President Obama said the federal government has to do something meaningful to prevent future shootings like the one in Newtown, Connecticut that killed 26 people. Though mental illness is as yet unconfirmed in the Newtown killer's case, here is what the federal government can do to prevent violence related to mental illness.
1) Start demonstration projects of Assisted Outpatient Treatment (AOT) -- Kendra's Law in NY, Laura's Law in Calif. -- throughout the country. AOT allows courts to order certain individuals with mental illness to stay in treatment as a condition of living in the community. It is only available to the most seriously ill who have a past history of violence, incarceration or needless hospitalizations. AOT is proven to keep patients, public, and police safer. The Department of Justice certified AOT as 'effective crime prevention program.' But mental health departments are reluctant to implement because it forces them to focus on the most seriously ill. Demonstration projects would help them see the advantage of the program.
2) End the Institutes for Mental Disease (IMD) Exclusion in Medicaid law. This provision encourages states to lock the front door of psychiatric hospitals and open the back regardless of whether the community is an appropriate setting. Sometimes, these discharged individuals become homeless, suicidal, sick and even violent. If you have a disease in any organ of your body, other than the brain, and need long-term hospital care, Medicaid pays. Failing to pay when the illness is in the brain is federal discrimination against persons with mental illness. Thirteen years ago wrote on Medicaid discrimination for the mass market in the Washington Post, and more recently in Huffington Post. But John Edwards wrote a more scholarly paper on ending the IMD Exclusion.
3) Create a federal definition of serious mental illness, and require "x" percent of all existing mental health funding go to it. Most mental health funding currently goes to the highest functioning, not most seriously ill. There is more than enough money in the mental health system provided it was spent on people truly ill. I wrote on this for a mass market on Huffington Post, but a much more scholarly paper was written by Howard H. Goldman and Gerald N. Grob. With the fiscal cliff approaching, prioritizing the most seriously mentally ill for services is more important than ever. We have to end mission creep in mental illness programs and send the seriously ill to front of line, rather than jails, shelters, prisons and morgues. This failure to fund serious mental illness is most acute in California, where they taxed millionaires to provide services to the mentally ill, and then used the money for the highest functioning.
4) Eliminate the Substance Abuse and Mental Health Services Agency (SAMHSA). SAMHSA is the epicenter of what is wrong with the American Mental Health System. SAMHSA actively encourages states to engage in mission creep and send the most seriously ill to the end of the line. They provide massive funding to organizations that want to prevent mentally ill individuals from receiving treatment. They have little positive to show for their efforts. I wrote on this for a mass market in Washington Times and Huffington Post. But Amanda Peters wrote a terrific scholarly piece on SAMHSA for a law journal.
If Obama is serious about wanting to do something -- and I believe he is -- the suggestions above would be the best first step. True, the mental health industry may throw a hissy fit as they find themselves obligated to serve the most seriously ill, but it's the right thing to do.