Heartland liberal

It’s de rigueur to blast the Democrats in Washington as a bunch of timid do-nothings, Some of that is well-deserved. But the recent passage of a gun control law was not celebrated as much as I thought it would be once people actually realized what it does do, rather than what it doesn’t.

Admittedly that law doesn’t do enough. But it did close some important loopholes partially responsible for the flood of illegal guns from gun-permissive states like Iowa, Indiana, Wisconsin and Michigan into gun-restrictive states like Illinois. (Poor Illinois — and Chicago — have the bad luck to be surrounded by states with few real controls on guns. Chicago’s gun problem is largely a surrounding state problem, even as Republicans sneer at Chicago for its astronomical rate of gun violence despite having gun control laws with teeth.)

But, the gun-related provisions in the Bipartisan Safer Communities Act of 2022 aren’t the only story. The bill included “the biggest single expansion of mental health care in American history.”

That’s a huge deal. You’ll never hear this on Fox News, however:

The Bipartisan Safer Communities Act has been framed as a gun reform, but perhaps a more fitting frame for the law is as the biggest single expansion of mental health care in American history—and the biggest expansion of Medicaid—with a few gun provisions.

To be sure, packaging the two together makes both gun reform and mental health advocates uncomfortable. The overwhelming majority of people with mental illness will never commit a violent act, though statistics show that they’re more likely to be victims. Tying mental illness with gun violence only stigmatizes it, reducing the likelihood that people who need care will get it. But gun rights activists see mental illness as a convenient distraction from the fundamental issue driving gun violence—the guns themselves.

Getting Republican participation on any gun law reform, though, required that the two be linked. And any investment in our anemic mental health care system—whatever the pretext—should be welcomed. So the new law leverages Medicaid to vastly expand America’s mental health infrastructure through a system of Certified Community Behavioral Health Clinics, or CCBHCs, and school mental health investments.

This piece in The New Republic goes on to say:

The law’s massive investment in mental health care didn’t just happen over the course of a few weeks. It was the product of nearly a decade of slow, methodical planning. Stabenow and GOP Missouri Senator Roy Blunt had been co-sponsors of the bill reauthorizing community health center funding—consistent federal dollars to support community clinics—when Stabenow proposed a similar approach to funding mental health care. Until that point, mental health clinics were forced to operate on grants that they simply couldn’t rely on. “On the behavioral health side of things, it [was] all stop and start. It [was] all grants that go away,” Stabenow told me.

She approached the Substance Abuse and Mental Health Services Administration, or SAMHSA, to design quality standards for the proposed mental health centers that would eventually become CCBHCs. These included 24-hour psychiatric crisis services and integration with physical health services. Stabenow and Blunt eventually co-sponsored a 2013 bill that was signed into law the next year by President Obama. The Excellence in Mental Health and Addiction Treatment Act initially allocated $1 billion to fund a demonstration project across 10 states. The program offers enhanced Medicaid reimbursements to cover 80 to 90 percent of the start-up and operating costs for CCBHCs meeting SAMHSA standards.

The results were impressive. According to Stabenow, there was a 60 percent reduction in jail bookings stemming from mental health crises, a 63 percent reduction in mental health emergency room visits, and a 41 percent decline in homelessness.

In a country that has chronically underfunded mental health care, this is a landmark development.