“It’s the guns, stupid.”

What happened to community mental health?

In a word.

Greed.

Many of you know that I am a Licensed Creative Arts Therapist and Licensed Mental Health Counselor who has worked in the mental health field for 27 years. I have watched the steady decline of mental health resources and have a fairly unique long range perspective as I’ve worked in many different settings over the years. These include: a psychiatric hospital, a partial hospital setting, a residential facility, and I’m currently working in private practice. I’ve worked with people with a range of mental health diagnoses and with people of all ages; from infants to seniors. Over the last 10 years, I have worked primarily with women and girls, ages 13 and over.

I’ve watched facilities close, programs end, and resources dwindle to just “barely surviving” levels. I’ve watched extraordinary professionals work as creatively as possible to continue to keep up with increasing demands of their work. I’ve watched as venture capitalists take over agencies and subsume private practitioners to create therapy “factories” (my word) where these licensed professionals with years of post-graduate training and clinical supervision are made to see approximately 30 – 35 people per week. That can leave one hour a day left for all the casework, documentaion, case planning, correspondence, consultation, and lunch. Profit is the goal, when healthcare is privatized by corporate entities. I’ve watched some of the best practitioners leave the field as they can’t pay off student loans and make a living. I’ve watched insurance companies decline to raise the reimbursement rate for providers of services; some have done this for as long as 20 (yes, 20.) years. *This is particularly curious as I’m sure you’ve realized, that your insurance premiums and healthcare costs have continued to rise. Someone is benefiting from these increases, right? but it isn’t the providers themselves.

Costs to maintain one’s license(s) continue to rise. These include rent, materials, office maintenance, professional dues and fees, malpractice insurance, and the ongoing monies needed for continuing education. There are some therapists who may live in affluent communities and serve clients who can afford to pay out of pocket. A majority of people cannot do this. This, of course, means that there are limited opportunities for those of lower economic means to see many private practitioners.

The prohibitive cost of education vs. the low salary expectations, severely limits smart, dedicated, and diverse people from going into the mental health field.

These are just some of the difficulties faced by mental health professionals and hopefully this post helps to explain why there are almost no community mental health organizations anymore: 1. Defunding. 2. The desire of the wealthy to try to profit by privatizing mental health 3. The prohibitive cost of education, 3. The ongoing costs of maintaining one’s license and 4. the inability to keep up with the cost of living; i.e., next to no raises in salary vs. increased demands of the work.

I’m not writing about this to induce sympathy, or simply to vent my personal frustrations and sacrifices made over the decades (Despite everything, I’m dedicated to working as a therapist for many more years) I am writing this because when there is a mass shooting in the United States (or other tragedy), the media reports that the perpetrator had tried to access mental health services and found them to be insufficient and unsuccessful. I often hear others talk about how the shooters should have been admitted to a facility when in all probabiity that facility has been closed for many years.

What all these perpetrators of mass shootings have in common: ready access to weapons of war. Blaming the mental health service community for not adequately meeting the needs of someone who should have been “red flagged” or at least “yellow flagged” is barking up the wrong tree. It takes the focus off the weapons. (*There aren’t “red flag laws” in many states and sometimes not even a “yellow flag law”). Providers are a convenient scapegoat as to the “why” there are so many mass shootings in the United States.

By focusing on mental health as the cause of mass shootings in the US, it does nothing to to draw attention to gun reforms at the level of legislative law and policies.

By focusing on mental health insufficient resources and linking mental illness with violence, rather than looking at the level of legislative law and policies to fund community mental health and social services; this appears to reinforce the stigma of mental illness and the efficacy of mental health treatment. When mental illness is associated with violence, this promotes the myth that all people with a mental illness are dangerous. Research shows people with mental illness are more likely to be victims rather than perpetrators of violence.

It is the guns.

It is the access to guns.

In 2017, Trump quietly rolled back an Obama-era regulation that made it harder for people with mental illness to buy guns.

Other countries have mental health issues. We (the United States) are not an outlier. Other countries all have comparable rates of those suffering from mental health issues. When other countries were faced with a mass shooting, It is the guns. That is what is different. Other countries, such as New Zealand, Norway, Australia, and the UK have made widespread legislative changes after a mass shooting such as implementation of restrictive gun control laws.

Yes, we have a crisis level lack of mental health resources. Some of the reasons, I discussed in this post. These are ongoing and not singularly prohibitive to dangerous people. Congress, primarily Republicans continue to point to mental illness as the cause of tragedy, all the while continuing to defund mental health. This is a fact.

Recently, the APA (American Psychological Association) published an article that busts the “inaccurate bias that people with mental illness are largely responsible for mass shootings and other acts of mass violence.” https://www.apa.org/monitor/2021/04/ce-mental-illness

(to be continued).