Ailise Delaney
Ailise Delaney is a Resident Forum Blogger shedding light on emerging issues in Mental Health Law and Disability Rights.
“The real issue is mental illness.” Variations of this statement are regurgitated by politicians and echo from news sources after almost every mass shooting in the United States. Less than 24 hours after the horrific events in San Bernardino, California, Speaker of the House Paul Ryan called for changes to our mental health laws, touting the largely unsupported notion that “mental health” is a “common theme among many of these mass shootings.”
The Mad Gunman Myth – that mentally ill people are the leading perpetrators of mass shootings despite empirical evidence refuting such claims – is a common misconception rampant in our country. Studies show that in terms of people with serious mental illness, the large majority are never violent: “Only about 4% of violence in the United States can be attributed to people diagnosed with mental illness.”
Sadly, lack of evidence has not prevented the public from creating illusory correlations between mental illness and mass shootings.[1] Mass media, politicians, and fear only exacerbate this “when mass shootings come to stand for all gun crime, and when ‘mentally ill’ ceases to be a medical designation and becomes a sign of a violent threat.”
The shortage of data regarding gun violence in general can be traced back almost 20 years, when in 1996 Congress passed an appropriations bill with an amendment asserting “none of the funds made available for injury prevention and control may be used to advocate or promote gun control.” Though the legislation didn’t explicitly ban research on gun violence, it essentially had that effect.
While initially aimed to prevent the Center for Disease Control and Prevention from funding research that could be viewed as advocacy for gun control, the amendment has a larger unforeseen chilling effect that “trickled down into academia.” Federally funded researchers shied away from gun related research altogether, “afraid [of] how the interpretation of their data might be used –and used against them.”
The Mad Gunman Myth highlights serious problems regarding the way we discuss about mental health in America. Mental health is an uncomfortable and touchy subject, not exactly the kind of thing you would talk about over dinner. Psychologists, and notably Last Week Tonight host, John Oliver, point out that, when we do talk about mental health, we don’t talk about it well. Conversations tend to be “reactive” rather than “proactive;” the only time there is a public discourse regarding mental health, an issue that immediately impacts one in four Americans, is when it is framed by a tragedy. The practice of only discussing mental health when paired with negative events reflects structural stigma while reinforcing public stigma against persons with mental health issues.
Stigma associated with mental health remains one of the largest barriers to care. Real or perceived stigma prevents people from seeking help, leading many to go undiagnosed or untreated; the serious effects of which are illustrated by survivors of suicide,[2] saying they had “no idea” a loved one was in peril, or wishing the person had said something.
Public stigma becomes structural when it “pervades societal institutions and systems.” Psychiatrists have long pointed to the disparity between funding provided for mental health research compared with medical research, as well as the fact that mental health care “is not covered by insurance to the same extent as medical care” as signs that mental health stigma exists at a cultural level.
Another mark of the structural impact of mental health stigma can be found in the proposed mental health legislation Helping Families in Mental Health Crisis Act of 2014, also known as the Murphy Bill, the same bill Speaker Ryan called upon Congress to pass in the days after the Colorado and San Bernardino shootings. This Bill in part gives greater freedom to the families of persons with mental health issues while simultaneously stripping individuals with mental health issues of constitutional protections.
At first glance, the Murphy Bill is an attractive piece of proposed legislation seeking to reform mental healthcare in America. Aiming high, the bill promises to empower parents and caregivers by modifying the Health Insurance Portability and Accountability Act (HIPAA) “so that family members can become more involved in treatment.” However, many, especially patient-advocates, view the bill as discriminatory and an unconstitutional violation of patient’s rights. In addition to modifying HIPAA, the bill would amend The Protection and Advocacy for Individual with Mental Illness Program (PAIMI), a federally funded program safeguarding the rights of individuals with mental health issues. Under the bill, Protection and Advocacy agencies would be prohibited from lobbying on behalf of persons with mental illness, informing patients of their rights, engaging in systemic lawsuits, investigating and seeking legal remedies on behalf of the individual with mental illness.
Another controversial component of the bill is the creation of financial incentives a 2% increase in funding, for states that adopt assisted outpatient treatment (AOT). AOT allows judges to mandate a patient’s treatment, including compelling patients to adhere to medication regimens.
The response of politicians and media in the immediate aftermath of a mass shooting, combined with personal anxieties and fear, makes the political climate ripe for haphazard legislation without contemplation of the serious constitutional implications it raises. While I agree that there needs to be a serious change in how we approach mental health in this country, abrogating the constitutional rights of an entire population should not happen as a knee-jerk reaction, nor be our first choice.