Mental health and gun violence meet at a bumpy crossroad

In an address during which he wiped away tears, President Barack Obama last week dared Republicans to finance mental health reform as part of a package of executive actions meant to combat gun violence.

“For those in Congress who so often rush to blame mental illness for mass shootings as a way of avoiding action on guns, here's your chance to support these efforts,” he said. “Put your money where your mouth is.”

Obama asked for $500 million to improve mental health services. But even White House press secretary Josh Earnest admitted the administration doesn't expect Congress to grant the funding, adding that he would “be happy to be proved wrong.”

While mental health advocates largely support the call for more funding, they are now stuck linking mental health and gun violence—two issues they've wished would remain separate.

“We desperately need mental health reform and increased funding for mental health services independent of the whole gun debate,” said Ron Honberg, national director of policy and legal affairs for the National Alliance on Mental Illness. He and others believe talking about reforming mental healthcare as a way to fix the country's gun violence epidemic propagates a stigma that's often responsible for the lack of treatment among almost half of the estimated 44 million Americans with mental illness.

According to HHS, people with severe mental illness account for 3% to 5% of all violent acts. Those individuals are actually 10 times more likely than the general population to be the victims of violent crime.

“The real issue here is that there's a huge problem with mental health,” said John Snook, executive director at the Treatment Advocacy Center, adding that he supports talking about solutions within any context.

And all signs point to the right climate for actual change.

In the aftermath of the shootings in San Bernardino, Calif., that killed 14 people, House Speaker Paul Ryan has called for reforming mental health laws. He and other Republican leaders have endorsed a proposal that was first introduced by Rep. Tim Murphy (R-Pa.) a year after the 2012 Sandy Hook shootings that killed 26, including 20 children. The bill included incentives for states to implement court-ordered treatment, but a $15 million pilot program for that was part of the omnibus budget deal at the end of December.

“A common theme among many of these mass shootings is a theme of mental illness,” Ryan said, echoing what a recent Washington Post survey on gun violence found: 63% of those surveyed believed a deficient mental health system was more responsible than weak gun laws for mass shootings. “We need to fix our mental illness laws, our policies. They're outdated,” Ryan said.

Murphy's bill is one of several bipartisan proposals to reform mental healthcare. Sen. Chris Murphy (D-Conn.) has a bill that would provide state grants for early intervention. It would also create an assistant secretary for mental health and substance abuse disorders within HHS. The bill has been criticized for a provision that clarifies the Health Insurance Portability and Accountability Act to ensure certain records can be shared with parents and caregivers, who otherwise may find it difficult to help patients in their charge.

Obama's executive actions likewise included some tweaks to the privacy law, allowing a small number of additional organizations to share information with the federal database that conducts background checks for potential gun owners.

Sen. John Cornyn (R-Texas) has introduced a bill approved by the National Rifle Association that would encourage states to share more mental health record information with a national database. But Democrats say that proposal on background checks would weaken the system. And finally, Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) introduced yet another bill last week that would increase funding to expand the number of community mental health centers that offer 24-hour psychiatric care.

The flood of proposed legislation—of which only one, Sen. Chris Murphy's, has a scheduled hearing—mimics what often happens during a time of crisis. Mental health advocates have historically watched support for their cause ebb and flow, along with badly needed funding.

The National Alliance on Mental Illness reported that 37 states bumped up their budgets for mental healthcare after a man with largely unchecked psychological issues killed those children and adults at Sandy Hook Elementary School. The next year, a financially tough one for many states, only 29 states increased funding. Medicaid expansion had a surprisingly negative impact on mental health services. Some states pulled funding from community clinics, believing more people would use their newly acquired benefits to seek the help of psychiatrists, a specialty that's losing professionals and often doesn't accept Medicaid patients.

Paul Gionfriddo, CEO of Mental Health America, noted a positive aspect of Obama's funding proposal: It did not detail how the money should be spent, leaving the door open to allocate those funds toward any of the bills being considered.

From a legislative perspective, linking mental health reform with the effort to reduce gun violence runs a risk of melding a largely bipartisan issue with one that has divided Republicans and Democrats for decades. And with a new president taking office next year and dozens of congressional seats in play, all bets are off.

Still, advocates are hopeful.

“I would be very surprised if we didn't see something at this point,” Snook said. “It would be an inexcusable failure at this point for there not to be some important changes made.”