Newtown Shootings

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A Public Health Approach to Gun Violence

So now we’ve heard from the NRA which asserts that we need to put armed police in every school, then adding, “The only thing that stops a bad guy with a gun is a good guy with a gun.”

It sounds good, but as Josh Sugarmann of the Violence Policy Center said today in a statement, that’s been tried already — and it didn’t work. “There were TWO armed law enforcement agents present at Columbine High School during the assault by Eric Harris and Dylan Klebold that left 15 dead and 23 wounded. They twice engaged and fired at Eric Harris in an effort to stop the shooting, but were unsuccessful because they were outgunned by the assault weapons wielded by the two teens.”

And if you’re thinking that having a gun protects you from guns, think again. After all, Rachel Davis, Managing Director of the Prevention Institute points out, in Newtown, Adam Lanza first killed his mother, a gun enthusiast. “The first victim of this shooting was a gun owner who was not able to stop this from happening,” Davis says. “The problem of guns is they raise the risk of lethality.”

We are a society that craves simple solutions, yet violence is a complex problem. That doesn’t mean nothing can be done. While Davis favors an assault weapons ban, she says that’s only one piece of a comprehensive approach. “Another piece,” she adds, “is addressing mental health needs — that includes access to high quality mental health services, reducing the trauma people are exposed to and then addressing the trauma.”

Mass shootings in Newtown understandably capture widespread media attention, but remember that children are murdered every day by firearms. In 2010, according to CDC numbers, 1,260 children up to age 18 were killed by someone who used a gun. That’s more than three children every day — or 21 children in the week since Newtown.

Davis argues for broad community-based prevention programs. Davis points to “GRYD” — the Gang Reduction Youth Development program which has been in place for several years in Los Angeles. GRYD is multi-pronged. “It’s not one single thing,” Davis says, “but a combination of strategies and efforts that are coordinated in the neighborhoods that are most affected by violence.”

For example, in LA’s successful Summer Night Lights program, parks are open after dark — prime gang-activity time — with free food and extra programs. Families flock there.

And it’s effective. Here are some statistics from the Summer Night Lights website:

(Image from Summer Night Lights website)

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After Newtown Shootings: Questions about Mental Health Insurance Coverage

By Jenny Gold, Kaiser Health News

President Obama speaks at an interfaith vigil for the shooting victims at Sandy Hook Elementary School (Olivier Douliery-Pool/Getty Images).

President Obama speaks at an interfaith vigil for the shooting victims at Sandy Hook Elementary School (Olivier Douliery-Pool/Getty Images).

On Monday White House spokesman Jay Carney pointed to the federal health law as evidence that the administration has already started to tackle the issue. Mental health issues are “clearly a factor that needs to be addressed in some of these cases of horrific violence,” Carney said. “Obamacare, if you will, has ensured that mental health services are a part of the services” provided under the health law.

While the Affordable Care Act, along with the Mental Health Parity Act of 2008, go a long way toward assuring coverage for most Americans, some gaps remain.

Here are some answers to frequently asked questions about mental health coverage:

Didn’t the Mental Health Parity Act already guarantee coverage for Americans with insurance?

The Mental Health Parity and Addiction Equity Act, signed into law in 2008, made a big dent in the problem of mental health coverage. But it depends on how you get your insurance

  • Large Employers (more than 50 workers): If large companies include mental health services in their insurance plans, they must cover those services at same or higher level as other medical conditions. That means that the plans could not provide fewer inpatient hospital days or require higher out-of-pocket costs, more cost sharing or separate deductibles for mental health conditions. But Paul N. Samuels, director and president of the Legal Action Center, says that some people still aren’t receiving equal coverage, and the law is not always enforced. “That’s a problem we’re really concerned about,” he says. Note that large employers are not required to offer mental health insurance, but most do.
  • Small Business/Individual Plans: Not included in the Parity Act.

In short, whether you have mental health coverage in an employer-sponsored insurance plan depends on where you work.

What if I don’t have mental health coverage in my employer’s insurance plan? Will the ACA change that?

Small group and individual plans will be required to offer the coverage in 2014 through health exchanges created under the law. But employers with 50 or more workers can continue to not offer the benefits.

I’m planning to buy an insurance plan through one of the new exchanges. What kind of mental health coverage will I have?

Again, as noted above, all plans sold in the exchanges will be required to provide coverage for mental health and substance abuse. The exchanges will be open to individuals and small businesses.

The same rules will apply to small group and individual plans purchased outside of the exchange.

In other words, beginning in 2014, if you (or your small employer) are purchasing any new insurance plan, coverage will include mental health benefits on par with any other medical condition.

I’ll be covered under the Medicaid expansion authorized by the law. What kind of mental health coverage will I get?

If you earn less than 138 percent of the federal poverty level (about $32,809 for a family of four), you may be newly eligible for Medicaid coverage in 2014. Like people who purchase coverage through the exchange, new Medicaid beneficiaries will receive mental health benefits on par with other medical or surgical needs.

What problems might arise?

While the ACA “provides enormous potential and opportunity to make sure than many millions more Americans obtain the services they need,” says Samuels, “that will only happen if the implementation of those reforms is effective.” Samuels worries that the rules from HHS will not be clear or strong enough to make the parity laws meaningful. He also worries about getting everyone who is eligible for coverage enrolled, particularly those with severe mental health disorders who be may homeless or living on the fringes of society.

Access to treatment will likely also remain a serious stumbling block. As many as 30 million people are expected to gain insurance coverage beginning in 2014. Of those, the U.S. Substance Abuse and Mental Health Services Administration estimates that 6 to 10 million will have untreated mental illnesses or addiction, adding additional demands to a system that is already overwhelmed. Patients may experience long wait times to see a psychiatrist, for example, and may require additional investments to expand the mental health workforce.

Learn More: KQED Forum Shooting Puts Spotlight on Mental Health

Newtown Shootings: Talk — or Don’t Talk — To Children?

(Douglas Healey/Getty Images)

(Douglas Healey/Getty Images)

I have an 8-year-old son and an 11-year-old daughter. On Friday, like parents across the country, I was shaken. I spent part of the day reading tips about how to talk to children about “scary news.”

Friday afternoon, my son went to a birthday party. I figured he would not hear anything about the shootings. But it was my daughter I worried about. She watches ESPN religiously after school, and I knew there would be some mention of the tragedy. I wanted to be the one who told her about what had happened.

By the time I reached her, I was too late; she’d already heard. But she seemed oddly unaffected, leaving me conflicted. I was glad she wasn’t worried, but concerned that she seemed so unmoved.

Then I caught KJ Dell-Antonia’s blog yesterday in the New York Times Motherlode column. Continue reading