This week, President Obama announced a sweeping series of executive actions to address the urgent need for gun reform in the United States, attempting to circumvent Congress since it refuses to act despite pleas from the White House. The fourfold plan contains a variety of measures designed to limit access to guns in the United States, and it’s vigorously opposed by the National Rifle Association, perhaps unsurprisingly. But there’s a section of the plan that should worry liberals as well, and that’s the section on mental health reform.
Before delving into the specifics of the mental health plan, it helps to understand how executive actions work. Part of the balance of the three branches of government includes the president’s ability to sign an executive order, a directive that isn’t a law — because it doesn’t pass Congress — but it can have the force of a law. Typically, the president issues such directives with the cooperation of Congress, but presidents can also provide guidance to government agencies through executive orders, and that’s the trick the president is using in this case.
Obama cannot sign an executive order requiring comprehensive federal background checks for all gun sales, as this is a matter for Congress. He can, however, direct federal agencies like the Bureau of Alcohol, Tobacco, and Firearms along with the Federal Bureau of Investigation to maintain better records, dedicate more agents to processing background checks, and clarify the roles of gun sellers (for example, his plans include clearly identifying online and gun show sales), which will increase the number of background checks and improve their effectiveness. Likewise, he can’t require that ammunition and gun prices be controlled, but he can direct the government to invest in smart gun research, laying the ground for future reforms that might require the sales of such weapons. Theoretically, though, Congress can attempt to pass laws that supercede his mandates. More worryingly, any president can reverse an executive order, which can result in a game of cat and mouse like that seen with the Global Gag Rule.
Turning to the president’s plan for gun reform in the US, the inclusion of a mental health component in the first place is dangerously irresponsible. People in the United States already believe in a false correlation between mental health and violence — in fact, mentally ill people are far more likely to be the victims of violence and they are statistically less likely to commit violence than their sane counterparts. Including commentary about mental health reform in a package of actions to combat violence sends an unmistakable message: Mentally ill people are violent.
Sadly, the only time people in the US discuss the dire state of mental health services across the nation is in the wake of a horrific act of mass violence, creating a feedback effect. People don’t talk about mental illness because they don’t find it relevant, even though 20 percent of the population experiences symptoms of mental illness; their primary associations with mental illness are of severe psychiatric crisis and pop culture stereotypes; acts of violence occur and they erroneously blame them on mentally ill people; and suddenly mental health services matter, until a few weeks pass and the issue fades to the background again. Cultural forces like this explicitly link mental health and violence, underscoring dangerous social attitudes.
Viewing mentally ill people as a threat means that life is very dangerous for people with mental health conditions in the United States. Over 50 percent of fatal police shootings in many areas of the country involve mentally ill people. Mentally ill people fear interactions with police, and often their friends and family mistakenly call law enforcement for help during psychiatric crisis — in part because there are no agencies designed for mental health response, and thanks to cuts to mental health services, more people end up in crisis than ever before. Few cities have explicit mental health crisis teams embedded within law enforcement agencies and trained to deal with people struggling with symptoms like paranoia and breaks with reality, and consequently, mentally ill people are often shot within minutes of law enforcement arrival on scene even though the only danger is to themselves.
Mentally ill people are also heavily profiled — while the ADA bars discrimination on the basis of disability, it doesn’t stop many federal agencies from refusing clearance to people with documented mental health conditions, which acts to discourage people from seeking treatment. Mentally ill people can experience harassment in the workplace as well as subtle discrimination like not being considered for promotions, and they are subject to profiling in housing and social settings as well. Being outed as mentally ill can be extremely dangerous, one reason people are extremely cautious about where, how, and when they seek treatment.
Which brings us to a key aspect of Obama’s reforms, and also one of the most troubling. The measure now requires the Social Security Administration to supply information about mentally ill people to the background check system, meaning that those receiving government benefits who have been deemed ‘unfit’ by dint of mental illness or legal incapacity (such as those under guardianship, a controversial practice in the US, in which all rights and autonomy are stripped by court order), will now have their data made available to anyone who can run a background check. This is a clear violation of patient privacy — which is why the Department of Health and Human Services has updated its rulemaking on the Health Insurance Portability and Accountability Act (HIPAA), which among other things specifies measures for patient privacy.
This rulemaking strips mentally ill people of privacy and dignity and it exposes them to unimaginable risks, as government databases are notoriously insecure. In addition to not knowing who might be eligible to access this mental health surveillance, which the government claims will contain no specific identifying information beyond a flag indicating that someone is not permitted to purchase weapons, there’s the potential for hacking and other database compromises. This could result in the release of medical information for thousands of people.
Ridiculously, only 75,000 people would be covered by this rule — an extremely small percentage of the US population. That the administration should go to such elaborate lengths to single out and profile these individuals but not others amounts to little more than a mental health witchhunt, further signaling to the public that mentally ill people are dangerous. For those 75,000, this amounts to a loss of dignity in a system that already threatens them with guardianship, institutionalisation, and other violations, but for the mentally ill community as a whole, it undoes decades of work dedicated to pushing back on stereotypes like the notion that mentally ill people are violent. Far more people are convicted of domestic violence annually and there is a clear and well-documented link between domestic violence and gun deaths — especially given that over 50 percent of gun deaths involve men shooting partners and children — but public announcements about the proposal haven’t announced any requirements for the Department of Justice to direct regional law enforcement agencies and courts to supply data about domestic violence convictions to the database. While such data should already be supplied, ample evidence suggests that people with a history of domestic violence have been able to purchase firearms and go on to commit crimes with them, illustrating that this is a problem.
The United States has a considerable problem with access to mental health services, comprehensive mental health care, and support for mentally ill people, especially homeless people (many of whom are veterans), LGBQT youth, and people of colour. Instead of responding to this problem with reforms that include dedicating substantial grants and other resources to communities in need, the government has chosen to crack down with humiliating laws that push people into mandatory treatment, forcibly institutionalise people, compromise their medical privacy, and remind them that their bodies are the property of the state. In addition to being inhumane and cruel, in addition to perpetuating harmful stereotypes, these laws do not work, because mentally ill people don’t pose a threat to public health and safety — if anything, the government should be dedicating legal resources to protecting mentally ill people from violence. Such measures should include better treatment, training for law enforcement, the development of mental health crisis team, sensitivity training for prosecutors who may be faced with cases in which mentally ill people are victimised, the abolition of forcible institutionalisation, the provision of more direct services to help people live in their communities, and aggressive anti-violence campaigns to illustrate to the public that mentally ill people shouldn’t be viewed as soft targets for violence. As long as mentally ill people are vilified and demonised, they will continue to be at risk.
The fact that people in the US only care about mental health in the context of convincing themselves that mentally ill people will shoot them is a grim testimony to their humanity, and to the failures of the social safety net. Even US progressives primarily address mental health services in the context of restricting their freedoms in the name of preventing violent crime, as seen by this initiative and the broad support for it among the Democratic campaigners for president, including Senator Bernie Sanders, widely considered a leftist in the context of US politics. President Obama has made a grave mistake here, and mentally ill people will pay the price.