Forget gun control, Congress isn't serious about mental health either

This week, House Speaker Paul Ryan went to the familiar place where Republicans retreat whenever there’s a mass shooting. Call it the “What about mental health care?” safe space. Instead of exploring whether a killer should have to clear a few reasonable obstacles before acquiring dozens of high-powered weapons capable of spraying bullets on a concert-going crowd in Las Vegas, Mr. Ryan held a news conference to brag about Republican-backed efforts to improve access to mental health care.

“One of the things we have learned from these things, we have learned from these shootings, is often a diagnosis of mental illness,” the speaker told reporters Tuesday. He then went on to talk about the Helping Families in Mental Health Crisis Act, which last year passed the House 422-2 and was signed into law by President Barack Obama. Originally drafted in wake of the Newtown school shooting several years earlier, the legislation included some modest reforms that advocates generously described as a “good start” toward achieving mental health care parity — that is, providing the same level of medical treatment for mental illness that is afforded to someone diagnosed with a bodily injury like a broken bone or heart attack.

Speaker Ryan is correct about mental illness being strongly linked to mass shootings. Untreated severe mental illness is more prevalent in homicides generally, studies show (although it’s also useful to point out the the mentally ill are more likely to be victims of violent crime than perpetrators). But to suggest Washington has gotten serious about providing more and better treatment to the mentally ill simply isn’t true. And the House Republican majority under Mr. Ryan’s leadership has surely made that point quite forcefully — particularly when it comes to funding mental health care.

Just a few weeks ago, psychiatrists and psychologists were warning that GOP health care reform efforts, most recently in the form of the Graham-Cassidy bill, would have devastated the quality and availability of mental health care in this country. It offered states the opportunity to allow insurance companies to drop mental health care coverage and reduced spending on Medicaid by billions of dollars. It effectively ended the Obamacare Medicaid expansion and reduced federal health insurance subsidies. That Medicaid component is especially important given that about one in three Americans covered by the Affordable Care Act’s Medicaid expansion has been diagnosed with either a psychiatric or substance abuse disorder.

But that’s just the start of Mr. Ryan’s hypocrisy. Earlier this year, the Republican-controlled Congress and President Donald Trump reversed a rule developed in the wake of the Virginia Tech shooting to make it more difficult for individuals with a severe mental illness — those diagnosed with a mental disability so severe they can’t hold a job of any kind or manage their own Social Security benefits — to purchase a gun. Under the rule finalized by the Obama administration, the Social Security Administration would provide disability information for background checks required for gun purchases. Republicans fretted that Second Amendment rights of these people judged severely mentally ill would be trampled.

If only this Congress was as serious about making sure the mentally ill can get medical care as they are about making sure they can buy a gun. While it’s still not clear what caused the Las Vegas gunman to so carefully plan and execute his attack, a diagnosis of paranoid schizophrenia is not outside the realm of possibilities. Colorado theater shooter James Holmes received a similar diagnosis by experts after his 2012 attack with an AR-15 that killed 12 people and injured dozens more. Las Vegas shooting perpetrator Stephen Paddock evidently could have afforded appropriate medical care, but many other Americans simply can’t. As a result many go untreated, and some commit crimes (albeit not usually as violent or terrible as the Mandalay Bay shooting) and end up in prisons ill-equipped to handle severe mental illnesses.

Speaker Ryan is welcome to propose any mental health reform he likes — improving access to care might be a good place to start, given that Nevada was ranked several years ago as the worst state in the country for it — but based on recent history, no one should take him seriously because he doesn’t really take the issue seriously. Conservatives like to blast Democrats for “playing politics” by raising gun control in the wake of the most deadly shooting in modern American history, but isn’t claiming to seek help for the mentally ill when you and most members of your party are actually intent on reducing that exact type of health care spending a far more cowardly and cynical version of political gamesmanship?

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