, mandatory care for people with severe mental illnesses, such as schizophrenia, monitored outside mental-health facilities. It would relax privacy standards that have served to keep families dangerously in the dark about the condition of their sick loved ones. It would insist the federal money go to programs that have some evidence to suggest they would help those with mental illness. And it would invest in community mental-health centers.
Some advocates for those with mental illness dislike the bill, arguing that forcing people into treatment is unduly coercive and that the government should stick to the sort of assistance many people really need, such as housing aid. Yet the whole point is to help people most in need — the severely mentally ill, particularly those who may not understand they have problems. These people may not be willing to take necessary medications or accept housing subsidies, and their families might not know much about their illnesses. The state has good reason to step in.
There are still several outstanding questions for lawmakers to work out. Among them is how to merge the House version with the Senate’s, which focuses more on funding several grant programs than on pressing for things such as assisted outpatient treatment. The question of how much to tell families is also open, though lawmakers appear to be wisely steering clear of opening therapy notes or reducing penalties on doctors who break patient confidentiality. Lastly, there is the issue of cost. Removing barriers to mental-health care coverage in Medicaid, for example, could well cost large amounts of money. It’s unclear if lawmakers will be able to keep costs manageable or to find additional funding to offset the price tag.
Any of these issues could sink the bill somewhere in the legislative process. That would be a shame. The Affordable Care Act has gone a long way to increase access to mental-health services in a landmark moment for psychiatric care. But the government has every reason to insist that the billions it spends on mental-health services are well-targeted and effective.