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Executive orders on guns address mental health changes

President Barack Obama signs an executive order beside

President Barack Obama signs an executive order beside Vice President Joe Biden and children who wrote the president about gun violence. (Jan. 16, 2013) Photo Credit: EPA

President Barack Obama’s proposals to increase access to mental health services and start a national dialogue as part of the effort against gun violence encouraged advocates who say the system fails many in need.

Obama’s measures include training teachers to recognize students who need help and refer them to mental-health services and finishing regulations that define what mental-health coverage must be included by insurance plans.

“The mental health care system is broken, everyone knows that,” Michael Fitzpatrick, executive director of the Arlington, Virginia-based National Alliance on Mental Illness, said in an interview. “And the challenge is really not to fix it, but rebuild it.”

Fitzpatrick said the so-called mental health parity act, passed in 2008 but unenforced as the final regulations have yet to be published, is intended to eliminate unequal access to care from insurers that may set higher co-payments and other limitations on services such as mental-health counseling compared with physical ailments.

“This is huge,” he said. “There are two reasons people don’t get services for serious mental illness. One is certainly the stigma around mental illness, it blocks people. But also people can’t afford it, it’s not in their health-care package.”

Early Detection

The administration’s $500 million package of legislative proposals and executive orders to combat gun violence announced yesterday includes at least $80 million for mental-health efforts. A measure to provide incentives for schools to identify and intervene early when children show symptoms on mental illness, may also help get treatment started, Fitzpatrick said.

Early detection is vital, especially in schizophrenia, said Garen Staglin, president and founder of the International Mental Health Research Organization. His group helped fund a consortium that uses neuroimaging and genetic tests to identify precursors that manifest years before the disorder emerges.

“We can’t say we prevent the illness, but we basically arrest the deterioration of their condition, so that they maintain themselves on much lower medications and with much higher function than they would have had they not been in this program,” Staglin said in an interview.

Stigma Concerns

While advocates say the increased resources are needed, they cautioned that stigmatizing mental illness could make matters worse.

“Anything that will increase mental-health services is a very positive thing,” Renee Binder, a professor and director of the University of California, San Francisco’s psychiatry and the law program, said yesterday in an interview. “The concern is it will increase stigma and decrease people trying to access mental health, because they’re so worried about what the repercussions could be to them.”

Binder, who has researched crime and mental health for two decades, said about 4 percent of violent crimes are committed by individuals who are mentally ill.

“I think it’s important not to overreact and to stigmatize people with mental illness,” she said.

The president’s plan was announced about a month after the Dec. 14 shooting that killed 20 elementary-school students and six adult staff members in Newtown, Connecticut.

Psychiatric Group

“We are heartened that the administration plans to finalize rules governing mental health parity,” Dilip Jeste, president of the American Psychiatric Association said in a statement. “Such action will best ensure that Americans get the full range of mental-health services we believe they are intended to receive under federal law.”

The National Education Association, the union representing more than 3 million teachers, administrators and support staff endorsed the president’s proposals.

“To solve the problem, we must have not only meaningful action on preventing gun violence, but also bullying prevention and much greater access to mental health services, so that educators and families can identify problems and intervene before it’s too late,” Dennis Van Roekel, the union’s president, said in a statement.

Obama also said Health and Human Services Secretary Kathleen Sebelius and Education Secretary Arne Duncan will develop and lead a national conversation about mental health.

“His call for a national dialogue on mental health is critical to changing the conversation surrounding mental health, improving understanding and eliminating stigma,” Wayne Lindstrom, president and chief executive officer of Mental Health America said in a statement. “The actions he announced today represent the beginning of a sea change in the way we look at mental health in this country.”

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