Is it fair to link the problem of mass slayings of innocent people with those who have sought treatment for mental health problems?  Many people I know, most of whom have either sought or are close to someone who has sought mental health services, would say no.  Yet that is exactly what politicians throughout the United States seem to be saying.  A focus on mental health is the one policy solution to gun violence where Democrats and Republicans march in unison with the National Rifle Association.

Why? Is this another example of scapegoating the mentally ill for society's ills? Or is there something worth considering in this particular policy solution?  

After Sandy Hook, the President and most politicians downstream sounded the drumbeat for improving the mental health system to make our communities safer.  Politicians seek popular policy solutions to dramatic public problems.  Shooters of recent memory- James Holmes in Colorado, Jared Loughner in Arizona, and Adam Lanza in Conn- all had serious mental health problems.  Voila: an emphasis on mental health. 

Governor Cuomo of New York quickly pushed through gun control legislation which included a requirement that mental health practitioners report worrisome patients who could then have their guns taken from them. This idea is being considered in many states. 

 The problem with this policy is that it doesn't work. Mental health practitioners are a large group of helping professionals including social workers, substance abuse counselors, psychologists, psychiatrists, and school guidance counselors. It takes considerable training to be able to predict with any reliability which "worrisome patients" pose a threat.  Few have the expertise.

So perhaps it would be best to take away guns from anyone seeking mental health treatment. This would be easy to enforce and take mental health workers off the hook for making tricky judgment calls.  

The problem is that it would create havoc. The gun-owning population is large: roughly 45% of American households.  Just about everyone finds it tough to seek mental health treatment. A threat to gun ownership is a great reason to decide not to seek help.  Not a smart policy.

And yet.

In an op-ed in the New York Times on January 18, 2013, Wendy Burton wrote about her struggles with depression and the danger that becoming a gun owner would pose to her life. She brought home a reality that more people die each year by gun suicides than by gun homicides in the United States.

What happens if the focus is on behavioral indicators of mental instability, not a diagnosis of mental illness? To actually reach those who use guns to kill would mean expanding the group of those who qualify for mental health services beyond the current target population of those with chronic mental illness like schizophrenia, major depression and bipolar disorder. It would include the 25% of veterans coming back from Iraq and Afghanistan who lawmakers estimate suffer from mental health problems.  Also targeted for help would be the many children suffering from exposure to trauma in early years of life. This group might also include domestic violence abusers at risk of killing in a fit of irrational rage; adolescents with a history of showing off with guns; bullies who flash guns in bars and on the street to intimidate, and depressed human beings seeking an easy way out.

Wait!  How much money will it take to adequately expand mental health services to reach those in need and thus protect the community against "dangerous people with access to guns?" Funding for mental health systems was reduced across the nation over the past few years as states struggled to balance budgets. Between 2009 and 2012,   Illinois' funding was cut by 31% to a total of $404 million a year.

Last Thursday, a bipartisan group of Senators introduced the Excellence in Mental Health Act. This Act would allow 2,000 federally qualified behavioral health centers to charge Medicaid for mental health services once they met certain criteria.  The cost estimate is about $ 1 billion over the next decade, a figure that does not come close to replacing lost state funding for mental health services. It is an important first step but strengthening the mental health systems needs much more than token appropriations if the policy goal of decreasing gun violence is met.

At the end of 2013, when gun violence prevention public policy has been passed, will funding for the expansion of mental health service be more than a symbolic gesture? Or will the outcome be a restriction of the access of "the other" to guns; a far cheaper policy for Congress to pass and enforce?