by William Van Ornum, Ph.D. on
On December 20, 2012, the American Psychiatric Association sent the following letter to Congressional leaders in Washington:
To: Majority Leader Reid, Speaker Boehner, Minority Leader McConnell, & Minority Leader Pelosi:
I am writing on behalf of the leadership and members of the American Psychiatric Association (APA), the medical specialty representing 36,000 psychiatric physicians, to convey our deepest sympathies to the families of the Newtown, Connecticut, victims of last week’s unspeakable tragedy. These events have touched us all, and like other Americans, we struggle to come to terms with and understand this profoundly inexplicable horror. We stand ready to do whatever we can to help alleviate the sufferings caused by the tragedy, and to help the survivors cope with life after a trauma of this unimaginable magnitude.
We know that you, as Congressional leaders, seek answers to the causes of such tragedy, along with effective responses. We respectfully urge you to proceed calmly and with deliberation to address both. Stigma remains one of the greatest barriers to early identification, intervention, and treatment for Americans seeking help for mental illness, and we hope that Congress will avoid making generalized assumptions about persons now in or seeking treatment for mental illness. The vast majority of violence in our society is not perpetrated by persons with serious mental disorders. Research suggests that individuals with mental illness engaged in regular treatment are considerably less likely to commit violent acts than those in need of, but not engaged in, appropriate mental health treatment (American Psychiatric Association, Resource Document on Access to by with Mental Illness, 2009).
We believe this offers an important insight for public policy-makers: access to comprehensive, effective psychiatric treatment works. Yet, at the very time of the Newtown tragedy, federal and state funding of critical mental health services is under siege. Across the country, states facing severe financial shortfalls have reduced public mental health funding by $4.35 billion from 2009 to 2012, according the National Association of Mental Health Program Directors (March 12, 2012). Twenty-nine states have reported that fiscal and other pressures have caused them to close more than 3,200 psychiatric inpatient beds in the past four years. We were heartened by the promise of the Mental Health Parity and Addiction Equity Act in 2008, and we strongly supported the inclusion of required coverage of mental health and addiction treatment services as core benefits under the Affordable Care Act. Unfortunately, the promise of better access to psychiatric treatment will not be a reality absent requisite federal and state funding. In the wake of the Newtown tragedy, we hope that Congress will act to protect federal funding for mental health and addiction treatment research and services.
Funding of public mental health research and treatment is one part of the equation. The APA believes that restricting access to firearms during a crisis is another. Laws permitting the temporary removal of firearms from individuals believed to be imminently dangerous are sensible from a public policy perspective, and would help psychiatrists respond prudently to genuine threats by their patients. In the wake of Friday’s tragic events, the APA believes that any discussion on fostering a robust mental health delivery system must not be isolated from discussions on strategies to reduce gun violence. Over the past two decades, APA has supported appropriately targeted proposals such as mental health registries and modified access to firearms as meaningful ways to curb gun violence. We are also profoundly disturbed by recent efforts in some states to curb or bar the ability of physicians, including psychiatrists, to prudently and confidentially inquire about the presence of firearms in the home when the behavior of their patients warrants such an inquiry. These ill-advised proposals should be rejected, as they interfere with the professional and ethical duties of psychiatrists and other physicians to carry out their responsibilities and in so doing, help reduce the risk of injury and death to individuals and the public at large.
Thank you for your leadership and for your consideration of these comments. The APA stands ready to work with the Congress and the Administration on comprehensive policy initiatives to better ensure the nation’s mental health and physical safety.
Dilip V. Jeste, M.D.