Obama gun-violence plan: Millions more for mental health services

In announcing the Administration’s plan to reduce gun-related violence,  President Obama said he would issue a series of 23 executive orders and ask legislators to approve additional initiatives totaling tens of millions more aimed at helping the nation “make access to mental health care as easy as access to a gun.” Among the key elements of the President’s announcement were:  

• a call to keep guns out of dangerous hands by strengthening the nation’s background checking system and to strengthen enforcement powers for existing laws regarding gun-related crimes, gun trafficking, gun importation, and the tracking of lost and stolen guns.  
• a proposed ban on military-style assault weapons along with high capacity magazines (> 10 bullets) and armor-piercing bullets.
• initiatives for improving school safety and the ability of school officials, staff, and professionals to identify and respond to mental health, substance abuse, and violence concerns.
• steps to improve access and quality of mental health services to all Americans, particularly young adults and school-age children and teens, and to launch a national dialogue about mental health.

While noting that the vast majority of people with mental illness are not violent, the President stated that “recent mass shootings have highlighted how some cases of mental illness can develop into crisis situations if individuals do not receive proper treatment.”  He called on the nation to “do more than just keep guns out of the hands of people with serious mental illness,” asserting that “we need to identify mental health issues early and help individuals get the treatment they need before these dangerous situations develop.” Then, he announced a series of executive orders that directed:

• the federal government to eliminate “unnecessary legal barriers” that prevent states from making relevant information, notably mental health information, available to the background check system due to misunderstanding or misapplication of the requirements of the Health Insurance Portability and Accountability Act (HIPAA).
• the Centers for Disease Control to conduct research into the causes and prevention of gun violence as a public health issue.
• the National Violent Death Reporting System to be expanded from the current 18 states to all 50 states so that anonymous details collected about the use of firearms in homicides or suicides can be better shared and understood.
• federal agencies to clarify that no federal regulations prevent health care providers from reporting threats of violence to law enforcement and that no elements of the Affordable Care Act limit the ability of doctors to ask patients about the presence of guns or about gun safety as needed, especially when the patient—or family members—are young or show signs of mental illness.
• federal agencies to expand training for law enforcement, first responders, and school officials to respond to an “active shooter” situation.

The President also ordered his Administration to follow through on timely completion of anticipated new regulations that support the implementation of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act of 2008. He ordered that:

• federal agencies complete and release long-awaited final regulations next month governing how private existing group plans that offer behavioral health benefits, as well as new private small-group and individual plans, must cover mental health and addiction treatment benefits at parity with other health benefits.  
• the Department of Health and Human Services clarify the scope of mental health services that state Medicaid plans must cover, specifically that these plans must comply with mental health parity requirements.

In addition, the President recommended that Congress pass a range of steps to improve school safety and expand access to behavioral health professionals and services, including:

• A call for $150 million for use by law enforcement or school districts to support the hiring of 1,000 new school resource officers and school counselors
• A $50 million initiative to assist 8,000 schools in training teachers and staff how to implement evidence-based practices that foster a safer and nurturing school environment.
• A call to reach 750,000 young people with a new initiative, Project AWARE (Advancing Wellness and Resilience in Education) that can help to identify individuals with mental illness early and enable their rapid referral to treatment.  Project AWARE has two key components:

—a $15 million grant would support “Mental Health First Aid” training for teachers and other adults who interact with young people that would help them to detect and respond to mental illness in young people and encourage them and their families to locate and seek treatment.   

—a $40 million grant to ensure that school districts can work with law enforcement, mental health agencies, or other local organizations to assure that students with mental health or behavioral issues are referred to appropriate and needed services.

• A $25 million grant program to support “innovative, state-based strategies” that support young people with mental health or substance-use problems to receive support beyond and outside high school.
• $25 million more in funding to provide mental health services for young people impacted by trauma and “pervasive violence” as a means of “breaking the cycle” of violence that affects the lives of one in five teenagers.  
• Educational supports, totaling $50 million, to cover stipends and tuition reimbursements for the training of 5,000 new mental health professionals—social workers, counselors, and psychologists— to serve young people in schools and communities nationwide.