Politics. It was a good sign that the bi-partisan legislation in the wake of the Uvalde tragedy is only 80 pages long. Congress' fervent need, in the twilight of federal dominance of all domestic policy, to "Go Big" was replaced with "Do Something."
With that the aspiration for “gun control” became “gun safety.” More a mental health bill than a challenge to the second amendment, the Bi-partisan Safer Communities Act passed with the ever elusive bi-partisan support - hence the name in case you ever forget - and was signed by President Joe Biden last week.
The law provides planning grants for mental health services; the development of billing codes and other support to create longitudinal data sets; and enhancement of Medicaid services. It also places restrictions on things like “straw man” purchases of guns and other similar provisions.
The mental health provisions may finally help answer several questions that have naturally emerged from a rash of large scale shootings. Why are the perpetrators almost always young, white men? Why has the pace of these events quickened since 2000?
While we can all deduce answers to these questions, Republicans in Congress have resisted funding research at NIH. State Medicaid programs, whose interest in preventing gun violence especially involving the young is more than academic, may provide a path forward to getting answers.
It really is the only way. The widespread prohibition on certain types of guns owned by certain types of people has hit a constitutional brick wall. Congressional authority has its limits, so it falls to the states to find an answer to what has gone so wrong this last decade or so.
With that, finally, some nuances can emerge, and more serious responses considered.
Policy. Before American states get serious about mental health care, particularly for the young, they are going to have to get serious about mental health services.
American mental health services are burdened by the psychiatric profession’s long history of going off the deep end every generation or so. Until recently, lobotomies for the mentally ill (and frequently the developmentally disabled) was the high water for the profession’s quackery.
Having been granted medical degrees, psychiatrists tend to ignore the things that contribute to poor mental health like isolation, self-absorption and poor socialization (I know, I just described internet culture) in favor of drugs and surgery.
Mental health, especially for the young and most urgently since traveling packs of that favorite high school archetype, the mean girl, found Instagram, has been ignored by the financing system.
States have been slow to catch up. Governors have frequently rejected expanding mental health services in schools, believing it was well beyond the education system’s mission or capacity. They frequently blamed poor parenting and family dynamics, which in the internet age, is especially useless policy.
After two years of de facto solitary confinement for many children, states will have to reconsider such a restrictive approach, most likely accelerated by a relaxation of Medicaid rules in the Safer Communities Act,
Power. This new era of state power brought on by so many governors refusing to fall into the federally encouraged “lockdown” line, presents many encouraging possibilities for a course correction on family policies and especially those important to mental health.
Every political campaign has a women’s group of supporters. My favorite will always be, “Old White Women for Obama,” of which my mother was a member. The purpose of these groups is to demonstrate electoral support of a very dependable group of voters.
Florida Governor Ron DeSantis’ 2022 gubernatorial campaign, which is likely a dry run for his Republican presidential nomination effort in 2024, now features a women’s group led by his wife, Casey.
Titled Mamas for DeSantis with the tag line, Mamas on a Mission drills into the gusher of anxiety over public school and university curriculums, the nearly unfettered exposure of children and young adults to age inappropriate and often harmful internet content and a frequently indifferent and often adversarial government.
In choosing to call her group Mamas for DeSantis and not Women for DeSantis as would normally be the case, Casey DeSantis has positioned herself not just as an advocate for children but as a fierce adversary of policies and politics that might harm them. The “mama” part immediately conjures the image of a very angry mama bear protecting her cubs.
The confrontational tone is on brand for the DeSantis family, of course. Like it or hate it, it might just be what is necessary to escape much of the crazy of these last few years.
It is also really good politics.
Have a great rest of your long weekend.
Emily Evans
Managing Director – Health Policy
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