EDITORIAL: We need better mental health care, not a return to institutionalization

Aug. 20--Last week, President Donald Trump reiterated the flawed notion that mental illness is the root cause of gun violence in America. He then called for the reopening of institutions to house Americans with mental illness, suggesting they were too dangerous to be "on the streets."

This is a perilous scapegoating that falsely stigmatizes the millions of Americans with mental health concerns. It also sidesteps other factors in gun violence, such as the prevalence of firearms in America and a flawed, incomplete background check system.

Research has not found a link between mental health conditions and gun violence. Rather, people with serious mental illness are actually 10 times more likely than the general population to be the victims of violent crimes, according to the U.S. Department of Health and Human Services. They are also much more likely to harm themselves than others, which is a reason to consider further limits on gun access to prevent suicides, which outnumber homicides in the U.S.

But, the president is right about one thing: Mental health care systems in America need dramatic improvement.

"Years ago, many cities and states I remember so well closed mental institutions for budgetary reasons. They let those people out onto the street," he said during a rally on Thursday in Manchester, New Hampshire. "We're going to have to give major consideration to building new facilities for those in need. We have to do it."

We do need to give major consideration to how to better help Americans with mental health concerns. Building institutions -- and blaming mental illness for gun violence -- is not the solution.

It is important to remember why mental health institutions were closed or downsized, as Maine experienced with its two state-run psychiatric facilities.

In essence, Americans with mental health issues had previously been locked away in institutions where they often received little treatment and were sometimes abused. These Americans were thought to be defective with little hope of getting better.

The president's words "fail to recognize the horrid lives these people lived for decades," Jenna Mehnert, the executive director of NAMI Maine told the Bangor Daily News. "They were warehoused, dehumanized and mistreated."

Suggesting that we return to this practice is "horrifying," Mehnert said. It also further stigmatizes mental illness, which can prompt people who are concerned with their mental wellness to delay seeking help.

Closing mental health institutions was well intended, but the community support services that were supposed to replace the warehouse-like facilities have not fully materialized. There are many reasons for this.

Despite federal and state laws requiring that mental health care be treated the same as health care -- so-called parity laws -- many insurance plans still impose limitations on mental health services, such as requiring pre-authorization for treatment and requiring higher out-of-pocket payments.

Reimbursement rates for mental health services are often lower than the rates for physical health care. One recent study found that mental health care reimbursement rates were about 20 percent lower. As a result, many mental health providers remain outside insurance networks, which raises costs for patients and their families, adding another barrier to treatment. There are also shortages of mental health providers, which can result in long waits for diagnosis and treatment.

Many improvements are needed to our country's mental health care system to ensure that Americans will mental health conditions can readily receive treatment and support. Reconstructing large institutions to warehouse patients is not one of them.

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