A time to act for the Innocents

The Newtown Tragedy has generated an exceptionally important dialogue between the mental health and substance use care community and the Obama Administration. The field has had a unique opportunity to help identify broad-based solutions for the Vice-Presidential Taskforce created by President Obama. At a meeting earlier this week chaired by Secretary Kathleen Sebelius of HHS and Attorney Eric Holder of the Justice Department, widespread agreement existed around the recommendations our community provided three weeks ago in a National Call to Action:

·         Immediately implement school, family, and community-based programs to promote mental health, to prevent mental illness and substance abuse, and to provide early interventions for those exhibiting these conditions.

·         Immediately begin teaching students at all levels to recognize the signs of mental illness and addiction, and to seek help when needed. 

·         Immediately double the capacity of mental health and substance abuse programs.

·         We commend President Obama for creating a Workgroup led by Vice President Biden, in part to examine the issue of banning assault rifles and large capacity clips.

Today, we are anticipating further dialogue with representatives of the Administration and the Congress regarding actions that they will propose in response to the Newtown Tragedy. We hope that these recommendations will include clear efforts to make our mental health and substance use care and prevention system much more responsive to the pressing needs that are apparent in  communities throughout America.

As we prepare for the release of these initial recommendations, it is very important to consider several things. If we are to make significant progress in addressing the mental health and substance use issues in our schools and communities, we must be able to move beyond our traditional comfort zone. This will involve accepting many new changes and helping to lead the necessary transformation of our field. 

Both the Affordable Care Act and the National Prevention Strategy can help us transition into a new world. We currently have very little experience with this new world: near universal insurance coverage that includes mental health and substance use benefits; a new focus on disease prevention and health promotion; integrated care systems dominated by primary care entities; performance-based case-rate systems, and a range of new IT tools, among other changes. We must not simply yearn for a past which no longer exists, but rather help our field, our colleagues, and our consumers make these essential transitions. 

But, clearly, in the wake of Newtown, our work does not and should not end here. Guided by our hard-won gains of recovery/community integration and resiliency/wellness, we also must engage head-on several concerns that are currently being debated in the broader milieu. Specifically:

·         We need to have a position on gun control. A good place to start would be to support a ban on assault rifles and large magazine clips. Assault rifles have been identified for decades as a major public health problem in the United States. Others do and will have positions about this, both pro and con. We need to do so as well.

·         We need to have a position about controls around the sale of guns, including questions around screening. What screening should be done? By whom? How? With what criteria? 

Without positions of our own, we simply will be reactive, and we likely will become a target for those who have very vocal positions and who promote stigma around mental illness.

As citizens, we have a right to be concerned about the proliferation of assault rifles. Today, there are 3 million assaault rifles in the hands of Americans--one for every 100 of us. Do you want an assault rifle in your home? In your neighbor's? In your community?

As citizens, we also have a right to be concerned about any gun controls that are proposed, and about the appropriateness and equity of any screening procedures. We need to balance community concerns about public- and gun-safety against personal concerns about privacy and individual rights.

As a field, we must exercise these rights, rather than engage in self-censoring. Courage will be required. There are likely to be negative consequences. But we must act.

If we self-censor around these issues, I suspect that, inadvertently and unfortunately, we too will contribute to mental illness stigma. We will do much better by confronting these questions head-on than by simply being reactive.

What are some of the primary considerations?

We probably can all agree that persons who are violent should not have access to firearms. But we also know that persons with behavioral health conditions are no more violent that are people from the general public. Hence, screening criteria for gun purchases should focus on propensity to violence rather than on mental illness. As a field, we need to make and support these types of arguments, and we need to help develop the necessary tools.

As a field, we also will need to address the culture of violence and death that surrounds us, our consumers, and our communities. This culture is fed by our decade of military involvement in Iraq and Afghanistan, our entertainment media, and violent video games. As the field of behavior change, we can and must make meaningful contributions to changing this culture. 

Similarly, we need to acknowledge that, today, lack of appropriate access to good community-based mental health and substance use care is a fundamental and major issue for both children and adults in most of our American communities. We must improve essential access through transformative strategies facilitated by the Affordable Care Act, rather than permit the view to prevail that commitment strategies are the solitary choice for our communities.

Finally, we need to "give voice" to our consumers who work side-by-side with us every day as peer supporters, coalition organizers, state leaders, and advocates. Giving voice to consumers will  demonstrate the critical reality of recovery and community life. It will also remove much of the mythology being promoted today.

There is great urgency for us to undertake all of these steps. The Vice President is due to submit his recommendations to the President next week. In turn, the President is expected to announce his proposed actions in the annual State of the Union Address in mid-February. Indeed, we have very little time within which we must act.