Last week, we were delighted that President Obama again made a very emotional and heart-felt appeal, backed formally this time by specific Executive Orders, to improve our national system of background checks for gun purchases. I have argued many times that such actions are vitally necessary.
We also support very strongly the president’s effort to increase our national budget for mental healthcare by $500 million in 2016. As we are painfully aware, such funds are essential to meet current service needs. This is especially true in light of the loss of about $4.35 billion in state and county mental health funds in recent years as a result of the Great Recession.
I hasten to point out, however, and we must emphasize repeatedly, these two actions—gun background checks and mental health funding--are quite separate from each other, and they are not causally related. It would be a very definite mistake to link them too closely. To do so runs the risk of further stigmatizing the population of persons who suffer from mental health and substance use conditions. As has been stated very frequently, persons with these conditions are far, far more likely to be the victims of crime than the perpetrators.
Our concerns with the Executive Orders
As part of these Presidential Executive Orders, we do have some very grave concerns about the removal of Health Insurance Portability and Accountability Act (HIPAA) privacy protections for persons with mental illness and the targeting in these Executive Orders of persons who have mental illness disabilities and who receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) payments from the Social Security Administration (SSA).
What are our primary concerns?
Concern with Definitions. First, let me begin by identifying some major problems regarding the definition of persons with mental illness. The definition being used includes persons subject to the “federal mental health prohibitor” established under the Gun Control Act of 1968 and regulations issued by the Department of Justice. The actual definition is: “individuals who have been involuntarily committed to a mental institution; found incompetent to stand trial or not guilty by reason of insanity; or otherwise have been determined by a court, board, commission, or other lawful authority to be a danger to themselves or others or to lack the mental capacity to contract or manage their own affairs, as a result of marked subnormal intelligence or mental illness, incompetency, condition, or disease.”
Unfortunately, this definition encompasses persons with so many different types of disability that it lacks any useful specificity. For example, it confuses persons with mental illness, persons with intellectual and developmental disabilities (ID/DD), persons unable to manage their business affairs, and persons who meet the legal definition of incompetency or not guilty by reason of insanity, each of whom can be quite different. Furthermore, the meaning of each of these terms varies from state to state. Finally, the definition also is very antiquated, because it uses terminology no longer recognized in our fields. In fact, our national mental illness definitions have undergone major revisions several times since 1968.