Health Reform and Mental Health

School shooting and other mass gun murders, the opioid crisis, homelessness; these social ills all could be improved with adequate attention to the mental health infrastructure in America. What is missing in most of this current national discussion is that mental health evaluation and treatment should be a primary part of the solution.

As a family physician, I contend that mental health evaluation and treatment is too late if we only concentrate on the prospective shooter, the addict, or the schizophrenic person who is living on the street. Do not misunderstand me: we need to help these individuals. What I am specifically saying is that we need to help them as well as the vast number of people with mental health diseases when the disease first occurs or even before they occur.

Studies indicate that at least 20 percent of Americans will have a diagnosable mental health condition sometimes in their life. In my family medicine practice, 40 percent of my patient visits involve patients with either a primary or secondary mental health diagnosis. Appropriate mental health care begins with universal health care which would enable access to medical care, including having a primary care physician.

As a family physician, using a questionnaire and as part of developing a relationship with my patient, I evaluate his or her mental health status at every encounter. Additionally, my physician-patient relationship hopefully creates the trust that the patient and the patient’s family can contact me if any signs of a mental health disease develop or a mental health crisis occurs.

Beyond primary care interaction with patients with mental health diseases, universe health coverage would allow patients with mental health diagnoses to access counselors, therapists, psychiatrists, psychiatric medications, and when necessary, outpatient and inpatient mental health programs.

Efforts by Republicans to block even discussions on universal health coverage leave vulnerable people without access to mental health services, either via primary care or other services. The end result is a greater likelihood for more school shootings such as the massacre that recently happened in the Parkland, Florida high school which left 17 people dead and 14 wounded, and the 63,600 opioid deaths that occurred in 2016 throughout America.

Even in the best scenario for universal health coverage—ready access to primary care and a good mental health infrastructure— some individuals with serious mental health issues will seek to harm other people on a grand scale. In these situations, we need a society that supports comprehensive background checks (with no loopholes), reasonable limits on the types of guns that can be purchased, elimination of kits and devices that convert a hunting rifle into a semi-automatic weapon, and strict limits on high capacities magazines. Finally, we must have a system where mental health specialists can, when necessary, interact with the appropriate authorities regarding specific individuals who own or have access to guns and could be a danger to themselves or others.

These types of efforts instituted by other countries prevent or minimize mass casualty shooting. A gun massacre in a primary school in Dunblane, Scotland in 1996 drastically changed gun regulations there. Strict limits were placed on guns of all types and magazines of any type. Licensing requires a comprehensive background investigation. Since comprehensive gun laws were implemented, no mass shootings have occurred in Scotland.

Our children are suffering and dying because of the societal deficiencies mentioned above. Children, their parents, and all voters must demand we enact more stringent gun control regulations.

Too many lives depend on it.