Yet another mass shooting illustrates the cycle of insanity in which we currently live. As long as we refuse to do anything about the systemic factors behind each incident, we guarantee that there will be others.
We’ve got another one. Aaron Alexis, a Navy contractor and former Navy reservist, opened fire on people in the Washington Navy Yard. He managed to kill 12 people and injure eight others before he was killed himself in a gun battle with police.
Albert Einstein once said, “Insanity is doing the same thing over and over again but expecting different results.” With respect to mass shootings, the United States has been doing the same thing (i.e., nothing much), while expecting that mass shootings will stop. Perhaps we should start asking if we even want them to stop, because it sure doesn’t seem that way.
In preparing to write this article, I went back and reread all the other blog posts I’ve written on this topic. Sadly, there were five that were directly related and all of them fit with this latest tragedy as well. After the school shooting in Ohio, I talked about the mix of violent masculinity and guns (See “Shots Heard Round the World; Let’s Look at the Bigger Picture”) and how the two don’t go together well. This latest shooting was perpetrated by a man armed with a shotgun. Check.
After the movie theatre shooting in Colorado, I discussed the options we have for preventing violence (see “Preventing Violence: What Can We Do to Stop Mass Shooting?”) and the need for greater community involvement when people seem troubled. Alexis was so disturbed that Rhode Island police contacted the Navy about him, but nothing further was done. Check. I also wrote about the nightmare inherent in having a child who is guilty of committing mass murder (see “Two Sides of Parenting: From the Olympics to Aurora”). Cathleen Alexis, the shooter’s mother, bravely gave a statement apologizing for her son’s actions and expressing sympathy for the victims. Check.
After the Newtown massacre, I explored the systemic factors involved in mass shootings (see “Enough is Enough: Facing the Toxic Mix of Men and Guns”). This tragedy had them all: male, gun, mental health issues. Check. I wrote another post about the increased need for mental health services (see “Mental Health Providers Could Do More”). The Rhode Island police were concerned that Alexis was hearing voices and experiencing paranoia, so although we will never know for certain what he was suffering from (schizophrenia, depression with psychotic features, or possibly a brain tumor), he was definitely having mental health problems. Check.
Are you bored yet? Because I sure am. In every single case of a mass shooting in the United States over the last few years, the same factors have been present: men, guns, and mental health issues. And yet we do little to address these things. There still are only a few voices even mentioning that men are the ones doing the killing, much less doing something to address that fact. Gun regulation is still dead on arrival in most parts of the United States. There recently were some brave politicians in Colorado (and I rarely use the words brave and politician in the same sentence) who passed basic gun regulation, but two of them paid for it in a NRA-backed recall election. And then there is mental health.
Despite President Obama’s mental health initiative and lots of talking heads nattering on about the need for improved mental health, the outlook for our mental health system seems pretty grim at the moment. Funding for mental health services continues to be cut, so places like Veteran Administration Hospitals (where Alexis may have sought treatment) and community mental health centers are struggling to get by with less staff and increased patient loads. It is a no-brainer to assume that when people are overworked and underpaid, treatment will suffer.
Private practitioners also are dealing with ever-decreasing reimbursement (which, let me be clear, was not high to begin with) and it appears likely that it will get worse. Although the newly enacted Patient Protection and Affordable Care Act will expand coverage for prevention and treatment of mental health issues, there is little in the bill that is encouraging about provider reimbursement. Thus, we in the mental health field are bracing ourselves for steep cuts in reimbursement and significant delays in payment. We’ve already been warned that Medicare may decrease payment by anywhere between 4 to 21% of current rates. Since Medicare often is the benchmark for reimbursement rates, we can expect other insurers to reduce payment as well.
If you follow this development to its logical conclusion, this probably means there will be fewer mental health providers in the field. After all, who wants to go through an extra two to six years of education and training, while racking up a significant amount of debt, only to be paid at a level commensurate with a college degree? That’s not even counting all the extra costs associated with supervision, licensure, malpractice insurance and continuing education. Factor in the fact that most of us pay for our own healthcare and you have hefty overhead costs coupled with a low salary. Who will be able to even afford to offer care? Thus, in a sad and ironic twist, the most likely outcome will be that coverage for mental health services will increase while accessibility of treatment will decrease. Ultimately this means that fewer people will receive the assistance they need.
So we’re back to insanity, as there has been no movement on the toxicity of violent masculinity, no movement on gun regulation, and possible backsliding on the accessibility of mental health treatment. We’re doing the same things, people, so there absolutely will not be different results. I don’t know what else to say. Can we at least acknowledge that we’re being insane? Because the first step toward seeking treatment is acknowledging that you have a problem.
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