(April 18, 2013) Dear Honorable Members of Congress:
The gun control legislation that last year’s Newtown tragedy and other rampage killings inspired is dead, but Congress still has a viable path to reducing violence: make treatment more accessible to the people with severe mental illness most at risk to commit violent acts.
The vast majority of individuals with mental illness are no more violent than the general public. But when an individual with a serious mental illness is untreated, the risk of violence rises. An estimated 10% of homicides and 50% of rampage killings are committed by a small subset of people with untreated mental illnesses, particularly those that include paranoia or command hallucinations. People with schizophrenia or bipolar disorder are also much more likely to die from suicide than others.
The Senate already has one mental health bill before it, and more may be introduced now that the gun control door is closed. If the goal of Congress is to identify and provide services to more people who are not at risk to commit violent acts, the proposals made so far may be useful. If the goal is to reduce the number of homicides and other violence by those who are at risk, lawmakers must look elsewhere.
The Treatment Advocacy Center in January proposed three mental illness treatment policies within the power of Congress to enact that specifically target the population most at risk to commit violence against others or themselves.
- Foster universal adoption and use of court-ordered outpatient treatment (“assisted outpatient treatment” or “AOT”) for at-risk individuals by establishing and funding a national AOT demonstration project. AOT already has been deemed an “effective” and “evidence-based” practice for reducing crime and violence by the Department of Justice. Mental health courts – which allow mentally ill criminal defendants to be diverted out of the penal system and into treatment – became widespread after a similar federal demonstration in the early 2000s. One benefit of AOT is that it does not require a person to commit a crime in order to qualify for help.
- Promote understanding and use of civil commitment laws by funding educational programs for judges, law enforcement, school officials and others in a position to use them. Court-ordered treatment options exist to safeguard those with the most severe mental illness, their families and their communities. As long as these laws remain unfamiliar, misunderstood or overlooked by people in a position to use them, the public will remain needlessly at risk.
- Address the catastrophic loss of public psychiatric beds for individuals in psychiatric crisis or with chronic mental illness by repealing the Institution for Mental Diseases (IMD) Exclusion in the Medicaid program. This 50-year-old federal policy creates an economic incentive for states to eliminate the inpatient treatment option that those most at risk for violence often require to stabilize and begin recovery.
President Obama, Vice President Biden’s task force and the Senate to date have focused the bulk of their response to the rampage killings of 2012 on gun control. That pathway to reducing violence is closed.
If our leaders are serious about reducing violence, they must focus now on the role of untreated serious mental illness. To change the math in which less than 1% of the U.S. population commits half the rampage killings, 10% of the homicides and countless other violent acts, including suicide, we have to add treatment to the equation.
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