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Mental Health Parity, Guns and Seung-Hui Cho

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As more comes to light regarding the horrific shootings at Virginia Tech, a host of troubling issues are being raised. Clearly, Seung-Hui Cho was profoundly mentally ill and there were strong warning signs indicating that he was potentially dangerous.

One thing I'd like to know is why someone who was declared by a court to be an "an imminent danger to self or others" in 2005 was able to pass a background check to buy guns. Surely, if you've ever had any mental-illness related court order confining you, you should forever be barred from buying firearms? I know that gun control is contentious, but is there anyone who would actually oppose such a law? Or is there a law and was there some mistake?

Second, I think this case makes the argument for evidence-based mental health parity even stronger. One Huffpo blogger, "Alexandra Zacharios-Haight" who doesn't even have the ovaries to use her real name used the shootings to attack my recent Times op-ed favoring evidence-based parity. She claimed that my proposal would prevent people like Cho from getting help. But in fact, it would ensure that when they do get care, they get the treatment most likely to work.

"Zacharios-Haight" argues that evidence-based care isn't required for insurance coverage of physical medicine-- which is simply not true. While some treatments have been "grandfathered," the FDA, for example, doesn't approve medications without clinical trials proving their safety and efficacy and insurers certainly don't cover unapproved drugs.

In fact, evidence-based medicine has grown in part as an attempt to figure out which treatments countries with national health care like the UK should cover. Whether the illness involves the brain or any other part of the body, in sensible medical systems, science determines what treatments are used, not the wishes of providers to do whatever they'd like and get paid for it.

Cho wasn't unknown to the mental health system-- we know that he was hospitalized, mandated to outpatient therapy and at some point, medicated. There's no indication that he was ever denied care because he didn't have insurance or because his insurer refused to pay for needed care. We don't know what treatments he actually got or how he responded or even whether he showed up for the outpatient therapy.

We do know he was prescribed medication-- but we don't know what it was or whether it was of a type that in a tiny minority can induce violence. We don't know who prescribed it or whether he was appropriately monitored.

"Zacharios-Haight" argues that if she is given carte blanche funding to treat patients however she likes for as long as she likes, she could prevent cases like that of a depressed friend who stabbed herself or by extension, the crimes of someone like Cho. I'd like simply like her to prove it before my insurance money is used to pay her.

It is the height of arrogance to believe that clinical experience alone should guide mental health care and that treatment shouldn't start with the kind of therapy and/or medication proven to help the largest number of people.

Of course, there is a need to be flexible, for example, in instances where the evidence is unclear and where some form of help is nonetheless absolutely needed. But that can be written into legislation mandating parity and is no reason to oppose using the financial incentives we have to make widely available the best treatments possible.

Mental illness is extraordinarily complex and human behavior profoundly difficult to predict. And that's exactly why we need to use the best tool we have-- the scientific method-- in our attempts to help.