Sunday, January 9, 2011

Unbalanced Gunman, Unbalanced Policy

Yesterday, a seriously disturbed young man shot twenty innocent people, killing a nine-year old girl, a federal judge, a 30-year old political staffer, an elderly gentleman trying to protect his wife, and two others, and wounding the rest, including Jewish Congresswoman Gabby Giffords. His precise motives remain unknown, although he clearly held some extreme political views, and there is some evidence that anti-Semitism may have played a role as well.

Many, including me, have pointed a finger at the irresponsible and violent rhetoric that has overtaken politics since the Obama election. It is so self-evident that the hateful, often racist, occasionally treasonous rhetoric coming from the Tea Party and other extremists contributed to this incident, it's hardly worth exploring here. In any event, that discussion will dominate the national debate for a while, just as it did in Israel following the 1995 assassination of Prime Minister Yitzchak Rabin.

I began to wonder, though, about the shooter. By all early accounts, he suffers from a degenerative, paranoid, and violent mental illness. While we cannot know at this point what diagnosis, if any, might be appropriate for him, it does appear that he began displaying abnormal behavior in his teens—typical of schizophrenia.

The shooter had attended Pima County Community College, where his increasingly erratic behavior did not go unnoticed. As a student in one of his classes observed, "He disrupted class frequently with nonsensical outbursts." He'd had brushes with the law as well. All in all, there were many people—his classmates, the school administration, and law enforcement—in a position to recognize the urgent need for some kind of intervention.

Unfortunately, the options for such intervention have narrowed considerably in the past decades. And so, like hundreds of thousands of others, the killer will spend his life in jail after committing a heinous, violent act, rather than spending time in a therapeutic setting that might have prevented such behavior in the first place. According to Pima County Sheriff Clarence Dupnik:
Back in 1960, when I was a young cop on the beat, we put mentally ill people who were threats into a system that incarcerated them. Today they're out on the street and we're paying a price for it.
The history is fairly well known. Ronald Reagan dismantled the federal system of mental health care. While state mental institutions deserved, by and large, to be shuttered, the Regan administration offered no safety net for the mentally ill who suddenly found themselves thrust back into society.  According to one paper on the subject:
[T]he number of beds available to the mentally ill in public and private hospitals dropped over forty percent between 1970 and 1984. Most of this decline was due to cuts in public hospitals. During the 1980s, the number of beds provided by general hospitals in psychiatric wards and in private hospitals for the mentally ill increased. In 1970, there were 150 private psychiatric centers... by 1988, there were 450 in the United States. General hospitals offering psychiatric services increased from 1,259 in 1984 to over two thousand in 1988. With such growth in the private sector, there were substantial profits to be made in mental illness, assuming that the patient had adequate health insurance. Those without medical insurance frequently did not receive adequate care.
(Emphasis added.) Mental illness isn't going away any time soon. In addition to the normal statistical occurrence of mental illness within a population of our size, we are adding thousands of post-traumatic stress disorder (PTSD) victims, veterans of the wars in Iraq and Afghanistan. Tragically, the Reagan administration's abandonment of mental health care has left many in the mentally ill population with only two places to go: the streets or the prison system.

What does all this have to do with Tea Party and Republican policy? The Tea Party was founded on the wrong, but at least defensible, principle that federal bailouts had grown out of control. Since then, however, the platform has grown to encompass opposition to all things Obama. By last year, the Tea Party had targeted (quite literally) Gabby Giffords, not for her position on government bailouts, but rather, for her support of health care reform.

Indeed, the Republican majority in the 112th Congress, assiduously ignoring all manner of pressing issues on which they might realistically have some impact, have decided that their first order of business will be purely symbolic: the repeal of health care reform. I say "purely symbolic" because, of course, such legislation will never make it to the floor of the Senate, and even if it were to pass the Senate, it would promptly be vetoed by the president. Thus, the Republicans are simply spinning their wheels on America's dime to score political points with the minority in this country who believe that health care reform was "too liberal".

Health care reform: hope for the mentally ill
One of the innovations of the health care reform legislation was to force insurance companies to cover mental health care to the same extent they cover traditional health care. This policy, known as "parity", has been the law since 2008, but only for group policies for employers with 50 or more covered employees. This loophole not only leaves out the 49 million previously uninsured, who of course also lack mental health coverage; it also excludes the over 30 million people who work for small businesses in America.

Permit me to suggest that leaving nearly 80 million Americans—call it one in four of us—without recourse to adequate mental health care hardly qualifies as "equity". Apparently the 111th Congress agreed, including parity in the health care reform legislation that became law last year. By guaranteeing adequate mental health care for nearly all Americans, health care reform assists the mentally ill to get off the streets and stay out of the prisons. Such a policy benefits not only the mentally ill, but all of society.

This, then, is the progressive reform that Tea Partiers and Republicans consider "socialist", evil, or simply unconstitutional. In the coming days and weeks you will hear right wing apologists defensively argue that the Giffords shooting was the work of an "unbalanced" individual, and not in any way the fault of their incendiary demagoguery. Perhaps. And yet, the policies that the Republicans put into effect in the Reagan era, and which they hope to continue through the repeal of health care reform, will ensure an uninterrupted supply of such individuals—untreated, uncared for, and unnoticed, until the next preventable atrocity splatters across our TV screens.

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